Polycystic ovary syndrome (PCOS) alters a woman’s hormone levels.
Women with PCOS create more masculine hormones than usual. This hormonal imbalance leads their bodies to miss menstruation cycles, making it more difficult for women to get pregnant.
PCOS also promotes facial and body hair growth, as well as baldness. It may also lead to long-term health issues such as diabetes and heart disease.
Birth control pills and diabetes medications (which tackle insulin resistance, a hallmark of PCOS) may help correct the hormone imbalance and alleviate symptoms.
Continue reading to learn about the probable causes of PCOS and its implications on a woman’s body.
What exactly is PCOS?
PCOS is a hormonal disorder that affects women throughout their reproductive years (ages 15 to 44). (1, 2)
PCOS affects between 2.2 and 26.7 percent of women in this age range.
Many women have PCOS but are unaware of it. According to one research, up to 70% of women with PCOS had not been diagnosed.
PCOS affects a woman’s ovaries, which are the reproductive organs that generate estrogen and progesterone, which control the menstrual cycle. The ovaries also create a limited quantity of androgens, which are male hormones.
The ovaries produce eggs, which are fertilized by a man’s sperm. Ovulation is the monthly release of an egg.
Ovulation is controlled by the pituitary gland’s production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH).
FSH encourages the ovary to develop a follicle — a bag containing an egg — while LH stimulates the ovary to release a mature egg.
PCOS is a “syndrome,” or collection of symptoms affecting the ovaries and ovulation. Its three primary characteristics are as follows:
- ovarian cysts
- male hormone levels that are abnormally high
- Periods that are irregular or skipped
Many tiny, fluid-filled sacs form within the ovaries in PCOS. The term “polycystic” indicates “having a lot of cysts.”
These sacs are called follicles, each of which contains an immature egg. The eggs never develop enough to cause ovulation.
Ovulation deficiency affects estrogen, progesterone, FSH, and LH levels. Progesterone levels are lower than normal, but androgen levels are greater.
Extra male hormones interrupt the menstrual cycle, resulting in fewer cycles for women with PCOS.
PCOS is not a new disease. In 1721, Italian physician Antonio Vallisneri reported its symptoms for the first time. (3)
PCOS Signs and Symptoms
With a name like PCOS, you’d assume the disorder would imply that women had cysts on their ovaries, but that’s not always the case. In reality, according to Endocrine Society recommendations published in The Journal of Endocrinology & Metabolism in December 2013, a woman must satisfy two of the following three criteria to be diagnosed with PCOS:
- Excess androgen This manifests as hirsutism, a condition in which dark, coarse hair develops in undesirable areas of the face and body; severe acne; and male-pattern hair loss.
- Ovarian Dysfunction This is the medical term for irregular menstruation (most often especially long cycles or absent cycles).
- Polycystic Ovaries Cysts do not affect every woman, although some do. They are discovered via ultrasound.
- Unfortunately, over half of all women with PCOS are unaware of their condition.
The following are some of the most frequent PCOS symptoms. Remember that not all women have every symptom. If you are having any of the following symptoms, see your doctor and inquire about the potential of PCOS:
- Periodic Irregularities Periods are irregular and the cycle is longer than it should be due to a shortage of progesterone. “Patients have erratic periods with eight or fewer cycles per year,” explains David A. Ehrmann, MD, head of the University of Chicago Center for PCOS in Illinois.
- Infertility PCOS limits the capacity of the ovaries to produce and release eggs. A woman may not even know she has PCOS until she has tried and failed to conceive and goes to the doctor for a checkup.
- Hirsutism, Hair Loss, and Acne are all symptoms of hirsutism. Excessive hair growth on the face and body, male-pattern hair loss on the head, and acne are some visible symptoms that a patient has high androgen levels and may have PCOS.
- Gaining Weight Half of women with PCOS gain weight unexpectedly or are obese. According to Amy Medling, a certified health coach, founder of PCOS Diva in Nashua, New Hampshire, and author of Healing PCOS: A 21-Day Plan for Reclaiming Your Health and Life With Polycystic Ovary Syndrome, you don’t have to be overweight or obese to have PCOS.
- Mood Disturbances According to Medling, anxiety, sadness, poor body image, and eating problems are widespread among PCOS women.
- Insulin Deficiency According to Medling, skin tags and dark, velvety patches of skin around the armpits, groin, and neck might be symptoms of insulin resistance.
- Fatigue Sleep apnea, which may cause daytime sleepiness, is regularly observed in women with PCOS.
PCOS Causes and Risk Factors
Given that PCOS affects 10 million women worldwide, it may surprise you to learn that researchers still don’t know the actual reason. According to Andrea E. Dunaif, MD, a professor of medicine and chairman of the Hilda and J. Lester Gabrilove division of endocrinology, diabetes, and bone disease at Mount Sinai Health System in New York City, there is a significant hereditary correlation among women in families. For example, if your sister was diagnosed with PCOS, she thinks you have a 40% chance of getting it as well. Other possible reasons include alterations in utero, notable exposure to an anti-Mullerian hormone.
While genetics are uncontrollable, there are specific difficulties and risk factors that bring out or intensify symptoms that you may be able to address, according to Dr. Ehrmann. These are some examples:
- According to a 2017 research published in Expert Review of Endocrinology & Metabolism, stress
- According to Fertility & Sterility studies, chronic inflammation
- weight gain
- Insulin resistance
- Obstructive sleep apnea
How Is PCOS Diagnosed?
According to the Office on Women’s Health, some individuals face a lengthy path to diagnosis, in part because no one test can detect the illness (OWH). To get at a PCOS diagnosis, doctors will rule out other possible diseases.
A physical exam (to look for acne, excess hair growth, male-pattern hair loss, or weight gain), a pelvic exam (to check the ovaries), a pelvic ultrasound (to look for cysts and the uterine lining), and blood tests (to examine hormone levels) are some of the screening tests that may be used, according to OWH.
Prognosis of PCOS
According to the OWH, there is no cure for PCOS. Treatment involves symptom management, which will significantly improve your health and quality of life. According to the PCOS Awareness Association, this may include drugs to manage acne and hair growth, infertility therapies, and weight reduction via a good diet and exercise routines. If left untreated, PCOS may raise your chances of developing high blood pressure, high cholesterol, and insulin resistance, all of which increase your risk of heart disease and diabetes.
Duration of PCOS
Because there is no treatment for PCOS, it is believed to be a lifetime condition. It may, however, be effectively treated with correct therapy. The OWH does observe that as women approach menopause, their menstrual cycle becomes more regular. Nonetheless, you may most certainly encounter symptoms after menopause as you age.
PCOS Treatment and Medication Options
Because there is no treatment for PCOS, clinicians treat each symptom individually. According to Dr. Dunaif, not every woman will get the same therapy; it all depends on whatever symptoms annoy you the most and what your objectives are.
Medication Options
- Metformin is a medication that is used to treat diabetes (Glucophage, Fortamet) Metformin, a medicine that reduces glucose production and insulin resistance, is often used as a type 2 diabetes therapy.
- Spironolactone This diuretic inhibits the production of extra masculine hormones. It is not advised to consume during pregnancy.
- Birth Control Tablets According to Dunaif, combination (estrogen and progesterone) pills deliver the proper quantity of hormones to manage a woman’s cycle and assist avoid issues such as endometrial hyperplasia.
- Clomiphene (Clomid, Serophene) or Letrozole (Femara) is ovarian-stimulating medications that are often taken when a woman wishes to get pregnant.
Complementary and Alternative Therapies
- Weight Loss According to the PCOS Awareness Association, a little amount of weight loss (around 5%) may assist ease symptoms and help a woman ovulate.
- Dietary Anti-Inflammatory Supplements According to Medling, chronic inflammation might aggravate symptoms. According to her, a diet rich in anti-inflammatory foods such as fruits and vegetables and omega-3 fatty acids can help calm things down. Research published in the North American Journal of Medical Sciences in July 2015 found that an anti-inflammatory diet helped the 100 overweight or obese individuals with PCOS lose roughly 7% of their weight, which helped 63 percent of the women control their menstrual cycles. (7) A further 12% got pregnant.
- Reduce Stress According to Medling, chronic stress is another key factor in inflammation levels. Furthermore, according to a study published in the journal Psychological Medicine in July 2019, women with PCOS are more likely to experience sadness, anxiety, and stress than women without PCOS. Stress-reduction measures are crucial for women with PCOS when employed on a daily basis.
- D-calcium palmitate According to a study, women who are weak in the Sunshine Vitamin are less likely to get pregnant. A vitamin D pill can replenish your levels, according to research published in The Journal of Clinical Endocrinology & Metabolism in August 2018.
- Supplements According to research published in the Archives of Gynecology and Obstetrics in February 2020, the plant extract berberine may lower insulin resistance and increase ovulation. Furthermore, studies have indicated that chromium, a trace mineral, may assist increase insulin sensitivity in women who are resistant to clomiphene (the ovarian-stimulating medication) after three months while being more tolerable than metformin. However, chromium did not outperform metformin in terms of inducing ovulation or resulting in pregnancy. Before beginning any over-the-counter supplements, consult with your doctor.
PCOS Diet
According to Medling, what you eat may make a difference in establishing a conducive environment for your body to reach a state of healing and balance. Concentrate on the following foods and eating strategies:
- Create your plate. Women should consume a plate that is half nonstarchy veggies, one-quarter gluten-free grains, one-quarter lean protein, and one dish of healthy fat, according to Medling.
- Choose omega-3 fatty acids. According to studies published in the Iranian Journal of Reproductive Medicine, supplements and sources of fatty fish, such as salmon, may help lower testosterone levels.
- Get yourself a larger breakfast. According to a study published in Clinical Science, eating the majority of your calories earlier in the day may enhance insulin function.
- Choose low-GI meals. Whole grains, fruits, and vegetables are low on the glycemic index and may help you maintain a stable blood sugar level.
- Food intolerances should be avoided. Foods that irritate your GI system will raise inflammation in your body, and a disruption in your gut microbiota may be linked to the development of PCOS, according to a study published in the journal Medical Hypotheses. This may vary from person to person, but gluten-containing foods, soy, and dairy are the most frequent sensitivities, according to Medling.
- Consider a weight-loss diet. According to research published in the Journal of the Academy of Nutrition and Dietetics, a weight-loss eating plan is more crucial than going high or low carb.
- Work with an RD. Consult with a registered dietician. According to research published in the journal Appetite in February 2017, binge eating disorder is frequent among women with PCOS. A licensed dietician who specializes in eating disorders can teach you techniques for developing good eating habits.
PCOS prevention
According to the Cleveland Clinic, PCOS cannot be avoided. That doesn’t mean you can’t do something about it.
By controlling symptoms and adopting a healthy lifestyle, you may avoid the repercussions of insulin resistance and high blood pressure, such as diabetes and heart disease.
PCOS Complications
Unfortunately, PCOS is a major cause of infertility in people who desire to get pregnant. The good news is that it is almost certainly curable infertility. The hormonal imbalance affects egg development and often hinders ovulation. You can’t become pregnant if you don’t ovulate. Because ovulation isn’t occurring or occurs infrequently, many women’s menstrual cycles are irregular — or they don’t receive their period at all. If you’re attempting to conceive but have unusually extended or nonexistent periods, see your doctor to rule out PCOS.
Remember how we stated this is a curable kind of infertility? This is due to the abundance of effective therapies. According to Ehrmann, decreasing 7% of your body weight may be enough to balance your hormones and allow your body to ovulate on its own. (According to other reports, it might be as low as 5%.) Following that, using oral medicine to promote ovulation is generally the initial line of action. The most often used is clomiphene, but a breast cancer medicine, Femara (letrozole), is increasingly frequently used off-label, and research suggests it may be even more beneficial, according to Dunaif. Injectable gonadotrophins, which stimulate the ovaries, are another treatment option.
PCOS complications include an increased risk of diabetes owing to insulin resistance. According to OWH, more than half of women with PCOS will develop diabetes or prediabetes by the age of 40. High blood pressure and cholesterol levels may raise the risk of heart disease and stroke, respectively, while sleep apnea has been linked to heart disease and diabetes. Women with PCOS are more prone to experience sadness and anxiety, and insulin resistance and ovulation abnormalities have been related to endometrial cancer.
PCOS Statistics and Research: How Common Is It?
PCOS is a prevalent disorder that affects up to 10% of adult women. According to the Centers for Disease Control and Prevention, this equates to around 5 million women (CDC). According to the CDC, PCOS may occur as early as age 11 or 12, as well as in one’s twenties or thirties. According to research published in PLOS Medicine in June 2020, there may be two kinds of PCOS: one that affects hormone levels essential for ovulation and conception, and another that is more directly associated with metabolic disorders and obesity. PCOS is also one of the primary causes of infertility.
PCOS in Hispanic Women
According to a study published in the International Journal of Environmental Research and Public Health in November 2018, “there are no racial or ethnic implications on the incidence of PCOS.” However, another research published in the American Journal of Obstetrics and Gynecology in May 2017 discovered that symptoms may vary across racial groups. Hispanic women, for example, were more likely to have metabolic syndrome than non-Hispanic Black women. Hispanic women had more severe instances, whereas non-Hispanic Black women had a more moderate illness, according to the researchers.
Related Conditions and Causes of PCOS
PCOS is linked to some other chronic health issues. If you’ve been diagnosed, you’ll want to work closely with your physicians to determine the appropriate treatment plan for you, so you can lower your risk of consequences like these:
Obesity
Half of PCOS women gain weight or are obese. This excess weight is often carried around the waist. If you are overweight or obese, decreasing only 5% of your body weight may make a significant impact on your symptoms. Clinicians often advocate combining this with a good diet and exercise regimen.
Diabetes Type 2
When you’re already struggling with a hormone disorder, the last thing you want to deal with is another medical issue. However, because of insulin resistance in PCOS, women with the disorder have a fourfold increased risk of acquiring type 2 diabetes, according to a study.
Discuss with your doctor the possibility of doing fasting glucose, A1C, or oral glucose tolerance test. Maintaining a healthy weight, undertaking strength training, and eating a blood sugar-controlling diet will help avoid the development of prediabetes and diabetes.
Depression and Anxiety
Women with PCOS are more likely to suffer from despair and anxiety. PCOS symptoms cause a disturbance in one’s life. Seeking therapy for infertility when you want to have a kid, for example, might be stressful. Acne, excessive hair growth or loss, and weight gain may all be quite upsetting.
Heart Disease
PCOS puts you at risk for high blood pressure, high LDL (“bad”) cholesterol, and sleep apnea, all of which lead to heart disease.
What Are Some of the Most Common PCOS Myths You Shouldn’t Believe?
Several myths are surrounding PCOS, ranging from what it is to who gets it, to dubious symptoms and unsafe treatments.
The following are the main PCOS misconceptions to be aware of:
Myth: To have PCOS, you must have polycystic ovaries.
Fact Many PCOS women do not have cysts on their ovaries. According to Ehrmann, if you have cysts, you do not have PCOS. This is one of the reasons why some specialists have advocated for renaming PCOS the “reproductive metabolic syndrome,” he explains.
Myth Every lady gets hair in places she does not want it.
Fact This varies greatly across women based on their ethnicity, according to Loren Wissner Greene, MD, clinical professor in the departments of medicine and obstetrics and gynecology at NYU Langone Health in New York City. Furthermore, not every woman has every PCOS symptom.
Myth: If you have PCOS, you can’t become pregnant.
Fact Women with PCOS may be able to have the families they want if fertility therapies are effective. Furthermore, some of these women get pregnant on their own.
Myth You have PCOS if your menstrual cycle is erratic.
Fact Other causes of a protracted or nonexistent cycle include nursing, excessive dieting, overexercising, pelvic inflammatory disease, uterine fibroids, and thyroid issues, according to the Mayo Clinic.
Myth You don’t have to worry about PCOS if you don’t want to become pregnant.
Fact According to Washington University Physicians, PCOS raises the risk of problems such as type 2 diabetes, high blood pressure, low cholesterol levels, sleep apnea, depression and anxiety, and endometrial cancer.
Myth: Women with PCOS can lose weight in the same way that anybody else can.
Fact Women with PCOS often struggle to lose weight. A doctor who encourages a lady to only eat and exercise is adopting an overly basic approach. Consult your doctor to determine which pharmaceutical alternatives are best for you.
Myth An ultrasound is required to make a diagnosis.
Fact Because cystic ovaries are not usually required for a diagnosis, an ultrasound is not always required.
Myth: Everyone with PCOS is obese.
Fact While weight growth is often a concern, there are skinny individuals with PCOS, according to Medling. Because it is often assumed that all women with PCOS are overweight or obese, a normal-weight woman is more likely to go misdiagnosed.
Myth: Insulin resistance promotes weight gain in PCOS.
Fact According to Ehrmann, experts aren’t clear why women with PCOS are often overweight. However, it is critical to understand that weight increase leads to insulin resistance, not the other way around.
Myth You are aware of whether you have PCOS.
Fact Many of the symptoms — acne, hair loss, mood swings — may occur for a variety of causes. And it’s typical for PCOS to go overlooked if you visit many physicians for each worry.
Myth: All PCOS women should use birth control medications.
Fact It may not be appropriate for every woman, and it is not a miracle pill that can cure all symptoms, particularly if you are trying to conceive.
Myth PCOS is a disease that will follow you for the rest of your life.
Fact The harsh reality is that there is no cure, but Medling believes that with little effort and concentration on self-care, you may feel better and live more in peace with PCOS.
Result in Bottom Line
PCOS may interrupt a woman’s menstrual cycle and make it difficult to conceive. Unwanted symptoms such as hair growth on the face and body are also caused by high amounts of male hormones.
Lifestyle modifications are generally the first therapies that physicians offer for PCOS, and they are often effective.
Weight reduction may help manage PCOS symptoms and increase your chances of becoming pregnant. Diet and aerobic exercise are two effective weight-loss methods.
If lifestyle modifications do not work, medications are an alternative. Metformin and birth control pills may help restore more regular menstrual periods and alleviate PCOS symptoms.
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