Polycystic Ovary Syndrome (PCOS): Causes, Symptoms, and Medication
PCOS affects a woman’s ovaries, the reproductive organs that produce estrogen and progesterone hormones that control the menstrual cycle. The ovaries also produce a small number of male hormones called androgens.
The ovaries discharge eggs to be fertilized by a man’s sperm. The discharge of an egg each month is called ovulation.
Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation. FSH stimulates the ovary to produce a follicle a sac that contains an egg and then LH triggers the ovary to release a mature egg.
PCOS is a “syndrome,” or group of symptoms that affects the ovaries and ovulation. Its three main features are:
- cysts in the ovaries
- high levels of male hormones
- irregular or skipped periods
In PCOS, many small, fluid-filled sacs grow inside the ovaries. The word “polycystic” means “many cysts.”
These sacs are actually follicles, each one containing an immature egg. The eggs never mature enough to trigger ovulation.
The absence of ovulation changes levels of estrogen, progesterone, FSH, and LH. Estrogen and progesterone levels are lower than usual, while androgen levels are higher than usual.
Extra male hormones disrupt the menstrual cycle, so women with PCOS get fewer periods than usual.
PCOS isn’t a new condition. Italian physician Antonio Vallisneri first described its symptoms in 1721.
What Causes PCOS
Doctors don’t know specifically what causes PCOS. They think that high levels of male hormones limit the ovaries from producing hormones and making eggs normally.
Genes, insulin resistance, and inflammation have all been linked to excess androgen production.
Researches reveal that PCOS runs in families.
It’s possible that several genes contribute to the condition.
Up to 70% of women with PCOS have insulin resistance, indicating that their cells can’t use insulin properly.
Insulin is a hormone the pancreas produces to help the body use sugar from foods for energy.
When cells can’t use insulin accurately, the body’s demand for insulin increases. The pancreas makes more insulin to compensate. Extra insulin triggers the ovaries to produce more male hormones.
Women with PCOS usually have increased levels of inflammation in their bodies. Overweight can also add to inflammation. Researches have linked excess inflammation to higher androgen levels
What are the Common Symptoms of PCOS
Some women begin noticing symptoms around the time of their first period. Others only find they have PCOS after they’ve gained a lot of weight or they’ve had trouble getting pregnant.
The most common PCOS symptoms are:
- Heavy bleeding: The uterine lining builds up for a longer period of time, so the periods you do get can be heavier than normal.
- Hair growth: More than 70 percent of women with this condition grow hair on their face and body including on their back, belly, and chest.
- Acne: Male hormones can make the skin oilier than usual and cause breakouts on areas like the face, chest, and upper back.
- Irregular periods: A lack of ovulation prevents the uterine lining from shedding every month. Some women with PCOS get fewer than eight periods a year.
- Weight gain: Up to 80 percent of women with PCOS are overweight.
- Male-pattern baldness: The hair on the scalp gets thinner and fall out.
- Darkening of the skin: Dark patches of skin can form in body creases like those on the neck, in the groin, and under the breasts.
- · Headaches: Hormone changes can trigger headaches in some women.
How PCOS affects your body
Having higher-than-normal androgen levels can affect your fertility and other aspects of your health.
To get pregnant, you have to ovulate. Women who don’t ovulate regularly don’t release as many eggs to be fertilized. PCOS is one of the leading causes of infertility in women.
Up to 80% of women with PCOS are overweight or obese. Both obesity and PCOS increase your risk for high blood sugar, high blood pressure, low HDL (“good”) cholesterol, and high LDL (“bad”) cholesterol.
Together, these factors are called metabolic syndrome, and they increase the risk of heart disease, diabetes, and stroke.
This condition causes repeated pauses in breathing during the night, which interrupt sleep.
Sleep apnea is more common in women who are overweight — especially if they also have PCOS. The risk for sleep apnea is 5 to 10 times higher in obese women with PCOS than in those without PCOS.
During ovulation, the uterine lining sheds. If you don’t ovulate every month, the lining can build up.
A thickened uterine lining can increase your risk for endometrial cancer .
Doctors typically diagnose PCOS in women who have at least two of these three symptoms :
- high androgen levels
- irregular menstrual cycles
- cysts in the ovaries
Your doctor should also ask whether you’ve had symptoms like acne, face and body hair growth, and weight gain.
A pelvic exam can look for any problems with your ovaries or other parts of your reproductive tract. During this test, your doctor inserts gloved fingers into your vagina and checks for any growths in your ovaries or uterus.
Blood tests check for higher-than-normal levels of male hormones. You might also have blood tests to check your cholesterol, insulin, and triglyceride levels to evaluate your risk for related conditions like heart disease and diabetes.
An ultrasound uses sound waves to look for abnormal follicles and other problems with your ovaries and uterus.
Pregnancy and PCOS
PCOS interrupts the normal menstrual cycle and makes it harder to get pregnant. Between 70 and 80% of women with PCOS have fertility problems.
This condition can also increase the risk of pregnancy complications.
Women with PCOS are twice as likely as women without the condition to deliver their baby prematurely. They’re also at greater risk for miscarriage, high blood pressure, and gestational diabetes.
However, women with PCOS can get pregnant using fertility treatments that improve ovulation. Losing weight and lowering blood sugar levels can improve your odds of having a healthy pregnancy.
Diet and lifestyle tips to treat PCOS
Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise.
Losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and improve PCOS symptoms. Weight loss can also improve cholesterol levels, lower insulin, and reduce heart disease and diabetes risks.
Any diet that helps you lose weight can help your condition. However, some diets may have advantages over others.
Studies comparing diets for PCOS have found that low-carbohydrate diets are effective for both weight loss and lowering insulin levels. A low glycemic index (low-GI) diet that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better than a regular weight loss diet.
A few studies have found that 30 minutes of moderate-intensity exercise at least three days a week can help women with PCOS lose weight. Losing weight with exercise also improves ovulation and insulin levels.
Exercise is even more beneficial when combined with a healthy diet. Diet plus exercise helps you lose more weight than either intervention alone, and it lowers your risks for diabetes and heart disease.
There is some evidence that acupuncture can help with improving PCOS, but more research is needed
Common medical treatments
Birth control pills and other medicines can help regulate the menstrual cycle and treat PCOS symptoms like hair growth and acne.
Taking estrogen and progestin daily can restore a normal hormone balance, regulate ovulation, relieve symptoms like excess hair growth, and protect against endometrial cancer. These hormones come in a pill, patch, or vaginal ring.
Metformin (Glucophage, Fortamet) is a drug used to treat type 2 diabetes. It also treats PCOS by improving insulin levels.
One study found that taking metformin while making changes to diet and exercise improves weight loss, lowers blood sugar, and restores a normal menstrual cycle better than changes to diet and exercise alone.
Clomiphene (Clomid) is a fertility drug that can help women with PCOS get pregnant. However, it increases the risk for twins and other multiple births.
Hair removal medicines
A few treatments can help get rid of unwanted hair or stop it from growing. Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis can get rid of unwanted hair on your face and body.
Surgery can be an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.
When to see a doctor
See your doctor if you:
- missed periods and you’re not pregnant.
- have symptoms of PCOS, such as hair growth on your face and body.
- been trying to get pregnant for more than 12 months but haven’t been successful.
- have symptoms of diabetes, such as excessive thirst or hunger, blurred vision, or unexplained weight loss.
If you have PCOS, plan regular visits with your primary care doctor. You’ll need regular tests to check for diabetes, high blood pressure, and other possible complications.