Polycystic Ovarian Syndrome (PCOS) is one of the most common endocrine disorders that affects in numbers as high as 1 in 10. While it has been recognized and diagnosed for over seventy-five years, less than 50% of women are diagnosed due to the lack of knowledge, and awareness. PCOS cannot be diagnosed with just one test, and can often be overlooked due to symptoms varying from person-to-person. In order to be diagnosed with PCOS, you need 2 of the following present: androgen excess, irregular/absent menstrual cycles, and/or ovarian cysts. 

The month of September is Polycystic Ovarian Syndrome Awareness Month, and here is what you need to know.

PCOS is a condition in which the sex hormones in a female’s body are imbalanced, which can cause ovarian cysts, weight gain, changes in menstrual cycle, infertility, and other symptoms. An early diagnosis is important with PCOS because the condition has been linked to an increased risk of multiple medical issues including insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease. PCOS has been known as the “Silent Killer”. There is no exact cause of the condition, although it has been linked to genetics and environment. While there is no known cure for the syndrome, there are treatment options to manage symptoms, and improve your PCOS health.

Female reproductive anatomy | Source

What are symptoms of PCOS?

When it comes to symptoms, it varies for person-to-person, which often makes a diagnosis difficult due to some individuals living with few symptoms. 

  • Weight gain or difficulty losing weight
  • Dandruff
  • Acne
  • Cysts on ovaries
  • Obesity
  • High cholesterol levels
  • Skin discolorations (dark, thick velvet like patches)
  • Elevated blood pressure
  • Insulin resistance
  • Repeated miscarriages
  • Thinning hair
  • Infertility
  • Pelvic pain
  • Male-type hair growth (hirsutism)
  • Irregular/absent menstrual cycles
  • Anxiety and/or depression

Regular menstrual cycle vs. PCOS menstrual cycle | Source

How is PCOS diagnosed?

Medical History
Your doctor will ask questions in regards to your past medical history, as well as your family’s. Studies have shown that if a parent has PCOS, there is a 50% chance that the daughter will have PCOS as well. Questions commonly asked will include details of your menstrual cycle, miscarriages, trouble with weight, depression, and other medical history.

Physical Exam
A physical exam will include height, weight, and blood pressure. As well as examining your body for any signs, such as excess hair growth patterns, skin discoloration, thinning hair, and acne. Be sure to let your doctor know of any hair growth patterns that maybe overlooked.

Blood Work
Your doctor may order numerous labs, but most common are a hormonal panel including testosterone, DHEA, estrogens; fasting glucose; insulin; lipid profile.

An ultrasound is an exam that will show images of your ovaries, uterus, and endometrial lining. It is often done to check for ovarian cysts, which is a common symptom of the condition. 

How is PCOS treated?

Lifestyle changes, medical management, and medication are the best ways to treat the syndrome because there is no cure for it. It is important to find a doctor that you are comfortable, and satisfied with, because it is vital to keep in contact when it comes to managing the syndrome. Treatment varies based on your symptoms, if you are trying to conceive, and overall health.

  • Birth Control Pills – Extremely common in medications prescribed, contraceptive will regulate menstrual cycles, reduce male hormone levels, aid in clearing up acne
  • Metformin (Glucophase) – Metformin is used to treat diabetes, however it is beneficial to people with PCOS because many have insulin resistance. The medication helps in regulating the amount of glucose (sugar) in your blood. It has shown to lower testosterone levels, which improves symptoms such as abnormal hair growth, ovulation, and weight gain. 
  • Spironolactone – Spironolactone is a diuretic (often known as a water pill) that is prescribed for high blood pressure or those with fluid retention, however it has other benefits that aid in PCOS health. The medication is often prescribed along with oral contraceptive pills for those who have hirsutism because it works by lowering androgen levels in the body. Androgens are hormones that people, both male and female, have in their bodies, but males have higher levels of the hormone. Androgens cause male patterned hair growth on the face, chest, and stomach, as well as acne, that some people with PCOS have. Spironolactone can cause birth defects, therefore it cannot be taken during pregnancy. 
  • Lifestyle Modifications – Dietary changes and exercise are important when it comes to managing PCOS because those living with the condition often have insulin resistance, and difficulty maintaining or losing weight. Eating well, and being active, can improve PCOS symptoms on their own. When it comes to dietary changes, it varies for everyone, however, nutrition is very important because the foods we put into our bodies affect us differently than others. So whole foods - fresh vegetables, lean meat, and focusing on low-GI foods, no processed or refined food, limiting dairy are typical PCOS meal plans. Keep in mind, some find keto, vegan, or paleo to be ideal for them.
  • Fertility Treatment – 70% of women diagnosed with PCOS have infertility, however, through fertility treatments and medication, many conceive and give birth to healthy children. Treatments include ovulation cycles, insemination, or IVF. Medications include Clomid, an oral medication that stimulates ovulation, and is often the first medication prescribed. Letrozole is another oral medication similar to Clomid by stimulating ovulation. It is determined by your doctor which treatment is best for you, and dosage.

What is Insulin Resistance?

Insulin is a hormone that is produced by the pancreas. When insulin is released into the bloodstream, it is the essential hormone that has many actions throughout the body such as controlling of sugars, starches, lipids, and proteins. Insulin helps regulate the body’s functioning cells, including their growth, which is important due to glucose being used as energy. 

Insulin resistance is when the body’s cells become resistant to the effects of insulin. Due to this, high levels of insulin are needed in order for the insulin to have its proper effects. The pancreas overcompensates by trying to produce more insulin, until it can no longer produce a sufficient amount for the body’s demands, which results in blood sugar rising. Insulin resistance is often considered pre-pre diabetes due to it being a risk factor for the development of diabetes, along with other health concerns such as heart disease. Insulin resistance is associated with other medical conditions including fatty liver, acanthosis nigricans, and skin tags.

What is Hirsutism?

Hirsutism (HUR-soot-iz-um) is a condition of male-type pattern hair growth on areas of the female body such as face, chest, abdomen, and back. The hair is different from the type some women have on their upper lip, breasts, or chin, which is often fine, “baby” like hairs. which is common. Women with hirsutism have dark, thick, and often coarse hair in male-type patterns. The condition is hereditary, although it is typically caused by high levels of male hormones, or can be caused by conditions such as PCOS, or Cushing’s syndrome. It can also be caused by hair follicles being overly sensitive to male hormones, however doctors do not know the cause. Medication can be prescribed to help lessen the hair growth.

What is Acanthosis Nigricans?

Acanthosis nigricans (ay-can-THO-sis NYG-ruh-cans) is a skin condition that causes areas of skin to become dark, thick, and velvety in areas of the skin that fold and crease, such as neck, armpits, and groin. It typically occurs in people who are obese, have insulin resistance, or diabetes. Treatment for the condition requires treating the underlying conditioners that affect the skin’s color and texture. Prescription creams and ointments can be prescribed to lighten the skin, antibiotics to reduce odor or discomfort, or retinoids to clear skin are treatment options aside from weight loss, and treating underlying health conditions.

PCOS Risks and Facts

  • PCOS affects 5% to 10% of women, making it the most common endocrine disorder in women of childbearing age.
  • Insulin resistance is not a part of the diagnostic criteria for PCOS, although between 50-70% with PCOS have insulin resistance.
  • Women with PCOS are at 4 to 7 times higher risk of heart disease compared to women of the same age without the syndrome.
  • Due to higher levels of testosterone, those with PCOS can build muscle easier than those without.
  • Ovarian cysts are more commonly a result of the hormonal imbalance, and not the cause of the syndrome.
  • A percentage of people with PCOS also have endometriosis.
  • Fish oil is beneficial for all aspects of PCOS, from improving moods to quality of skin and hair.
  • The diagnostic criteria states that a patient has PCOS if they have at least 2 of the following 3 criteria: androgen excess, irregular/absent menstrual cycles, and/or ovarian cysts. 
  • It is estimated that 4 billion dollars is spent annually in the United States to identify and manage PCOS.

What are Reliable PCOS Resources?

  • The PCOS Nutrition Center
  • PCOS Foundation
  • PCOS Diva
  • Soul Cysters 
  • PCOS Challenge 
  • PCOS Network 
  • The Hormone Foundation 
  • Polycystic Ovarian Syndrome Association 
  • PCOS Diet Support 
  • Androgen Excess and PCOS Society

If you would like a printable pamphlet on polycystic ovarian syndrome, PCOS Foundation has one that you can find here, and print out to offer to family and friends. The PCOS Foundation also offers volunteer opportunities, if you’re interested, you can read more information here.

Due to the fact that PCOS is of unknown etiology, and currently there is a lot unknown about the syndrome despite the annual national health care cost associated with PCOS being around $1.16 billion in 2010. Keep in mind, that does not mean you cannot take steps to control symptoms, and take precaution to prevent health risks from occurring if left untreated. It affects 1 in 10, and around 5 - 7 million of the female population with numbers rising as people announce their diagnosis’ daily.

Please make yourself aware of all PCOS symptoms, gather all the knowledge that is available from reliable sources, and raise your voice. Speak out, if you have a family or friend that expresses concern about symptoms that are similar to PCOS, let them know. While PCOS is manageable, it is vital to get diagnosed, and treated properly with medical care.

After you are diagnosed, make sure you have regular follow-ups with your health care provider, take medications prescribed to you to lessen your risks, and manage your symptoms. Due to the fact people with PCOS are at a higher risk of other health conditions, please keep your health a top priority. If you cannot afford insurance or care for any reason, please check out HRSA or NeedyMeds to find free/low-cost/sliding-scale clinics around your area.