PCOS
PCOS
Overview
Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects women of reproductive age. It usually starts during adolescence, but symptoms may fluctuate over time.
PCOS can cause hormonal imbalances, irregular periods, excess androgen levels and cysts in the ovaries. Irregular periods, usually with a lack of ovulation, can make it difficult to become pregnant. PCOS is a leading cause of infertility.
PCOS is a chronic condition and cannot be cured. However, some symptoms can be improved through lifestyle changes, medications and fertility treatments.
The cause of PCOS is unknown but women with a family history or type 2 diabetes are at higher risk.
Scope of the problem
PCOS a significant public health problem and is one of the commonest hormonal disturbances affecting women of reproductive age. The condition affects an estimated 6–13% of women of reproductive age, and up to 70% of cases are undiagnosed.
The prevalence of PCOS is higher among some ethnicities and these groups often experience more complications, in particular related to metabolic problems.
The biological and psychological effects of PCOS, particularly those related to obesity, body image and infertility, can lead to mental health challenges and social stigma.
Symptoms
Symptoms of polycystic ovary syndrome can differ from person to person. Symptoms may change over time and often occur without a clear trigger.
Possible symptoms include:
- heavy, long, intermittent, unpredictable or absent periods
- infertility
- acne or oily skin
- excessive hair on the face or body
- male-pattern baldness or hair thinning
- weight gain, especially around the belly.
People with PCOS are more likely to have other health conditions including:
- type 2 diabetes
- hypertension (high blood pressure)
- high cholesterol
- heart disease
- endometrial cancer (cancer of the inner lining of the uterus).
PCOS can also cause anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other life areas such as family, relationships, work and involvement in the community.
Diagnosis
Polycystic ovary syndrome is diagnosed by the presence of at least two out of the following:
- signs or symptoms of high androgens (unwanted facial or bodily hair, loss of hair from the head, acne or an elevated blood level of testosterone) – after other causes for this have been excluded;
- irregular or absent menstrual periods – after other causes for this have been excluded; and
- polycystic ovaries on an ultrasound scan.
Blood tests can be used to identify characteristic changes in hormone levels, although these changes are not universal. Women with polycystic ovary syndromemay have elevated levels of:
- testosterone (an ovarian androgen hormone that influences hair growth);
- oestrogen (an ovarian hormone that stimulates growth of the womb lining (endometrium);
- luteinising hormone (LH, a pituitary hormone which influences hormone production by the ovaries and is important for normal ovulation);
- insulin (a hormone that is principally involved in utilization of energy from food); and
- anti-müllerian hormone (which is measures the fertility level of the ovaries).
When making a diagnosis, doctors also take into account that irregular periods and ovulation can be a normal part of puberty or menopause, having polycystic ovaries may run in families, and women with a family history of PCOS or type 2 diabetes are at higher risk of PCOS. In addition, the ultrasound picture is not always clear and some women with PCOS may have an ultrasound scan that does not demonstrate polycystic ovaries.
Treatment
There is no cure for PCOS, but treatments can improve symptoms.
People who have irregular periods, trouble getting pregnant or excessive acne and hair growth should speak to a healthcare professional.
Some symptoms of PCOS can be reduced through lifestyle changes. Eating a healthy diet and getting enough exercise can help reduce weight and reduce the risk of type 2 diabetes.
Birth control medicines (contraceptive pill) can help regulate the menstrual cycle and reduce symptoms. Other medicines can reduce acne or unwanted hair growth caused by PCOS.
Treatments for infertility due to PCOS include lifestyle changes, medicines or surgery to stimulate regular ovulation. In-vitro fertilization (IVF) may be used but it has some risks
Alternative
What is polycystic ovary syndrome (PCOS)?
Polycystic ovary syndrome (PCOS) is the name for set of symptoms that are related to an imbalance of hormones. PCOS affects the ovaries, as well as many other parts of the body.
People with PCOS usually have at least two of these problems:
- Not ovulating. Normally, your ovaries make the egg that is released each month as part of a healthy menstrual cycle. This is called ovulation. But with PCOS, the egg may not develop as it should, or it may not be released during ovulation. Your periods may be irregular, or you may not have them at all.
- High levels of androgens. Androgens are hormones that are important for normal male sexual development. Women normally make smaller amounts of androgens. Having higher levels of androgens can cause you to have extra body or facial hair (called hirsutism).
- Cysts in one or both ovaries. Cysts are growths that are small, fluid-filled sacs.
What causes polycystic ovary syndrome (PCOS)?
The exact cause of PCOS in unknown. Research has shown that different factors may play a role, including:
- Genetics. PCOS tends to run in families.
- Imbalances in androgen levels.
Insulin resistance. This is a condition in which your body can’t use insulin properly. Insulin is a hormone that helps move blood glucose (sugar) into your cells to give them energy. Insulin resistance can lead to high blood glucose levels
What are the symptoms of polycystic ovary syndrome (PCOS)?
PCOS often develops as young as age 11 or 12, around the time of your first period. But you can develop it later.
The symptoms can vary from person to person. Some people have few or even no symptoms. They may not realize they have PCOS until they have trouble getting pregnant. Other people may have more severe symptoms.
The symptoms of PCOS may include:
- Irregular or missed menstrual periods.
- Too much hair on the face, chest, stomach, or thighs.
- Obesity, weight gain, or trouble losing weight.
- Severe acne which may be hard to treat.
- Oily skin.
- Patches of thickened dark skin (called acanthosis nigricans).
- Infertility. PCOS is one of the most common causes of infertility. But many women with PCOS can still get pregnant.
What other health problems are linked to polycystic ovary syndrome (PCOS)?
PCOS is linked to many other health problems, including:
- Insulin resistance, which can lead to prediabetes and type 2 diabetes.
- Heart disease. Having PCOS increases your risk, and this risk goes up as you age.
- High blood pressure.
- High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol. This increases your risk of heart disease.
- Sleep apnea, a disorder that causes you to repeatedly stop breathing during sleep.
- Depression and anxiety.
Although there are links between PCOS and these conditions, researchers do not know whether:
- PCOS causes some of these problems
- Some of these problems cause PCOS, or
- There are other conditions that cause both PCOS and these other health problems
Not everyone who has PCOS will have all these problems. However, you and your health care provider may want to monitor your health for signs of them, so they can be treated early.
How is polycystic ovary syndrome (PCOS) diagnosed?
There is no specific test for PCOS. To find out if you have PCOS, your provider:
- Will do a physical exam, which will include looking for the physical signs of PCOS.
- Will ask about your medical history and family health history.
- May do a pelvic exam to check for signs of extra male hormones and to see if your ovaries are enlarged or swollen.
- May order a pelvic ultrasound to look for cysts on your ovaries and check the thickness of your endometrium (the lining of your uterus, or womb).
- May order blood tests, including tests to check your hormone levels.
What are the treatments for polycystic ovary syndrome (PCOS)?
There is no cure for PCOS, but treatments can help you manage your symptoms. The treatments may include:
- Lifestyle changes, which can help reduce many symptoms. They can also lower your risk for or help manage related health problems. These changes include:
- Medicines:
- Hormonal birth control, such as pills, shots, and IUDs, can make your period more regular. They may also help remove acne and extra facial and body hair. But you would only use them if you don’t want to get pregnant.
- Anti-androgen medicines, which block the effect of androgens. This can help reduce hair loss on your head, the growth of facial and body hair, and acne. Providers do use them to help with these symptoms, but anti-androgen medicines are not approved by the U.S. Food and Drug Administration (FDA) to treat PCOS. These medicines can cause problems during pregnancy. Your provider may have you take them with birth control (to prevent pregnancy).
- Insulin-sensitizing medicines, which are medicines that are used to treat type 2 diabetes. They improve insulin resistance and keep your blood glucose levels steady. They may also lower your androgen levels. They are not approved by the FDA to treat PCOS. But they may help with your symptoms.
- Medicines for acne. These medicines come in pills, creams, or gels.
- Treatments for hair removal, such as facial hair removal creams, laser hair removal, and electrolysis.
- Fertility treatments if you are having trouble getting pregnant. They include medicines and procedures such as in vitro fertilization (IVF).
Can endometriosis cause weight gain?
Endometriosis doesn’t cause weight gain, but the bloating and fluid retention can make you feel like you’re gaining weight.
What causes endometriosis?
Healthcare providers don’t know for sure what causes endometriosis. When you have endometriosis, tissue that is similar to the lining of your uterus grows in the wrong places. Researchers are looking for a connection between endometriosis and conditions like retrograde menstruation, immune system conditions and hormone disorders as possible factors that may lead to the condition.
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