Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, Tests, and Treatment

January 13, 2020   |   Gynecology

Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, Tests, and Treatment

It’s estimated that polycystic ovary syndrome (PCOS) affects roughly 1 in 10 women in the United States. PCOS is a condition that is classified as a hormonal imbalance. Overall, it can affect a woman’s appearance, but it can cause underlying health problems as well, such as affecting fertility. Beyond that, it can cause more serious long-term health complications, such as heart disease and diabetes. Read on to learn more about polycystic ovary syndrome, its causes, symptoms, how it may affect your health, and what treatment options are available.

What Is Polycystic Ovary Syndrome (PCOS)?


PCOS is a hormonal problem that affects women of childbearing age, affecting up to 26 percent of women between the ages of 15 and 44. Many women go undiagnosed and are completely unaware that they have PCOS. A woman’s ovaries produce both progesterone and estrogen, which are the hormones that regulate the menstrual cycle. However, the ovaries also produce androgens, which are male hormones. In women without PCOS, they only produce a small amount. In women with PCOS, they produce a much larger amount. This disrupts the menstrual cycle. However, PCOS is a syndrome, which means it is multi-layered or has several conditions or symptoms behind it. PCOS also includes symptoms of cysts on the ovaries and irregular or skipped periods (in part due to the higher levels of male hormones).

Polycystic stands for “many cysts,” which means that there are many cysts (fluid-filled sacs) found inside the ovaries of a woman that has PCOS. In PCOS, these cysts are actually unfertilized eggs. Unfortunately, these eggs never grow to maturation, and because of their increased number, further disrupt the level of hormones in the body. A woman may infrequently ovulate, which will alter her levels of progesterone, luteinizing hormone (LH), and follicle-stimulating hormone (FSH), all needed hormones to induce fertilization.

What Are the Symptoms of PCOS?


Many women do not even know that they suffer from PCOS and have no symptoms at all. Others are symptomatic. Some women discover that symptoms begin after significant weight gain, or they begin to wonder why they’re not getting pregnant after months or years of trying, which leads them to a healthcare provider for answers. For women that do have symptoms, there are a few to note. Because of the high level of male hormones, some women are affected by PCOS in their appearance by hair growth in irregular areas, such as hair on the face, stomach, chest, or back. This is known as hirsutism and is one of the most common PCOS symptoms, affecting up to 70 percent of women. Women with PCOS may also be affected by male-pattern baldness on their scalp.

Lack of ovulation and irregular periods are other telltale signs. Some women with PCOS get fewer than eight periods a year because their eggs fail to come to maturation. Because of this, when women do menstruate, they may have extremely heavy uterine bleeding, because of the long break in between menstrual cycles. 

Women with PCOS may also have affected skin, with conditions such as acne or dark patches. Darkening of the skin may be noticeable under the breasts, on the neck, or in the groin. Acne may be present in places such as the back and face. 

Many women with PCOS are also overweight or obese, with roughly 80 percent of women having a BMI outside of the average range. 

What Causes PCOS?


Doctors and researchers are not entirely sure what causes PCOS and why it affects certain women but not others. Certainly, genetics plays a role. There are some theories as to why it affects some people and not others. Research does show that PCOS runs in families, but doctors are not sure why. 

Insulin resistance is also tied to PCOS, with up to 70 percent of women with polycystic ovary syndrome also being insulin resistant. This means that their cells don’t use insulin properly and that they are at a much higher risk for development of type 2 diabetes. When the cells can’t use insulin properly, the body makes more to compensate. Depending on lifestyle and genetics, this can cause diabetes. 

Those with PCOS also have higher levels of inflammation in their bodies, but again, doctors are not sure what the exact correlation is between inflammation at the PCOS itself, just that women with the condition have higher levels. Being overweight or obese on its own, without PCOS, also contributes to higher levels of inflammation.

How Is PCOS Diagnosed?


PCOS is diagnosed in several ways. First, your doctor will have a clinical interview and physical exam with you to discuss your symptoms. He or she will ask you about excess body hair, acne, weight gain, and if you’re experiencing problems with infertility (depending on your age). Most likely, your physician will order blood tests to check for high androgen (male hormone) levels as well as high cholesterol. Blood tests will also check your insulin levels to see if they are abnormal. 

While you will have an ultrasound to look for polycystic cysts, your doctor will also provide you with a pelvic exam to look for any abnormalities. 

All in all, your healthcare provider is looking for three things: irregular periods, cysts in the ovaries, and high levels of male hormones. These are the three markers behind a PCOS diagnosis. 

Is PCOS Linked to Other Health Problems?


PCOS is linked to other health problems, the most common of which is infertility. However, it is linked to more serious complications later in life, the most serious of which is endometrial cancer. PCOS is also linked to metabolic syndrome, sleep apnea, and depression. PCOS is linked to sleep apnea and metabolic syndrome because of the obesity aspect of so many patients. Metabolic syndrome is a blanket term for high blood sugar, high cholesterol, and high blood pressure, all of which can lead to heart disease. 

How Is PCOS Treated?


There are different treatments for PCOS, depending on the symptom of PCOS you are attempting to treat. For example, taking birth control is one of the most common treatments to regulate hormones and decrease unwanted hair growth, but this wouldn’t be the option to treat infertility. 

For overweight and obese patients with PCOS, simple diet and lifestyle changes are highly recommended, such as changing diet and exercise. It can be challenging, but with a supportive care team, it can be accomplished. 

Metformin is an option for PCOS patients with type 2 diabetes. It is often used in conjunction with diabetic PCOS patients who also struggle with weight gain.

Clomiphene is the first-line treatment for PCOS patients who are struggling with fertility. It does come with a risk, however, of having multiple births. Surgery is also an option if this medication does not work.

How Can I Improve My PCOS Symptoms?


Because so many women struggle with weight, the best advice is to begin to eat better and make other lifestyle changes. Low-carbohydrate diets are recommended by physicians, with 30 minutes of moderate-intensity exercise three times a week. If a patient can lose just 5 to 10 percent of their body weight, the menstrual cycle can regulate immensely. For any patient struggling with PCOS, diet and lifestyle changes are highly recommended for symptom improvement. If you need more information on polycystic ovary syndrome (PCOS) or would like to be seen by a physician, schedule an appointment at The Woman’s Clinic today. We have two offices and early hours, along with an extensive team for individualized and thorough care.


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