Polycystic Ovary Syndrome (PCOS) is a leading cause of female infertility and frequently remains undiagnosed. Here’s what you should be aware of.
Polycystic Ovarian Syndrome, commonly referred to as PCOS, is among the leading causes of infertility in women.
However, its hallmark symptoms irregular menstrual cycles, excessive body hair, acne, and weight gain are so prevalent that the syndrome frequently goes undiagnosed or is misidentified as another issue.
Moreover, as Hannah Alderson, a nutritionist and hormone specialist who was diagnosed with PCOS at the age of 21, notes, “no two women experience the same symptoms of PCOS.”
Here’s a comprehensive guide on Polycystic Ovary Syndrome (PCOS), specifically designed for the 10% of women who experience this condition.
Table of Contents:-
1. What is PCOS?
2. Symptoms of PCOS
3. Causes of PCOS
4. Diagnosis
5. Treatment Options
6. Frequently Asked Questions (FAQs)
What is PCOS?
PCOS, or Polycystic Ovary Syndrome, is defined as “an endocrine disorder that affects women during their reproductive years,” according to Alderson.
Despite its name, women with PCOS typically do not have cysts on their ovaries. Instead, they often have an excess of follicles small sacs that contain eggs within their ovaries.
The hormonal imbalances associated with PCOS hinder these follicles from maturing and releasing eggs, leading to irregular ovulation and menstruation. This can also make it challenging for women to conceive.
In addition to these issues, women with PCOS frequently produce elevated levels of testosterone hormones present in small amounts in all women as well as increased cortisol, known as the stress hormone.
They may also exhibit lower levels of female sex hormones such as estrogen and progesterone.
Insulin resistance stands out as a significant characteristic of PCOS, with women affected by this syndrome often producing elevated levels of insulin.
This can create challenges in weight management and increase the risk of developing diabetes.
While these aspects are central to understanding PCOS, the syndrome is highly complex, and each woman’s experience can vary significantly.
“People write entire essays about what PCOS is,” notes Dr Channa Jayasena, a consultant in reproductive endocrinology at Imperial College, London.
In simpler terms, PCOS is “a common issue that impacts the reproductive systems and metabolism of many women.”
Symptoms of PCOS:
Women with PCOS may experience a range of symptoms, though not everyone will have the same ones.
These symptoms can include:-
1. Irregular periods, or the absence of menstruation altogether
2. Excess hair growth on the face, chest, or back
3. Weight gain or challenges in losing weight, particularly around the abdominal area
4. Acne or excessively oily skin
5. Male-pattern hair thinning, such as patches on the crown and front of the scalp
6. Difficulty sleeping
7. Frequent headaches.
8. Skin tags
It is important to note that while many women with PCOS exhibit some of these symptoms, some may even be considered underweight.
“There is a common misconception that one must be overweight to have PCOS,” explains Alderson. “In my practice, I frequently encounter cases referred to as ‘lean PCOS.’”
Infertility is often associated with PCOS, but it’s important to note that many women with this condition can still conceive.
They simply have lower chances of pregnancy compared to women without PCOS, mainly due to less frequent ovulation.
Some women with PCOS, particularly in their early twenties, may experience a complete cessation of their menstrual periods.
More commonly, they have nine or fewer periods each year, as their menstrual cycles can extend to 40 days or more.
Additionally, women with PCOS may be susceptible to anxiety, depression, and severe fatigue, as noted by Alderson.
This can be exacerbated by sleep disturbances linked to difficulties in producing the sleep hormone melatonin. Research into the connection between PCOS and mental health issues is still in its early stages.
As Dr Jayasena points out, “Women with PCOS often feel distressed by their symptoms and face numerous challenges that may affect their mental well-being.”
What remains unclear is whether these hormonal imbalances have a direct impact on mental health conditions.
Causes of PCOS:
Although the precise causes of PCOS remain unclear, genetics significantly contribute to its development, according to Alderson.
Approximately 35% of women diagnosed with PCOS have a mother who also has the condition, and this percentage increases to 40% when a sister is affected.
It is indeed possible to have a genetic predisposition to Polycystic Ovary Syndrome (PCOS) without necessarily activating those genes.
As Dr Jayasena explains, “Some women may carry the genetic risk for PCOS but live their entire lives without ever reaching the threshold for the condition to manifest.”
Several lifestyle factors, such as diet, physical inactivity, and stress, significantly influence whether these genes lead to the hormonal imbalances that trigger PCOS symptoms.
Diagnosis of PCOS:
Polycystic Ovary Syndrome (PCOS) can be diagnosed by a general practitioner (GP), a gynaecologist, or an endocrinologist whom your doctor may refer you to if you exhibit symptoms of the condition.
In the UK, to receive a PCOS diagnosis, women must display at least two out of the following three criteria.
1. Anovulation: This refers to irregular or absent menstrual periods.
2. Hyperandrogenism: Elevated levels of male sex hormones, which can be detected through blood tests or manifested in symptoms such as excessive body hair or male-pattern hair loss.
3. Polycystic Ovaries: An internal ultrasound may reveal a pattern of circular cysts on the ovaries.
Dr Jayasena explains, “The three primary concerns for women with PCOS include irregular periods, excessive body hair, and sometimes issues like acne or male pattern baldness, as well as difficulties with weight management.”
Fortunately, these aspects can be assessed without the need for invasive testing.
In certain cases, an internal scan may not be required if a woman has already consulted a specialist clinic for a diagnosis.
“Rather than opting for an ultrasound, a blood test measuring anti-Müllerian hormone (AMH) can be a suitable alternative,” explains Dr Jayasena.
“AMH levels tend to be elevated in women diagnosed with PCOS, highlighting its importance in assessing reproductive health.”
“This can be a lot more comfortable for women who are young or are not sexually active, but it is also quite expensive so typically isn’t offered.”
Treatment:
“While PCOS cannot be entirely cured, individuals can positively influence the expression of the genes linked to hormonal imbalances, effectively adjusting their impact,” explains Alderson.
Many women first become aware of their PCOS during their teenage years, often recognizing irregular periods as their initial symptom.
Consequently, healthcare providers frequently recommend the contraceptive pill to help regulate their menstrual cycles.
This intervention may take place either before or after a PCOS diagnosis. “I frequently see young women in their early twenties who have recently stopped taking the pill for the first time, and they start to notice a variety of new symptoms,” Alderson notes.
Dr Jayasena explains that “prescribing the contraceptive pill for PCOS is akin to merely applying a band-aid to a deeper issue.”
Women with PCOS often receive the contraceptive pill to address menstrual irregularities and symptoms like excessive body hair or acne.
“It poses a significant danger for women with PCOS not to experience menstruation, as this leads to a thickening of the uterine lining, which increases the risk of endometrial cancer,” he clarifies.
“The contraceptive pill helps mitigate this risk by ensuring regular withdrawal bleeds.”
Specific contraceptive pills, including those marketed as Yasmin and Dianette, can also help lower or reduce excess testosterone levels.
However, there are potential health risks associated with the pill, such as the risk of blood clots, and it is not suitable for women who are trying to conceive.
Therefore, this prescription “may not be appropriate for every woman with PCOS.”
FAQs:
What other medications can help alleviate the symptoms of PCOS?
Several additional medications may help manage the symptoms of PCOS. For instance, some women may be prescribed metformin, a medication primarily used for diabetes, to help lower insulin and blood sugar levels.
However, Dr. Jayasena emphasizes that this treatment typically does not restore menstrual cycles for most women.
Women with PCOS who are aiming to conceive might be offered medications such as clomifene or letrozole to stimulate ovulation and assist in achieving pregnancy.
It’s important to note that accessing these treatments often requires a referral to a specialized fertility clinic.
Can PCOS be prevented?
While it’s not possible to entirely prevent the development of PCOS if you have a genetic predisposition, Dr Jayasena notes “that many women who maintain a healthy lifestyle can often avoid experiencing the associated symptoms”.
Minimizing the consumption of simple carbohydrates or thoughtfully integrating them into a balanced diet can help women prevent insulin spikes.
Additionally, overweight women with PCOS may experience a reduction in symptoms by losing just 5 to 10 per cent of their body weight.
Maintaining a balanced diet, engaging in regular exercise, and managing stress levels effectively can contribute to preventing the development of PCOS.
Can you still become pregnant if you have PCOS?
Women diagnosed with PCOS don’t need to feel that this condition will negatively impact their health or hinder their chances of having children.
“While conceiving may be more challenging, it is possible to build a family with a PCOS diagnosis. I am living proof of this, as are many of my clients,” shares Alderson.
”When I was first diagnosed, I was often confronted with phrases like, ‘infertility’ and ‘you’ll struggle to conceive,’ which were carelessly thrown around by doctors.
However, my positive approach to managing PCOS through diet and lifestyle changes enabled me to conceive naturally with both of my children”
I achieved this by focusing on my diet maintaining balanced blood sugar levels, increasing my consumption of protein, healthy fats, and fibre, managing stress effectively, and engaging in appropriate physical activities like gentle running and weightlifting, while also allowing time for recovery.
Perhaps the most crucial aspect was that I didn’t strive for perfection, recognizing that a flawless diet simply doesn’t exist.
Does PCOS ever fully resolve?
PCOS does not simply “disappear.”
While it primarily impacts women during their reproductive years, it can also affect those in perimenopause and menopause, as noted by Alderson.
Dr Jayasena concurs, stating, “The reproductive symptoms of PCOS may lessen over time, and it is common for women to experience more regular menstrual cycles after their early.”
However, he emphasizes, “The metabolic effects of how your body processes food for energy do not vanish.”
Is it possible to develop PCOS suddenly?
Polycystic ovary syndrome (PCOS) does not typically arise suddenly.
However, a gradual change in lifestyle or dietary habits can lead to the emergence of symptoms that may have previously been manageable.
According to Dr Jayasena, “It is much more common for PCOS to develop gradually over several years, especially in younger women.”
As Alderson notes, “While your genetics cannot be altered, PCOS may manifest in various ways throughout your life.”
At what age does PCOS typically begin?
Polycystic Ovary Syndrome (PCOS) can emerge as early as puberty, with some women experiencing symptoms shortly after they begin menstruating.
However, for others, symptoms may not appear until their early twenties. Many seek assistance from healthcare professionals, such as Alderson, when they notice continued irregularities in their menstrual cycles, which is quite common among teenagers who have just started their periods.
Dr. Jayasena acknowledges that the late teenage years and early twenties are often considered the prime period for the onset of certain issues.
However, some women may not recognize these problems until their thirties, particularly when they begin trying to conceive and encounter difficulties related to fertility.
