What is PCOS?

Polycystic ovary syndrome (PCOS) is a health condition that affects the hormone levels of millions of women worldwide. This disorder affects different aspects of a woman’s health, from your menstrual cycle to your fertility and overall well-being. PCOS starts during adolescence in most women, but symptoms may fluctuate over the years. 

Statistics from the World Health Organization (WHO) show that this complex condition affects about 8–13% of women of reproductive age (between 15 and 44). Sadly, many women do not know that they have PCOS. Studies show that about 70% of women with this condition have not been diagnosed. Understanding PCOS will help with early detection, management, and improved quality of life. 

This comprehensive article will explore the potential cause of PCOS, its signs, symptoms, diagnosis, and other related conditions.

What is PCOS?

At its core, PCOS affects the ovaries and their ability to function normally. The ovaries play a vital role in the female reproductive system. They are responsible for regulating the menstrual cycle and producing eggs and sex hormones—estrogen and androgens (male hormones like testosterone).  

In women with PCOS, their ovaries produce excess amounts of androgens and estrogen. It interferes with the development and release of eggs during ovulation. The imbalance in reproductive hormone levels has a domino effect, leading to a range of symptoms and potential health complications. 

As the word “polycystic” suggests, multiple small cysts grow on the ovaries. It is important to note that not all women with PCOS have these cysts.

Signs and Symptoms of PCOS

PCOS shows signs and symptoms that differ from person to person. Some women may experience only a few symptoms, while others may have more complex symptoms. The most common signs and symptoms associated with PCOS include:

• Irregular menstrual cycle: This is usually one of the first signs of PCOS which may come with:
  • No menstrual periods (amenorrhea) 
  • Frequently missed periods (oligomenorrhea)
• Heavy bleeding or periods: The uterus lining builds up over an extended period, so your periods may be heavier than usual. 
• Light bleeding or periods: Bleeding may be lighter than usual because your ovaries did not release an egg. The lack of ovulation is known as anovulation or anovulatory period. 

• Excess androgen production: Increased levels of male hormones can lead to several physical symptoms.

• Excessive hair growth (hirsutism): You may notice more hair on your face, chest, and back.

• Acne and oily skin: Hormonal imbalances can cause persistent acne, especially on the face, chest, and upper back.

• Weight gain or difficulty losing weight: About 80% of women with PCOS are overweight or struggle with weight management caused by insulin resistance. 

• Thinning hair or hair loss (alopecia): Some women may experience notice that the hair on their scalp is getting thinner and can fall out over time. 

• Darkening of the skin (hyperpigmentation) and skin tags: These usually appear in areas of your body with creases like the neck or under the breasts.

• Headaches: Hormonal imbalances can trigger frequent headaches.

• Fatigue: Women who have PCOS complain about feeling constantly tired.
• Mood swings: Fluctuation in hormone levels can affect mood, potentially leading to depression or anxiety in severe cases.
• Abnormal growth (cysts): As a result of the formation of cysts in the ovaries, the ovaries will be larger than usual. 
• Infertility or difficulty conceiving: PCOS is one of the major causes of infertility. The absence of ovulation will affect your ability to conceive. 
• Decreased libido: Women who have PCOS tend to have a lower sex drive because of the imbalance in hormone levels. 

It is important to note that not all women with PCOS will experience these symptoms, and the severity can vary. If you are experiencing any of these symptoms, especially irregular periods and difficulty getting pregnant, you need to consult your healthcare provider. Early diagnosis can help manage symptoms and reduce the risk of long-term complications.

Causes /Risk Factors for PCOS

The exact cause is unknown. Various risk factors, including inflammation, insulin resistance, and genetics, primarily contribute to the development of PCOS. 

Hormonal imbalance

The hormonal imbalance in PCOS disrupts the luteinising hormone (LH) and follicle-stimulating hormone (FSH) produced in the pituitary gland. These hormones both control ovulation. FSH boosts the ovaries to produce a follicle, which contains the eggs. LH triggers the release of mature eggs by the ovaries. 

Due to the abnormally high levels of luteinising hormone, your body produces more androgens. Women who have PCOS have higher levels of androgens like testosterone than usual.  The imbalance hinders the normal development and release of eggs from the ovaries, which causes irregular periods. 

Insulin resistance 

About 70% of women with PCOS have insulin resistance, meaning their bodies don’t respond as they should to insulin. Insulin is a hormone produced in the pancreas and regulates blood sugar levels. You will naturally need more insulin if your body cells can’t use insulin effectively. So, your pancreas produces more insulin to meet your body’s demands. The increase in insulin triggers the ovaries to produce more male hormones (androgens). 

Inflammation

Chronic inflammation contributes to the development of PCOS. Being overweight (obese) is associated with chronic inflammation.  Women with PCOS usually have high levels of specific inflammatory markers. 

Environmental factors 

While research is ongoing, some studies suggest that exposure to certain chemicals may contribute to PCOS.

Diagnosis of PCOS

Before a woman is diagnosed with PCOS, the healthcare provider will look out for at least two of these symptoms:

• Unusually high androgen levels (hyperandrogenism)
• Irregular or absent menstrual periods (because your ovaries do not release eggs regularly during ovulation)
• Cysts in the ovaries, as seen in an ultrasound

There’s no single test for PCOS, so healthcare providers usually run a combination of tests before they make a diagnosis. Some of these include:

Physical examination

During this examination, your doctor will ask about your medical and family history, including questions about your menstrual cycle, weight changes, and other symptoms. They will also perform a physical exam to check for symptoms of PCOS on your skin. These may include excess hair growth (hirsutism), acne, alopecia, skin darkening, skin tags, and other physical signs.  

Blood tests

These blood tests will measure your hormone levels. The test will check for hormones like:

• testosterone (which is responsible for hair growth)
• oestrogen (the primary sex hormone produced by the ovaries that stimulates the growth of the womb lining)
• luteinising hormone (LH) (which influences hormone production and is essential for regular ovulation);
• insulin (which regulates blood sugar)
• follicle-stimulating hormone (FSH) (which measures the quality of eggs and the fertility level of the ovaries).

They can determine if any of the hormones are higher than usual. Any sign of hormonal imbalance may be linked to PCOS. 

Pelvic ultrasound

The ultrasound will give a clearer picture of your ovaries and uterus. Imaging will reveal any abnormal changes. Your healthcare provider will check whether the ovaries are enlarged or contain multiple small cysts.

It is important to note that other conditions can cause similar symptoms, so your healthcare provider may need to rule out other potential causes before making a diagnosis.

Related Conditions for PCOS

PCOS doesn’t exist in isolation. It is usually associated with several other health conditions, some of which can be serious if left untreated. Some of these include:

Infertility 

PCOS is one of the most common causes of infertility in women. Women who have PCOS are most likely to experience irregular or no ovulation (anovulation). If your menstrual cycle is irregular, it may be harder to get pregnant. About 70 to 80% of women with PCOS fall into this category. 

Pregnancy complications

PCOS can also increase the risk of pregnancy complications during pregnancy.

Women with PCOS are two times more likely to deliver their babies prematurely than women who do not have PCOS. They also have a higher risk for complications:

• Miscarriage
• High blood pressure in pregnancy (pre-eclampsia)
• Gestational diabetes 

Due to the increased risk of pregnancy complications, the doctor will regularly assess your body mass index (BMI), blood pressure, and oral glucose tolerance. Maintaining a healthy weight and blood sugar levels ensures that you enjoy a healthier pregnancy journey.

Endometriosis and endometrial cancer

Endometriosis is a condition in which endometrial tissue, the kind found in the lining of the uterus (endometrium), grows outside the uterus. This can happen in the ovaries, fallopian tubes, and tissues in the pelvic area. 

During ovulation, the lining gets thicker and sheds during your periods. The lining will build up if you have irregular menstrual cycles and do not ovulate every month. With endometriosis, the blood cannot leave the body. So, it comes with abnormally painful periods, pelvic pain, and excessive bleeding.  A thickened or abnormal growth of the uterine lining can increase the risk of infertility and endometrial cancer.  

Metabolic syndrome 

As mentioned earlier, a good number of women with PCOS are overweight or obese. This means that they have a higher risk of having diseases like:

• High cholesterol levels 
• High blood pressure (hypertension)
• High blood sugar
• Heart diseases 
• Stroke 

The insulin resistance associated with PCOS also increases the risk of developing type 2 diabetes. 

PCOS is also associated with health conditions such as:

• Eating disorders – bulimia nervosa and anorexia nervosa.
• Sleep apnea 
• Being overweight or obese may contribute to low self-esteem 
• Mental health issues like anxiety and depression, in worse cases

Conclusion

PCOS affects various aspects of women’s health, from irregular periods to infertility and long-term complications. 

Understanding PCOS and other related conditions allows women to make proactive efforts to manage their symptoms, reduce potential health risks, and enhance their overall quality of life. If you feel like you may have PCOS, do not hesitate to speak to a healthcare provider for proper diagnosis, evaluation, and personalised treatment options.