In this article:
- How Common Is PCOS?
- Causes of PCOS
- Symptoms of PCOS
- Medical Treatment
- How Is PCOS Diagnosed?
- Who Is at Greater Risk of PCOS?
- Complications
- When to See a Doctor
- Expert Answers (Q&A)
- Final Word
Polycystic ovary syndrome (PCOS) is an endocrine disorder that affects women of reproductive age, but its symptoms may persist well beyond menopause.
It is characterized by an excess of androgens, which are male sex hormones that are found in both genders. Thus, women with PCOS tend to have abnormally high levels of androgens, which hamper the functioning of their ovaries and thwart the ovulation process.
The ovary releases a mature egg into the fallopian tube every month, which if fertilized by a sperm leads to a pregnancy.
Given that ovulation is an essential prerequisite for pregnancy, PCOS can make it very difficult for a woman to conceive by causing anovulation, or lack of ovulation in a menstrual cycle.
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In fact, PCOS is regarded as one of the leading causes of both anovulation and female infertility. A lot of women with PCOS become aware of their condition only after getting tested for infertility issues.
How Common Is PCOS?
PCOS is the most prevalent hormonal disorder among menstruating females, affecting 4%–8% of all women of childbearing age. (1) It is estimated that 1 in every 10 such women suffers from it.
In the United States alone, 6%–12% of females are diagnosed with PCOS during their childbearing years, which translates to approximately 5 million women. (2)
Causes of PCOS
While the exact cause of PCOS remains unidentified, it is typically related to a hormonal imbalance in the woman’s body.
1. High levels of androgens
All women secrete a minimal quantity of male hormones, but in women with PCOS, the ovaries produce abnormally high levels of androgens. The ovarian function is negatively affected when there is an excess of these hormones in the female body.
This type of hormonal imbalance can prevent the ovaries from releasing a mature egg during each menstrual cycle. This can cause irregularities in the menstrual cycle and fertility issues.
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2. High levels of insulin and obesity
Insulin is a peptide hormone that plays a critical role in the regulation of blood sugar levels and the conversion of food into energy.
Researchers have also observed a link between increased levels of insulin and the corresponding increase in the secretion of male hormones in some women. Thus, in effect, it can be said that high levels of insulin stimulate the ovaries to produce more male hormones. (3)
3. Low-grade inflammation
Another common characteristic found in many women with PCOS is they suffer from a type of low-grade inflammation that triggers their ovaries to secrete high levels of the male hormones.
Over time, this excess of androgens can pave the way for heart and blood vessel problems. (4)
4. Heredity
Genetics is also considered an important factor as PCOS tends to run in families. If your mother or sister has PCOS, you have a 50% chance of having it as well.
Symptoms of PCOS
Women with PCOS usually have at least two of the following three conditions: (5)
- The ovaries fail to release an egg regularly, leading to an unstable menstrual cycle. The absence of ovulation is characterized by irregular or prolonged periods (abnormal mensuration) and, in some cases, cessation of periods altogether (amenorrhea).
- In the majority of PCOS cases, one or both the ovaries sprout benign fluid-filled sacs or cysts.
- The excessive androgen secretion can lead to male-like features such as hirsutism, or the growth of extra unwanted hair on the face, chin, and other parts of the body where women typically do not have hair.
The signs and symptoms of PCOS vary from patient to patient. Some of the most commonly reported ones are:
- Hair loss from the scalp or male-pattern baldness (6)
- Excessive cramping and bloating during menstruation
- Skin that is greasier than normal, causing acne breakouts on the face, chest, and upper back
- Dark skin patches on the body, especially in areas with skin folds, such as the neck, groin, and under the breasts
- The appearance of skin tags, or small flaps of excess skin, in the armpits or around the neck
- Difficulty conceiving due to irregular ovulation or no ovulation at all
- Psychological stress and depression
- Fatigue and low energy for no discernible reason (other PCOS-related issues such as poor sleep may further aggravate the feeling of fatigue)
- Pelvic pain
- Rapid weight gain and difficulty shedding the extra kilos, making women with PCOS prone to obesity
- Increased susceptibility to mood swings, depression, and anxiety
PCOS can also lead to the onset of other chronic ailments over time. Women with this condition are at an increased risk of developing insulin resistance, type 2 diabetes, high blood pressure, high cholesterol, and heart disease. (7)
Early treatment and regular follow-ups can help safeguard you from these negative outcomes.
Medical Treatment
There is no absolute cure for PCOS. Hence, the primary aim of treatment is to manage the condition.
Several medical interventions can address the main symptomatic concerns associated with PCOS, which include hirsutism, acne, weight issues, menstrual irregularities, and infertility.
Managing hirsutism (excessive hair growth)
One of the most conspicuous ill effects of PCOS is hirsutism, or excessive hair growth on the face and the body. A couple of treatment techniques can address this problem:
- Removing hair: Facial hair removal creams, laser hair removal, and electrolysis help remove excess hair. While hair removal creams and products are readily available at drugstores, procedures such as laser hair removal or electrolysis require the expertise of a doctor and can only be performed clinically.
- Slowing hair growth: Your doctor may prescribe a skin treatment using eflornithine HCl cream to reduce the growth rate of unwanted facial or body hair.
Medication
Doctors routinely recommend the following medicines to manage PCOS symptoms:
These drugs are attributed with anti-inflammatory properties that can help diminish certain inflammatory markers that are typically elevated in PCOS. (8)
How Is PCOS Diagnosed?
If your physician suspects that you have PCOS, he or she will most likely refer you to a gynecologist or an endocrinologist for a more thorough analysis.
For the diagnosis of PCOS, two of the following three are required:
- Irregular periods
- Excess body and facial hairs, acne, or blood tests indicating high levels of testosterone
- Ultrasound scan showing cysts on the ovaries
Based on these criteria, PCOS can be classified as mild, moderate, or severe.
Who Is at Greater Risk of PCOS?
According to a 2017 study, PCOS is more common among Middle Eastern women than among Caucasian females residing in the United States and Europe, but the highest incidence is reported among black women of African-American and Afro-Brazilian descent. (9)
Complications
Women with PCOS are increasingly prone to the following complications:
When to See a Doctor
It is well-advised to consult your healthcare provider for proper diagnosis and treatment if you are:
- Regularly missing your periods without being pregnant
- Concerned about symptoms such as hirsutism, acne, and male pattern baldness
- Unable to conceive despite repeated attempts
- Experiencing symptoms related to diabetes such as increased thirst, hunger, blurred vision, and sudden weight loss
Expert Answers (Q&A)
Answered by Dr. Harshal Deshmukh, MBBS, PhD (Endocrinologist)
Final Word
PCOS is generally a lifelong condition that can best be managed rather than cured. Early diagnosis is crucial for reducing the severity and potential complications associated with this problem.
So, you must consult your doctor as soon as you suspect the first sign of PCOS. Based on a preliminary checkup, your physician may refer you to an endocrinologist for a thorough assessment. The specialist can then recommend suitable dietary, lifestyle, medicinal, and other therapeutic interventions to help you deal with this chronic problem.
