What You Need To Know About Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a hormonal disorder that is common in women of child-bearing age. It affects about 7% of reproductive-aged women in the United States with symptoms often developing during puberty, around the time of the first menstrual period. PCOS can, however, also develop in later years due to excessive weight gain. Women with PCOS have a hormonal imbalance that affects their menstrual cycle. Some hormones that play a role in PCOS include insulin, estrogen, progesterone, androgens (male hormones like testosterone and androstenedione), luteinizing hormone (triggers ovulation and sustains pregnancy), and follicle stimulating hormone (controls menstrual cycle and stimulates growth of eggs in the ovaries).

Symptoms of PCOS

The signs and symptoms of PCOS can vary widely from asymptomatic to a variety of symptoms including: 

Infrequent, irregular, or prolonged menstrual periods

Abnormal menstrual cycle is a classic symptom of PCOS. Women with PCOS may experience up to 35 days between periods, abnormally heavier bleeding, and less than 9 periods in a year.

Polycystic ovaries

This is when the ovaries become enlarged and develop small follicles (collection of fluid). In PCOS, the ovaries are often unable to function properly and do not release eggs.

Excessive androgen (hyperandrogenism) 

Androgen is a male hormone that can lead to male-pattern baldness, excessive body hair, and severe acne in females.

Sometimes, especially in asymptomatic cases, PCOS is an incidental finding of multiple ovarian cysts during an ultrasound procedure. 

Causes of PCOS

The exact cause of PCOS is unknown; however, several factors are known to play a role in the development of PCOS including 

• Excessive androgen – male hormones
• Genes – PCOS has a hereditary component 
• Insulin resistance – insulin is one of the key factors in PCOS. If cells become resistant to insulin, blood sugar rises, causing more production of insulin. Excessive insulin can cause increased production of androgen, which causes irregular menses and other physical signs of hyperandrogenism
• Inflammation – women with PCOS have a low-grade inflammation which stimulates polycystic ovaries to release androgen 
• Environmental factors
• Lifestyle and dietary factors 

Diagnosis of PCOS

PCOS is complex, and diagnosis can sometimes be challenging since presentation is variable with some women exhibiting no symptoms. The first step to diagnosis is a careful consideration of medical history as well as a physical examination. Your doctor might ask about menstrual history and changes in weight. During the physical examination, the doctor might focus on dermatological findings like excessive hair, alopecia, and acne. A basic laboratory test checking for testosterone levels can also help with diagnosis. 

For a definite diagnosis of PCOS, the Endocrine Society mandates that two of three symptoms below must be present:

• Hyperandrogenism 
• Ovulatory dysfunction – cycles that are more than 35 days but less than six months apart
• Polycystic ovary – ovaries containing multiple follicles 

It is also recommended to avoid diagnosing adolescents until at least two years from the onset of their menstrual period unless they have accelerated or rapid onset of symptoms. And for this young age group, they should have all three symptoms above to be definitively diagnosed with PCOS.

Treatment of PCOS

Since the signs and symptoms of PCOS vary, treatment of PCOS is individualized based on symptoms as well as the desire for future pregnancy. Treatment options include:

• lifestyle modification (for treating obesity)
• hormonal contraceptives including pills, dermal patches, and vaginal rings (for treating male-pattern hair growth on the face, chest, and back; infertility; ovulatory problems; menstrual irregularities; and acne)
• electrolysis and light-based therapy (for treating male-pattern hair growth)
• topical creams and antibiotics (for treating acne)
• metformin (anti-diabetic medication for treating insulin resistance, lack of ovulation, menstrual irregularities)
• Clomiphene or letrozole (medication for inducing ovulation and treating infertility) 
• other medications based on symptoms

Early diagnosis and treatment of PCOS as well as weight management can reduce the risk of health complications like heart diseases and Type 2 diabetes. Weight reduction and lifestyle modification can also improve ovulation and is typically the first line of treatment for women with PCOS who are overweight. 

Prevention of PCOS

There is currently no proven way to prevent PCOS; however, eating nutritious foods, maintaining a healthy weight, and exercising regularly can reduce the risk of PCOS. Even a small amount of weight loss can help regulate the menstrual cycle and reduce symptoms of PCOS. Lowering stress levels can also help with PCOS. 

Complications of PCOS You Need to Know

Some common complications of PCOS include:

• Infertility 
• Abnormal uterine bleeding
• Endometrial cancer (cancer of the uterine lining)
• Sleep apnea 
• Eating disorders
• Mood disorders, including depression and anxiety 
• Prediabetes or Type 2 diabetes 
• Pregnancy-induced high blood pressure
• Gestational diabetes 
• Premature birth
• Miscarriage 
• Severe liver inflammation caused by fat accumulating in the liver 
• Metabolic syndrome, which is a cluster of many conditions including high blood sugar, high blood pressure, and high cholesterol. Metabolic syndrome increases the risk of cardiovascular disease 

Conclusion

While PCOS can be a cause for concern, it is a very common hormone problem for those of childbearing age. If you feel you may be suffering from PCOS reach out to your primary care physician. Before your appointment write down any questions you may have, symptoms you've experienced or anything else that may help you and your provider with a diagnosis. 

Have you or someone you know been diagnosed with PCOS? If so, what's something you think everyone needs to know about PCOS?