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• Polycystic ovary syndrome
• Signs and symptoms of polycystic Ovary Syndrome
• Causes of polycystic ovary syndrome
• Diagnosis of polycystic ovary syndrome
• Treatment of polycystic ovary syndrome
• Preventing polycystic ovary syndrome
• Preparing for your appointment
• Frequently asked questions

Polycystic ovary syndrome (PCOS)

Polycystic ovary syndrome (PCOS) is a condition in which irregular menstrual periods develop due to the absence of monthly ovulation. Around 5 to 10 percent of women are affected by this condition. PCOS is associated with increased androgen levels. Excess amounts of androgen can lead to hirsutism, androgenic alopecia, and acne. In most cases, women with PCOS have a higher risk of obstructive sleep apnea, diabetes, and overweight or obesity. PCOS is not curable, but treatments can alleviate symptoms, enabling women with PCOS to live without significant complications.

What are the signs and symptoms of polycystic ovary syndrome?

Common signs and symptoms of polycystic ovary syndrome include:

• Acne: In people with PCOS, acne can appear on their back, face, or chest and is hard to treat.
• Irregular menstrual periods: PCOS can lead to irregular or absent periods. Heavy bleeding during periods can also result from this condition.
• Hirsutism: As many as 70 percent of women affected with PCOS have hirsutism. Hirsutism is a condition with excess hair growth, especially in the arms, chest, face, or abdomen.
• Obesity: 40 – 80 percent of people with PCOS are overweight and struggle to maintain their weight in a healthy range.
• Acanthosis nigricans: Skin in the neck, armpits, groin, or under the breasts of people with PCOS may darken and thicken.
• Cysts: Egg follicular cysts can develop in the ovaries of people with PCOS, making the ovaries look larger on ultrasound.
• Skin tags: In people with PCOS, skin tags usually develop on the neck or armpits.
• Alopecia: People with PCOS may have alopecia, losing patches of their scalp hair.
• Infertility: PCOS is the most common cause of infertility in people who were assigned female at birth (AFAB). Irregular ovulation can affect a womans ability to conceive a child.

PCOS can be asymptomatic. Many people with PCOS may not realize they have the condition until they have trouble conceiving a child or put on weight without known reasons. In mild PCOS, symptoms are not severe enough to be easily noticeable.

What causes polycystic ovary syndrome?

In PCOS, there are reproductive hormone imbalances, with higher levels of androgens, LH, FSH, and lower levels of estrogens and progesterones. This hormonal imbalance is thought to contribute to ovarian dysfunction, which disrupts ovulation and can lead to irregular periods.

The menstrual cycle is an orchestration of hormones secreted from the hypothalamic-pituitary-ovarian axis to prepare the body for pregnancy. During the first half of a menstrual cycle, a growing follicle develops in the ovary due to rising FSH and estrogen levels. At mid-cycle, the pituitary secretes a surge level of LH to release a matured egg from the ovarian follicle. Afterward, the follicle develops into a corpus luteal cyst, producing progesterone and estrogen to prepare the uterus for possible implantation.

However, in women with PCOS, the follicles fail to grow to the size they can release an egg. There is an imbalance of hormones with elevated levels of LH and androgens but lower estrogens and progesterones. Some believe an increase in androgens is also due to elevated insulin secondary to insulin resistance.

People with insulin resistance require higher insulin levels to maintain glucose in a healthy range. Hyperinsulinemia is commonly present in women with PCOS. Obese women with PCOS are three-fold more likely to be at risk for prediabetes. Apart from obesity, a family history of diabetes, race, and ethnicity are also risk factors for developing diabetes in women with PCOS.

Complications

PCOS may increase the risk for pregnancy complications and others. Complications of PCOS can include:

• Anxiety and depression
• Eating disorders
• Endometrial cancer
• Gestational diabetes, preeclampsia, and pregnancy-induced high blood pressure 
• Infertility 
• Metabolic syndrome
• Nonalcoholic steatohepatitis
• Risk for miscarriage or preterm birth
• Sleep apnea
• Type 2 diabetes or prediabetes

Diagnosis of polycystic ovary syndrome

To diagnose PCOS, a doctor conducts a physical examination and additional tests to identify signs and symptoms of the condition. Weight and blood pressure are determined, followed by inquiries into the symptoms and medical and family history. Physical examination may reveal skin discoloration, hair loss, skin tags, acne, hirsutism, and irregular or absent periods. Additionally, blood tests are used to assess hormone and glucose levels. Doctors may perform a pelvic exam to investigate irregular menstrual cycles or uterine lining thickness.

Treatment of polycystic ovary syndrome

Treatment options depend on your medical history, symptoms, other health issues, and future pregnancy plans.

Treatments for women with PCOS with no plan for future pregnancy include:

• Hormonal birth control: Contraceptives such as oral contraception, contraceptive patches, contraceptive injections, hormonal rings, and an intrauterine device (IUD) help regulate your menstrual cycle.
• Insulin sensitizer: Metformin is a diabetic drug that increases insulin sensitivity. Menstrual cycles in people with PCOS may improve once their hyperinsulinemia is under control.
• Antiandrogens: Antiandrogens help counteract the effects of androgens. They can reduce acne and excess hair growth.
• Lifestyle modification: Eating healthy diets and maintaining a healthy weight can positively impact insulin levels.

Treatment for women with PCOS who wish to be pregnant includes:

• Ovulation induction drugs: There are certain drugs proven to induce ovulation, such as clomiphene, letrozole, and gonadotropins.
• Surgical procedure: Although it is rare, surgeons may perform surgery to remove tissue in the ovaries that produce androgens.
• In vitro fertilization (IVF): If medication cannot induce ovulation, IVF can be an alternative option for pregnancy. In IVF, an egg is fertilized with sperm outside the body before being implanted into the uterus.

Preventing polycystic ovary syndrome

Although there are no proven methods to help prevent PCOS, you can avoid the effects of this condition by:

• Maintain a healthy weight. Losing weight can lead to decreased insulin and androgen levels, restoring ovulation.
• Reduce carbohydrate intake. Consuming high carbohydrate diets can raise insulin levels. Incorporate more complex carbohydrates from vegetables, fruits, and whole grains while avoiding refined carbohydrates.
• Make exercise a routine. Regular exercise can reduce blood sugar levels and ease or prevent insulin resistance. Staying active also helps you maintain your weight in a healthy range and reduce the risk of developing diabetes.

Preparing for your appointment

If you have PCOS, specialists that you can see are a gynecologist, endocrinologist, and reproductive endocrinologist. To prepare yourself before an appointment, make sure you write the following information down:

• Your periods: how long they persist and how frequent and heavy they are.
• Information about your periods, including how often they occur, how long they last, and how heavy they are.
• A list of medications or supplements that you are taking
• Important personal information.
• Questions to ask your doctor, such as what test should you have, how does PCOS affect my chance of pregnancy, what medicines can improve the symptoms or increase the chances of pregnancy, what should I do to minimize symptoms, and what are the long-term effects of PCOS to my health.

Apart from the preparation mentioned above, you should prepare answers for the following questions your doctor may ask:

• What are your symptoms?
• How often and how bad are your symptoms?
• When did your symptoms begin?
• When did your last menstrual period occur?
• Has any of your female first-degree relatives been diagnosed with PCOS?
• What may seem to improve or worsen your symptoms?
• Do you desire to conceive a child?

Frequently asked questions

Is PCOS a genetic disorder?

There is some evidence indicating PCOS is genetic, meaning that it is more likely to develop PCOS if your biological mother has it.;

What hormones affect PCOS?

Hormones involved in PCOS include androgens, estrogen, follicle-stimulating hormone (FSH), luteinizing hormone (LH), insulin, and progesterone.

What is the difference between PCOS and endometriosis?

Although both PCOS and endometriosis can lead to ovarian cysts and infertility, they are distinct conditions. In endometriosis, there is abnormal, ectopic growth of endometrial tissues in the ovaries, fallopian tubes, or vagina. Symptoms of endometriosis include menstrual cramps or pelvic pain. On the other hand, symptoms of PCOS include irregular periods, ovulation problems, and other side effects due to hormonal imbalance.

A Note from MedPark Hospital

Polycystic ovary syndrome is a common condition that is manageable with medical treatment and lifestyle modification. Treatment can vary from person to person depending on ones desire to conceive a child now or in the future. Therefore, it is advisable to consult a doctor for a suitable treatment.