Polycystic Ovary Syndrome (PCOS) affects the normal level of female hormones. It is a condition due to which a woman experiences an increase in the level of the male hormones in the body, which causes issues with fertility and the menstrual cycle.
Not only does polycystic ovary syndrome affect a woman’s ability to have children, but it also causes acne and excessive unwanted body or facial hair or hirsutism due to the elevated levels of the male hormone Androgen. Some women with PCOS also develop many cysts on the ovaries, which are fluid-filled sacs and hence the term ”polycystic” or ‘’ many cysts.’’
These fluid-filled sacs containing immature eggs that do not go through ovulation. Hence it disturbs the balance between hormones. The excessive levels of the male sex hormone androgen disrupt the menstrual cycle, thereby causing a woman to have irregular and fewer periods, also known as Oligomenorrhea.
What Hormones are related to PCOS?
Polycystic ovary syndrome is an endocrine disorder affecting women in their reproductive years. The signs and symptoms of PCOS start early during puberty and continues to develop throughout a woman’s reproductive age During the fertile years polycystic ovary syndrome exposes a woman to infertility and various gestational complications like preeclampsia or a sudden hike in the blood pressure causing swelling the face, hands, and feet, miscarriages, etc. In postmenopausal women, there is a risk of developing cardiovascular diseases, diabetes, high blood pressure.
Polycystic ovary syndrome affects around 5- 10 % of women in their reproductive age. Its main features are the absence of ovulation, polycystic ovaries, and excessive body or facial hair (Hirsutism). Hormones play a very big role in the proper functioning of bodily functions. The main hormones that play a big role in PCOS are:
It is often seen that women with Polycystic Ovary Syndrome have a considerable prevalence of insulin resistance. Insulin is a hormone secreted by pancreatic β cells, and insulin helps control the amount of sugar or glucose in the blood. With insulin resistance, the body’s cells don’t normally respond to insulin. Glucose can’t enter the cells as easily, so it builds up in the blood. This can eventually lead to type 2 diabetes. Women with PCOS develop insulin resistance, and thus, their bodies cannot react well to this hormone.
The pituitary gland in the brain makes the Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) that control the process of ovulation. FSH stimulates the ovary to produce a follicle or a sac that contains an egg, and then LH signals the ovary to release the mature egg. All women have small levels of androgen or the male hormone being produced by their ovaries, but PCOS causes the ovaries to produce excessive amounts of androgen. This excessive production of androgen is linked to the spike in insulin produced by the pancreas. Excessive androgen levels cause excessive facial and body hair or hirsutism, and severe acne and male-pattern baldness.
During a normal menstrual cycle, the brain sends luteinizing hormone (LH) and Follicle-stimulating hormone (FSH) to the ovaries. A big surge of LH triggers the ovaries to ovulate, or release an egg. The egg then travels down the fallopian tube and into the uterus, progesterone from the ovary causes the lining of the uterus to thicken and prepare for the pregnancy. If the egg isn’t fertilized, the lining of the uterus is shed. After the menstrual period, the cycle begins all over again. But with PCOS, the LH levels are often high when the menstrual cycle starts, the levels of LH are also higher than FSH levels. Too much LH can cause higher levels of androgen and estrogen and lower levels of progesterone. Without progesterone, the process of ovulation does not occur, and periods are irregular.
Symptoms of Polycystic Ovary Syndrome
Polycystic ovary syndrome or PCOS, as it is widely known, is an endocrine disorder that affects women in their childbearing years. The term ”polycystic” means ” many cysts” as some women with PCOS develop cysts on their ovaries, these cysts are actually not cysts but partially formed follicles that each contains an egg. Polycystic ovary syndrome is characterized by the excessive body and facial hair (hirsutism), male-pattern baldness, acne, weight gain, infertility, irregular or infrequent periods. Some symptoms of PCOS are:
- Irregular Periods
Higher levels of androgens (male sex hormone) and insulin can disrupt the monthly cycle of ovulation (by which an egg is released) and menstruation. As a result, women with PCOS have irregular periods, or their periods may stop altogether.
Excess hair (hirsutism)
Another symptom of PCOS is hirsutism or excessive body and facial hair, and the hair typically grows in areas where it is more usual for men to grow hair such as the chin, upper lip, lower abdomen, chest, and thighs, etc. Hirsutism is linked to the excessive levels of androgen in the body. Usually, the ovaries produce a small amount of androgen, which is quite normal, but in women with PCOS, the level is excessive, which causes them to develop hirsutism.
Hair loss (alopecia)
Some women with PCOS also suffer from male-pattern baldness or a receding hairline.
A high level of androgen also stimulates the oil glands in the skin to produce more sebum or oil that can cause severe acne in women with PCOS.
High levels of the hormone insulin and androgen also affect the normal monthly process of ovulation by which an ovary releases an egg for fertilization by the sperm cell. It causes women with PCOS to skip their periods altogether or to have irregular periods. Since ovulation is disrupted, the chances of conceiving is reduced drastically. Some women, however, do conceive naturally without undergoing any sort of treatment, while others might have to resort to treatments to help them conceive.
Multiple cysts on the ovaries
The term ”polycystic” means ”many cysts”. Some women with PCOS develop cysts on their ovaries. These cysts are actually not cysts but partially formed follicles that each contain an egg.
Women with PCOS have a higher risk of developing depression and anxiety, acne, infertility, weight gain, etc. all these take a huge toll on the self-esteem of women with PCOS. Hence, they suffer from mood swings and, in some cases, depression and anxiety.
The excessive production of androgen (the male sex hormone) in addition to insulin resistance results in weight gain in women with PCOS.
Causes of Polycystic Ovary Syndrome
The exact cause of polycystic ovary syndrome is unknown, yet it has been seen that an imbalance in hormones causes PCOS. PCOS usually happens when a hormone called luteinizing hormone (LH) (produced by the pituitary gland), or levels of insulin (produced by the pancreas) are too high, which then causes the ovaries to make extra amounts of androgen or the male sex hormone. The excess amount of androgen then disrupts the ovulation process
Some of the main causes of PCOS are:
- Insulin resistance: Insulin is a hormone secreted by the pancreas, and insulin helps control the amount of sugar or glucose in the blood. With insulin resistance, the body’s cells don’t normally respond to insulin. Glucose can’t enter the cells as easily, so it builds up in the blood. Since the cells are not able to use the insulin properly, the pancreas compensates by producing even more insulin, which triggers the ovaries into producing more androgens. Excessive levels of insulin can eventually lead to the development of type 2 diabetes.
- Inflammation: Women with PCOS tend to gain more weight as a result of the excessive levels of insulin in their bodies. This can, in turn, lead to inflammation. Higher levels of inflammation is linked to PCOS.
How Can PCOS Affect Your Body?
For the body to function normally, there needs to be a balance in the normal bodily functions, hormonal imbalances can cause a wide variety of changes in the body, and hence it can disrupt the normal bodily functions. PCOS is associated with an imbalance in the hormones. PCOS can affect the body in many ways:
- Infertility: Polycystic ovary syndrome is the leading cause of infertility in women. The imbalance in hormones affects and disrupts the process of ovulation, and when the ovaries are not able to ovulate, a woman cannot conceive.
- Sleep apnea: Sleep apnoea is when the upper airway is obstructed during sleep. Excessive fatty tissue in the neck can partially block the airway leading to sleep loss, fatigue, tiredness. This is generally seen in women with PCOS that are overweight or insulin resistant.
- Endometrial cancer: During a normal menstrual cycle, the uterine lining is thickened which is triggered by the female hormone progesterone to prepare the uterus for pregnancy; when the egg is not fertilized by the sperm cell, the lining disintegrates and is shed with the period, with PCOS a woman skips this process of ovulation entirely which causes the lining to build up every month which can increase the risk of developing endometrial cancer.
- Depression: PCOS results in women developing acne, excessive facial and body hair, dark patches of skin around the neck, and other parts of the body along with developing male-pattern baldness. All these take a huge toll on their self-esteem, which can cause them to experience mood swings, depression, and anxiety.
The diagnosis of polycystic ovary syndrome can be a time-consuming process since some symptoms like having multiple cysts on the ovaries do not necessarily point towards a woman having PCOS. The doctor generally asks various questions as to whether they have had acne problems, facial and body hair, weight gain, etc.
Along with that, a physical examination is also done, which includes a pelvic exam. In this, the health of the reproductive organs is checked both internally as well as externally. Apart from a pelvic exam, blood tests and ultrasound is also done. Blood tests to check the levels of androgen and other hormones. Ultrasound, to check for any irregularities in the size of the ovaries and also to check if there are any cysts on them.
Common Medical Treatments for PCOS
Changing lifestyle like shedding extra pounds, exercising daily, and mindful eating does help relieve and even reverse the effects of polycystic ovary syndrome to a great extent. While some might get all the help necessary to control the symptoms of PCOS by changing their lifestyle, for others, this might not work, and along with lifestyle changes, they have to take the help of medications to manage some harder to control symptoms like infertility and insulin resistance.
Some of the commonly prescribed medications are:
- Birth control: Oral contraceptive pills or birth control pills contain hormones like estrogen and progesterone, taking these pills helps regulate the menstrual cycle and thus helps in managing the symptoms of PCOS. Birth control can also help with excessive hair growth on the body and face and acne. They also reduce the risk of developing endometrial cancer as it helps in the shedding of the uterine lining. Additionally, they also can reduce the production of the male hormone androgen.
- Metformin: This drug is prescribed to treat PCOS. It is an insulin-sensitizing medication that can help the body to respond more easily to the insulin produced by the pancreas and to control the glucose levels better. Metformin can also reduce insulin resistance and high insulin levels, and in turn, can reduce high androgen levels.
- Hair removal medicines: Eflornithine– sold under the brand name Vaniqa, is a medication used to treat excessive hair growth on the face in women. It comes in a cream form that is prescribed to women with PCOS to slow down the growth of new hair. However, it does not remove the already existing hair.
Diet & Lifestyle Remedies to Treat PCOS
Having a healthy lifestyle does not help in the overall well being of a person, but it also can help women with polycystic ovary syndrome to reverse the effects of PCOS. Eating mindfully, getting regular exercise, sleeping better and managing stress all can help in managing the symptoms of PCOS.
According to the American College of Obstetricians and Gynecologists (ACOG) dropping just 5 to 10% of your body weight can make more sensitive to insulin, leading to more regular menstrual cycles, and could even help control severe acne and excess hair growth.
Taking a 30-minute brisk walk three days a week can greatly help in weight loss and when exercising it is coupled with a healthy diet like low carbohydrate diet or a low glycemic index diet where most of the carbohydrates are obtained from nuts, grains, fruits, and vegetables can help in a greater amount of weight loss than opting for just one of the either two.