Polycystic Ovary Syndrome (PCOS): Symptoms, Causes & Treatment

According to the US Center for Disease Control (CDC), polycystic ovary syndrome (PCOS) is the most common cause of female infertility. Read on to learn more about how to identify and treat PCOS.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that typically occurs in women during their reproductive years. Besides infertility, it may also result in a wide range of long-term health concerns.

When a woman has PCOS, her ovaries produce too much androgen. Androgen is a group of hormones primarily responsible for the growth and development of the male reproductive system; this is why many of us refer to them as “male hormones”.

Besides the notable increase in the levels of androgen, a person with PCOS may also have imbalances in the female hormones — oestrogen and progesterone.

Moreover, PCOS is also linked to obesity and insulin resistance, a phenomenon where the cells do not respond well to the hormone insulin, which is key in helping cells absorb sugars. This can lead to high blood glucose levels. 

Although it is not always the case, women with PCOS can also develop fluid-filled sacs or cysts in their ovaries; hence, the term “polycystic”.

Polycystic Ovary Syndrome Symptoms

Being a syndrome entails that PCOS results in several symptoms that commonly occur together. However, please keep in mind that each woman’s experience is different, so an individual with PCOS may develop some but not all of the following signs and symptoms:

Irregular or Missed Periods

Period irregularity may be a sign of PCOS.

Under typical circumstances, a woman releases an egg cell each month in the process called ovulation. If fertilization does not happen, the body sheds the egg cell off along with the thickened endometrium, the tissue prepared for implantation. This “shedding off” process is our monthly menstruation.

However, in individuals with PCOS, the increased levels of androgen interfere with ovulation, resulting in irregular menstruation. In addition, the prolonged inability to release an egg cell contributes to female hormonal imbalances, which is why women with PCOS often also develop low levels of progesterone and increased levels of estrogen.

Infertility

The lack of ovulation results in infertility or the inability to conceive after a year of trying. In many cases, women find out about their PCOS condition only after consulting a doctor about their fertility issues.

Male-Hormone Related Symptoms

Excess amounts of androgen in the body may also trigger the following symptoms:

• Oily skin
• Acne breakouts
• Excessive hair growth in body parts such as chest, back, face, and underarms (hirsutism)
• Thinning head hair or male-pattern baldness

Weight Gain

As mentioned earlier, many women with PCOS experience unhealthy weight gain, which can lead to obesity. When patients try to lose the extra pounds, they find that it is extremely difficult.

The reason why PCOS results in unhealthy weight gain is still unclear, but experts say it could be due to insulin resistance.

High Blood Sugar Levels

Since it is possible for women with PCOS to experience insulin resistance, high blood sugar levels might also be one of the symptoms.

It is not easy to spot high blood sugar levels without blood tests, but women – or even adolescents – might observe patches of darkened skin (acanthosis nigricans) in the back of the neck, underarms, or groin area. Acanthosis nigricans may result from excessive insulin levels secondary to the cells’ resistance to the hormone.

Besides the appearance of darkened skin patches, one may also notice little flaps of skin or skin tags on their body. These, too, could be indicative of insulin resistance.

PCOS Causes

Currently, the exact cause of PCOS is unknown, but the symptoms usually result from imbalances in hormones discussed earlier. Here is a summary of the hormonal imbalance associated with PCOS:

• Increased Levels of Insulin: This primarily happens because of insulin resistance; since people with PCOS cannot properly use insulin, it builds up in the blood. Some reports also indicate that increased insulin levels can lead to excessive production of testosterone, which is a kind of androgen.
• Increased Levels of Androgens: Not only does excessive androgen prevent ovulation, it can also result it male-hormone related symptoms.
• Estrogen Dominance: Long-term lack of ovulation may trigger an increase in estrogen levels and reduced progesterone. This, too, contributes to irregular periods and male-hormone related concerns.

While we have yet to discover the exact reason behind these hormonal imbalances, reports have found that the issue could be in the organs that produce these hormones or in the part of the brain that controls their function.

Other factors that may contribute to the development of PCOS include:

• Low-grade Inflammation: This refers to the white blood cells’ production of chemicals and substances that fight infection. Experts report that a type of low-grade inflammation can trigger the polycystic ovaries to release androgen.
• Heredity: Genetics also seem to play a role. Women who have mothers, siblings, or other relatives with PCOS tend to have an increased risk of developing the condition too.

PCOS Diagnosis

Unlike other health conditions, there is no single test to diagnose PCOS. The following health assessments may be helpful in diagnosing PCOS: 

Health Interview

Your doctor may ask about your symptoms and medical history over a consultation. This may include questions like how long you have been experiencing irregular menstruation, how long have you been trying to conceive, and any family history of PCOS.

Physical Assessment

After a health interview, your doctor will conduct a physical assessment. This includes taking a measurement of your Body Mass Index (BMI) and the distribution of fat in your body. They may also check for skin discoloration, excess body hair, and other male-hormone related concerns.

Pelvic Exam

Another possible assessment is a pelvic exam, where you will need to lie down on the medical table for the doctor to visually inspect your reproductive organs. They will look for abnormalities such as enlarged clitoris, which could be the result of increased androgen levels.

Pelvic Ultrasound

Your doctor may also request for a pelvic ultrasound to check there are cysts in your ovaries. Sound waves can also be used to assess the lining of the uterus (endometrium).

Blood Tests

Doctors also often order blood tests to find out your androgen and blood sugar levels. In addition, blood tests can help to identify other disorders that may present PCOS-like symptoms, such as a thyroid condition.

Typically, from these 5 assessment strategies, the doctor will make a PCOS diagnosis if you have at least two of the following:

• Irregular periods, which can translate to periods that come too often and periods that are few and far in between. Missed periods also count.
• Increased androgen levels.
• The appearance of cysts on one or two of the ovaries.

PCOS Complications

Besides irregular menstruation, infertility, and male-hormone related concerns, PCOS can also lead to the following health problems:

• Prediabetes or diabetes: Authorities mentioned that more than half of women with PCOS develop prediabetes or diabetes before turning 40 years old.
• Hypertension: Women diagnosed with PCOS are more likely to have high blood pressure. This is significant because hypertension is a strong risk for serious health conditions like stroke and heart attack.
• High Cholesterol: Another possible problem that may arise from PCOS is increased levels of bad cholesterol and low levels of good cholesterol. This can be dangerous as it is a contributing factor for cardiovascular diseases.
• Sleep Apnea: This is a condition where sleep is interrupted by momentary and repeated stops in breathing. In PCOS, excessive weight may lead to sleep apnea. Interestingly, this condition also heightens risks of heart disease and diabetes.
• Endometrial Cancer: Insulin resistance, excessive weight, ovulation problems, and diabetes, all of which are common in PCOS, raise a woman’s risk of developing cancer of the endometrium (lining of the uterus).
• Depression: Due to the symptoms and complications of PCOS, many women also struggle with depression.

Do take note that there is little evidence to prove that PCOS is the cause of these conditions; it is just that they are highly associated with it.

PCOS Treatment

As the exact cause of PCOS is still unknown, there is no single cure or treatment for it. However, this does not mean that PCOS cannot be managed.

Presently, the treatment for PCOS focuses on medications and lifestyle modifications.

Medication for PCOS

• Birth Control Pills: Oral contraceptive pills are helpful in decreasing androgen levels and promoting balance between progesterone and estrogen. In other words, they help regulate irregular periods and improve male-hormone related symptoms.
• Progestin Therapy: In this treatment strategy, you need to take progestin for up to two weeks every one to two months. While it does not regulate androgen levels nor prevent pregnancy, it does help to regulate menstruation.
• Clomiphene: This anti-oestrogen medication promotes ovulation, which can be helpful to women who want to get pregnant. Typically, you will have to take it in the first part of your menstrual cycle.
• Metformin: Metformin is a common medication for diabetes; it helps with insulin resistance and in lowering insulin levels. Doctors prescribe it to PCOS patients diagnosed with prediabetes. Likewise, it can also be used alongside clomiphene to increase the chances of becoming pregnant.
• Letrozole: Letrozole is a medicine that stimulates the ovaries to help women with PCOS conceive.
• Gonadotrophins: Gonadotrophins also help women ovulate, but are usually administered through injections.

Besides these medicines, some women also use anti-androgen medicines under strict medical supervision. These medications work by blocking the effects of androgen; however, they may have side-effects such as a loss of sex drive and depression. Authorities also do not recommend anti-androgens to women who are planning to get pregnant.

You may find that your doctor will prioritise regulating your hormonal levels as it is important in protecting you against endometrial cancer.

Lifestyle Changes for PCOS

Along with medications, your healthcare team will most likely suggest the following lifestyle modifications to help improve your condition:

• Maintain a healthy weight: Having a healthy weight is crucial for women with PCOS. Not only does it help with insulin and androgen levels, but it also promotes ovulation. One of the best ways to achieve a normal BMI is through a healthy, balanced diet and regular exercise. If you have difficulty with meal planning, it is best to consult a dietitian.
• Pay close attention to carbohydrates: High carbohydrate intake can increase our insulin levels. Having a low-carb diet can be extra beneficial to women who experience prediabetes along with their PCOS.
• Stay active: Being physically active is essential because it helps to improve insulin resistance and lower blood sugar levels. However, it is best to consult your doctor before starting a new exercise regimen.

PCOS and Pregnancy

While infertility is one of the common outcomes of PCOS, it does not mean that a woman with this condition cannot get pregnant at all.

As mentioned earlier, there are medications that can help to stimulate the ovaries and promote ovulation. Other options to get pregnant include:

• In Vitro Fertilization: In this procedure, the healthcare team takes sperm and egg cells from the couple and fertilizes them in the laboratory. The fertilized egg is then implanted in the uterus.
• Surgery: Another option to increase the chances of pregnancy is a surgery that drills several holes in the ovaries. As most women with PCOS have thickened outer shells in their ovaries, experts believe it contributes to ovulation problems. This operation restores ovulation, but only for about 6 to 8 months.

Before trying to get pregnant, women are advised to achieve a healthy weight and blood sugar levels. The doctor may also prescribe folic acid.

However, it is important to note that woman who get pregnant while experiencing PCOS may have a higher risk of:

• Miscarriage
• Gestational diabetes
• Preeclampsia

Furthermore, PCOS also increases the risk of C-section delivery in mothers and longer neonatal intensive care unit stay in newborn babies.

Are You Worried About PCOS?

If you or someone you love experience symptoms of PCOS such as irregular or missed periods, infertility, and excessive hair growth, consulting a doctor is a must.

If you prefer speaking to a doctor in the privacy of your home, book an appointment with a house call doctor who will visit you at your doorstep, or consult a doctor online.