Polycystic ovarian syndrome, or PCOS, is a shockingly common condition, affecting as many as 10% of women in the US. Unfortunately, there is still relatively little known about it – as many as 50% of people who have it don’t know that they do. We do know that it is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance. There is also an increased production of androgen and/or testosterone, all of which leads to the growth of several ovarian cysts (benign masses on the ovaries). Experts still don’t know exactly what causes it, but we do know a few key factors.
PCOS is a hormonal disorder.
Your ovaries normally produce some “male” hormones called androgens, but women with Polycystic Ovary Syndrome make too much. This can cause missed periods, thick and excess body hair (hirsutism), weight gain, and acne. Excess androgens also interfere with ovulation: each cycle, a follicle is supposed to break open and release a mature egg. In women with PCOS, that doesn’t happen – instead, the follicle sticks around as a tiny cyst. The cysts themselves produce androgen, so it’s not clear if they’re what’s causing PCOS or if they’re the result of having too much androgen to begin with.
Researchers also think insulin may be linked to PCOS (insulin is the hormone that controls the change of sugar, starches, and other food into energy for the body to use or store); many women with PCOS have too much insulin in their bodies because they have problems using it correctly. Insulin resistance can cause increased androgen levels, but doctors are still researching whether it works the other way around (having too much androgen causes insulin resistance). Either way, doctors have found the diabetes drug metformin helpful in controlling PCOS symptoms, as well as a low glycemic diet.
There’s more to PCOS than cysts.
PCOS is a pattern of symptoms, and the hallmark cysts are just one of them. Your doctor can spot these cysts on an ultrasound, but they’re often the last piece of the PCOS puzzle. More likely, your doctor will initially start testing for PCOS (perhaps with blood tests to measure hormone levels) because of other telltale symptoms, like irregular periods, excessive body hair, and acne. There are other potential symptoms, including:
- Infertility because of not ovulating.
- Infrequent, irregular, or absent menstrual periods
- Hirsutism — increased hair growth on the face, chest, stomach, back, thumbs, or toes
- Acne, oily skin, or dandruff
- Weight gain or obesity, usually with extra weight around the waist
- Male-pattern baldness or thinning hair
- Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
- Skin tags — excess flaps of skin in the armpits or neck area
- Pelvic pain
- Anxiety or depression
- Sleep apnea — when breathing stops for short periods of time while asleep
PCOS is the leading cause of infertility in women.
Many women don’t realize they have PCOS until they try to become pregnant and their irregular periods go from being an inconvenience to an actual problem. If you don’t get a period every month, then you’re not ovulating every month; so the chances of getting pregnant go down. You may need help from a fertility doctor or ob-gyn. Most women with PCOS still have plenty of healthy eggs, so it’s often just a matter of your doctor helping you get your cycle back on track.
Weight loss may be the best medicine.
Obesity doesn’t cause PCOS, but there’s a significant overlap between the two conditions. The theory is that obesity contributes to insulin resistance, which boosts androgen levels and can make PCOS symptoms worse. Losing just 5% body weight will have an impact on a woman’s whole metabolic profile. So if you’re currently at 200 pounds, losing just 10 could significantly reduce your symptoms and help you get pregnant. If you aren’t trying to conceive, oral contraceptives can relieve symptoms by regulating your menstrual cycle and hormone levels.
Treating PCOS right away can prevent serious health risks.
PCOS symptoms are relatively mild, so if you aren’t trying for a baby, you may not be inclined to rush to the doctor. Unfortunately, however, ignoring PCOS symptoms can make them more aggressive: irregular periods may increase the risk of uterine cancer, rogue body hair can get coarser, acne can cause scarring, and weight can become more difficult to manage.
Make an appointment today for a consultation with Dr. Ghayouri, a leading PCOS doctor in San Diego.