Introduction

Polycystic ovary syndrome (PCOS) is a common hormonal disorder that affects women of reproductive age.

The name of the syndrome comes from the cysts that can form on the ovaries of women with this condition.

However, not all women with PCOS have ovarian cysts, and the cysts are not the root cause of the disorder.

In this blog, we will explore the characteristics of PCOS, its causes, symptoms, diagnosis, associated challenges, and strategies for effective management. 

What is Polycystic Ovary Syndrome (PCOS)?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that occurs due to an imbalance in the production of hormones by your ovaries, which are responsible for releasing eggs.

If you have PCOS, your ovaries produce higher levels of hormones called androgens, leading to an imbalance in your reproductive hormones.

This can cause irregular menstrual cycles, missed periods, and unpredictable ovulation.

You may also have small, fluid-filled sacs with immature eggs visible on ultrasound due to a lack of ovulation.

However, it is important to note that the presence of cysts is not necessary for a diagnosis of PCOS, and they are not dangerous or painful.

PCOS is a common cause of infertility in women and can also increase the risk of other health conditions. 

Causes

The exact cause of PCOS is not fully known. It may be associated with family history, genetics, and lifestyle. 

Some significant causes may also include:

Insulin resistance: Women with PCOS often have difficulty using insulin effectively, which leads to higher blood sugar levels and increased androgen production.

Excess Androgen: Due to the higher level of the male hormone androgen, it disrupts ovulation and menstrual cycles. 

Chronic Inflammation: Low-grade chronic inflammation is also believed to play a role in PCOS, which causes insulin resistance and other symptoms.

Symptoms

The symptoms of PCOS can vary from woman to woman, but some of the most common include:

Menstrual disorders: PCOS commonly causes irregular menstrual cycles, including oligomenorrhea (less than 9 periods per year) and amenorrhea (no periods for 3 or more months).

Infertility: This generally results directly from chronic anovulation (lack of ovulation).

High levels of masculinizing hormones: High levels of masculinizing hormones can cause a condition known as hyperandrogenism.

This condition is characterized by various symptoms, including acne, hirsutism (male pattern of hair growth, such as on the chin or chest), hypermenorrhea (heavy and prolonged menstrual periods), and androgenic alopecia (increased hair thinning or diffuse hair loss).

It is estimated that around 75% of women with Polycystic Ovary Syndrome (PCOS) experience hyperandrogenemia.

Metabolic syndrome: This tendency towards central obesity and other symptoms associated with insulin resistance, including low energy levels and food cravings, is more prevalent in women with PCOS.

Women with PCOS also have higher levels of serum insulin, insulin resistance, and homocysteine.

Acne: A rise in testosterone levels can increase the production of oil in the sebaceous glands, leading to clogged pores and acne. This can have a significant impact on a person's emotional well-being and quality of life.

Androgenic alopecia: Women with PCOS may also experience androgenic alopecia, which is a result of high testosterone levels that turn into dihydrotestosterone. This hormone clogs hair follicles, leading to hair loss and preventing further growth.

Acanthosis Nigricans (AN): A skin condition where dark, thick, and velvety patches can form on the back of the neck, in the armpits, and under the breasts.

Diagnosis

Your doctor will ask you about your medical history and symptoms and also go for a physical examination. It includes a urinary tract examination.

During a physical examination, your reproductive system is examined properly both internally and externally.

Ultrasound: The main purpose of ultrasound is to examine the size of the ovaries and detect any cysts. Additionally, this test can evaluate the thickness of the uterus lining (endometrium).

Blood tests: These tests check for high levels of hormones, such as androgens. Your healthcare provider may also test your blood glucose, cholesterol, and triglyceride levels.

Types of Polycystic Ovary Syndrome

The four types of PCOS include the following:

Insulin-resistant PCOS:  Due to high insulin concentrations in the body, it is one of the most frequent types of PCOS. It may also occur because of metabolic syndrome. The body triggers insulin resistance when the cells of the muscle and the body stop responding to insulin.

Inflammatory PCOS: Inflammatory PCOS may result from inflammation, which will further prevent ovulation, and this will eventually cause an imbalance of hormones, thereby increasing androgens in the body. Toxic environments, stress, and the consumption of inflammatory foods such as gluten may contribute to inflammation.

Post-pill PCOS: Many women who abruptly stop oral contraceptive pill consumption will be prone to post-pill PCOS. Some common post-pill PCOS symptoms include excessive hair growth, irregular periods, and acne.

Adrenal PCOS: Adrenal PCOS is also a type of PCOS with no insulin resistance, and it is also not caused by inflammation or the use of hormonal contraceptives. The way our body responds to stress is the driving force of adrenal PCOS. Women who suffer from adrenal PCOS will have higher levels of stress.

Difference between PCOS and PCOD

PCOD (Polycystic Ovary Disease) and PCOS (Polycystic Ovary Syndrome) are related conditions but have some distinctions: 

Polycystic Ovary Disease (PCOD) is a medical condition that is characterized by the development of multiple cysts on the ovaries, irregular menstrual cycles, and frequently elevated levels of androgens (male hormones) in the body. This condition is primarily an ovarian disorder.

Polycystic Ovary Syndrome (PCOS), on the other hand, is a broader syndrome that includes a range of symptoms beyond just cysts. In addition to the presence of cysts on the ovaries, PCOS also involves hormonal imbalance, insulin resistance, irregular menstrual cycles, and sometimes difficulties with fertility.

Complications Associated with Polycystic Ovary Syndrome

The complications associated with polycystic ovary syndrome are:

• Infertility
• Gestational diabetes in pregnancy and high blood pressure
• Miscarriage or premature birth
• Fat accumulation in the liver is the primary cause of non-alcoholic steatohepatitis, a severe liver inflammation
• Metabolic syndrome is 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
• Sleep apnea causes repeated pauses in breathing during the night, which interrupts sleep
• Depression, anxiety, and eating disorders
• Cancer of the uterine lining (endometrial cancer)

Treatment for PCOS

While there is no cure for PCOS, there are treatments that can help manage the symptoms.

Lifestyle changes are the first line of treatment for PCOS.

These include:

Losing weight: Even a small amount of weight loss can improve insulin sensitivity and ovulation.

Eating a healthy diet: A diet that is low in processed foods and sugar and high in fruits, vegetables, and whole grains can help regulate blood sugar levels and improve overall health.

Exercise regularly: Exercise can help improve insulin sensitivity, reduce weight, and improve mood.

Medications can also be used to treat PCOS.

These include:

Hormonal birth control: Birth control pills can help regulate periods, reduce acne, and slow hair growth.

Diabetic control medicines: This medication is used to treat type 2 diabetes, but it can also help improve insulin sensitivity in women with PCOS.

Anti-androgen medications: These medications can help block the effects of male hormones, which can reduce hair growth and acne.

Always consult with a physician before taking any medications.

Psychological Impact of Polycystic Ovary Syndrome

PCOS can also lead to other psychological impacts, including: 

• Body weight and body-image disturbances
• Sexual and relational functioning
• Femininity
• Fertility and sexuality concerns
• Health-related quality of life
• Stress

FAQs

Is PCOS a serious health issue?

Women who have PCOS are more likely to suffer major health issues. These include Type 2 diabetes, high blood pressure, heart and blood vessel issues, and uterine cancer. Women with PCOS frequently struggle with their capacity to conceive (fertility).

What other health problems can occur with PCOS?

Women who suffer from Polycystic Ovary Syndrome (PCOS) are more likely to develop diabetes, high cholesterol, and high blood pressure.

The link between PCOS and an increased risk of cardiovascular disease is not yet fully understood, but some studies suggest that women with PCOS may have a higher risk of long-term cardiovascular complications.

Additionally, women with PCOS are also more likely to experience obstructive sleep apnea.

Can PCOS be cured?

Polycystic ovary syndrome (PCOS) is a hormonal disorder that cannot be cured, but its symptoms can be managed. Available treatment options may vary depending on the severity and type of symptoms experienced by an individual.

Are there fertility treatments for women with PCOS?

Reproduction techniques like in vitro fertilisation (IVF) and ovulation induction medications can be beneficial for women with polycystic ovary syndrome (PCOS) who are experiencing difficulties in conceiving.

Conclusion

It is crucial to highlight the significance of early detection and proactive management of polycystic ovary syndrome (PCOS).

Making lifestyle changes such as maintaining a balanced diet, engaging in regular exercise, reducing stress, and getting sufficient sleep can significantly relieve symptoms and improve overall health for individuals with PCOS.

In addition, seeking medical guidance and personalized treatment plans from healthcare professionals is essential to effectively manage the condition and address its specific challenges.

Furthermore, increasing awareness and building a supportive community are important for empowering individuals affected by PCOS.

Understanding, empathy, and education can be crucial in breaking stigmas and misconceptions surrounding this condition.

References

• Johns Hopkins Medicine (2023). Polycystic Ovary Syndrome (PCOS). Available at https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos. (Accessed 19/12/2023).
  
• Healthline (2023). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment. Available at https://www.healthline.com/health/polycystic-ovary-disease. (Accessed 19/12/2023).
• Better Health Channel (2023). Polycystic ovary syndrome (PCOS). Available at https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos#causes-of-pcos. (Accessed 19/12/2023).
• Women's Health (2022). Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, Tests and Treatments. Available at https://www.webmd.com/women/symptoms-of-pcos. (Accessed 19/12/2023).
• Women's Health (2022). A Guide to PCOS, Causes, Symptoms, Treatments, Complications. Available at https://www.webmd.com/women/ss/slideshow-pcos-overview. (Accessed 19/12/2023).
• U.S. Food and Drug Administration (2023). Knowledge & News on Women: Polycystic Ovary Syndrome (PCOS). Available at https://www.fda.gov/consumers/knowledge-and-news-women-owh-blog/knowledge-news-women-polycystic-ovary-syndrome-pcos-blog. (Accessed 19/12/2023).
• Mayo Clinic (2022). Polycystic ovary syndrome (PCOS) - Diagnosis and treatment. Available at https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443. (Accessed 19/12/2023).
• NIH (2023). Polycystic Ovary Syndrome (PCOS). Available at https://www.nichd.nih.gov/health/topics/pcos.(Accessed 19/12/2023).