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Jeffrey Steinberg, M.D., FACOG
Board Certified Specialists dedicated to the management and control of
PCOS
Contact Telephone:
800-222-2802
818-728-4600
Welcome to our web site.
This site is dedicated to explaining to the public the nature of PCOS, it’s health effects upon affected individuals and most important, the medical and alternative treatments that are available to effectively deal with this disorder.
Information on this web site is not intended to be a substitute for qualified professional medical care. You should see a licensed health care professional before making any decisions about your personal health care needs.
The Los Angeles Center for Polycystic Ovarian Syndrome is a division of the Fertility Institutes medical group, a full service reproductive endocrinology medical practice. Our focus includes providing state of the art medical care and treatment to women living and dealing with PCOS. We are active clinical research investigators. This means that we are constantly looking for improved treatment options for PCOS and are involved in the cutting edge research investigations that we hope will some day lead to even more effective and permanent solutions to the problems seen with PCOS. You may have seen us on television news programs such as CNN, Fox, ABC, NBC, MSNBC, CBS or read articles about us in the Los Angeles Times, the Wall Street Journal or a variety of other media outlets where our work with a variety of hormonal and other disorders has been regularly featured.
If you live in or near Los Angeles, or are willing to visit from afar and are seeking a medical health provider whose focus is PCOS, we encourage you to call our facility. We maintain a staff of Gynecologic Reproductive Endocrinologists , Pediatric and Adolescent Endocrinologists, Women’s Health Nurse Practitioners, Nutritional Specialists, Hormone Laboratory specialists, electrologists and ultrasonographers, all dedicated to providing focused care to those with PCOS.
We also invite you to visit our web site dealing with infertility problems including those associated with PCOS: http://www.fertility-docs.com
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FIRST, THE GOOD NEWS.
PCOS has now been recognized as perhaps the most common of all hormone disorders affecting women. With this recognition comes increased understanding by medical professionals that the problems associated with having PCOS are significant, widespread and deserving of far more attention than what has been provided to the disorder in the past. Many excellent patient self-help and support organizations and groups have been established providing much needed sounding boards for those with the disorder.
THE GOAL OF THIS WEB SITE
This web site will provide you with valuable information about PCOS in “PLAIN ENGLISH”. If you are a medical professional, the terminology used on this site may seem somewhat basic. But if you are an individual concerned about PCOS, regardless of your medical background or lack of background, you will find this site a great aid in providing you the down to earth facts that you need to better understand the disorder and what to do about it.
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HOW DO I KNOW IF I HAVE PCOS?
It is often difficult, if not impossible for an individual to “know” they have PCOS without consulting with a medical professional. One may, however strongly suspect that one has PCOS based on the set of criteria used in our center to help screen for the possibility of PCOS in new patients. Although the complex disorder has been named “Polycystic ovarian syndrome” much if not most of the PCOS disorder involves body systems other than the ovaries. In fact, one can have PCOS without any evidence that the ovaries are abnormal or cystic except for the fact that ovulation is nearly always irregular. Irregular ovulation is usually detectable by a long history, usually dating back to when your periods first began, of irregular cycle length or unpredictable menstrual bleeding. Some women with PCOS however, will begin their reproductive lives with regular cycles and then have the cycles become irregular during their early 20’s. We screen all patients in our center with a menstrual calendar history. We ask patients to track their cycles and report these results to us to assist us in determining how “regular” or “irregular” the cycles are.
The second big tip off to possible PCOS is a history of abnormal male hormone production in a woman. Male type hormones are known medically as androgens. All women normally make a small amount of these androgens. The most common androgen that is found elevated beyond the normal low female levels in women with PCOS is Testosterone. Testosterone is a very potent male hormone. And this elevation of male Testosterone hormone in women with PCOS helps explain many of the “clinical findings” (what we see) found with PCOS. As mentioned, all women normally make a little “male” hormone and all men normally make a little of the “female” hormone (estrogen). And a “little” is fine. It is when a “lot” of the hormone of the opposite sex is made by either women or men that nature’s natural balance is upset and the patient begins to suspect that “something is not right”. And with PCOS, this natural balance is upset and you begin to feel and see (facial or body hair growth, pigmentation of the skin, especially on the neck, acne resistant to the usual treatment methods or persisting beyond age 15) the effects of this abnormal balance.
So, there are two essential criteria that we use to screen for possible PCOS in the hundreds of patients that call us or come to see us concerned about possible PCOS. First, we enquire about menstrual history. Are your periods “regular” or “irregular”. The answer in those with PCOS is almost always “irregular”. When the irregularity began may be important as well. Next, we screen with a physical examination for the effects that we know may be caused by an elevation of Testosterone as seen in PCOS. While we always suggest that you see a medical professional for these screenings, for those of you that may like to get a head start on the process, excess androgen screening can be started at home by looking for the “difference between the boys and the girls”. At puberty, the boys begin to produce large amounts of androgen (Testosterone). And this is what makes the boys different from the girls at puberty. The same androgen induced changes seen in adolescent boys can bee seen in most women with PCOS. What are the changes we look for? We look for changes that include growth of body hair in excess or in locations not commonly seen in hormonally normal women. We look for hair growth on the upper lip, on the chin, in the "sideburn" areas, in the middle of the abdomen, in the area around the nipples and in on the fingers or toes. We examine for excess brownish pigmentation on the neck or behind the ears ("acanthosis nigricans"). We evaluate weight gain and the inability to lose weight with normal weight loss measures. Any or all of these conditions may raise a red flag for the existence of PCOS.
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If you are concerned about your condition or feel that you may have PCOS and would like more information about evaluation and treatment options from a Center dedicated to the condition, please feel free to contact us at 818-728-4600. You may also fill in this simple response form and you will be contacted by a trained nurse specialist who will be happy to answer your questions and provide counseling to assist you. Our Board Certified physician specialists are leading authorities on PCOS and have been seen on CNN, Fox News, CBS, NBC and ABC News programs. Nearly all "PPO" and "POS" type insurance plans will cover PCOS evaluation and treatment if not related to infertility and we will verify and accept such plans. We can provide those with HMO plans an intial treatment outline and you may request an "out of network" referral from your primary care Doctor for continued covered treatement at our Center. We look forward to hearing from you and assisting you. There ARE valid answers and treatments for PCOS. Our physicians can provide answers for problems with acne, abnormal or excessive hair growth, weight related hormone disorders, irregular menstrual cycles, iinfertility and more. Please call or email us today!
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THINGS WE LOOK FOR IN PCOS: ANDROGEN EFFECTS At puberty, many boys develop acne from their sudden rise in testosterone production. Acne is the skin’s reaction to sebum or oil production where the excess oil blocks the normal drainage channels of the skin causing inflammation and pimples. The boys make far more testosterone than the girls, so the boys tend to get far more acne than the girls. Acne in an adolescent female is also the result of a (normally) small amount of testosterone arising from the awakening ovary. The girls normally make very little testosterone, so their skin conditions and associated acne are usually far less severe than that seen in the boys. A sign of underlying excess male hormone production in a female may be excess or severe acne. So, if a woman with irregular cycles is having problems keeping her skin clear, PCOS is placed high on our diagnostic list of possibilities. One of the research projects at our center involves quantifying the amount or number of hair follicles seen in women in very specific “hormone sensitive” skin areas. Using very specialized medical instrumentation and by very precisely counting the number of hair follicles in these defined areas, we are learning how to more accurately diagnose PCOS and at an earlier stage in it’s progress. To better understand the all of the additional potential effects of excess androgen production, we can again turn to our model of the adolescent boy: What else happens to the boys at puberty as a result of the rise in androgens?
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- Facial hair growth
- Hair growth on the upper lip
- Hair growth on the chest
- Hair growth on the arms and legs
- Hair growth on the back
- Excess skin oiliness
- Resistant Acne
- Weight gain that "won't come off"
- Pigmentation of the skin on the neck or behind the ears
- Social aggression or seclusion
- Increased libido
So, an individual with irregular menstrual cycles self-screening for possible excess male hormone production could look for any or all of the above as possible evidence of PCOS related excess hormone production. Such individuals should be evaluated by a center or physician with an interest in PCOS.
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Impact of Obesity on Reproductive Health & PCOS
There is more than ample research to show a direct parallel between body weight and death due to all causes such that, as weight increases substantially, so does the incidence of death due to cardiovascular disease, stroke, diabetes, hypertension and colon cancer to name a few. But how can this research be understood by the average person without a scientific backround? By understanding some of the benchmarks used and definition of terms you may see time and time again. Usually, weight or being overweight is described using what is referred to as the Body Mass Index or the BMI. This is expressed as the weight (in kilograms) divided by the height (in meters squared). For those that aren’t familiar with the metric system, there are 2.2 pounds per kilogram (Kg) and 3 feet per meter. But, don’t worry about the math! All you need to know is, that any BMI between 25 & 29.9 is considered overweight and anything beyond (30 or greater) is obesity.
In terms of reproductive health, being overweight or obese clearly increase one’s risk to uterine cancer and may impact on the overall risk of developing breast cancer. Moreover, these patients tend to have more obstetrical complications relating to hypertension, diabetes, an increase in the induced vs. natural labor, an increase in caesarian sections and its’ associated problems; anesthesia difficulties, infection, blood loss, infection, poor wound healing and protracted hospital stays. Additionally, a great number of overweight and obese women who suffer with irregular menses, ovulation problems and infertility have PCOS, where that extra weight actually worsens the problem. Those women that do not have PCOS may independently have high insulin levels which may predispose to infertility, poor implantation of a pregnancy and early pregnancy loss.
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OTHER HEALTH EFFECTS OF PCOS Our increasing understanding of PCOS is also helping us understand why women with PCOS have an increased risk of developing several other health related issues. Indeed, certain disorders thought in the past to be simply isolated diseases may be, instead another part of the PCOS puzzle. Women with PCOS appear to be at increased risk of developing several additional health related disorders during their lives. As we come to understand more about PCOS, it is becoming apparent that some or all of these additional disorders may, in fact be PCOS. Disorders thought to be a part of the PCOS puzzle and links to a description of the disorder are as follows:
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