PCOS: Causes, Symptoms, & Treatment

Polycystic ovarian syndrome (PCOS) is a health problem that affects 1 in every 10 women of reproductive age. It is a common cause of infertility in women and increases the risk of other health problems.
Read on to learn more about PCOS.

What is PCOS?

PCOS or polycystic ovarian syndrome is a health condition, which is related to disturbances in the reproductive system. The ovaries (responsible for producing and releasing eggs) of women having PCOS produce unusually high androgen (male sex hormones) levels, causing a hormonal imbalance.

An ultrasound might reveal the presence of cysts (fluid-filled sacs) in the ovaries of women with PCOS. However, a person does not need to have cysts on their ovaries to be diagnosed with PCOS. All of this results in disrupting menstrual cycles (irregular or missed periods) and unpredictable ovulation. Female infertility is often caused by PCOS. Additionally, women with PCOS have an increased risk of other health conditions, such as diabetes and endometrial cancer.

PCOS treatment may depend on several factors including one’s future plans of having children. Obesity (closely related with PCOS) makes the condition even worse; hence, almost all women are recommended to follow a healthy exercise regimen.
Unfortunately, the science has not evolved enough to find a cure for PCOS. However, medication and other treatment are prescribed by doctors to manage symptoms and reduce the risk of PCOS and its health problems.

Symptoms of PCOS & When to consult Doctor?

Often the symptoms of PCOS start with the first menstrual cycle, but in some cases, these symptoms appear after some time. PCOS symptoms vary from person to person. A woman should have at least two of the following symptoms for diagnosis of PCOS:

1. Irregular or missed periods
2. Diminished bleeding (very little flow)
3. Hirsutism (excessive body hair)
4. Weight gain especially around the belly
5. Acne or oily skin
6. Enlarged ovaries or ovaries with many cysts
7. Infertility
8. Skin tags
9. Dark patches of skin on the neck, in the armpits, or under the breasts
10. Thinning hair or male-pattern baldness

You should seek medical attention when you have trouble getting pregnant or irregular periods as some women can have asymptomatic PCOS. Besides, if you seem to be gaining weight for inexplicable reasons, you should opt for gynaecologist consultation.
Not every person has evident symptoms, which might be due to a mild case of PCOS. Medical diagnosis is required to ascertain whether a woman has PCOS.

How is PCOS diagnosed?

During gynaecologist consultation, the doctor may ask about the symptoms, medical history, medications being taken, and details about menstrual cycle and recent weight changes of a patient. This discussion will probably be followed by a physical exam to check for the sings of acne, excess hair growth, and dark patches caused by insulin resistance.

To check the health of a woman’s reproductive organs, a doctor may proceed with the following:

1. Transnational ultrasound
   An ultrasound report can provide the information about the size of the ovaries and highlight the presence of any cysts. This test can also be used to examine the thickness of the endometrium lining (lining of the uterus). A transducer (shaped like a wand) is inserted in the vagina to perform the ultrasound.
2. Blood tests
   Specific blood tests are performed to measure hormone levels and eliminate the possibility of other health conditions that have symptoms similar to PCOS symptoms. A doctor may also require the fasting cholesterol and triglyceride levels of a patient. In addition, glucose tolerance tests are performed to understand the body’s response to sugar (glucose).
3. Pelvic exam
   If need be, a doctor will assess the reproductive organs of a patient to rule out the possibility of any growths, masses, or other changes inside the patient’s vagina. If tests confirm that a woman has PCOS, the doctor will likely recommend additional tests for determining if she has any other complications.

These tests include:
1. Screening for obstructive sleep apnoea
2. Screening for depression and anxiety
3. Basic full body check ups
4. Regular checks of glucose intolerance, blood pressure, and cholesterol & triglyceride levels

Causes of PCOS

The causes of PCOS, a complex endocrine disorder, are unclear as of yet. However, genetics and insulin resistance have a part to play along with higher (than normal) levels of androgen.

Insulin resistance
A hormone created by the pancreas, insulin, enables cells to use sugar for energy supply. Blood sugar levels are likely to increase if the body becomes resistant to insulin, which in turn causes the body to make more insulin to reduce blood sugar. An abnormal amount of insulin in the body may lead to the production of high levels of male hormone, androgen, thereby causing hormonal imbalance and issues with ovulation, which disrupt the menstrual cycle.

A common sign of insulin resistance is the appearance of dark velvety patches of skin on armpits, groin, under the breasts, or on the lower part of the neck. Other noticeable symptoms may include subsequent weight gain and an increased appetite. A person’s lifestyle has a huge impact on the body’s ability to process insulin. Women who are overweight are recommended to follow a healthy diet and increase physical activity (both of which aid the processing of insulin). Women who have type 2 diabetes or PCOS have are likely to have more women with PCOS in their family.

Low-grade inflammation
In case of an injury or infection, the body increases the production of white blood cells (WBCs) to heal the injury or combat the infection. However, for many women with PCOS, low-grade chronic inflammation is reported in research. The WBC, CRP, and IL-6 concentrations in their body increase. The increase in CRP and IL-6 concentrations further leads to a rise in WBC count, thus trapping a patient in a vicious cycle. This leads to an increase in the production of androgens by polycystic ovaries, which may also cause problems with the heart and blood vessels.

Effects of PCOS

PCOS can affect people’s lives, altering their future in terms of family and social life, physical health, and mental health. Every woman with PCOS may not lead a complicated life, but there is a high risk for women with PCOS who are overweight to develop serious health problems.

Other health problems and complications of PCOS include the following:

1. Difficulty in pregnancy
   Many women have to deal with infertility as a result of PCOS. Miscarriages and premature birth are also common in some women with PCOS who get pregnant.
2. Gestational diabetes/prediabetes/type 2 diabetes
   Women with PCOS have a high risk of gestational diabetes (diabetes during pregnant). This also puts the baby at a risk of diabetes and may lead to type 2 diabetes in both the mother and baby later in their lives. More than 50% women develop prediabetes (glucose intolerance) or type 2 diabetes before turning 40.
3. Non-alcoholic steatohepatitis
   Non-alcoholic steatohepatitis (NASH) is severe liver inflammation due to fat build up in the liver. In worst cases, NASH can lead to advanced scarring (cirrhosis) and/or liver failure.
4. Metabolic syndrome
   Women with PCOS may develop metabolic syndrome, also known as syndrome X, in which multiple health problems are encountered at the same time (including high blood sugar, high blood pressure, and unhealthy triglyceride or cholesterol levels). There is an increase in the risk of cardiovascular diseases as the level of LDL (or bad) cholesterol rises and that of HDL (or good) cholesterol decreases significantly in women with PCOS. If left unchecked for long, high blood pressure can damage the heart, kidneys, and brain. Cholesterol and WBCs (plaque) may end up clogging blood vessels, and therefore, leading to blood clots, which trigger a stoke.
5. Sleep apnoea
   As a severe sleep disorder, sleep apnoea can cause breathing to stop momentarily for multiple times during sleep. Obesity can lead to sleep apnoea in women with PCOS, which further increases the risk of diabetes and heart diseases.
6. Endometrial cancer and endometrial hyperplasia
   Insulin resistance, disturbed ovulation cycle, obesity, and diabetes raise the risks of developing cancer of the endometrium. Some women with PCOS develop endometrial hyperplasia, which involves the uterine lining to become abnormally thick because of the presence of too many cells (hyperplasia).
7. Mental health disorders
   Women with PCOS may develop anxiety, depression, and/or eating disorders. Even though doctors do not completely understand the connection between these mental health disorders and PCOS, these conditions likely occur due to the social and psychological impacts of living with a disease like PCOS.

Pregnancy and PCOS

Due to the irregularity in their menstrual cycles, many women find it difficult to conceive and face an increased risk of other complications even when they do. In comparison, women with PCOS have high rates of miscarriage, preeclampsia, cesarean section (C-section), and gestational diabetes.

PCOS can also lead to foetal macrosomia and increase the likelihood of the baby staying in the neonatal intensive care unit (NICU) for long. For women who find it hard to get pregnant, in vitro fertilisation (IVF) is recommended by doctors when medication doesn’t help. The IVF process involves the fertilisation of a woman’s egg with her partner’s sperm in a lab. This fertilised egg is later transferred to the woman’s uterus.

Menopause and PCOS

PCOS symptoms will likely stay even after menopause for many women. PCOS is a disease that affects many systems of the body, and only one of these systems is the reproductive system. Women have reported that their menstrual cycles regularise as they reach menopause, but the hormonal imbalance stays put. Thus, women still show the symptoms of PCOS. Besides, an increase in the risk of PCOS-related health problems, including diabetes, heart attack, and stroke, can be seen when women grow older.

PCOS treatment
Depending on a variety of factors including age, medical history, symptoms, and some other health conditions, a doctor will share the appropriate combination of medications and/or lifestyle changes based on whether a woman wishes to have a child or not.

1. Diet and lifestyle
Generally, doctors would recommend a change in the current diet and activity levels since it helps in managing overall health and loosing weight. These positive changes can also help the body process insulin efficiently, lower the blood sugar level, and even regulate the menstruation cycle. Some people may be advised to consider an aggressive approach for weight loss and others may be advised to increase their daily physical activity depending on the health of the person.

2. Medication
Hormonal birth control: A person can take this form of medication via pills, shots, patches, intrauterine device, or vaginal ring. Containing both oestrogen and progestin, these decrease androgen production and regulate the oestrogen level. Some additional benefits of this method include reduction in excess acne and hair growth and more regular bleeding than normal.

Insulin-sensitising medicine: Drugs, such as metformin (utilised in diabetes treatment), help the body use insulin efficiently and lead to improvements in the ovulation cycle.
Androgen blockers: Medicines that block the effects of excessive androgens on the body may be recommended by a gynaecologist to help women with ovulation. These medicines also help with hair growth and acne.

Progestin therapy: Another option that doctors suggest is to take progestin for 10–14 days after every 1 to 2 months to regulate periods and prevent endometrial cancer. Progestin therapy does not prevent pregnancy and has no effect on androgen levels.
Ask a doctor about progestin-only mini-pill or progestin-containing intrauterine device to avoid pregnancy.

Ovulation inducing drugs: PCOS hinders with the release of eggs (ovulation) in most women, thus preventing a pregnancy. To stimulate ovulation, a combination of letrozole and clomiphene are administered orally, whereas gonadotropins are taken intravenously (by injection). Some of these drugs are time-sensitive; for example, clomiphene is taken on day 4 or 5 of a menstrual cycle.

It is important to note that a certain level of risk is also associated with these medicines—ovarian hyperstimulation, where multiple eggs are released at one time. This increases the chances of multiple births (twins or more). Common side effects of these drugs include bloating in the abdomen and pelvic pain.

Spironolactone (Aldactone): Some drugs are able to block the effects of androgen on the skin and prevent excessive acne and body and facial hair growth. However, spironolactone is to be taken with caution as it can cause birth defects in infants. A doctor will likely include effective birth control in a prescription with this drug.

Eflornithine (Vaniqa): Topical creams such as Vaniqa are known to slow facial hair growth, which can be embarrassing for many women due to the social stigma associated with it. Some women also prefer going for permanent hair removal treatments (such as electrolysis and laser hair removal).

3. Surgery
Ovarian drilling was used by surgeons to stimulate ovulation by removing androgen producing tissues from the ovaries earlier. The advancement of science has provided medications to treat PCOS that are more effective than a surgery, leaving behind the surgical procedure for only special cases.

Risk Factors of PCOS

PCOS is a very common disorder affecting nearly 15% of women population of the childbearing age. Although most woman are diagnosed with PCOS when they are trying to get pregnant (i.e., in their 20s or 30s), the symptoms of PCOS can surface any time after puberty. Women who are overweight, have insulin resistance or have family members with PCOS are likely to get PCOS.

Life with PCOS

PCOS can disturb a woman’s menstrual cycle and cause social struggles due to hirsutism (excess body hair), acne, and or weight gain. In addition, getting pregnant and having a healthy pregnancy can prove to be challenging for women with PCOS. Even if there is no cure for PCOS as of yet, efficient medical treatment and adequate lifestyle changes can help in managing the symptoms effectively. Cosmetic treatments, including electrolysis or laser hair removal, can help with physical symptoms.

It is always a good idea to seek out gynaecologist consultation to understand PCOS better and ask for available options for treating bothersome symptoms of PCOS.