PCOS: Symptoms and Complications of Polycystic Ovary Syndrome & How to Treat
Polycystic ovary syndrome is a hormonal condition common in women of reproductive age, resulting in menstrual abnormalities and an excess of androgen testosterone.
What is polycystic ovary syndrome?
Polycystic ovary syndrome (PCOS) is a hormonal condition very common in women of reproductive age, resulting in menstrual abnormalities as well as an excess of the androgen testosterone. PCOS can affect a woman's overall health and appearance and often has a significant effect on fertility.
Beyond the presence of enlarged ovaries with surrounding follicles, ovaries will function improperly by failing to carry out ovulation in many cases. Other symptoms include irregular menstrual cycles, excess hair growth on the body or hair loss on the scalp, acne, darkening of the skin, and excess androgens in the blood.
Treatments focus on addressing your individual symptoms through medication and possible lifestyle adjustments.
You should visit your primary care physician to discuss your symptoms.
Symptoms of polycystic ovary syndrome
Signs and symptoms of PCOS can develop at any time after a woman begins her menstrual cycle. Some women experience PCOS at the beginning of puberty, while others develop PCOS later in response to substantial weight gain, for example.
Symptoms of PCOS can vary from woman to woman. There is a list of criteria and the diagnosis of PCOS is made when at least two of the following signs are met. Symptoms can be categorized as related to the menstrual cycle and ovaries, skin symptoms, and androgen-related symptoms.
Menstrual and ovarian symptoms
Irregularity in the menstrual cycle is the most common symptom of PCOS.
- Irregular menstrual cycles: Women with PCOS experience a wide range of variability in their cycles including missed, infrequent, or prolonged menstrual cycles. Some women have fewer than eight or nine periods per year. Others have periods characterized by very heavy bleeding or no bleeding at all.
- Polycystic ovaries: In many cases, the ovaries are enlarged and contain follicles that surround the eggs. This also causes the ovaries to fail in their proper function.
Imbalanced hormones, such as an excess of androgens discussed in the next section, can lead to certain skin-related symptoms such as:
- Acne: Women with PCOS also experience increased acne on their faces, back, and arms.
- Acanthosis nigricans: This is a term for darkening of the skin, particularly along the neck creases, in the groin, and underneath breasts. The skin often has a velvety, thickened appearance.
Excess androgen is a symptom of PCOS in itself and is often looked for in blood tests. Due to the excess of androgen, the following male-patterned symptoms may occur.
- Hirsutism (excess hair growth): This is characterized by hair growth on women in places where men normally have hair growth, such as the face, chin, and arms. Hirsutism affects up to 70 percent of women with PCOS.
- Male pattern baldness: This is characterized by thinning hair and hair loss on the scalp.
Since PCOS involves dysfunction of the reproductive cycle and hormonal imbalances, the complications can be varied and affect all aspects of health. Complications of PCOS can include:
- Infertility: In other words, an inability to get pregnant.
- Pregnancy complications: This includes miscarriage or premature birth.
- Metabolic syndrome: A cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease.
- Conditions associated with obesity: Such as diabetes, sleep apnea, or abnormal uterine bleeding.
- Nonalcoholic steatohepatitis: This is severe liver inflammation caused by fat accumulation in the liver.
- Endometrial cancer: The presence of PCOS is sometimes associated with the development of endometrial cancer.
- Depression: The stresses of such complications can cause depression and anxiety, as well as eating disorders given that PCOS is associated with unintentional weight gain.
Causes of polycystic ovary syndrome
The exact cause for PCOS is not fully understood, but research has shown that PCOS is a multifactorial condition that seems to be associated with genetics, increased androgen levels, and increased insulin levels. It may also be helpful to know a bit about the female reproductive system versus what occurs with PCOS.
The female reproductive cycle
This is a complex sequence of hormone changes and events all with the goal of creating and sustaining the ideal environment for a potential fetus.
- The ovaries begin the cycle: The ovaries produce a key hormone, called estrogen, that initiates the cycle, and are also where all female reproductive eggs, also called oocytes, are produced and stored.
- Ovulation: In this phase, the oocytes are released and transported each month to the fallopian tube for potential fertilization by male sperm.
- With PCOS: The oocyte either does not develop as it should or is not released during ovulation, resulting in problems such as irregular periods, development of cysts in the ovaries, and infertility.
Increased androgen levels
As mentioned above, the ovaries produce a hormone called estrogen vital to the female reproductive cycle. Estrogen is often referred to as the "female hormone." In addition, the ovaries also release small amounts of "male hormones," called androgens. In women with PCOS, the ovaries release more androgens than normal. Higher than normal androgen levels in women can prevent the ovaries from releasing an egg during each menstrual cycle (ovulation), and result in the male-patterned symptoms of PCOS such as excess hair growth and acne.
Increased insulin levels
Insulin is a hormone released from the pancreas that allows cells to take glucose from the blood and use it as energy. In some conditions, the body's cells become resistant to insulin and do not respond normally to its action. Cells cannot take up glucose properly and it builds up in the blood. This causes a release of more insulin from the pancreas. Studies suggest that excess insulin increases androgen production, causing the difficulties in ovulation discussed above.
Who is most likely to be affected
PCOS can occur in all women of reproductive age, but the following factors can increase risk of developing the condition:
- Diabetes: Since higher insulin levels are thought to be a cause of PCOS, people with conditions such as Type I and Type II diabetes are at increased risk.
- Obesity: Being overweight or obese is associated with insulin resistance and development of Type II diabetes.
There is no universal cure for PCOS; rather, treatment focuses on managing your individual concerns, such as infertility, hirsutism, acne, or obesity. Specific treatment involves strategies such as lifestyle changes, but your physician will typically prescribe medications that can also help control your symptoms.
Lifestyle changes that can be helpful in treating PCOS include:
- Maintaining a healthy weight: Weight loss can reduce insulin and androgen levels and may restore ovulation. Losing weight or keeping a healthy weight may also help with infertility and to increase the effectiveness of medications your physician may recommend.
- Participating in physical activity: Exercise helps lower blood sugar levels. If you have PCOS, increasing your daily activity and participating in a regular exercise program may treat or even prevent insulin resistance and help you keep your weight under control.
There are many medications available to target specific dysfunctions caused by PCOS such as:
- Birth control or progestin therapy: Your physician may prescribe medications such as combination birth control pills or progestin therapy. Birth control pills can decrease androgen production and regulate estrogen, as well as lower the risk of endometrial cancer. Progestin therapy can also protect against endometrial cancer.
- To treat hirsutism: Hirsutism can also be treated indirectly by the medications above, as well as specific medications that slow facial hair growth such as eflornithine (Vaniqa).
- To address ovulation problems: There are many medications that can help stimulate your ovaries and trigger ovulation, such as clomiphene (Clomid) and letrozole (Femara).
When to seek further consultation
If you notice irregularity in your menstrual cycle, hirsutism, acne, or are experiencing infertility, make an appointment with your physician promptly.
Questions your doctor may ask to diagnose
- Have you been feeling more tired than usual, lethargic or fatigued despite sleeping a normal amount?
- Are you sexually active?
- Have you had any changes in your weight?
- Do you have trouble sleeping?
- Do you have painful periods?
Self-diagnose with our free Buoy Assistant if you answer yes on any of these questions.
Dr. Gambrah-Lyles is a resident pediatrician at the Children's Hospital of Philadelphia. She is a graduate of the University of Pennsylvania Perelman School of Medicine (2019). She graduated cum laude and received her undergraduate degree in Biochemistry and Spanish from Washington University in St. Louis (2013). Her research explores the intersections between neurology, public health, and infectious disease. She has investigated nutrition and cerebral palsy in Botswana, and completed a year-long project in Brazil, researching growth and developmental outcomes of Zika virus infection in pediatric patients as a Doris Duke International Scholar. Dr. Gambrah-Lyles speaks four languages, loves staying active, and enjoys sharing her love for medicine through teaching and writing.
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