What is PCOS?

PCOS vs. PCOD

Polycystic ovary disease (PCOD) is an older term used to describe PCOS. The condition was formally known as Stein-Leventhal syndrome.

Endometriosis vs. PCOS

Endometriosis differs from PCOS in that it involves the growth of uterine-like tissue in areas outside the uterus, such as the vagina or ovaries. Each menstrual cycle, this tissue can break down and bleed, causing inflammation. Like PCOS, endometriosis can result in ovarian cysts and may contribute to infertility. However, endometriosis is primarily characterised by severe cramping and abdominal pain, unlike PCOS, which is associated with symptoms such as acne and excessive hair growth.

Types of PCOS

Some researchers suggest categorising PCOS into specific types based on an individual's symptoms and hormone levels:

Non-hyperandrogenic PCOS (Type D)

This type is characterised by issues with ovulation, which may result in irregular or absent periods, along with cysts on the ovaries. Unlike other forms, androgen (male hormone) levels remain within the normal range.

Non-PCO PCOS (Type B)

This involves elevated levels of androgen alongside ovulation problems but without cysts on the ovaries.

Ovulatory PCOS (Type C)

People with this type experience increased androgen levels and cysts on the ovaries.

Full-blown PCOS (Type A)

This is the most severe type, involving a combination of high androgen levels, ovulation issues, and ovarian cysts.

Alternative classifications of PCOS

In informal contexts, PCOS may also be described based on its potential causes or symptoms:

Insulin-resistant PCOS

A significant number of individuals with PCOS also have insulin resistance, a condition in which the body produces insulin but cannot utilise it effectively. Insulin resistance predisposes people to a high risk of type 2 diabetes.

Inflammatory PCOS

Chronic low-grade inflammation has been linked to PCOS. Inflammation occurs as the immune system responds to perceived threats and can worsen symptoms. Insulin resistance and obesity are often associated with heightened inflammation, further worsening the condition.

Hidden-cause PCOS

This term is used on some platforms to describe PCOS with unidentified underlying causes. However, the exact cause of PCOS remains unknown in general. Researchers say that both genetic and environmental factors contribute to its development.

Pill-induced or post-pill PCOS

Hormonal contraceptives do not cause PCOS. However, after discontinuing these contraceptives, an individual may experience temporary symptoms such as irregular periods or symptoms that are similar to PCOS. Birth control pills can also suppress PCOS symptoms, delaying a diagnosis until after cessation. Doctors sometimes recommend hormonal contraceptives to manage PCOS symptoms effectively.

PCOS and Hormones

Hormones are defined as the chemical messengers that regulate various bodily functions. Several of these hormones are vital to a woman's menstrual cycle and reproductive health. In PCOS, the reproductive hormones become imbalanced, leading to the symptoms and complications commonly associated with the condition. A lot of these hormones play a vital part in PCOS.

PCOS and Insulin Resistance

Insulin is an important hormone that is responsible for the regulation of sugar levels in the blood. Research suggests that 30% to 80% of individuals with PCOS experience insulin resistance. In this condition, the body does not respond effectively to insulin, leading to an excessive buildup of the hormone in the body. This excess insulin is thought to contribute to the overproduction of androgens, leading to PCOS symptoms.

Hormones Involved in PCOS

Several hormones influence the development and symptoms of PCOS:

Androgens

Commonly referred to as male hormones, androgens are present in everyone. In PCOS, the ovaries produce higher-than-usual amounts of androgens. This hormonal imbalance can disrupt ovulation, leading to irregular periods or the absence of menstruation.

Excess androgens are also responsible for symptoms such as acne, hair thinning, and unwanted body and facial hair (hirsutism).

Follicle-stimulating hormone (FSH)

FSH plays an essential role in preparing the body for ovulation and regulating the menstrual cycle.

Luteinising Hormone (LH)

LH triggers the release of an egg from the ovary and also helps regulate the monthly cycle.

Progesterone

PCOS may result in lower levels of progesterone, causing irregular or absent periods. This makes it difficult to predict when menstruation will occur.

Oestrogen

In PCOS, oestrogen levels may become disproportionately high in relation to progesterone, contributing to menstrual irregularities and other symptoms.

What are the initial symptoms of PCOS?

Polycystic ovary syndrome is not classified as a disease but rather a group of symptoms that can differ from one person to another. The most common early signs of PCOS are:

• Missed, irregular, infrequent, or prolonged menstrual cycles
• Hair Loss: PCOS can cause hair to thin, particularly in middle-aged or older individuals
• Hirsutism: Excess hair growth may appear in unwanted areas, including the face, chest, abdomen, arms, fingers, and toes
• Oily Skin: High androgen levels can make the skin oilier
• Acne: Breakouts can occur on the face, chest, or back due to hormonal changes
• Darkened Skin: Patches of darker skin may develop on the neck, under the breasts, or in the armpit region
• Skin Tags: Small excess skin flaps frequently appear on the neck or underarms
• PCOS-Associated Pain: Some individuals experience pelvic or lower abdominal pain, often coinciding with menstrual periods, though it can also occur at other times
• Weight Gain or "PCOS Belly": Approximately 50% of individuals with PCOS experience weight gain, with fat accumulation concentrated around the abdominal area
• Ovarian Cysts: An ultrasound might reveal enlarged ovaries or numerous small, fluid-filled sacs (follicles)
• Mood Changes: Hormonal imbalances and the challenges of managing PCOS symptoms increase the likelihood of mood swings, anxiety, and depression

Can You Have PCOS Without Symptoms?

Yes, it is possible to have PCOS without noticeable symptoms. In a few cases, the symptoms are so mild they go unnoticed. Additionally, as other medical conditions can cause similar menstrual irregularities, diagnosing PCOS may take time. This is one reason why a large percentage of cases remain undiagnosed.

Causes of PCOS

While doctors do not fully understand what causes polycystic ovary syndrome (PCOS), several factors are believed to contribute to the condition:

Excess Weight

The link between weight and PCOS is complex—weight gain can both contribute to and result from the condition.

High Levels of Androgens

Hyperandrogenism, characterised by elevated androgen (male hormone) levels, is a condition affecting the majority of those with PCOS. These excess androgens can interfere with ovulation and other bodily processes.

Insulin Resistance

Insulin resistance occurs when the body cannot use insulin properly, leading to excess insulin. This can disrupt ovarian function, affecting egg release (ovulation), and contribute to weight gain and difficulty losing weight.

Long-term, Low-grade Inflammation

If there is persistent low-grade inflammation in the body, it may contribute to the increased production of androgens.

Is PCOS Genetic?

While the exact genetic link to PCOS is still unclear, the condition tends to run in families. Research suggests that individuals with close relatives who have PCOS are more likely to develop it themselves. Approximately 20% to 40% of people with PCOS have a mother or sister who is also affected, likely due to a combination of shared genetics and lifestyle factors.

PCOS Risk Factors

Many factors may increase the risk of developing PCOS, including:

• A family history of menstrual issues or disorders (including PCOS)
• Type 2 diabetes
• Being overweight or obese
• Rapid weight gain

Additionally, transgender men (also known as female-to-male transsexual individuals or FTMs) are at an increased risk of developing PCOS. Hormone therapy might play a role, but it is not the sole cause, as many other contributing factors are involved. Research has shown that while hormone therapy can alter ovarian function in transgender men, it does not directly cause PCOS.

What Are the Complications of PCOS?

People with PCOS face higher risks of developing various other health conditions, including:

Infertility

Hormonal imbalances in PCOS can disrupt ovulation, preventing the release of healthy eggs for fertilisation. While fertility can be impacted, many people with PCOS still conceive, often with the help of medications and fertility specialists.

Pregnancy Complications

Though most individuals with PCOS have healthy pregnancies, the condition does increase the risks of developing gestational diabetes, preeclampsia (high blood pressure during pregnancy), preterm birth, miscarriage, and the need for a caesarean section.

Insulin Resistance and Diabetes

Insulin resistance hampers the body's ability to process blood sugar, resulting in elevated blood sugar levels. Typically, insulin resistance does not cause symptoms until blood sugar levels rise to the point of type 2 diabetes. More than half of individuals with PCOS will develop type 2 diabetes by age 40.

Metabolic Syndrome

This is a combination of various symptoms that may increase the risk of cardiovascular disease. These symptoms include elevated blood sugar levels, high blood pressure, high triglyceride and low HDL ("good") cholesterol levels.

Other possible complications of PCOS include:

• Depression and anxiety
• Abnormal uterine bleeding and increased risk of uterine and endometrial cancers
• Sleep issues, including sleep apnea
• Inflammation of the liver

PCOS diagnosis

Polycystic ovary syndrome (PCOS) can be diagnosed if you exhibit at least two of the following symptoms:

• Irregular periods
• Signs of excessive androgen production, such as acne, excess body and facial hair, or blood test results showing high androgen levels
• Ovarian cysts or enlarged ovaries visible on an ultrasound

How to get tested for PCOS

Currently, no single test can definitively diagnose PCOS. Your doctor will begin by gathering details about your medical history and symptoms. A physical exam will be conducted to check for signs such as acne or unwanted body and facial hair.

A pelvic exam may also be performed. During this, a healthcare provider assesses the reproductive organs for any masses, growths, or abnormalities.

An ultrasound is often used to identify ovarian cysts or to assess the lining of your uterus. A transvaginal ultrasound may be used, where the doctor inserts a wand into the vagina that uses sound waves to produce images of your reproductive organs. Blood tests to measure androgen levels, as well as other hormones, may also be required.

Other tests you might need

If PCOS is suspected, additional tests may be conducted to rule out other health conditions unrelated to PCOS, including:

• Blood pressure measurement
• Blood tests to assess blood sugar, cholesterol, and triglyceride levels
• Mental health evaluations
• Screening for sleep apnea

PCOS treatment

Although there is no cure for PCOS, treatment options are available to manage symptoms. Your doctor will recommend treatments tailored to your goals, particularly if you're trying to conceive, as some treatments may pose risks to a developing fetus.

Treatment options include:

Hormonal Birth Control

If pregnancy is not the goal, your doctor may suggest hormonal birth control methods such as the pill, patch, injection, or hormonal IUD. These methods contain oestrogen, progesterone, or both and can regulate menstrual cycles, reduce acne and excess hair growth, and lower the risk of endometrial cancer.

Progestin Therapy

Progestin is a synthetic form of progesterone. It can help regulate periods and reduce the risk of uterine cancer, but it doesn't prevent pregnancy or lower androgen levels.

Insulin-Sensitising Medications

Medications like Metformin, typically used for treating type 2 diabetes, can lower insulin and androgen levels. While Metformin is not specifically FDA-approved for PCOS treatment, it may help with ovulation and menstrual irregularities.

Androgen Blockers

These medications counteract the effects of excessive male hormones, reducing issues such as unwanted hair growth and acne. These should not be used during pregnancy or while trying to conceive, as they can cause congenital disabilities. Two types of contraception are advised during treatment.

Acne Medications

If acne is a significant concern, a dermatologist can prescribe topical creams or oral medications to address and prevent breakouts.

Excessive Hair Growth Treatments

To reduce unwanted body or facial hair, options include:

Electrolysis or Laser Therapy

Electrolysis uses an electric current to remove hairs by destroying their roots. Laser therapy targets and destroys hair follicles. Both methods require multiple treatment sessions. Although some hair may regrow, it is typically finer and less obvious.

Depilatories

Over-the-counter creams, gels, or lotions help in breaking down hair proteins, causing the hair to fall out. It is crucial that you follow the product's instructions closely.

PCOS and Pregnancy

Can You Get Pregnant with PCOS?

It is possible to become pregnant with PCOS, though it may require medication to promote ovulation or the use of fertility treatments like in vitro fertilisation (IVF).

Medicines that help in ovulation

If you're trying to conceive and need assistance with ovulation, certain medications may help:

• Clomiphene (Clomid, Serophene): An anti-oestrogen medication that stimulates ovulation early in your menstrual cycle
• If clomiphene doesn't work, Metformin (a diabetes medication) may be prescribed to help regulate ovulation
• If neither of the above treatments is effective, gonadotropins, a class of hormonal medications administered via injection, may be used
• Letrozole (Femara): This medication is sometimes used when other ovulation drugs fail

Additional fertility options:

• Ovarian Drilling: If ovulation medications aren't successful, ovarian drilling, which involves making a small incision and removing parts of the ovaries that produce excess androgens, may be considered. This method is less common today due to the availability of more effective medications
• In Vitro Fertilisation (IVF): This assisted reproductive technology is considered one of the most effective methods for those with PCOS. The procedure involves removing eggs from your ovaries and fertilising them outside the body before implanting the embryo back into your uterus. However, it can be quite expensive

It's essential to consult your doctor to explore ways to increase your chances of a healthy pregnancy, including making lifestyle changes before conception.

Diet and lifestyle changes for PCOS and fertility

Living a healthy lifestyle, including weight management, regular exercise, and controlling blood sugar levels, can improve PCOS symptoms and enhance fertility.

Managing weight

Although not everyone with PCOS is overweight, many individuals with the condition struggle with weight gain. Excess weight can affect hormone balance, so maintaining a healthy weight is crucial. Even a weight loss of around 10% of body weight may help normalise menstrual cycles.

Your healthcare provider may recommend a balanced, lower-calorie and lower-fat diet with controlled portion sizes to manage weight. Working with a nutritionist can be beneficial, and tracking your meals through a journal or app may support consistency.

PCOS Diet

To regulate blood sugar levels, it is advisable to focus on foods with low glycemic index, such as whole grains, lean meats, fish, and high-fibre fruits and vegetables. It's recommended to limit refined carbohydrates, such as those in white flour, white rice, and sugary processed foods, which cause a quick rise in blood sugar.

Exercise

Regular physical activity is important for burning calories and increasing muscle mass, which helps reduce insulin resistance. Exercise can also improve your mood and boost self-esteem.

Getting Enough Sleep

Lack of sleep can contribute to hormone imbalances and insulin resistance. Building a regular sleep schedule and creating a peaceful environment can help improve your sleep quality. If you struggle to get at least seven hours of sleep per night, speak to your doctor.

Reducing Stress

PCOS can cause stress, which can worsen symptoms. Stress triggers the production of cortisol, a hormone that can disrupt other hormone levels and contribute to issues like weight gain and depression. Stress-relief methods, such as exercise, deep breathing, or mindfulness meditation, may be beneficial.

Limiting Caffeine

While moderate caffeine intake (around four cups of coffee per day) is generally fine, excessive amounts could disrupt sleep and potentially affect hormone balance. It's worth discussing with your doctor whether caffeine reduction might benefit you.

Avoiding endocrine disruptors

Chemicals that may contribute to hormone imbalances are found in many everyday products, including plastics and cosmetics. Minimising exposure to these chemicals can support hormone regulation. Some recommendations to reduce exposure include:

• Avoiding products with added fragrances
• Storing food in glass or stainless-steel containers
• Choosing foods not packaged in BPA-lined cans
• Washing your hands regularly, especially before eating
• Using a vacuum with a HEPA filter

Alternative medicine for PCOS

Although no alternative treatments have been definitively proven to alleviate PCOS symptoms, a few studies suggest that certain herbs and supplements might have some benefits.

A 2014 review of 33 studies highlighted several herbs and supplements that may offer help:

• Chaste tree berry
• Licorice mixed with Chinese peony
• Black cohosh
• Tribulus terrestris
• Cinnamon
• Licorice plant

Berberine, a plant-derived compound found in goldenseal, has shown promise in some studies in improving fertility and insulin resistance for people with PCOS. Further research is needed for conclusive evidence.

In conclusion, while alternative medicine offers potential, more robust studies are necessary to determine its effectiveness for managing PCOS symptoms.

Dietary Supplements for PCOS

It's essential to be cautious when considering dietary supplements, as the FDA does not regulate these products for effectiveness or safety. Always consult your doctor before starting any new supplement, especially if you're taking other medications. Discuss any potential side effects, interactions, and the latest evidence regarding the supplement's effectiveness for your condition.

Spearmint Tea for PCOS

Some studies suggest that spearmint tea may help balance hormones and reduce excess facial and body hair in individuals with PCOS. Since the tea is caffeine-free, you might try drinking 2-3 cups a day. However, as with any treatment, it's advisable to speak with your doctor before using spearmint tea, particularly if you're pregnant, trying to conceive, or have other underlying health conditions.

Acupuncture for PCOS

Acupuncture is a form of complementary medicine where thin needles are inserted at specific points in the body. Some studies suggest that acupuncture may help regulate hormones, support ovulation, and reduce insulin resistance in people with PCOS. However, there is insufficient solid evidence to confirm acupuncture as an established treatment for PCOS, so more research is required.

PCOS and Menopause

Symptoms related to PCOS, such as irregular periods, often improve as menopause approaches. After menopause, the ovaries cease functioning, which results in a drop in androgen levels. Consequently, the irregularity of periods no longer becomes a concern. However, some individuals may still experience higher-than-normal androgen levels, leading to continued symptoms like excessive hair growth.

While PCOS symptoms may subside with menopause, your risk of developing complications such as diabetes and metabolic syndrome may increase as you age, necessitating ongoing care and monitoring.

Frequently Asked Questions

How can I tell if I have PCOS?

The common signs of PCOS include irregular periods, acne, excessive hair growth, and trouble getting pregnant. However, not everyone with PCOS displays these symptoms. If you suspect you have PCOS, it is crucial to speak with your doctor.

Does PCOS self-resolve?

PCOS doesn't go away, but its symptoms can improve over time or with treatment. For instance, menopause brings about hormonal changes that often relieve symptoms of PCOS.

Can I get pregnant with PCOS naturally?

Although getting pregnant with PCOS can be more challenging due to irregular ovulation, it is possible to conceive without intervention. However, fertility treatments may be necessary for many individuals with PCOS.

Takeaways

PCOS is a hormonal condition that disrupts the normal functioning of the ovaries and causes a range of symptoms, including irregular periods, acne, excessive hair growth, and fertility issues. While there is no cure for PCOS, treatments are available that help alleviate symptoms and improve the likelihood of conception. Maintaining a healthy lifestyle, taking prescribed medications, and discussing fertility options with a doctor can help manage this condition effectively.

Contact us today to learn more about PCOS and explore treatment options.