10 PCOS (polycystic ovary syndrome) facts
In this article we will describe 10 PCOD (polycystic ovary syndrome), focussing on its symptoms, causes, and treatment.
1. What is PCOS?
Polycystic ovary syndrome (PCOS) is one of the most common endocrine conditions in women of reproductive age and yet the disorder has remained an enigma for many decades, with little progress made towards the improvement of symptoms and wellbeing of patients.
PCOS is common, with a prevalence of PCOS varies from 5 to 20%. Around 50% of women are not aware that they have PCOS, or they have a delayed diagnosis.
2. Cause
This is uncertain. In fact, the main reason for the lack of effective treatments for PCOS is that the causes are complex and multifactorial, including:
Insulin resistance
Insulin is a hormone that the pancreas makes. It allows cells to use sugar, your body’s primary energy supply. If cells become resistant to the action of insulin, then blood sugar levels can go up. This can cause your body to make more insulin to try to bring down the blood sugar level.
Too much insulin might cause your body to make too much of the male hormone androgen. You could have trouble with ovulation, the process where eggs are released from the ovary.
One sign of insulin resistance is acanthosis nigricans (see below) which are dark, velvety patches of skin on the lower part of the neck, armpits, groin or under the breasts. A bigger appetite and weight gain may be other signs.
Low-grade inflammation
White blood cells make substances in response to infection or injury. This response is called low-grade inflammation. Research shows that people with PCOS have a type of long-term, low-grade inflammation that leads polycystic ovaries to produce androgens. This can lead to heart and blood vessel problems.
Heredity
Research suggests that certain genes might be linked to PCOS. Having a family history of PCOS may play a role in developing the condition.
Excess androgen
With PCOS, the ovaries may produce high levels of androgen. Having too much androgen interferes with ovulation. This means that eggs don’t develop on a regular basis and aren’t released from the follicles where they develop. Excess androgen also can result in hirsutism and acne.
Obesity
3. When does PCOS start?
It’s common for women to find out they have PCOS when they have trouble getting pregnant, but it often begins soon after the first menstrual period, as young as age 11 or 12. It can also develop in the 20s or 30s.
4. Symptoms
Symptoms of PCOS often start around the time of the first menstrual period. Sometimes symptoms develop later after you have had periods for a while.
Irregular periods
Having few menstrual periods or having periods that aren’t regular are common signs of PCOS. So is having periods that last for many days or longer than is typical for a period. For example, you might have fewer than nine periods a year. And those periods may occur more than 35 days apart. You may have trouble getting pregnant.
Too much androgen
High levels of the hormone androgen may result in excess facial and body hair. This is called hirsutism. Sometimes, severe acne and male-pattern baldness can happen, too. A rash called acanthosis nigricans can occur in the armpits, groins and back of the neck.
Acanthosis nigricans on the neck
And in the armpits
Polycystic ovaries
Your ovaries might be bigger. Many follicles containing immature eggs may develop around the edge of the ovary. The ovaries might not work the way they should.
PCOS signs and symptoms are typically more severe in people with obesity.
5. Diagnosis
There’s no single test to specifically diagnose polycystic ovary syndrome (PCOS). Your health care provider is likely to start with a discussion of your symptoms, medications and any other medical conditions. Your provider also may ask about your menstrual periods and any weight changes. A physical exam includes checking for signs of excess hair growth, insulin resistance and acne.
Vaginal examination
During this examination, your doctor can check your reproductive organs for masses, growths or other changes.
Blood tests
Blood tests can measure hormone levels. This testing can exclude possible causes of menstrual problems or androgen excess that mimic PCOS. You might have other blood testing, such as fasting cholesterol and triglyceride levels. A fasting blood glucose can look for diabetes.
Ultrasound
An ultrasound can check the appearance of your ovaries and the thickness of the lining of your uterus. A wandlike device (transducer) is placed in your vagina. The transducer emits sound waves that are translated into images on a computer screen.
Although no clear diagnostic criteria exist, a diagnosis can usually be made if the patient meets at least two of the following Rotterdam criteria: hyperandrogenism, irregular menstrual cycles, and polycystic ovary morphology.
6. When should I see a doctor?
See your doctor if you’re worried about your periods, if you’re having trouble getting pregnant, or if you have signs of excess androgen. These might include new hair growth on your face and body, acne and male-pattern baldness.
7. Treatment
PCOS is difficult to manage both for health-care professionals and patients as different phenotypes exist and management is dependent on an individual’s symptoms. Prescribing the contraceptive pill to regulate periods, giving general (and sometimes, vague) advice on how to self-manage symptoms such as acne and hirsutism, and ways to self-improve diet and lifestyle, are not enough.
For women trying to get pregnant, clomifene – used to treat infertility in women who do not ovulate – is usually recommended, and metformin can be used to lower the level of insulin.
These are used to treat symptoms and are not disease modifying drugs.
8. Costs of treatment
With the cost of living increasing, many women with PCOS might not be able to cover costs of laser hair removal or electrolysis to remove hair, gym memberships to reduce weight, and in some countries—especially low-income and middle-income countries—the contraceptive pill to regulate periods.
Laser hair removal and electrolysis are not covered by the National Health Service (NHS) England because they are considered cosmetic procedures and funding is only provided for exceptional circumstances, yet NHS Scotland has taken action to make it available.
More options are needed than currently available, including more funding for research on this topic and approved drugs for use.
9. Complications
Complications of PCOS can include:
- Infertility
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Nonalcoholic steatohepatitis (NASH) – a severe liver inflammation caused by fat buildup in the liver
- Metabolic syndrome – a cluster of conditions including high blood pressure, high blood sugar, and unhealthy cholesterol or triglyceride levels that significantly increase your risk of heart and blood vessel (cardiovascular) disease]]
- Type 2 diabetes or prediabetes
- Obstructive sleep apnoea (OSA)
- Depression, anxiety and eating disorders
- Cancer of the uterine lining (endometrial cancer).
Obesity commonly occurs with PCOS and can worsen complications of the disorder.
10. Associations
PCOS is strongly associated with other long-term conditions including type 2 diabetes, endometrial cancer, and cardiovascular disease. Therefore, more needs to be done for women with PCOS to improve their quality of life and prevent the known associated risks. In addition to the long-term health risks, the psychological wellbeing of patients with PCOS is also important.
A 2021 study found that 40% of women with PCOS have depression and 15% have mood disorders, i.e at least 55% of women with the condition have mental health problems. Causes can include low confidence as a result of hirsutism and managing the side-effects of the contraceptive pill, which is usually prescribed to treat symptoms.
Summary
We have described 10 PCOS (polycystic ovary syndrome) facts, and its symptoms, causes, and treatment. Even though not a huge amount is known about its cause, treatments exists and should be offered to all.
