What is Polycystic Ovarian Syndrome?
Polycystic ovarian syndrome (PCOS) is caused by an imbalance in a female’s androgen hormone levels. This hormonal imbalance can cause a number of issues, including difficulty achieving pregnancy by creating an irregular menstrual cycle.1 During ovulation, females with PCOS do not create all the necessary hormones for their eggs to fully mature. This causes some of the eggs to remain in the fluid-filled sacs in which they were produced, which leads to the formation of cysts in the female’s ovaries. These cysts are not harmful but can create hormone imbalances, making PCOS the most common cause of female infertility.2
Causes of PCOS
The cause of polycystic ovarian (or ovary) syndrome is unknown; however, certain factors such as genetics or insulin levels may play a vital role.1 One of the main underlying issues marking this condition is a hormonal imbalance. The body overproduces androgen (a male hormone that females also produce at low levels) which impedes the production of hormones that accompany ovulation, such as progesterone. Both progesterone and estrogen are sex hormones that are imbalanced in females with PCOS.3 Experts have concluded that the following factors may influence this syndrome:
- Excess insulin: Insulin allows your body to use the sugars that you ingest as energy. It is a hormone produced in the pancreas that gives your cells the ability to process and utilize sugar. If you have an insulin resistance (type 2 diabetes), your body cannot process insulin effectively and your pancreas produces excess amounts of this hormone in order to get the proper amount of glucose (sugar) to your cells. Excessive insulin may result in the ovaries producing more androgen, which in turn affects ovulation.3
- Low-grade inflammation: Inflammation is when a body’s white blood cells produce substances to fight infection. Research has shown that many females with PCOS are also at an increased risk for coronary heart disease and type 2 diabetes. Those conditions often result in low-grade inflammation which may influence polycystic ovaries to produce more androgen.
- Genetics: Researchers are studying the possibility that certain genes are linked to PCOS, based on the fact that a female is more likely to have this condition if her mother or sister has it too.4
While the exact cause of PCOS is uncertain, each of the aforementioned factors may play a key role in the presence of this condition.
Symptoms of PCOS
PCOS affects females as young as eleven years of age. Between 1 in 10 and 1 in 20 females of childbearing age have PCOS. This syndrome affects up to 5 million females in the United States.4 Signs usually appear soon after the female’s first menstrual cycle. However, the syndrome may also develop later in life, especially after a considerable weight gain. One of the main consequences of this syndrome is an excess production of androgen, which is produced only in small amounts in unaffected, healthy females. This hormone imbalance can affect females’ bodies in several ways.2 It is possible that one or more of the following symptoms will accompany a diagnosis of PCOS:
- Infertility due to lack of ovulation
- Irregular, infrequent, and/or absent periods
- Cysts in the ovaries
- Anxiety or depression
- Weight gain (especially around the waist)
- Excess hair growth (on the face, chest, stomach, back, and tops of thumbs and toes)
- Acne and/or oily skin
- Dark patches of skin (on neck, arms, breasts, or thighs)
- Thinning hair
- Skin tags (excess flaps of skin in the armpits or neck area)
- Pelvic pain
PCOS manifests itself differently in many females who are diagnosed, so it is possible for a female to experience any mixture of the formerly mentioned symptoms if she is dealing with this condition.
How PCOS Affects the Menstrual Cycle
The hormonal imbalance that accompanies PCOS is the main factor influencing the irregularity or absence of menstruation. The body produces excess androgens which affects the development and release of eggs during ovulation. This process usually starts in the ovaries, where eggs are produced. They begin as small fluid-filled sacs called follicles or cysts. This follicle builds up fluid as an egg develops inside. Normally, when the egg fully matures the follicle ruptures and releases the egg which then travels down the fallopian tube to the uterus to be fertilized. However, in females with PCOS the excess androgens disrupt this process. The result is that the follicles start to grow but never properly rupture and release the egg, so they remain as cysts.5
These cysts continue to build up fluid and fail to release eggs, which then results in a lack of ovulation and a lack of production of the hormone progesterone. Without progesterone, a female’s menstrual cycle will be irregular or absent.4
PCOS during Pregnancy
PCOS is the most common cause of female infertility; this is because it disrupts the natural cycle of ovulation. There are fertility medications that help alleviate complications that may arise during pregnancy. They include Clomiphene, Metformin, and Gonadotropins (more details on this below in the Treatment section of this article).3 When a female with PCOS can become pregnant, she often faces a much higher risk of the following complications:
- Gestational diabetes
- Premature delivery
- Preeclampsia (pregnancy-induced high blood pressure)
A female with PCOS may not ever experience these complications, and for females who do find themselves facing these challenges, there are a number of effective resources available.
Effects of PCOS at Menopause
A few of the symptoms caused by PCOS (such as irregular or infrequent periods) are no longer a concern once a female reaches menopause. However, PCOS affects many systems in the body so oftentimes these symptoms will persist even though ovarian function and hormone levels change during menopause. Following menopause, excess hair growth continues and male-pattern baldness (or thinning hair) worsens. Furthermore, the risk of other health complications such as strokes, diabetes, and heart attacks increase.2
Females with PCOS have a higher risk of developing other serious health conditions.1 These include the following:
- Hypertension (high blood pressure)
- High cholesterol
- Heart attack
- Sleep apnea (when a person stops breathing periodically during sleep)
- Breast cancer
- Endometrial cancer
- Anxiety or depression
The effects of anxiety or depression on females with PCOS are often overlooked. Fluctuating hormones can have a profound influence on the emotional state of females with this condition.5 It is also possible that the degree of anxiousness or depressive symptoms some female feels may increase as she deals with the full impact that the symptoms of PCOS may have on her life. It is important and very helpful for females with PCOS to communicate with family and friends and to consult a professional physician when dealing with these challenges.
Furthermore, the risk of endometrial cancer is especially high for females with PCOS.3 Irregular menstrual cycles and lack of ovulation means the body is still producing the hormone estrogen, but not the hormone progesterone. Progesterone is the hormone that causes the endometrial lining to shed each month. Without it, the walls of the endometrium become thicker, increasing the risk of cancer. This may also lead to very heavy or irregular bleeding when females with PCOS do get their period.4
There is not a singular test that is administered in order to diagnose PCOS. To identify this condition, a doctor will look for at least two of the following:2
- Irregular periods: This is the most common symptom. Doctors tend to look for menstrual cycles that last over 35 days, for fewer than 8 menstrual cycles in a year, for absent menstruation spanning 4 months or longer, and for prolonged periods that are either very light or extremely heavy.
- Excess androgen: A doctor can test hormone levels for excess androgen, which most commonly shows up in the form of testosterone. Other indicators of excess androgen may result in physical signs, such as excess hair growth, severe acne, or male-pattern baldness.
- Polycystic ovaries: An ultrasound can detect the presence of polycystic ovaries, which become enlarged due to fluid-filled follicles surrounding the eggs. This exam can also reveal thickened endometrial lining, which results from infrequent periods where the intrauterine lining does not get the chance to shed with menstruation.
In order to detect these symptoms, a doctor may also want to administer the following tests in order to fully confirm the presence of this syndrome:2
- Medical history: A doctor may ask about the frequency of a patient’s menstrual cycle, potential weight gain, difficulty achieving pregnancy (if they are attempting to conceive) as well as other symptoms such as hirsutism (excess hair growth), pelvic pain, or acne outbreaks.
- Blood tests: A doctor may screen for increased androgen levels (which often manifest in the form of excess testosterone in females), as well as decreased glucose levels, which may be a sign that the body is producing excess insulin (which is often an indicator of type 2 diabetes).
- Physical exam: A doctor may check a patient’s BMI (body mass index), BP (blood pressure), and waist size. They will also look for potential physical indicators such as excess hair growth (letting hair grow naturally prior to exam often aids this identification), skin tags, severe acne, signs of male-pattern baldness, or dark patches on the neck, arms, breasts, and thighs.
- Ultrasound: A doctor may administer an ultrasound, in order to detect ovarian cysts. This test is also the easiest way to measure the thickness of the endometrial lining.
While there is no single test to determine the presence of PCOS, each of these diagnostic methods help narrow down the symptoms and determine whether or not a female is being affected by this condition.
Unfortunately, PCOS has no cure, but it is important to manage one’s symptoms in order to avoid future complications. Treatments vary and depend on a number of factors including how severe a female’s symptoms are, whether or not they are trying to get pregnant, and how high their chances of getting heart disease or diabetes are. Many females will need to pursue more than one of these treatments in order to fully manage their symptoms:
- Healthy diet and exercise: A clean diet and regular exercise is recommended to all females with PCOS, especially because weight gain often exacerbates this condition. Dieting and exercising may help normalize the menstrual cycle of females who may be overweight as well as regulate blood glucose levels. Even just a 10% decrease in body weight can restore a regular period.1
- Birth control pills: Females who do not wish to become pregnant are often prescribed birth control pills. This treatment is incredibly effective and can help clear acne, reduce male hormones, and normalize the menstrual cycle.1
- Fertility medication: For females who do wish to become pregnant, the lack of ovulation caused by PCOS may make pregnancy very difficult. Other factors influencing infertility (in either the female or male partner) should be ruled out before any of these treatments is administered. The following are several treatment options that may be considered:3
- Clomiphene – stimulates ovulation; usually the first choice for patients
- Clomiphene & Metformin – respectively stimulates ovulation and helps control blood sugar levels for women with type 2 diabetes; this combination is tried if clomiphene alone fails
- Gonadotropins – stimulates ovulation (administered as shots); may increase risk of multiple births (twins or triplets)
- Diabetes medication: These medications are especially helpful to females who may be overweight or obese. This medication regulates blood sugar levels the same way normal insulin levels would as well as lowers testosterone levels. The following treatment may be considered:1
- Metformin – helps control blood sugar levels; may also aid in the slowing of unwanted hair growth and may regulate ovulation
- Anti-androgen medication: These medications reduce the number of androgens that females with PCOS overproduce. They are used to reduce unwanted hair growth and clear up acne. The following are several treatments (including medications and alternative options) that may aid in the removal of acne or excess hair:
- Spironolactone (Aldactone) – prescription pill original used to treat high blood pressure, also shown to reduce the impact of male hormones in women’s hair growth; should not be taken while pregnant or breastfeeding
- Finasteride (Propecia) – prescription pill originally used by men to treat hair loss, also shown to reduce the impact of male hormones in women’s hair growth; should not be taken while pregnant or breastfeeding
- Electrolysis (laser hair removal) – laser treatment that removes hair growth on women’s bodies
- Vaniqa – cream that removes facial hair
- Surgery: A procedure known as “ovarian drilling” may increase the chance of ovulation. During this procedure, your doctor punctures your ovary with a small needle that conducts an electric current, in order to destroy a small part of your ovary. This can lower male hormone levels and regulate ovulation. However, this solution is short-term, and treatment may only be effective for a few months.3
PCOS is a common condition in females that manifests itself in many ways, so every treatment must be established at an individual basis in order to determine the patient’s specific needs. There are a vast number of resources available to female’s with PCOS so that they may live a happy and risk-free life.
Polycystic Ovarian (or Ovary) Syndrome, commonly referred to as PCOS, is the number one condition affecting female fertility. This condition causes the body to produce excess androgens (male hormones) which in turn causes a number of symptoms, including interruptions to the regular menstrual cycle (which affects fertility), increased risks for certain cancers, anxiety and depression, as well as a number of physical manifestations. The exact causes of PCOS are unknown, but research has found that insulin levels and genetics may plan a key role. Luckily, there are a number of resources and treatments available for females with PCOS and its overall effect on a person’s life can be effectively handled with the correct treatment. And while the health prospects for a female with PCOS are optimistic, dealing with this condition can be very difficult on both a medical and personal level, so please communicate with family and friend and consult with a medical professional if you are experiencing any of these symptoms or feel you may be at risk for PCOS.
For online support visit the PCOS Awareness Association.
- “Polycystic Ovary Syndrome (PCOS).” Mayo Clinic. Mayo Foundation for Medical Education and Research, 2016. Web.
- “What is Polycystic Ovarian Syndrome?” PCOSupport. Polycystic Ovarian Syndrome Association, Inc., 2009. Web.
- “Polycystic Ovarian Syndrome (PCOS).” WebMD. WebMD, 2016. Web.
- “Polycystic ovary syndrome (pcos) fact sheet.” WomensHealth.gov. U.S. Department of Health and Human Services, 23 Dec 2014. Web.
- “What is Polycystic Ovarian Sydrome?” Health Line. Health Line Media, 2016. Web.
Last Updated: 29 December 2017.