What is PCOS? Many people who are diagnosed with Polycystic Ovarian Syndrome aren’t even sure how to fully answer this question. PCOS is largely underdiagnosed and misunderstood. So let’s dive in to understand what is PCOS, how to know if you may have it, getting diagnosed, and prospective treatments.
What is PCOS?
PCOS is a common reproductive condition affecting hormone levels in some people with periods. PCOS is an imbalance in hormones specifically resulting in high androgens (a group of hormones that includes testosterone). Androgens are typically lower in a person’s body when PCOS is not present, meaning PCOS carries symptoms as a result of these high hormones.
Common PCOS Symptoms
Some common symptoms of PCOS are¹:
Missed periods, irregular periods, light periods (due to missed/irregular ovulation)
Cysts on the ovaries causing pain
Excess body hair growth as well as hair growth on chest, chin, stomach, back
Weight gain with difficulty to keep weight off
Acne
Hair thinning/loss
Fertility struggles
Darkened/thickened patches of skin on the neck, armpits, and under the chest.
PCOS Characteristics
Irregular Ovulation
A PCOS menstrual cycle often functions differently than the average cycle. Due to the hormonal imbalance, many people with PCOS will not ovulate regularly. To have a menstrual period, our body must ovulate. If the body isn’t ovulating or is ovulating late, this results in late or missed periods. This explains why some people with PCOS experience infertility as their body is not regularly releasing eggs. (If you’re not doing so already, tracking your period helps to monitor symptoms.)
Insulin
As discussed above, there are a few contributing factors to these anovulatory (irregular/missed) cycles, including insulin resistance. Insulin is a hormone that plays an important role in processing sugar but also acts as a signal to the ovaries to make testosterone. This means that a high amount of insulin floating around the body signals the overproduction of androgens like testosterone. This excessive testosterone results in slowed/stopped release of eggs for ovulation, contributing to those anovulatory cycles.
Ovarian Cysts
Cysts are also related to the irregular cycles in PCOS. When the follicles in the ovaries aren’t releasing eggs, the follicle continues to grow which results in cysts forming. Not everyone with PCOS will have cysts, but they are common with this condition and can result in pain.
In summary, a person with PCOS has difficulty regulating hormones which result in an excess of Androgens, triggering a waterfall effect of symptoms when not managed.
What Causes PCOS?
The exact cause of PCOS is unknown, but there are a few thoughts on contributing factors.
Insulin Resistance
Many people with PCOS experience insulin resistance, which plays a large role in the hormonal imbalance. This often presents as the body has no trouble making insulin, but difficulty utilizing that insulin, resulting in overproduction. This overproduction of insulin leads to higher androgen levels.
Stress
High stress levels and inflammation in the body have also been linked to PCOS. When the adrenal glands (our stress center in the body) become fatigued, it can send signals for excess testosterone production, contributing to PCOS. Some people with PCOS may not even have insulin resistance and may find that stress and inflammation in the body is the direct link to their excess androgen production!
Genes
It’s also thought that PCOS may have hereditary links. Studies have found that insulin resistance may run in families’ genetics, being passed down as a contributing factor to PCOS¹-³.
It’s important to note that PCOS is not your fault. If you have PCOS, there’s nothing you did to bring this upon yourself, it’s something that just is.
How is PCOS Diagnosed?
The first step a doctor generally takes in diagnosing PCOS is ensuring the patient meets two of the following three criteria:
Irregular cycles
Symptoms of excess androgens (refer to symptoms listed above such as excess body hair)
Cysts present on the ovaries
A practitioner may go through several steps to gather this information but typically includes:
an in-depth intake of the menstrual cycle and family history
physical testing may be completed to further gain knowledge on what’s going on inside. This may include blood work to check markers of inflammation, insulin, glucose, and thyroid hormones.
an ultrasound will also possibly be done to identify if any cysts are present on the ovaries/uterus⁴.
The more information a practitioner can gather the better. PCOS is not always the cause of irregular periods and may be caused by other health conditions. By gathering as much knowledge as possible to confirm PCOS, they can ensure an accurate diagnosis.
How is PCOS Treated?
PCOS is a lifelong chronic condition, and while there isn’t a cure, there are many options to manage it and improve symptoms. The most optimal treatment for PCOS may differ from person to person as the root cause of the PCOS must be treated (eg. insulin resistance, inflammation, etc.). The goal of treating PCOS is both to manage current symptoms and to prevent future complications from the condition.
While treatment plans may vary these are a few common options to manage PCOS:
Birth Control
For somebody not actively trying to conceive, birth control may be a recommended option in the management of PCOS. This is often recommended to stabilize the person’s hormones to reduce cyst formation, improve chances of regular ovulation in the future when off birth control, and mask symptoms of PCOS. When unmedicated, PCOS hormones may be like a roller-coaster wreaking havoc, birth control acts to tame those peaks and drops of hormones. Due to the reduction in androgens from taking hormonal birth control, symptoms like acne and excess body hair may lessen. Of course, birth control brings its own risks and side effects so it’s important to collaboratively talk with your health provider on what’s best for you.
Ovulation Induction Medication
For somebody who is actively trying to conceive medications such as Metformin may be recommended to bring on ovulation. These medications can carry their risks as well, but for someone experiencing fertility struggles with PCOS may be the best plan of management.
Lifestyle & Nutrition Changes
Stress and diet play a large role in PCOS and the symptoms that come along with it. Lifestyle changes to mitigate high stressors can have a big impact. For some people, this may mean psychotherapy, for others a change in day-to-day life and work.
As discussed, insulin plays a large role in PCOS, meaning nutrition changes may help manage PCOS symptoms. Many people with PCOS find reducing sugars/carbs may help their insulin-resistant PCOS. Reinforcing good eating habits with whole foods such as fruit, veggies, lean proteins, and good fats is a positive way to eat. It may be beneficial for a person with PCOS to work with a dietician or holistic nutritionist who specializes in hormones to best manage their nutrition to work in harmony with their hormones.
Other Medications
Other medications, herbs, or supplements may be recommended by your trusted health provider to manage symptoms like acne and hair loss/excess growth.
Some people will work with alternative health practitioners and naturopathic doctors to manage their PCOS as well if pharmaceuticals are not the desired route. This is up to each person on what they feel is right for them.
What Do I Do if I Think I Have PCOS?
If you think you may have PCOS it’s important to advocate for yourself to your doctor. PCOS is often under-diagnosed and written off as ‘normal symptoms’, but there are treatments to help you feel better once it’s identified!
Here are a few next steps to take:
Book an appointment with your health provider (request a double appointment slot if you have lots of questions!)
Be prepared to bring as much tracking info as possible to advocate for yourself. This may include cycle length, frequency of ovulation/periods, skin changes (breakouts/timing/location), digestion, and weight fluctuations.
Before your appointment, write down questions you have so you don’t forget any.
Feel free to bring a pen/paper to your appointment to write down anything your doctor mentions that you may want to look further into yourself.
Remember that you can contact your provider at any time for further questions/testing!
Ask for a second opinion/referral out if they do not pursue further testing.
If you do receive a diagnosis, ask to be given some information on what PCOS is and the plan going forward to manage it.
References
Rocha, A., Oliveira, F., Azevedo, R., Silva, V., Peres, T., Candido, A., . . . Reis, F. (2019, April 26). Recent advances in the understanding and management of polycystic ovary syndrome. Retrieved May 10, 2021.
Norman, R., Masteres, S., & Hague, W. (1996, December). Hyperinsulinemia is common in family members of women with polycystic ovary syndrome. Retrieved May 10, 2021.
Rosenfield, R., & Ehrmann, D. (2016, October). The pathogenesis OF polycystic ovary Syndrome (PCOS): The hypothesis of Pcos as Functional ovarian Hyperandrogenism revisited. Retrieved May 10, 2021.
Bani Mohammad, M., & Majdi Seghinsara, A. (2017, January 1). Polycystic ovary syndrome (pcos), diagnostic criteria, and amh. Retrieved May 10, 2021.