Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects women during their reproductive years. It impacts various bodily systems, extending beyond just the reproductive organs to include metabolism and mental well-being.
What is PCOS?
PCOS is a complex endocrine disorder marked by hormonal imbalances, metabolic irregularities, and reproductive challenges. It affects an estimated 6–13% of women of reproductive age worldwide, though up to 70% of those affected may remain undiagnosed. The name “polycystic ovaries” refers to the presence of multiple small follicles, which are underdeveloped sacs containing eggs, on the ovaries.
These follicles often do not release an egg, meaning ovulation does not occur regularly. This condition is primarily associated with abnormal hormone levels, including elevated insulin and androgens (often called “male” hormones), which can disrupt normal ovarian function. While the name suggests cysts, the condition is fundamentally related to these hormonal disruptions rather than true cysts.
Recognizing PCOS: Symptoms and Signs
The symptoms of PCOS can differ significantly among individuals and may change over time, often becoming apparent in the late teens or early twenties. A common sign is irregular menstrual periods, which can manifest as fewer than nine periods in a year, no periods for three or more consecutive months, or unpredictable cycles. This irregularity often stems from a lack of regular ovulation.
Another frequent symptom is excess androgen, or “male” hormone, levels, which can lead to various physical changes. These include hirsutism, which is excessive hair growth on the face, chest, back, or buttocks. Many individuals also experience acne or oily skin, and some may notice thinning hair or male-pattern baldness.
Weight gain, particularly around the abdomen, is also a common indicator. Individuals with PCOS may also experience difficulty conceiving due to irregular or absent ovulation. Less common signs can include skin tags or patches of thickened, darkened skin, especially on the neck, armpits, or under the breasts.
Understanding the Causes and Diagnosis
The exact cause of PCOS is not fully understood, but it is believed to involve a combination of genetic factors, insulin resistance, and chronic low-grade inflammation. It often runs in families, suggesting a genetic predisposition. Insulin resistance, where the body’s cells do not respond effectively to insulin, leads to higher insulin levels, which can then increase androgen production.
The diagnostic process for PCOS typically involves a review of a person’s symptoms and a physical examination. Blood tests are conducted to measure hormone levels, such as testosterone, and to check glucose and lipid levels. A pelvic ultrasound may also be performed to assess the ovaries for the presence of multiple small follicles.
The diagnosis of PCOS is commonly made using the Rotterdam criteria, which require at least two out of three features: signs of high androgens, irregular or absent menstrual periods, and polycystic ovaries on an ultrasound scan. It is also important to exclude other conditions that might mimic PCOS symptoms.
Managing PCOS: Treatment Approaches
Managing PCOS involves strategies tailored to an individual’s symptoms and goals, such as improving fertility or addressing metabolic health. Lifestyle modifications are a primary approach, including dietary changes and regular exercise, which can help with weight management and improve insulin sensitivity. Even a modest weight loss of 5% can improve symptoms.
Medical treatments are also used to address specific symptoms. Oral contraceptives are commonly prescribed to regulate menstrual cycles and reduce androgen-related symptoms like acne and excessive hair growth. For those with insulin resistance, medications like metformin can help improve the body’s response to insulin, potentially reducing androgen levels and improving menstrual regularity.
When fertility is a concern, specific medications are used to induce ovulation, such as clomiphene or letrozole. Anti-androgen medications may also be prescribed to directly reduce the effects of excess male hormones. Personalized care is important for effective management.
Long-Term Health Considerations
PCOS is associated with potential long-term health implications, requiring ongoing management and monitoring. Individuals with PCOS have an increased risk of developing Type 2 diabetes due to insulin resistance. This can lead to elevated blood sugar levels over time.
There is also a higher risk of cardiovascular disease, including high blood pressure and other heart problems. Irregular periods, which are common in PCOS, can lead to a buildup of the uterine lining, potentially increasing the risk of endometrial cancer. Additionally, individuals with PCOS may experience mental health issues such as anxiety and depression, which can be linked to the hormonal imbalances and the challenges of managing the condition.