What is PCOS?
Polycystic Ovary Syndrome, abbreviated as PCOS, is a complex condition that affects women’s hormone levels. It affects the way a woman’s ovaries function. ‘Polycystic’ simply means ‘many cysts’.
How common is PCOS?
PCOS is a common health condition among women of reproductive age- according to the NHS, around 1 in every 10 women in the UK are affected.
Worldwide, it’s reported that 4-20% of women suffer with PCOS, with between 12-18% being aged between late adolescence and menopause. Despite its frequency, its estimated that up to 75% of these cases remain undiagnosed, according to this 2018 study.
What are happens when PCOS occurs?
Women are born with the all the egg cells in their ovaries that they will have in their lifetime. These egg cells are located in small pockets on the ovary called follicles. With PCOS, there are multiple partially formed follicles which rarely grow into maturity or are able to produce eggs that can be fertilised.
Polycystic ovaries also contain a large number of follicles that are harmless. These follicles are underdeveloped sacs where the eggs that develop can be up to 8mm in size. The follicles are often unable to release the egg which means ovulation cannot take place.
What causes PCOS?
What causes PCOS in women is uncertain, however it is considered to be related to abnormal hormone levels.
Hormones and PCOS
While doctors cannot pinpoint the exact cause of PCOS and why it occurs, it’s thought to be related to an imbalance in hormone levels, in particular an increase in insulin. Insulin controls sugar levels in the body, and when a person suffers with PCOS the body becomes resistant to it.
This results in the body producing more insulin to compensate, which then leads to an increase in production of other hormones, such as testosterone. The high levels of testosterone interferes in the development of the follicles, which leads to no ovulation.
According to the NHS, being overweight or obese can also affect insulin levels in the body, and this too can lead to a development of PCOS.
Other hormonal imbalances can include:
- Increased levels of Luteinising hormone (LH) – a hormone that stimulates ovulation. It can have an adverse effect on the ovaries when the levels are too high.
- Increased levels of Prolactin – This hormone stimulates the breast glands for milk production during pregnancy.
- Reduced levels of sex hormone-binding globulin (SHBG) – This is a protein found in the blood which binds to testosterone to reduce its effect.
- Increased levels of testosterone – this is referred to as the male hormone. Biologically, women are supposed to only produce small amounts of it.
A Cardiff University study found that women with PCOS were three times more likely to develop Type 2 Diabetes, indicating clear links between the two diseases.
Sometimes, PCOS runs in families, although specific genes associated with this condition are yet to be identified. In some cases, PCOS may occur due to weight gain or being overweight - and PCOS can also cause weight gain for many too, again due to the imbalance of hormones.
This 2019 study found that although some women are genetically predisposed to developing PCOS, there is a link between obesity and the disease. It noted that 38-88% of women with PCOS are either overweight or obese and there is a “significant association between body mass index (BMI) and features of PCOS at all ages.”
The same study goes on to conclude that weight loss results in improvements of PCOS.
What are the symptoms of PCOS?
Most women notice symptoms of PCOS in their late teens or early twenties- and some will only experience a few, while others may experience them all.
- Excessive hair growth – Women who have PCOS normally grow excess facial hair and/ or har on the chest, back or buttocks. This is due to excess levels of testosterone.
- Weight Gain – due to the increase in insulin, women with PCOS end up gaining weight easily.
- Oily Skin or Acne.
- Difficulty in getting Pregnant – as a result of irregular ovulation, or absence of ovulation, women with Polycystic Ovary Syndrome find it difficult to get pregnant.
- Hair Loss or Baldness – women with PCOS go through loss of hair on their heads due to excessive androgenic hormones.
- Irregular periods – This is one of the most common symptoms of PCOS. However, there are many other factors that can cause irregular periods; it’s a good idea to visit your doctor to confirm what the cause may be before making conclusions.
- Heavy bleeding – since the uterine walls build up for a longer period of time before your period appears, menstrual bleeding becomes heavier than normal when it does eventually occur.
- Darkened skin – women with PCOS tend to have dark patches formed on their skin around the neck, in the groin area and under the breast.
PCOS has also been linked with an increased risk of developing other health conditions, such as high cholesterol levels and high blood pressure later in life.
Polycystic ovarian syndrome vs ovarian cysts
The main difference between PCOS and ovarian cysts is the hormonal imbalances that PCOS sufferers experience.
Ovarian cysts are usually harmless and most will disappear on their own within a few months. Some women may have more than one ovarian cyst, but that doesn’t mean they have PCOS as there are no related hormonal disruptions taking place.
The NHS advises that cysts are also common for women who have been through the menopause, and in some cases can be caused by endometriosis.
PCOS vs endometriosis
It is possible to have both PCOS and endometriosis at the same time, and both are caused by hormone imbalances. But because endometriosis is linked to excess oestrogen and PCOS is linked to excess male hormones, both require different treatments and both have some different symptoms too.
PCOS and menopause
Symptoms of PCOS can remain even after the menopause, due to the different ways that hormones are affected. Some symptoms of menopause are also quite similar to symptoms of PCOS, which can make it difficult to diagnose for some women.
Doctors believe that levels of male hormones remain elevated in women with PCOS until after menopause, and according to this 2017 study, women with PCOS reach menopause on average two years later than expected too.
Does PCOS affect fertility?
PCOS can affect fertility (because PCOS inhibits ovulation, it’s one of the leading causes of infertility in women of reproductive age)- but if symptoms are managed, then women with the condition can still get pregnant.
If you have PCOS and you’re trying to get pregnant, talk to your doctor about the things that you can do to improve your fertility. Losing weight, managing stress and regular exercise will be recommended, and your doctor may also discuss trialling some medicines that can help too.
How is PCOS diagnosed?
Typically, doctors diagnose for PCOS in women when they find at least two of the following symptoms:
- Cysts on the ovaries
- High androgen levels
- Irregular menstrual cycles
Your doctor might also ask you if you’ve had other symptoms, such as weight gain or hair growth. You may also have a pelvic exam to check your ovaries and other parts of the reproductive tract. During the exam, your doctor may have to insert gloved fingers into your vagina to check for growths in your ovaries or uterus.
A blood test may be conducted to check for high levels of male hormones as well as other hormonal imbalance. Blood tests may also be conducted to check insulin levels, cholesterol and triglyceride levels to evaluate risk for related conditions like heart disease or diabetes.
An ultrasound scan might also be carried out to check for abnormal follicles and other issues they might be present in your ovaries and uterus.
Treatments for PCOS
Although PCOS can’t be cured, the symptoms can be treated. The condition won’t go away on its own and if unmanaged, PCOS can cause a variety of short and long term health issues.
Luckily, there are medical treatments as well as lifestyle changes that you can implement yourself that will help you to manage the symptoms.
Because PCOS can cause weight gain, its a good idea to try to lose that weight through diet and exercise changes. This should positively affect your menstrual cycle and aid in its regulation too. This will in turn improve PCOS symptoms and raise the chances of proper ovulation.
Weight loss may also improve your cholesterol level, and it may help lower insulin levels to normal rate and reduce the risk of heart diseases and diabetes. Speak to you doctor about the safest ways for you to lose weight.
If you are not already participating in sports or regular exercise, try to work in 30 minutes of moderate-intensity exercise at least three times a week into your schedule. A balanced diet combined with exercise can improve your health by lowering the risk of developing diabetes and heart diseases.
There are various medical treatments that your doctor might recommend to manage symptoms of PCOS.
Hormonal contraceptives containing oestrogen and progestin can help to eradicate hormonal imbalances and regulate ovulation. They can also relieve symptoms such as excessive hair growth, and offer protection against endometrial cancer. You can get these hormones in form of a patch, pill or a vaginal ring.
Metformin is another drug that can be used to treat PCOS by improving insulin levels. Also known as Glucophage or Fortamet, this drug was originally used for treating type 2 diabetes.
Clomiphene (Clomid) is a drug used to treat infertility in women. It can be used to help women with PCOS get pregnant. However, it can increase the risk for twins and other multiple births.
To tackle excessive hair growth, there are products that will either remove or stop the har rom growing; for example, eflornithine (Vaniqa) cream slows down hair growth. Laser hair removal and electrolysis can also be used to remove unwanted hairs on the face or any part of the body.
Surgery may also be an option to improve fertility, especially when other treatments fail to work. Your doctor may suggest Laparoscopic ovarian drilling (LOD), a process to restore normal ovulation, during which tiny holes are created in the ovary with a laser or thin heated needle.
Its a good idea to discuss all methods of treatment with your doctor, to see what could work for you.
When to see a doctor about PCOS
Most women might not even know when they have Polycystic Ovary Syndrome, since not all the symptoms appear in all cases.
- If you’ve been trying to get pregnant for over 12 months without success, you should see your doctor.
- If you are having symptoms of diabetes like excess thirst or hunger, blurred vision or unexplained weight loss, please see your doctor.
- If you’ve missed 1 or more periods, and either had a negative pregnancy test or haven’t had hetersexual intercourse, see your doctor.
- If you are experiencing symptoms of PCOS such as facial hair growth as well as excessive hair growth on some other parts of your body, see your doctor.
If you’ve been diagnosed with PCOS, visit your primary care doctor regularly to continually check for diabetes, high blood pressure and other health problems that might accompany PCOS.
Can PCOS be cured?
PCOS can’t be cured, but the symptoms can be managed. There are lifestyle changes you can make, such as losing weight and managing stress. There are also medical treatments that can ease the symptoms.
Can PCOS cause infertility?
PCOS is one of the leading causes of infertility, but some women can still get pregnant if they have the condition. Fertility drugs can be helpful, alongside managing weight and taking regular exercise.
Does PCOS cause weight gain?
Higher levels of insulin that occur with PCOS lead to a condition called insulin resistance. This is where the body is unable to convert sugars into energy- and as a result, inflammation and weight gain occurs.
How does PCOS affect my period?
Is PCOS genetic?
Some women may be more predisposed to developing PCOS if a family member has it- although doctors aren’t sure which gene actually causes it.