What is PCOS? What are the symptoms and what to do about it?

PCOS is one of the most common causes of female infertility, affecting 6% to 12% (as many as 5 million) of US women of reproductive age. Although PCOS is fairly common, it is often misdiagnosed. Women may experience PCOS symptoms for years before discovering what's causing their problems.


What is polycystic ovary syndrome?


Polycystic ovary syndrome(PCOS) is a hormone disorder defined by a group of signs and symptoms. Signs of PCOS include:


Male hormone (androgen) excess
  • Elevated testosterone levels in the blood 

  • Clinical signs of androgen excess such as acne, hair on the face, and in a male pattern on the body, and thinning hair on the scalp.

Problems with ovulation 
  • Irregular or absent menstrual cycles 

  • Infertility

Ultrasound findings 
  • Large ovaries with many small follicles (which look like cysts, hence the name "polycystic"). These follicles are not cancerous.


In what other ways does PCOS affect your body?


Metabolic syndrome

Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high blood pressure, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.

Together, these factors are called metabolic syndrome, and they increase the risk of heart disease, diabetes, and stroke.


Sleep apnea

This condition causes repeated pauses in breathing during the night, which interrupts sleep.

Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.


Endometrial cancer

During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.

A thickened uterine lining can increase your risk for endometrial cancer.


Depression

Both hormonal changes and symptoms like unwanted hair growth can negatively affect your emotions. Many with PCOS end up experiencing depression and anxiety.


In the United States, an estimated 5 to 6 million women have PCOS. PCOS is the most common hormonal disorder among women of reproductive age, but many women don’t know they have it.


PCOS in Teens


Teens with PCOS may have slightly different signs and symptoms. Irregular cycles are common in normal girls in the first years after periods start (menarche). Therefore, signs of ovulation problems for girls include irregular periods more than 2 years after menarche, absence of cycles for more than 3 months, or never having a first period by the time puberty is completed. Also, heavy or overly frequent periods may be a sign of problems related to PCOS. Adolescents do not require an ultrasound for the evaluation of PCOS, since large ovaries with many follicles develop as part of normal puberty.


What health conditions can occur along with PCOS?


Many women with PCOS have decreased sensitivity to insulin, the hormone that regulates glucose (sugar) in the blood. This condition, known as insulin resistance, is a major risk factor for type 2 diabetes. Women with PCOS often have type 2 diabetes, which occurs more frequently in women with PCOS. Signs of insulin resistance include weight gain (especially around the waist), acanthosis nigricans (skin thickening around the neck, armpits, belly, button, and other creases), and skin tags.


The combination of type 2 diabetes mellitus, low HDL levels (good cholesterol), and high levels of LDL and triglycerides (bad cholesterol and blood fat) in women with PCOS may increase the risk of heart attack or stroke in women PCOS. 


Women with PCOS who are overweight or obese can also develop a condition called obstructive sleep apnea when breathing stops repeatedly during sleep. This condition can worsen the insulin resistance and cardiovascular problems of women with PCOS.

Women with PCOS may also develop fat accumulation in the liver (non-alcoholic fatty liver disease), which can lead to liver damage (non-alcoholic steatohepatitis) and fibrosis over time. 


Because of irregular menstrual cycles and lack of ovulation, the lining of the uterus may not shed as often as it should. Left untreated, this may increase the risk of cancer of the uterine lining (endometrium).


Adolescents and women with PCOS are also at higher risk for depression and anxiety. Women with PCOS, especially those who are overweight, may experience pregnancy complications, including gestational diabetes, preterm delivery, or pre-eclampsia. 


What causes PCOS?


The exact causes of PCOS are unknown; there is probably more than one cause and these may be different between individual girls or women. Androgen excess (male hormone excess), seen in 60-80% of girls and women with PCOS, is a key problem in the disorder and likely comes from ovaries in most women. Insulin resistance or elevated insulin levels may worsen androgen excess. Abnormalities in how the brain or pituitary gland communicates with the ovaries may also lead to androgen overproduction. Other hormones from the ovary or fat tissue may also be involved. 


PCOS seems to be inherited. Female relatives or children of patients with PCOS are at increased risk of having PCOS. Environmental risk factors, including low birth weight, rapid weight gain in infancy, early pubic hair and puberty development, childhood obesity, excess adult weight, and unhealthy lifestyle, are also important and may interact with genes to lead to PCOS (called epigenetics). 


How is PCOS diagnosed?


Along with irregular periods, the first signs of PCOS may be the growth of facial and male-patterned body hair, thinning scalp hair, acne, and weight gain. Weight gain, however, is not always present. Normal-weight women can also have PCOS.


In addition to assessing signs and symptoms of PCOS, medical providers take a medical history, perform a physical exam, and check blood hormone levels (including testosterone). They may also perform an ovarian ultrasound. Other tests looking for complications of PCOS may also be done, such as glucose tolerance tests or a mental health screening survey. 


Other disorders that mimic the clinical features of PCOS should be excluded: thyroid disease, high prolactin levels, and non-classical congenital adrenal hyperplasia. 



How is PCOS treated?


While PCOS is not curable, symptoms are treatable with lifestyle and diet changes and in some cases medications are needed.


Lifestyle and diet changes to manage PCOS:

  • A healthy balanced diet low in high-glycemic foods can help manage the symptoms of PCOS by improving the way the body processes glucose and potentially improving fertility.

  • Limiting to minimum sugary beverages, pre-packed foods, cold-pressed juice, saturated and trans fats, conventional dairy, and alcohol may help to manage the symptoms of PCOS.

  • Studies have found that 30 minutes of moderate-intensity exercise at least three days a week can help women with PCOS by improving ovulation and insulin levels.

Medication:


In some cases, medication might be prescribed by your doctor. Because the severity of PCOS can vary from person to person, treatment plans are highly individual, it’s very important to talk to a provider about all the potential treatment options. Hormonal imbalances could be treated with birth control pills, androgen blocking medications, or medications that help the body use insulin better. Medications that help the body respond better to insulin may also be prescribed. For women whose infertility problems are not resolved with lifestyle changes alone, medications that improve ovulation (fertility drugs) may be an alternative.


👇Tap to watch PCOS conversation with top NYC endocrinologist Dr. Ana Kausel👇


Sources:

The Hormone Health Network

Obesity and Polycystic Ovary Syndrome

The American College of Obstetricians and Gynecologists

Metabolic dysfunction in PCOS: Relationship to obstructive sleep apnea

Exercise therapy in polycystic ovary syndrome: a systematic review

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