Q:  Is it normal to have abnormal periods?

It depends.  It is normal to occasionally miss a period or have a lighter or heavier period, however, if periods are less than 21 days or greater than 35 days apart or if there are prolonged periods or no periods for 3-6 months this is considered abnormal.
There are varied reasons for abnormal periods; however, Polycystic Ovarian Syndrome (PCOS), is an increasingly prevalent cause of irregular bleeding and a leading cause of infertility.  PCOS is estimated to affect 1 in 10 to 1 in 20 women and may affect as many as 5 million women.
PCOS is a condition characterized by abnormal periods, cystic acne, oily skin, abnormal hair growth, and multiple cysts on the ovaries.   PCOS is a result of excess androgens (male hormones….yes women have these too!).

Androgens are produced in the ovaries, adrenal glands, our skin and fat tissue, as well as the liver.  Insulin resistance is another major factor in the development of PCOS.  Insulin resistance is the inability of the body’s cells to respond to insulin leading to excess amounts of glucose in the blood.

Approximately, 80% of women diagnosed with PCOS are obese.  This being said, there is increasing recognition of the disorder in women who are of normal weight.  Independent of weight, the contributing factors of PCOS remain the same.

Q:  Why should I care if my cycles are irregular?

PCOS has been reported in individuals as young as 11, and though it does not seem important at that young an age, irregular periods can lead to infertility.  Ovarian cysts can develop on the ovaries.   Absence of periods can lead to thickening of the lining of the uterus called endometrial hyperplasia, which increases the risk of endometrial cancer.

Q:  Are there risk factors for the development of PCOS?

A:  There appears to be a genetic risk for the development of PCOS. Women diagnosed with PCOS often report a family history of a mother or sister with irregular periods or excessive hair growth.  A family history of type 2 diabetes mellitus in a first degree family member also appears to be a risk factor.  Excessive weight gain often “unmasks” underlying PCOS.

Treatment is individualized.

In women who do not desire current pregnancy, oral contraceptive pills (OCPs) are an initial treatment.  Birth control pills help to regulate menstrual cycles as well as protect the lining of the uterus from becoming thickened (remember that risk of endometrial cancer).  Often women are reluctant to use OCPs because they have suffered through unwanted side effects of a pill in the past.

There are multiple formulations of OCPs available, and often through discussing the side effects or concerns of side effects, we can find something that will work for her.  If OCPs are not an option there are alternatives, such as taking a medication that will assure she has at least 3-4 periods a year.

For women who desire pregnancy, the treatment centers around stimulating ovulation and restoring ovulatory menstrual cycles.  Ovulation is commonly stimulated with the use of medications, though surgical procedures are another possible intervention.

Regardless of family planning needs, dietary modification and weight reduction are considered the first-line treatment for PCOS.  Insulin resistance places a woman at risk for development of type 2 diabetes and coronary artery disease.  Research has shown that a modest weight reduction of 5-10% is beneficial in lowering insulin resistance and helps to restore normal periods.

One diet over another has not been found to have increased benefit in the treatment of PCOS; however, I often recommend a low glycemic index diet, as focusing on these types of foods has shown benefit in prediabetic and diabetic populations.   A low glycemic diet is also easy to accommodate as it does not rely on counting carbohydrates or the absolute exclusion of certain foods.

Some women will also benefit from the addition of medication to help lower blood glucose levels.
It is predicted that as many as 70% of the cases of PCOS are undiagnosed.  Not every woman who struggles with PCOS fits the “mold” making it a difficult disorder to recognize.  Despite this, the cause of PCOS remains the same; excess androgens and insulin resistance.

Weight loss and reducing insulin resistance through dietary modification can help women restore normal, ovulatory cycles and in turn decrease the often embarrassing cosmetic concerns of facial hair and cystic acne, and ultimately for many women improving her ability to achieve a healthy pregnancy.

* Health Answers can be found in the current issue of 406 Woman Magazine.

**Kimberley Forthofer, ARNP joined Kalispell OB/GYN in July of 2013.  She was raised in Whitefish and returned to the Flathead Valley after working for 4 years as a primary care provider in Idaho.  She offers a wide range of experience in primary care as well as women’s health and her clinical experience includes both acute and chronic care.  She and her husband, Joe, have two children and have enjoyed getting back to the outdoor recreational opportunities that Montana offers.