Polycystic ovary syndrome (PCOS) is a common issue many women of reproductive age experience. It represents a set of symptoms caused by a hormonal condition that includes elevated androgen hormone levels, follicle overgrowth in the ovaries, and irregular periods. Secondary symptoms are also common, such as excessive hair growth on parts of the body where hair does not normally grow excessively in women (e.g., on the face, neck, chest), acne, infertility, or lack of ovulation in menstrual cycles.

While any woman of reproductive age can experience PCOS, the condition typically starts in adolescence. However, most women are not diagnosed until much later, as symptoms can fluctuate and become more severe over time. The origin is unknown, but a family history of PCOS can put women at higher risk, as can type 2 diabetes.

Polycystic Ovary Syndrome (PCOS) – Symptoms and Causes

PCOS is associated with other health conditions that can have long-term effects on a woman’s physical and mental well-being. While PCOS is an incurable and chronic condition, there are treatments, medications, and lifestyle changes that can dramatically improve symptoms.

The World Health Organization (WHO) reports that 8% to 13% of women of reproductive age are affected by PCOS worldwide, and 70% of women who are affected by PCOS remain undiagnosed and/or untreated. For this reason, it is important for women to become informed on the causes, symptoms, diagnosis, and treatment options for PCOS. Below, you will find information and insight on PCOS as well as tips for women managing the condition.

What Triggers Polycystic Ovary Syndrome?

The absolute cause of PCOS is not yet known, but doctors and researchers believe it originates from a combination of issues with genetics, insulin resistance, and imbalanced hormone levels.

Hormonal Imbalance

Many women who experience PCOS are found to have specific hormonal imbalances. These can include:

• Increase in Luteinizing Hormone (LH) – This hormone plays a significant role in the reproductive cycle in that it stimulates ovulation. Too much of it may have a negative effect on the ovaries.
• Increase in Testosterone – Women produce small amounts of this hormone, which is the primary male hormone. Too much of it can wreak havoc on a woman’s body and cause many of the most common PCOS symptoms.
• Increase in Prolactin – This hormonal imbalance is only found in some women with PCOS, but this is the hormone that stimulates milk from the breast glands during and after pregnancy.
• Decrease in Hormone-binding Globulin (SHBG) – This sex hormone is a protein that is found in the blood that binds to testosterone and weakens its effect.

Although these hormonal changes are well documented, the cause of PCOS remains a mystery because researchers do not know what causes the hormonal changes in some women. Some experts suggest the problem starts in the ovaries, while some believe it starts in endocrine system glands. Yet others believe it may be the part of the brain that is responsible for telling the glands how much hormone to produce. While these are all very likely possibilities, the cause of PCOS could be related to another potential hormonal issue: resistance to insulin.

Resistance to Insulin

Insulin is also a hormone. It is produced by the pancreas, and its job is to control the amount of sugar in the blood. Essentially, it assists in the transfer of glucose from the blood to the cells; the cells then break down the glucose, which is used to make energy. When someone experiences insulin resistance, it means quite literally that the tissues in the body are resistant to the effects of insulin, which means the body (the pancreas) must make more insulin to compensate for the resistance.

To exacerbate the problem, resistance to insulin and the production of too much insulin can also cause weight gain, and excess body fat leads the body to produce even more insulin. These are all contributors to PCOS and can make symptoms of PCOS worsen.

Another problem with too much insulin in a woman’s body is that it causes the ovaries to produce more testosterone, which interferes with follicle development. Follicles are located in the ovaries and are the sacs where eggs develop. Women who have PCOS often have enlarged follicles, and these conditions are not ideal for healthy, normal ovulation. As a result, enlarged follicles are not conducive to fertility. For this reason, many women with PCOS have a very hard time getting pregnant before they learn to manage their symptoms. In fact, many women who have PCOS do not get diagnosed until they approach a doctor to treat infertility.

Genetics

Doctors also believe genes are one potential contributing factor to PCOS. Sometimes, it appears that PCOS can run in the family, and when female members of an individual’s family have been diagnosed with PCOS, their risk of also developing PCOS is heightened. However, scientists have not yet identified a specific gene associated with the condition. Still, more recent research conducted on animals suggests that PCOS may be the result of chemical or genetic changes that occur when a female embryo is still inside the womb.

Symptoms of PCOS

Symptoms of PCOS often cause embarrassment for women and result in lower self-esteem and even depression. Alone, these symptoms can be embarrassing or irritating, but together, they can be debilitating – especially because many women do not know what is causing them. Symptoms of PCOS include weight gain, acne, excessive and misplaced body hair, and a skin condition referred to as acanthosis nigricans.

Acanthosis nigricans is a direct result of a resistance to insulin or too much testosterone production in the body and causes dark, velvety patches of skin, usually found in skin creases under the arms and around the neck area. The clinical term for excess body hair is hirsutism, in which hair growth is found on areas of the neck, chin, abdomen, chest, or back. Like acanthosis nigricans, hirsutism is a direct result of the overproduction of testosterone.

One of the most common symptoms of PCOS is infertility. Most women discover they have PCOS in seeking an answer to why they are having a hard time getting pregnant. A PCOS diagnosis is often a relief for most patients because while PCOS is an incurable condition, its symptoms can be managed by adjusting lifestyle, taking supplements and/or medications, and receiving proper medical care and treatment. Once PCOS is diagnosed and treated, most women can experience success in conceiving.

PCOS Diagnosis

Diagnosing PCOS can sometimes be difficult because the symptoms linked to PCOS have multiple possible causes. Furthermore, other conditions like thyroid disease, non-classical congenital adrenal hyperplasia, and other conditions mimic the clinical description of PCOS. However, there are three required criteria that an individual’s condition is measured against when diagnosing PCOS.

For a PCOS diagnosis, two of the three following criteria must be met:

• Irregular menstrual cycle
• Clinical signs or blood test results showing excessive androgens
• Polycystic ovaries

A variety of tests may be performed in the diagnosing of PCOS, as there is no one test designed specifically to detect PCOS. Diagnosis will begin with a doctor making a note of a patient’s symptoms. Next, a pelvic exam can reveal masses or growths on the reproductive organs. An ultrasound is also a good indicator of specific physical indications of the uterus and ovaries. This test uses a wand to send soundwaves to the reproductive organs via the vagina and emits images back to a computer screen to check the thickness of the uterine wall and the appearance of the ovaries.

A blood test is almost always administered when a physician is making a potential PCOS diagnosis because it measures hormone levels such as testosterone and insulin in the blood. A blood test is also important because it can help rule out other potential diagnoses. Cholesterol, triglyceride, and glucose tolerance are additional blood tests that can help confirm PCOS.

What Are the Four Different Types of PCOS?

In diagnosing PCOS, it is helpful to identify which of the four types an individual is experiencing. Type A PCOS is the most severe type and the most common type. Type D is the least severe. With proper treatment and management, it is possible for someone to move from a more serious category to a milder one.

Each type is described below.

Does PCOS Go Away?

There is no cure for PCOS, but with treatment, medication, lifestyle changes, and even alternative treatments, PCOS symptoms and the trouble they cause can be mostly alleviated if managed properly. To treat PCOS, it is recommended that individuals with a diagnosis focus on the symptom that is most concerning to them, whether it be infertility, acne, obesity, or excessive hair growth. Individuals wanting to treat PCOS symptoms should discuss which of the treatments described below are best for their medical condition.

Lifestyle Modification

Weight loss through a daily low-calorie diet and exercise can essentially maintain PCOS symptoms to the point of basically curing an individual of PCOS; however, if healthy habits and lifestyle changes stop, PCOS symptoms will return.

Physical Activity

Exercising in any form or fashion is very important in managing PCOS symptoms. Swimming, walking, cycling, jogging, or other physical activities can reduce type 2 diabetes and cardiovascular risks. They can also improve sensitivity to insulin and reduce PCOS symptoms. Exercise can also improve menstrual and ovulation cycles.

Medication

In some cases, doctors prescribe combination birth control pills to regulate periods. Birth control pills containing both estrogen and progestin decrease the production of androgens in the reproductive system and help regulate estrogen. By regulating hormones, patients can correct irregular menstrual and ovulation cycles, reduce excess hair growth, and minimize acne. Alternatively, progestin-only pills will regulate your periods but do not help to balance androgen and hormone levels.

For women diagnosed with PCOS and wanting to treat infertility, a doctor may recommend they take other medications to induce ovulation. Alternatively, for patients not trying to get pregnant but wanting to treat other symptoms of PCOS, such as acne or excessive hair growth, there are several medications and creams that can be effective in treating these symptoms. Hair removal treatments may also be effective for some individuals.

Alternative Treatments for PCOS

Many women have success in treating PCOS with alternative treatment options such as using herbal supplements like those below or others recommended by a doctor. A list of some of the most common supplements include the following vitamins and minerals:

It is important that anyone suffering from symptoms akin to those of PCOS get diagnosed and treated by a gynecology practice that has experience treating PCOS and has successfully helped patients manage symptoms. Diagnosis is important to rule out other medical conditions.

Tips for Managing PCOS

With the advice of a medical professional, it is possible to safely manage PCOS symptoms almost to the point that they are virtually unnoticeable. The treatments described above, whether used individually or in conjunction with others, seem to work well for most women with PCOS. Below are some additional tips that can increase the potential for successful management of symptoms.

• Be conscious of your diet – Even a 5% to 10% weight loss can make enough of a difference to regulate periods. A change in diet is one of the most effective ways to alleviate symptoms.
• Consider adding the following foods to your meals – Broccoli, lean protein like fish, chicken and tofu, high-fiber foods that slow digestion and lower blood sugar like almonds, arugula, and beans, and anti-inflammatory foods like tomatoes, kale, spinach, olive oil, almonds, walnuts, strawberries, blueberries, salmon, sardines, Brussels sprouts, cabbage, cauliflower, lentils, pumpkin, red and green peppers, red leaf lettuce, sweet potatoes, and winter squash.
• Avoid the following foods – refined carbohydrates, which increase resistance to insulin, like breads, muffins, anything made with white flour, sugary snacks and drinks, and pasta made with semolina or durum flour. Also, avoid inflammatory foods such as red meat and processed foods.
• Read labels and avoid anything with the following ingredients – Dextrose, high fructose corn syrup, or sucrose.
• Consume fiber – This is an excellent way for women experiencing PCOS symptoms to lose weight and reduce excessive body fat. Reducing insulin resistance will also improve all other symptoms.
• Get ample protein.
• Significantly reduce carbs.
• Visit a gynecologist regularly to help manage symptoms effectively.

Schedule a Consultation

If you believe you may be experiencing PCOS symptoms, it is crucial to schedule an appointment with a trusted gynecologist to confirm or rule out PCOS. Then, you can begin addressing the symptoms that have affected you the most. For more information regarding PCOS or to begin participating in regular gynecological exams, contact Arizona Gynecology Consultants to schedule an appointment.

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References:

1. Cedars-Sinai Medical Center. (n.d.). Polycystic Ovary Syndrome. Retrieved from
   https://www.cedars-sinai.org/blog/polycystic-ovary-syndrome.html
2. World Health Organization. (n.d.). Polycystic Ovary Syndrome. Retrieved from https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome#:~:text=Key%20facts,a%20leading%20cause%20of%20infertility
3. NHS UK. (n.d.). Polycystic Ovary Syndrome (PCOS): Causes. Retrieved from
   https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/causes/#:~:text=The%20exact%20reason%20why%20these,by%20the%20resistance%20to%20insulin.
4. Mayo Clinic. (n.d.). Polycystic Ovary Syndrome (PCOS): Diagnosis & Treatment. Retrieved from https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443
5. Harvard Health Publishing. (2021, April 29). Polycystic Ovarian Syndrome and the Skin. Retrieved from https://www.health.harvard.edu/blog/polycystic-ovarian-syndrome-and-the-skin-202104292552#:~:text=Both%20of%20these%20hair%20issues,around%20the%20neck%20and%20underarms.
6. World Health Organization. (n.d.). Polycystic Ovary Syndrome. Retrieved from
   https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20affects,a%20leading%20cause%20of%20infertility.

Polycystic ovarian syndrome (PCOS) is the most common hormonal disorder found in women. PCOS can be a metabolic dysfunction causing hormonal imbalances or hormonal imbalance causing metabolic dysfunction. PCOS symptoms may be metabolic alone (metabolic X syndrome) or they may be hormonal alone and not affect the metabolism.

Understanding which type of PCOS you have will help guide you to the right treatment options.

What Is Polycystic Ovary Syndrome (PCOS)?

PCOS is a condition in which either:

• the ovaries produce abnormal amounts of androgens (testosterone, male sex hormone),
• hyperinsulinemia (too much insulin in the blood stream) binds with luteinizing hormone (from the pituitary gland- the center of our brain that communicates with the ovaries on which hormone to produce) which converts to testosterone,
• or, rarely, it may be caused by a lesion or mass on your ovary or adrenal glands.

The Signs and Symptoms of PCOS:

Please note that symptoms vary, you may experience one or all of the symptoms above.

PCOS Treatment Options:

• Lifestyle changes-
  • a dietary (low carbohydrate) plan that stabilizes your insulin levels can prevent the conversion of testosterone
  • Low intense workouts for >45 min/ 5 days a week (such as walking, yoga)
• Metformin- helps stabilize insulin levels, making hormones more usable in the body
• Spironolactone – helps with acne, lowers testosterone
• Weight loss- a 5% reduction in your BMI (body mass index) can improve PCOS
• Stress reduction (acupuncture, massages)
• Specific hormonal birth control pills- that bind with the testosterone and lower the levels. This is a temporary fix that is often utilized to improve future fertility
• Progestin releasing IUD- this does not treat systemic symptoms but rather protects the uterus from hyperplasia (pre-cancer) and cancer of the uterus
• Cyclic progestin- to induce a monthly cycle

These treatments can be used together or individually depending on your type of PCOS and your healthcare goals.

Frequently Asked Questions About Polycystic Ovary Syndrome

Women often have similar questions when it comes to PCOS symptoms and treatment. In addition to the important questions answered above, we’ve prepared some additional FAQs to help you better understand this hormonal disorder.

What is considered an irregular period?

Great question. To answer this is it important to note that periods are tracked from the beginning of one cycle (first day you bleed) to the beginning of the next cycle. If this is less than 24 days apart or longer than 38 days apart then this is irregular. It is common to have a few day differences between the months but routinely skipping or having many periods is concerning and should be evaluated with a healthcare provider.

Can I get pregnant with PCOS?

Possibly. It depends on how well controlled it is. Often, women have oligomenorrhea (a few periods per year) and may ovulate during that time. A metric healthcare provider often reviews to determine ovulation status is the free testosterone lab value, how often you are having a menstrual cycle, and your BMI (body mass index). Do not be discouraged there are several holistic approaches, conservative medicines, and lifestyle changes you can make that can improve your symptoms and help you achieve pregnancy.

How do you get diagnosed with PCOS?

An evaluation with a healthcare provider and taking a detailed history including menstrual (period) history, vitals (blood pressure, weight), medical history, family history, and physical exam. Testing includes- fasting morning blood work and a pelvic ultrasound. If you first period was less than eight years ago the work up may not include a pelvic ultrasound.

I have PCOS, now what?

A follow up visit is needed to review your results and determine the best treatment for your desired healthcare goals. There is not a “one size fits all” treatment for PCOS. During this educational visit, your healthcare provider will review the type of PCOS you have and provide information of the best treatment options for your healthcare goals. Once you have chosen your chosen treatment. You will be followed (either every month or every three months) to monitor your progress and ensure your healthcare goals are being met.

Additional screening may be completed at these visits because individuals with PCOS are more likely to suffer from depression, have sleep disturbances, experience weight gain and pelvic pain.

I was diagnosed with PCOS. I am transgender (FTM), and I want elevated testosterone but how can I control my PCOS?

Depending on your symptoms and healthcare goals, your provider will help you with treatment options that controls the symptoms you do not want while promoting your overall health. Often this involves treatment with non-hormonal or localized treatment options that protect you from cancer.

Are there supplements I can take to help with my PCOS?

Yes. There are several great supplements. The top three most commonly recommending are:

• Omega 3- lowers testosterone and decreases inflammation
• Inositol – improved insulin and blood sugar levels
• Chromium- stabilizes insulin levels

Does PCOS resolve with menopause?

No, PCOS continues to affect women after menopause. Treatment goals are focused on health promotion such as prevention or reversal of diabetes or hypertension (high blood pressure), weight management, and control of menopausal symptoms (hot flashes, night sweats, insomnia).

Does PCOS require surgery?

Surgery can be an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.

Is there a medication that can help with hair removal?

A few treatments can help get rid of unwanted hair or stop it from growing.

Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis can get rid of unwanted hair on your face and body.

Getting Help With PCOS

Although the exact cause of PCOS is unknown, an early diagnosis and professional treatment along with lifestyle changes, such as weight loss, may reduce the risk of long-term complications. Prolonged treatment may lead to additional health issues such as 2 diabetes and heart disease.

Make an appointment with your doctor if:

• You have missed more than one period and you are not pregnant
• You have other symptoms of PCOS, such as the growth of hair on your face and body
• You’ve been actively trying to get pregnant for a year or more but have not been successful
• You’re experiencing excessive thirst or hunger, have blurred vision or unexplained weight loss – all of which are symptoms of diabetes.

If you are concerned about your symptoms and don’t already have a doctor you can talk to, please reach out to us. Our team of clinicians and surgeons specialize in all aspects of women’s health and we are dedicated to practicing excellence in women’s care.