Polycystic Ovarian Syndrome (PCOS) is a relatively common disorder in women that results from an imbalance of reproductive hormones, though the cause of this imbalance is unknown. Women with this condition may have infrequent or prolonged periods, or excess male hormone levels. Their ovaries may develop numerous small pockets of fluid (the titular poly-cysts) and fail to regularly release eggs, contributing to infertility.
Between 5-10% of women of reproductive age have PCOS, with most discovering it during early adulthood, as signs and symptoms of the syndrome usually develop during puberty. In some cases, it can develop later, for example in response to substantial weight gain. While polycystic ovarian syndrome cannot be cured, that does not mean its effects cannot be controlled or managed.
What Causes Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome is often linked to high levels of male hormones, but this is not always the case. Researchers believe that many factors might play a role, including:
- Excess insulin. This is the hormone produced in the pancreas that allows your cells to use sugar as your body’s primary energy supply. If your cells become resistant to insulin, your blood sugar levels might rise, and your body might attempt to compensate by producing even more insulin. This can be linked to androgen production, and difficulty ovulating.
- Low-grade inflammation. This describes your white blood cells and their production of substances to fight infection. Research has shown that women with polycystic ovarian syndrome have a kind of low-grade inflammation that stimulates the ovaries to produce androgens, which can lead to cardiovascular problems.
- Heredity. Research also suggests that certain genes might be linked to developing PCOS.
What are the Symptoms and Effects of Polycystic Ovarian Syndrome?
As the root cause of polycystic ovarian syndrome is unknown, its signs and symptoms can vary substantially. Generally speaking, a diagnosis of PCOS is made when at least two of the following signs are present:
- Irregular periods. These can be either infrequent, unpredictable, or prolonged, and are the most common sign of PCOS. For example, you may have fewer periods than is expected per year, abnormally heavy bleeding, or more than 35 days between individual periods.
- Excess male hormones, or androgen. Elevated levels of androgen may result in noticeable physical signs such as excess facial and body hair (hirsutism), and occasionally severe acne or male-pattern baldness.
- Polycystic ovaries. If your ovaries are enlarged and contain many fluid-filled follicles that surround the eggs and prevent their effective release, this is a likely sign of PCOS.
If you are experiencing infertility or concerns about your menstrual periods, or if you have signs of excess androgen such as worsening hirsutism and acne, consult your doctor. The symptoms of polycystic ovarian syndrome may also be more severe if you are obese. You may also experience less obvious symptoms of PCOS such as:
- Sudden weight gain or difficulty losing weight.
- Darkening of skin, particularly along the neck, groin and underneath breasts.
- The presence of skin tags, or small excess flaps of skin in the armpits or neck area.
If you suspect you might have polycystic ovarian syndrome, you should also consult your doctor, as the condition has been linked to a number of complications, such as:
- Gestational Diabetes
- Pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Severe liver inflammation
- Metabolic syndrome, a cluster of conditions including high blood pressure, blood sugar and cholesterol levels.
- Type 2 Diabetes
- Sleep apnoea
- Depression and anxiety
- Eating disorders
- Abnormal uterine bleeding
- Endometrial cancer
How can Polycystic Ovarian Syndrome be Diagnosed?
There is no test to definitively diagnose PCOS, but if you are experiencing symptoms linked to the condition, consult a doctor—they will still be able to examine you, look for clues, and make a judgment. You will likely discuss your medical history with your healthcare professional first, including unusual weight changes, the regularity of your periods and so on. You may also be subject to a physical exam, noting signs of excess hair growth, acne and insulin resistance. Following this, your doctor might recommend:
- A pelvic exam, visually inspecting your reproductive organs for masses, growths or other abnormalities. This could be as simple as inserting a finger into your vagina and feeling for abnormalities. It might also involve a laparoscopy, a minor surgery where a narrow telescope is inserted through an incision in the abdomen to observe the uterus and ovaries for growths.
- Blood tests, where your blood is analysed to measure your hormone levels. This might exclude possible causes of menstrual abnormalities or androgen excess that mimics PCOS. Additional blood tests might be taken to measure insulin tolerance and cholesterol levels.
- An ultrasound, most likely a transvaginal scan. This consists of a small wand-like device called a transducer, placed in the vagina to emit sound waves and translate the reflections as visual data on a computer screen. This will help check the appearance of your ovaries and the thickness of your uterine lining.
If you are ultimately diagnosed with polycystic ovarian syndrome, your treatment will focus on managing your individual concerns such as hair growth, infertility or obesity. It is important to note that PCOS itself cannot be ‘cured’, and you may have to manage your expectations—most treatments will lessen your symptoms or relieve your issues, but cannot eliminate them entirely.
How is Polycystic Ovarian Syndrome Treated, and What Can You Do Next?
Your doctor might recommend lifestyle changes, such as weight loss through a low-calorie diet and moderate exercise. Even a modest reduction in weight might improve your condition, or increase the effectiveness of medications recommended to treat other symptoms.
To help regulate your menstrual cycle, your doctor might recommend birth control pills or hormone therapy, to decrease the production of androgens and introduce more oestrogen and progestin into the body. This can help lower your risk of endometrial cancer and correct excessive bleeding, hair growth and acne. Instead of pills, you might opt to use a skin patch or vaginal ring with similar effects. If you also wish to avoid pregnancy, taking progestin for between 10 and 14 days every two months can also help regulate periods and protect against cancer, though this form of therapy will not improve androgen levels or work as birth control.
To help you ovulate, your doctor might recommend:
- Letrozole. A breast cancer drug that is also known to stimulate the ovaries.
- Clomiphene. An oral, anti-estrogen medication taken during the beginning of your menstrual cycle.
- Metformin. An oral medication for type 2 diabetes that can improve your insulin resistance and lower the levels in your body. If you still find difficulty in becoming pregnant using Clomiphene, your doctor might recommend also taking Metformin.
- Gonadotropins. Hormone medications given by injection.
To reduce excessive hair growth, you might take birth control pills to manage hormones, facial creams to slow hair growth, or undergo electrolysis treatments where your hair follicles are destroyed with electrical currents. An effective medication is Spironolactone, which blocks the effects of androgen on the skin. However, this drug can cause birth defects, so effective contraception is required, and it will not be recommended if you are planning to become pregnant.
Once you are home following your diagnosis, there are still things you can do on your own to manage the symptoms of polycystic ovarian syndrome. Combined with medical treatments, limiting carbohydrates, maintaining healthy weight and activity levels can help keep the levels of insulin and androgen levels under control. Though polycystic ovarian syndrome will never ‘go away’, there are a wealth of options to prevent it from causing you stress and discomfort. Once diagnosed and treated, you can continue to ensure your own happiness and a good quality of life.
If you are experiencing symptoms of PCOS, make an appointment with Dr.Nicole Stamatopoulos here.