Published On By Dimitar Marinov [MD, PhD]

All About PCOS

PCOS could affect about 8-13% of women of reproductive age. It leads to small fluid-filled sacs developing on the ovaries, causing irregular periods as male hormones (androgens) increase.

Symptoms commonly experienced during PCOS may include ovarian cysts, excess hair growth, weight gain, hormonal imbalance, or infertility. Women with PCOS may also have a higher risk of diabetes and obstructive sleep apnea.

According to the NHS, there is no treatment for curing PCOS. However, there are some standard treatment options such as lifestyle measures and medications that may help reduce certain PCOS symptoms.

This article shall provide an in-depth understanding of PCOS, covering its causes, symptoms, and health implications. The article will also discuss strategies to manage PCOS and mention the tests that help diagnose PCOS.

What Is PCOS?

PCOS or Polycystic Ovary Syndrome is known as an endocrine disorder that majorly affects women of childbearing age, between 15 to 44 years old. It is a common condition, with a prevalence ranging from 2.2% to 26.7% in this age group.

In PCOS, the ovaries produce higher-than-normal levels of androgens, which are male hormones. The hormonal imbalance may result in irregular menstrual cycles, the formation of ovarian cysts, and difficulties with ovulation.

Excess androgen levels may cause symptoms like hirsutism (excessive hair growth), acne, and weight gain in women. However, the exact cause of PCOS is not fully understood.

Factors like insulin resistance, inflammation, or genetic makeup could play a role in the development of PCOS. Disruptions in the follicle-stimulating hormone (FSH) and luteinizing hormone (LH) may affect the ovulation cycle, possibly causing PCOS.

Causes Of PCOS

  1. Insulin resistance

    Around 70% of women with PCOS have insulin resistance, which could disrupt healthy insulin utilization and cause hormonal imbalances. Insulin (secreted by the pancreas) is essential for metabolizing sugar from foods as energy.

    However, when cells develop resistance to insulin, the body compensates by producing more insulin, which stimulates the ovaries to produce excess male hormones. The hormonal imbalance may cause the development and progression of PCOS symptoms.

    Being overweight makes it difficult for the body to utilize insulin properly, which might lead to type 2 diabetes. Lifestyle alterations like keeping a healthy weight and regular exercise may help improve insulin sensitivity and reduce the hormonal imbalances with PCOS.

    Effects of Insulin Resistance in PCOS
    Increased insulin production Dysregulated insulin utilization
    Excess male hormone production Hormonal imbalances
    Elevated risk of type 2 diabetes Aggravation of PCOS symptoms
  2. Genes

    PCOS is a complex disorder influenced by multiple genes rather than a single gene. The multigene inheritance pattern makes it challenging to pinpoint one specific gene responsible for the condition.

    Studies suggest a genetic component in PCOS, indicating that the risk of developing PCOS is higher in people with affected family members. However, the exact genetic mechanisms underlying PCOS inheritance are still being researched.

    Certain gene variants are linked to PCOS, affecting different aspects like hormone regulation, insulin sensitivity, and ovarian function. These genetic variations might influence the development and severity of PCOS symptoms.

    Environmental factors and lifestyle choices could also influence how genes related to PCOS are activated or silenced. These factors are also termed epigenetic factors.

  3. Inflammation

    Women with PCOS may exhibit higher levels of inflammatory markers like C-reactive protein (CRP) and interleukin-6 (IL-6) in their blood. These markers may indicate a state of chronic inflammation within the body.

    Inflammation in PCOS is closely linked to insulin resistance, where the body’s cells become less responsive to insulin. The resistance may further exacerbate inflammation and hormonal imbalance in women with PCOS.

    Excess inflammation in PCOS might trigger ovarian dysfunction, leading to irregular ovulation, the formation of ovarian cysts, and disruptions in hormone production, particularly androgens like testosterone.

    PCOS-induced inflammation may worsen common symptoms like irregular periods, acne, hirsutism (excess hair growth), and difficulties in managing weight. It highlights the close association between inflammation and the manifestation of PCOS symptoms.

Symptoms Of PCOS

Below we have outlined some of the most common PCOS symptoms. It is important to note that not all patients experience each symptom.

  1. Too much androgen

    During PCOS, the levels of the male hormone androgen increase in women. Elevated androgen levels may lead to the development of hirsutism, characterized by excess facial and body hair growth.

    Excess androgen production in PCOS might also result in severe acne and male-pattern baldness, impacting women both physically and emotionally. Managing androgen levels is vital in addressing these symptoms and improving the quality of life for women with PCOS.

    The following table highlights the potential symptoms associated with elevated androgen levels:

    Effects of Elevated Androgen Levels
    Hirsutism (excess hair growth)
    Severe acne
    Male-pattern baldness
    Irregular menstrual cycles
    Weight gain

    Managing androgen levels in PCOS involves a comprehensive approach that may include:

    • Certain lifestyle modifications
    • Medications to regulate hormone levels
    • Addressing underlying insulin resistance

    Working closely with healthcare providers may help develop personalized treatment plans to target the effects of excess androgen in women with PCOS.

  2. Irregular periods

    The irregular menstrual cycle is characterized by infrequent or unpredictable periods. It is a common indicator of hormonal imbalance often associated with polycystic ovary syndrome (PCOS).

    Women having PCOS may get fewer than eight periods in a year, indicating a lack of regular ovulation and hormonal irregularities. Menstrual cycles lasting more than 35 days apart are common in PCOS, reflecting disrupted hormonal patterns.

    Periods lasting for many days or being excessively heavy are typical manifestations of PCOS, often leading to discomfort and inconvenience.

    Irregular periods in PCOS may result in difficulties conceiving due to irregular ovulation. Therefore, women with PCOS should seek medical advice if pregnancy is desired.

  3. Weight gain

    Up to 80% of women affected by PCOS are overweight. Factors like insulin resistance, hormonal imbalances, and genetic makeup could influence weight gain in PCOS.

    Insulin resistance may cause difficulties in controlling blood sugar levels, which may promote weight gain. Excess androgen levels in PCOS may also contribute to weight gain, as androgens play a role in fat distribution and storage in the body.

    The hormonal imbalances in PCOS may affect metabolism, making it easier to put on weight and harder to lose it. Weight gain in PCOS can create a cycle of worsening symptoms and complications.

    You could manage PCOS-induced weight gain through strategies like lifestyle modifications, dietary changes, regular exercise, and medical interventions. These strategies might also help improve other symptoms associated with PCOS.

  4. Polycystic Ovaries

    Women with PCOS may have many small sacs with immature eggs around the edges of their ovaries. It may potentially cause the ovaries to become enlarged, giving them a larger-than-normal appearance during ultrasound examinations.

    The formation of these small sacs may disrupt the normal functioning of the ovaries. The altered ovarian function may trigger hormonal imbalances, irregular menstrual cycles, and difficulties with ovulation, contributing to PCOS symptoms.

    The presence of these immature follicles may result in increased production of androgens, like testosterone. Such hormonal imbalance may further exacerbate PCOS symptoms, such as hirsutism (excess hair growth), acne, and male-pattern baldness.

    It could also negatively impact female fertility. Difficulties with ovulation and hormonal imbalances might make it challenging for women with PCOS to conceive naturally. It may necessitate the need for medical interventions to support fertility.

  5. Darkening of the skin

    Women with PCOS may notice skin darkening, particularly in body creases like those found on the neck, in the groin area, and under the breasts. The darkening, known as acanthosis nigricans, is commonly associated with PCOS.

    Insulin resistance may lead to elevated insulin levels in the blood. The excess insulin may trigger skin cells to grow rapidly, causing dark, velvety skin patches in body folds.

    PCOS often involves an imbalance in hormone levels, including androgens. Elevated androgen levels might contribute to the development of acanthosis nigricans, leading to skin darkening in specific areas.

    Some women may have a genetic predisposition to developing acanthosis nigricans. Genetic factors could influence the severity and extent of skin darkening in PCOS patients.

How PCOS Affect Your Body?

  1. Infertility

    PCOS significantly impacts fertility due to irregular ovulation patterns. The irregularity in ovulation could make it difficult for women with PCOS to conceive naturally.

    Women with PCOS often experience anovulation, where the ovaries do not release eggs regularly. The lack of ovulation reduces the chances of fertilization and pregnancy.

    The presence of ovarian cysts may interfere with normal ovulation. These cysts might affect the maturation and release of eggs, further complicating fertility.

    Due to excessive hormonal imbalances and irregular menstrual cycles, women with PCOS may experience changes in the endometrial lining. These changes may impact the implantation of a fertilized egg and raise the risk of miscarriage.

  2. Metabolic syndrome

    Metabolic syndrome is common among women with PCOS, especially those who have gained excess weight. It could increase the risk of various health complications in women.

    It surrounds multiple health conditions, including high blood sugar, high blood pressure, low HDL “good” cholesterol, and high LDL “bad” cholesterol. These factors collectively might increase the risk of stroke, diabetes, and heart disease.

    Metabolic Syndrome Risk Factors Description Associated Risks
    High blood sugar Elevated blood glucose levels Increased risk of diabetes
    High blood pressure Elevated blood pressure levels Risk of heart disease and stroke
    Low HDL cholesterol Decreased “good” cholesterol levels Higher risk of heart disease
    High LDL cholesterol Increased “bad” cholesterol levels Greater likelihood of heart disease
  3. Sleep apnea

    Sleep apnea, a condition that induces repeated pauses in breathing during sleep, poses a significant risk for women with PCOS. Women with PCOS often experience weight gain, which may put pressure on the airways during sleep, potentially causing sleep apnea.

    Hormonal imbalances in PCOS may contribute to the development of sleep apnea. Certain hormonal fluctuations may affect the muscles involved in breathing, potentially leading to airway collapse during sleep.

    Sleep apnea could disrupt the quality of sleep for women with PCOS, leading to daytime fatigue, decreased cognitive function, and an overall reduced quality of life.

    PCOS and sleep apnea may collectively increase the risk of other health complications. These may include cardiovascular issues, insulin resistance, and mood disorders. It highlights the importance of managing sleep apnea to mitigate such risks.

  4. Endometrial cancer

    Due to the hormonal disruptions and irregular menstrual cycles in PCOS, the uterine lining thickens, a condition known as endometrial hyperplasia. This thickened lining increases the risk of endometrial cancer, which typically affects the uterus lining.

    Endometrial cancer is a serious health hazard that requires medical attention in women with PCOS. Women with PCOS should be aware of monitoring any abnormal bleeding patterns, as irregular or heavy bleeding may indicate endometrial issues.

    Regular screenings and discussions with doctors are vital for early detection and management of endometrial cancer. You may minimize the risks associated with endometrial cancer by managing weight, addressing hormonal imbalances, and monitoring symptoms.

  5. Depression

    Dealing with the physical manifestations of PCOS, like irregular periods and acne, could take a toll on your mental health. It might contribute to feelings of sadness and hopelessness, potentially leading to anxiety and depression.

    The emotional impact of PCOS may extend to social interactions, leading to difficulties in relationships, social isolation, and a sense of inadequacy.

    Managing depression in PCOS may require a comprehensive approach. It could include therapy, medication, lifestyle changes, and support from doctors and mental health professionals.

    Women with PCOS should build a strong support system, whether through family, friends, support groups, or counseling. It is essential to navigate the emotional challenges they may face.

Diagnosis Of PCOS

  1. Blood Test

    Blood tests provide valuable information that may help doctors understand the hormonal imbalances associated with PCOS. They measure various hormone levels like testosterone, luteinizing hormone (LH), follicle-stimulating hormone (FSH), and insulin.

    Elevated levels of testosterone and LH, along with low levels of FSH, are commonly observed in women with PCOS. Blood tests may also assess insulin levels and insulin resistance, which are often present in PCOS.

    Thyroid-stimulating hormone (TSH) levels are usually checked as part of blood tests. They could rule out any thyroid abnormalities that may mimic PCOS symptoms or exacerbate existing ones.

    Blood tests could evaluate lipid profiles, including cholesterol levels, to assess the risk of cardiovascular issues and guide preventive measures.

  2. Pelvic Ultrasound

    During a pelvic ultrasound, doctors use imaging technology to check the reproductive organs, including the uterus and ovaries. It helps them assess for any abnormalities or conditions like Polycystic Ovary Syndrome (PCOS).

    It is a non-invasive approach that utilizes sound waves to establish images of the pelvic organs. It allows doctors to visualize the size, shape, and texture of the ovaries. Pelvic ultrasound may help reveal the presence of multiple small cysts in the ovaries.

    Pelvic ultrasounds could also help identify other potential causes of symptoms like irregular periods, ovarian pain, or fertility issues. The thickness of the uterine lining may be assessed during the ultrasound, providing further insights.

Must Visit: Menopause: Symptoms, Causes, And More

Tips To Treat PCOS

You could manage PCOS by integrating lifestyle changes, like weight loss, diet modifications, and regular exercise. Here is a breakdown of these tips to manage PCOS:

  • Weight Loss: Losing around 5-10% of body weight could help regulate menstrual cycles, reduce the risk of heart disease, and improve insulin sensitivity associated with PCOS.
  • Low Carbohydrate Diet: Studies suggest that low carbohydrate diets could support weight loss and reduce insulin levels in women with PCOS. A low glycemic index diet, focusing on vegetables, fruits, and whole grains, may also help regulate menstrual cycles more effectively.
  • Regular Exercise: Engaging in 30 minutes of moderate-intensity exercise at least 4 days a week may support weight loss, improve ovulation, and regulate insulin levels. Combining exercise with a nutritious diet may improve weight loss results.
  • Acupuncture: Some evidence suggests that acupuncture may be beneficial in improving symptoms of PCOS. However, more research is needed to establish such claims conclusively. Acupuncture may potentially complement other measures for PCOS management.

When To See A Doctor?

If you experience missed periods or symptoms of PCOS like excessive hair growth or fertility issues, seeking medical attention becomes essential.

Women who experience signs of diabetes like excessive thirst, hunger, blurred vision, or unexplained weight loss should consult a doctor. Waiting for a year to seek fertility evaluation is unnecessary if your periods are already irregular or absent.

Even if pregnancy is not desired, irregular periods do not serve as a form of birth control. It is essential to use contraception to prevent unwanted pregnancy and prioritize regular check-ups with your doctor if you have PCOS.

Reason to See a Doctor Importance
Missed periods Early detection of underlying issues
Symptoms of PCOS Proper diagnosis and treatment
Challenges with fertility Address potential reproductive health concerns

Regular monitoring may help in the early identification and management of possible complications associated with PCOS.

Frequently Asked Questions

  1. Are There Specific Foods That Worsen PCOS Symptoms?
    High-glycemic index foods, sugary drinks, excessive caffeine, and processed foods may worsen insulin resistance and hormone imbalances in PCOS. A nutritious diet rich in lean proteins, whole grains, vegetables, and fruits is beneficial.
  2. Can PCOS Cause Hair Loss or Thinning?
    PCOS causes hormonal imbalances and increase androgen levels, which may cause hair loss or thinning in women with PCOS. The imbalance may affect hair follicles, leading to hair thinning or loss. Consultation with a doctor could help address this concern.
  3. Is Excessive Exercise Harmful for Individuals With PCOS?
    Excessive or high-intensity exercises may exacerbate hormonal imbalances and stress responses in women with PCOS. It could potentially impact their menstrual regularity and fertility. Balancing physical activity with rest and proper nutrition is essential to manage PCOS.
  4. Can Stress Exacerbate PCOS Symptoms?
    Excessive stress may raise cortisol levels, disrupting hormone balance and worsening insulin resistance. Managing stress through relaxation techniques, counseling, exercise, and a support system may help alleviate these effects on PCOS.

Conclusion

Women of reproductive age often experience PCOS, which may cause symptoms like acne, irregular periods, weight gain, and thinning hair.

Lifestyle modifications like exercising regularly, maintaining a moderate weight, and monitoring for any symptoms of PCOS might help prevent its onset.

The focus of PCOS management is tackling specific issues like acne, hormonal imbalances, irregular periods, or excess weight gain.

Dealing with PCOS may be challenging, but with the right support and treatment, you could lead healthy lives.

Regular check-ups, open communication with doctors, and connecting with others who have PCOS could help you manage PCOS effectively.

Disclaimer
  • This article is for informational purposes only and should not be considered medical advice.
  • It is not recommended to disregard/delay seeking professional medical advice or treatment because of what you read or accessed through this article.
  • The results may vary from individual to individual.
  • Consult your doctor for any underlying medical conditions or if you are on any prescribed medicines before following health tips or instructions.

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