In part 6, the conclusion of this Exclusive Interview, Rhoda Cobin talks with Diabetes in Control Medical Editor Joy Pape about PCOS prevention, specifically looking for the signs and getting treatment.
Rhoda H. Cobin, MD, MACE is Clinical Professor of Medicine at the Ichan School of Medicine at Mount Sinai in New York.
Transcript of this video segment:
Pape: So, what could we do about this?
Cobin: Look for it, find it, and treat it, and educate women. So, first you have to look for it. And if we’re speaking to people who are seeing patients in their offices, pediatricians who are seeing young women, maybe not your toddlers, but your preadolescent young women if they have signs that they might have PCOS, early hair growth, early puberty can be a sign of impending PCOS. So, if a woman has early puberty, in addition for looking for other causes, you might think of PCOS as a reason. Women who have a funny discoloration of the skin. At the dermatologist’s office, there’s a condition that’s called acanthosis nigricans which is kind of a thickening velvety skin along the back of the neck. And the dermatologist may pick this up or the family doctor may pick this up, or even the child herself, and often this starts to occur in, again, preadolescent or adolescent girls. And sometimes they’ll go to their moms or the moms will say something like, “Gee, you didn’t clean your neck very well. What’s going on there?” And if the family doctor says, “Oh, no, no, no. That’s really a sign of an underlying condition called insulin resistance,” it’s a marker. And now, when you see a marker, you go on and evaluate further. So, pediatricians, dermatologists, family practice doctors, general internists, when you see irregular periods, signs of hyperandrogenism, some of these skin markers, this is the time to look for the other parts of PCOS. Dermatologists treating acne, right. Now, not all women with acne have PCOS but a lot of women with acne do have PCOS. So, if you look for and you find it, you then send this woman on for further evaluation and management. On the patient’s side —
Pape: So, you said, “Send on.” Send on to who?
Cobin: Often to the endocrinologist.
Cobin: Because the clinical endocrinologist is really the expert in polycystic ovary syndrome, certainly for women. And now, we’re learning even for men that they may be at risk as well. So, in addition to finding the woman in the office, the other part of this is just for people themselves to be aware of the situation and to report their symptoms, “So, I saw something funny,” or, “I’m breaking out,” or, “I’ve loss some hair,” or, “I’m growing hair,” or, “My periods are irregular.” Now, we give adolescent girls a couple of years from when their periods start for them to become regular, that sort of normal development. But if it’s more than two or three years since your period started and you’re not getting regular, then that’s already a sign. Irregular periods are a very good marker for PCOS which is the most common reason for this. It’s not the only reason but it’s a good place to look. So, if young girls and their mothers and their families know to look for these things and know to be aware of them, then they’re going to bring that to the physician’s attention. And then there’s the family, “Oh, yes. Well, let’s check Uncle Joe because mom has PCOS and she had some facial hair, and she had irregular periods, and she had an awful lot of trouble getting pregnant. She wasn’t ovulating regularly. How about her brother? And he’s a little overweight. Let’s just check to find out whether he has diabetes or prediabetes and counsel.” So, the last part of the puzzle of course is what do you do to treat. And there are specific treatments for the irregular periods, and there are specific fertility treatments, and there are things that you can for hair growth and acne. But more importantly if you’re going to look at, what we call the cardiometabolic consequences, the first thing you do is counsel them to eat properly, maintain an ideal body weight, and exercise regularly. And that alone has been shown in many studies, including the diabetes prevention trial that everybody talks about so much, that’s wonderful prevention. And you can delay the onset of full-blown diabetes or even in some cases reverse it with just diet and exercise. If that’s not doing the trick or there are lipid abnormalities, then obviously you are going to treat with oral agents or insulin, whatever you require to control diabetes, control the blood sugar, keep it in the normal range. We have targets for glycohemoglobin to make sure that people are well-controlled, keep the lipids under control, and certainly control high blood pressure. And all of those things then will reduce the risk of microvascular complications of diabetes, heart attack, and stroke. And that’s what we’re worried about.
Pape: All I can say is thank you very much. And to everybody reading or watching this, stay tuned because you’ll hear a lot more here at Diabetes in Control about PCOS. Thank you so much, Dr. Cobin!
Cobin: You’re very welcome, Joy!