Polycystic ovary syndrome or PCOS is a hormonal disorder that women in their reproductive or childbearing age that is from 15 to 44 suffer from. Women with polycystic ovary syndrome suffer from Oligomenorrhea- or infrequent periods (where some women have less than six periods in a year) or prolonged periods.
It affects the ovaries where the hormones estrogen and progesterone are produced, and these hormones affect a woman’s menstrual cycle, thereby affecting fertility, the ovaries of women with polycystic ovary syndrome are seen to produce excessive amounts of the male hormone Androgen. Each month a woman goes through the process of ovulation whereby the ovaries produce an egg, and when this egg is fertilized by a male sperm cell, results into conception, and hence a woman gets pregnant.
Since polycystic ovary syndrome affects the normal functioning and the balance of hormones, it, in turn, affects a woman’s ability to have children. Some women develop the symptoms and signs of polycystic ovary syndrome early during puberty, while some develop it later in life due to sudden and excessive weight gain.
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:
Darkened skin or excess skin (skin tags)
Women with PCOS have high levels of insulin in their bodies due to which patches of darkened skin, also known as acanthosis nigricans, appear on the neck, groin, armpits. They are also prone to skin tags, which are not at all aesthetically pleasing, and as a result, it takes a toll on their self-esteem.
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:
- Genes: Immediate female relatives (ie, daughters or sisters) of women with PCOS have up to a 50% chance of developing PCOS. Thus it can be said that PCOS is hereditary in nature.
- 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.
- Metabolic syndrome: Women with PCOS not only do they suffer from problems related to reproduction, but these problems go way beyond just that. Since women have higher levels of insulin in their blood, they develop the risk of gaining weight and type 2 diabetes in the longer run. Insulin resistance is seen in 80% of women with PCOS.
- 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.
- Clomiphene: It is a non-steroidal fertility medicine. Clomiphene is used to induce ovulation (egg production) in women; however, they can increase the risk of twin or multiple births.
- 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.
- Surgery: If all the other treatment options fail to work, doctors resort to surgery. Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome. In this small punctures are made in the ovaries using a laser beam or thin heated needles. This is done to the normal process of ovulation.
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.
Commonly Asked Questions about PCOS
Who can get PCOS?
Polycystic ovary syndrome or simply PCOS is a hormonal disorder that affects around 10-15 % of women in their reproductive age that is 15-44 years. The signs of PCOS start early during puberty and continues to develop throughout a woman’s reproductive age. The risk of developing it is not restricted to a particular race as women of every race can develop it. The risk is usually higher if some have a family history of PCOS or if they are obese.
Can you still get pregnant if you have PCOS?
Yes, it is possible. The imbalance in hormones caused by polycystic ovary syndrome causes the body to skip the process of ovulation by which an egg is released by an ovary each month; without ovulation, a woman cannot get pregnant. Infertility caused by PCOS is very common and also treatable. Doctors can prescribe various medications to treat infertility caused by PCOS.
Is PCOS linked to other health problems?
Yes, PCOS has been linked to various other health problems like:
- Diabetes: Women with PCOS have insulin resistance where the body cells do not respond readily to the insulin levels in the blood, and it causes insulin levels to build up in the blood and to compensate for that, the pancreas produces more insulin, which can increase the risk of developing type 2 diabetes.
- High blood pressure: PCOS also causes hypertension or high blood pressure, which can lead to cardiovascular diseases in the longer run.
- Unhealthy cholesterol: Women with PCOS have higher levels of bad cholesterol or LDL in their blood, which can raise the risk of developing cardiovascular diseases in them.
- Sleep apnea: Brief but repeated pauses in breathing during sleep is known as sleep apnea. Women with PCOS are at a higher risk of developing sleep apnea due to obesity. Sleep apnea can raise the risk of developing heart problems and diabetes.
- Depression and anxiety: The various symptoms of PCOS, including weight gain, acne, excess body, and facial hair, raises the risk of women experiencing depression, mood swings, and anxiety.
- Endometrial cancer: During a normal menstrual cycle, the uterine lining is shed every month, but during a menstrual cycle with PCOS, since ovulation does not occur, the uterine lining does not shed and can keep on building up, this can cause endometrial cancer in women with polycystic ovary syndrome.
What are the treatment options for PCOS if you want to get pregnant?
Many options can make a woman with PCOS to get pregnant:
- Losing weight: Even losing 10-15% of body weight can help in regulating the menstrual cycle in women with PCOS, thus improving fertility. Through a combination of exercising and a healthy diet, weight can be managed in a better way.
- Medicine: Another option to treat PCOS is through medications. Clomiphene is such a drug that is used to induce ovulation in women who do not ovulate.
- In vitro fertilization (IVF): IVF is the process of fertilization by extracting eggs, retrieving a sperm sample, and then manually combining an egg and sperm in a laboratory dish. The embryo is then transferred to the uterus to develop. This method is prescribed when medications do not work. IVF has a higher pregnancy rate as compared to medications, and it also helps avoid the risk of twin or multiple births.
- Surgery: Laparoscopic ovarian drilling is a surgical treatment that can trigger ovulation in women who have polycystic ovary syndrome. In this small punctures are made in the ovaries using a laser beam or thin heated needles. It helps in regulating ovulation.
How does PCOS affect pregnancy?
Polycystic ovary syndrome exposes a woman to infertility and various gestational complications like:
- Cesarean section (C-section)
- Gestational diabetes
- Preeclampsia- a sudden rise in blood pressure and swelling in the face, hands, and feet.
- Macrosomia- where a baby is born much larger than the average for their gestational age.
- Learn more about pregnancy-related complications and risks for young women in our blog Common-Pregnancy Complications Types, Risk, and Treatments.