PCOS Explained (Polycystic Ovary Syndrome)
– by James P. Haley, MD, FACOG, FPMRS
Polycystic ovary syndrome is a hormonal endocrine disorder that disrupts the menstrual cycle often resulting in anovulation (not ovulating) during a women’s childbearing years.
Women suffering from PCOS will have disruption of normal female hormones and produce higher than normal levels of the male hormone, testosterone, (hyperandrogenism). This imbalance can cause a growth of numerous small cysts filled inside the ovaries, (hence the name “polycystic.”) The ovaries are often enlarged. These cysts are follicles that house eggs that have never matured due to the glut of male hormones inhibiting ovulation.
Most PCOS sufferers (possibly all) are also more resistant to insulin. This leads to further problems, including weight gain and susceptibility to developing diabetes.
Polycystic ovary syndrome can begin in utero, but symptoms only usually begin to occur when a female begins puberty. These include:
- Obesity or undesirable weight gain
- Absence of, or irregular periods
- Heavy, prolonged menstruation
- Excessive hair growth on face, neck, buttocks, and chest
- Skin issues such as acne, psoriasis, skin tags, etc.
- Male pattern baldness
- Hair loss (alopecia)
- Mood swings
- Inflammation which may cause brain fog, joint pain, aches and fatigue.
- Glucose intolerance
- Patched, dark skin in creased body areas such as thighs, underarms, nape etc.
- Difficulty becoming pregnant
- Abdominal pressure and pain
- Pregnancy complications- i.e. miscarriage, premature birth etc.
What Causes PCOS?
There are varying theories as to what causes PCOS. Poor nutrition and diet at a young age can be a contributing factor. Insulin is produced by the pancreas to extract food sugars for energy. PCOS causes women to produce too much insulin. As a result of insulin resistance which, in turn, stimulates more over-production of androgens. These male hormones interfere with ovulation, impacting fertility. Male hormones then dominate female ones, resulting in some of the masculine characteristics mentioned earlier.
Since other factors can also contribute to surplus androgen development, medical science is still trying to pinpoint the exact cause of PCOS.
How is PCOS Diagnosed?
There is no actual test to diagnose PCOS. It is a matter of eliminating other disorder possibilities until the diagnosis of PCOS is reached.
Two primary contributing factors of PCOS:
1) A history of skipping periods
2) Elevated androgen hormone levels (hyperandrogenic effect) alert physicians to suspect that a woman may have PCOS. Being overweight or obese strengthens the possibility, especially in females with more upper body fat. Weight gain in this area is more male-related, thus indicating the existence of higher testosterone levels.
This diagnosis is derived through:
- Menstrual history
- Blood tests
- Gynecologic examination
- Pelvic ultrasound
- Evaluation of family medical history
- Visual and reported confirmation of other common PCOS symptoms.
What are the Risks of PCOS?
Overweight and obesity alone can cause severe health problems. Compounded with PCOS, the following risks are elevated:
- Diabetes or pre-diabetes: It is estimated that more than half of women suffering from PCOS will develop the disease by the age of 40. Diabetes is so serious that it aversely affects health more than almost anything else.
- Cardiovascular disease and heart attack: Carrying around unhealthy weight can raise anyone’s risk of cardiovascular disease. However, compounded with other PCOS-related problems, women with polycystic ovary syndrome have a 4 to 7 times higher chance of having a heart attack.
- Endometrial cancer: A natural buildup occurs monthly on the uterus lining (endometrium) which is sloughed off during menstruation. Infrequent periods can result in an accumulation, leaving PCOS sufferers three times more likely to develop endometrial cancer that can occur as a result of this surplus.
- Abnormal lipids: Insulin resistance, too much body fat, and the production of excessive androgens can wreak havoc on the delicate balance between good and bad cholesterol.
- Obstructive sleep apnea: This is a dangerous condition of abrupt breathing cessation during sleep, characterized by snoring, gasping, choking or continual awakening. It can lead to serious issues such as hypertension, cardiovascular problems, sleep deprivation, etc. Overweight and additional male hormones contribute to the condition.
- Hypertension: PCOS-related symptoms like obesity and hormonal imbalance may raise blood pressure.
- Metabolic syndrome: Women with PCOS are at higher risk for having two or more of the above risks.
- Breast cancer: Though it is not proven that PCOS causes breast cancer, PCOS sufferers with a family history of it are more susceptible to the disease than those without.
Can Being Overweight Lead to PCOS?
Polycystic ovary syndrome, or PCOS, has recently received a great deal of exposure in the media. 5 to 10% of women in the United States suffer from this condition. It is one of the leading causes of infertility, yet fewer than 50% of those women are diagnosed correctly. That amounts to a staggering 5 million women!
Not every woman diagnosed with polycystic ovary syndrome is overweight, but approximately 80% are. Other female family members tend to be overweight or obese as well. Realize, however, that PCOS causes weight gain for most patients, but being overweight or obese does not “cause” PCOS.
Can PCOS be Controlled?
Though it is a lifelong condition and a leading cause of infertility in women, PCOS can be controlled, especially if treated early.
What are the Treatments?
Once it is established that you have PCOS, your physician may recommend some or all of the following:
- Lifestyle changes: You will be encouraged to follow a healthy diet and to exercise regularly if you need to lose weight. Even less than 10% loss can have a tremendously positive impact on ovulation and fertility problems. If you smoke, you will be told to stop. Smoking elevates androgen levels.
- Medications: Birth control, other hormone-controlling drugs, and diabetes medication may be prescribed.
- Electrolysis or other hair removal options may be recommended.
- Surgery when warranted may be considered.
- In vitro fertilization (IVF): If all other interventions are unsuccessful, your physician may propose IVF, providing you are deemed healthy enough to undergo treatments.
PCOS-prescribed medications may have strong side effects, or become more potent with steady, consistent weight loss. You will have to be monitored and tested regularly to insure proper dosage for your continuing good health.
If You Have PCOS, We Can Help
Our broad-based establishment has specialists at your disposal to deal with all PCOS irregularities. Doubly accredited, board-certified urogynecologists holding enviable degrees in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS), nutritionists, and more professionals are available. We are trained to diagnose, treat, and encourage you throughout your struggles with polycystic ovary syndrome until and after a healthy and manageable level is reached.
You are the best judge of any bodily changes that might be of concern. By seeing a physician immediately when you suspect something is wrong, you stand an excellent chance of correcting troublesome symptoms of PCOS before they become detrimental to your reproductive health.