PCOS Overview: Symptoms, Causes, and Effective Treatments

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting women. It occurs when the ovaries produce higher-than-normal amounts of androgens, male hormones typically present in small amounts. This imbalance can disrupt normal ovulation, leading to the formation of small cysts on the ovaries. However, not everyone with PCOS has these cysts.

“Polycystic ovary syndrome is characterized by irregular or no menstrual periods and often obesity or symptoms caused by high levels of male hormones (androgens) ”, claims JoAnn V. Pinkerton, MD in her article for MSD Manual.

According to the WHO, Polycystic ovary syndrome (PCOS) affects about 8–13% of women of reproductive age. The hormonal imbalances associated with PCOS increase the risk of developing conditions like type 2 diabetes and cardiovascular disease. Recognizing what PCOS is can help you manage its symptoms and seek appropriate medical care.

What Causes PCOS?

The exact cause of Polycystic Ovary Syndrome (PCOS) is not fully understood, but several factors are believed to contribute to its development. Depending on the type, these include hormonal imbalances, insulin resistance, low-grade inflammation, and genetic factors.

Hormonal Imbalances

One of the primary factors in PCOS is an imbalance in reproductive hormones. Women with PCOS typically have higher levels of androgens, which are male hormones. These elevated androgen levels can prevent the ovaries from releasing an egg during each menstrual cycle, leading to irregular periods and other symptoms of PCOS. The imbalance can also contribute to symptoms like acne, hirsutism, and thinning hair on the scalp.

Insulin Resistance

Insulin resistance is another key factor in PCOS. Insulin is a hormone that allows cells to use glucose for energy. In insulin resistance, the body's cells do not respond effectively to insulin, leading to higher blood sugar levels. To compensate, the body produces more insulin, which can increase androgen levels and exacerbate PCOS symptoms. Many women with PCOS have insulin resistance, which can lead to weight gain and increase the risk of type 2 diabetes. Managing insulin levels through diet and lifestyle changes is a crucial aspect of PCOS treatment.

Low-Grade Inflammation

Research has shown that women with PCOS often have a type of low-grade inflammation, states Frontiers. This chronic inflammation can stimulate the polycystic ovaries to produce androgens, further contributing to the hormonal imbalance seen in PCOS. Inflammation can also lead to other health issues, including cardiovascular problems. Identifying and managing inflammation through lifestyle changes and medical treatment can help alleviate some of the symptoms of PCOS.

Genetic Factors

Genetics also play a role in the development of PCOS. If other members of your family, such as your mother or sister, have PCOS, you may be more likely to develop the condition. Researchers believe that multiple genes may be involved in the development of PCOS, and ongoing studies are working to identify these genetic factors. Understanding your family history can be important for early diagnosis and management of PCOS.

Symptoms of PCOS

Recognizing the symptoms of Polycystic Ovary Syndrome (PCOS) is crucial for early diagnosis and effective management. The symptoms can vary widely among individuals, but some common signs include:

• Irregular Periods: One of the most common symptoms of PCOS is irregular menstrual cycles. This can mean having fewer periods than usual, prolonged periods, or missing periods altogether. Some women may experience heavy bleeding during their periods.
• Excess Androgen Effects can cause several noticeable symptoms:
  • Hirsutism: Excess hair growth on the face, chest, and back.
  • Acne: Severe acne, particularly on the face, chest, and back, that may persist beyond the teenage years.
  • Thinning Hair: Hair loss or thinning on the scalp, similar to male-pattern baldness.
• Polycystic Ovaries: Many women with PCOS have enlarged ovaries containing numerous small cysts. These cysts are actually immature eggs that have not been released due to the disrupted ovulation process. An ultrasound can detect these polycystic ovaries, but not all women with PCOS will have visible cysts.
• Symptoms Variation with Obesity: Obesity can exacerbate the symptoms of PCOS. Women with higher body weight are more likely to experience severe symptoms. That being said about 50% of women in the U.S. with PCOS are obese, states Yale Medicine.

Additional symptoms that may indicate PCOS include:

• Darkening of the Skin: Patches of dark, thickened skin, often around the neck, groin, and under the breasts.
• Skin Tags: Small, excess flaps of skin, particularly in the armpits or neck area.
• Weight Gain: Difficulty losing weight despite regular diet and exercise efforts.
• Infertility: Difficulty conceiving due to irregular ovulation or lack of ovulation.

If you are unsure about whether your symptoms are related to PCOS, consider using Symptom Checker to explore potential health issues further. Remember, while online tools can provide insights, they are not a substitute for professional medical advice.

Diagnosing PCOS

Medical History

• Menstrual History: Irregular periods, such as prolonged menstrual cycles or amenorrhea (absence of menstruation), are common indicators.
• Symptom Inquiry: Asking about symptoms like hirsutism (excessive hair growth), acne, weight gain, and scalp hair loss.
• Family History: Checking for any family history of PCOS or diabetes.

Physical Examination

• Body Mass Index (BMI): Measuring weight and height to calculate BMI.
• Skin Examination: Checking for signs of insulin resistance, such as darkened skin patches (acanthosis nigricans).
• Hair and Acne: Evaluating the severity of acne and excess hair growth.

Blood Tests

• Hormone Levels: Testing for elevated levels of androgens (male hormones) like testosterone.
• Glucose and Insulin: Assessing blood sugar and insulin levels to check for insulin resistance or diabetes.
• Other Hormones: Measuring levels of LH (Luteinizing Hormone), FSH (Follicle-Stimulating Hormone), and prolactin to rule out other conditions.

Ultrasound

• Ovarian Appearance: A transvaginal ultrasound can reveal multiple small cysts on the ovaries, a hallmark of PCOS.
• Endometrial Thickness: Assessing the thickness of the endometrial lining to rule out other abnormalities.

Treatment Options for PCOS

• Lifestyle Changes: Making healthy lifestyle changes is a fundamental part of managing PCOS. Regular physical activity and a balanced diet can help regulate menstrual cycles, improve insulin sensitivity, and reduce symptoms.
• Diet and Exercise: A healthy diet is crucial for managing PCOS. Focus on eating whole foods like fruits, vegetables, lean proteins, and whole grains. Avoid processed foods, sugary snacks, and refined carbohydrates. This helps maintain stable blood sugar levels and manage weight.
• Medications: Medications can help manage the symptoms of PCOS and address specific health concerns. Your healthcare provider will recommend medications based on your symptoms and health goals.
• Birth Control Pills: Birth control pills can help regulate menstrual cycles, lower androgen levels, and reduce symptoms like acne and excessive hair growth. They work by balancing hormone levels and ensuring regular menstrual cycles.
• Diabetes Medications: These medications help improve insulin sensitivity and manage blood sugar levels. By improving the body's response to insulin, these medications can help reduce androgen levels and improve ovulation.
• Fertility Treatments: For women trying to conceive, fertility treatments can stimulate ovulation. Medications that induce ovulation, such as certain hormone therapies, can help increase the chances of pregnancy. In some cases, assisted reproductive technologies like in vitro fertilization (IVF) may be recommended.

Complications of PCOS

Polycystic Ovary Syndrome (PCOS) can lead to several complications if not managed properly. Understanding these potential complications can help you take proactive steps to mitigate the risks.

• Infertility: PCOS is one of the most common causes of infertility in women. Irregular ovulation or the absence of ovulation can make it difficult to conceive.
• Pregnancy Complications: Women with PCOS have a higher risk of developing complications during pregnancy, such as gestational diabetes, preeclampsia (high blood pressure), and preterm birth. Regular monitoring and medical care are essential to manage these risks.
• Metabolic Syndrome: This is a cluster of conditions that increase the risk of heart disease, stroke, and type 2 diabetes. It includes high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol levels.
• Cardiovascular Risks: Women with PCOS are at a higher risk of developing heart-related issues, including high blood pressure and high cholesterol. Managing weight, diet, and exercise can help reduce these risks.
• Type 2 Diabetes: Insulin resistance, a common feature of PCOS, can lead to type 2 diabetes. Regular monitoring of blood sugar levels and maintaining a healthy lifestyle are crucial.
• Sleep Apnea: This condition, characterized by interrupted breathing during sleep, is more common in women with PCOS, especially those who are overweight. It can lead to fatigue and other health issues.
• Depression and Anxiety: The physical symptoms and hormonal imbalances of PCOS can contribute to mental health issues such as depression and anxiety. Seeking support from mental health professionals can be beneficial.
• Endometrial Cancer: Women with PCOS are at an increased risk of endometrial cancer. This risk is due to prolonged exposure to estrogen without the balancing effect of progesterone, which can occur with infrequent or absent periods.

When to See a Doctor

If you suspect you have PCOS, it’s important to seek medical advice early. Early diagnosis and treatment can help manage symptoms and reduce the risk of complications. Here are some signs that you should see a doctor:

• Irregular Menstrual Cycles: If you have irregular periods, such as prolonged cycles, missed periods, or very heavy bleeding, consult with a healthcare provider.
• Excess Hair Growth or Acne: If you notice excessive hair growth on your face, chest, or back, or if you have persistent acne that doesn’t respond to typical treatments, seek medical advice.
• Difficulty Getting Pregnant: If you have been trying to conceive for a year or more without success, it may be due to PCOS. Early intervention can help address infertility issues related to PCOS.
• Weight Gain and Obesity: If you are gaining weight rapidly or struggling to lose weight despite a healthy diet and exercise routine, it could be linked to PCOS.
• Other Symptoms: If you experience darkening of the skin, skin tags, or hair thinning on your scalp, these could also be signs of PCOS.