Understanding the Realities of PCOS

Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age in the US, and the most common of infertility. Unfortunately, many women don’t know they have it, and worldwide, an estimated 70% of all cases go undiagnosed. That’s particularly alarming because in addition to causing infertility, PCOS can cause a variety of health issues that affect a women’s physical and mental wellbeing. Symptoms generally appear in late teens, 20s, and 30s, but PCOS can occur at any time after puberty.

PCOS is caused by an imbalance of hormones which disrupts the normal function of ovaries. In a healthy woman, the ovaries make an egg which is released each month as part of the menstrual cycle. With PCOS, the egg may not develop normally, or the ovaries may not release it during ovulation. This can cause irregular or missed periods, or in some cases periods that may last for days. While the exact cause of PCOS isn’t known, genetic components and other factors that may increase risk include:

• High levels of insulin. When your body can’t use the insulin it makes effectively, it can cause insulin resistance. Insulin resistance increases your risk of developing type 2 diabetes. In fact, according to the CDC, more than half of all people with PCOS who don’t get proper treatment may develop type 2 diabetes by age 40.
• High levels of androgen. Although androgens are often called “male hormones”, women also produce a small amount. When a woman produces more androgens than normal, it can prevent the ovaries from releasing an egg during the menstrual cycle. Too much androgen can also cause extra hair growth and acne – two common symptoms of PCOS.
• Low-grade inflammation. Low-grade inflammation is caused when white blood cells make substances in response to infection or injury. Long-term inflammation can lead to polycystic ovaries that produce too much androgen.
• Family history. Some studies indicate that certain genes are related to PCOS, so having a family history may increase your risk.

Symptoms of PCOS can have a profound effect on a woman’s physical health, but the nature of many of them can also take a toll of emotional and mental health – particularly when they are attributed to other causes. Common symptoms include:

• Irregular menstrual periods. As mentioned above, some women may have very infrequent periods, while others may have them as frequently as every 20 days or less.
• Increased hair growth. Unfortunately, rather than resulting in a fuller head of hair, women often experience unwanted hair growth on their face and body – and other areas where men typically grow hair.
• Thinning hair or hair loss. Some women may also see thinning hair on their scalp – typical of male pattern baldness.
• Acne – usually on the face, chest and upper back.
• Weight gain. This is another frustrating symptom that is often blamed on lifestyle or other factors. Making matters worse, obesity can also worsen other symptoms of PCOS.
• Skin tags and darkening skin. Darkening skin, particularly along neck creases, in the groin, and under the breast along with the development of multiple skin tags (small mole-like flaps of skin) in those areas is a very common symptom of PCOS.

Many women aren’t diagnosed with PCOS until they experience fertility problems. There is no specific test for PCOS, so diagnosis usually involves discussing your symptoms with your doctor, reviewing your medical history, and undergoing a complete medical exam to rule out other causes. Blood tests are also used to measure hormone levels, including androgens. PCOS is generally diagnosed if you have high androgen levels or cysts on one or both ovaries, along with at least one other symptom that can’t be attributed to another health issue.

Treatment for PCOS is usually personalized to better manage the symptoms that are most concerning to you. If infertility is your primary concern, your doctor may prescribe one or more medications such as Clomiphene or Metformin to help regulate ovulation so you can become pregnant. Birth control pills or progestin therapy may be used to help regulate your menstrual cycle. Anti-androgen medicines can help reduce hair loss, facial and body hair growth and acne. Lifestyle changes including a reduced-calorie diet and exercise can help with weight loss – while also helping to make your menstrual cycle more regular and improving your fertility. This is particularly important as even a modest weight loss of 5-10% of your weight can significantly improve your PCOS.

Getting an appropriate diagnosis and finding the right treatment path for you can help you avoid many long-term complications of PCOS, from infertility and type 2 diabetes to cardiovascular disease and depression. If you have two or more of the symptoms of PCOS, it’s time to talk to your doctor. The team of Women’s Health experts at El Camino Health can help. Learn more about our services today. Or, for help finding a doctor, click here.

This article appeared in the September 2024 edition of the HealthPerks newsletter.