Polycystic Ovarian Syndrome

Polycystic Ovarian Syndrome (PCOS) is a prevalent hormonal condition among reproductive-age women. It is marked by two or more of the following:

  • Irregular periods;
  • Hyperandrogenism (a woman manifests many physical features of a man);
  • Polycystic ovaries (multiple cysts in the ovaries).
Last Updated: February 21, 2024

PCOS is the most common hormonal disorder in women of childbearing age worldwide. Depending on the diagnostic criteria, it affects anywhere from 5% to 15% of women.

PCOS doesn't merely affect the reproductive system. In fact, it raises a woman's chance of life-threatening conditions. For example, PCOS causes metabolic syndrome (problems with the breakdown and synthesis of compounds in the body), and type II diabetes. Further, in some women, PCOS causes endometrial hyperplasia (or thickening of the uterine lining), eventually leading to endometrial cancer. Lastly, women with PCOS may have sleep difficulties like sleep apnea and have an increased risk for depression.

PCOS is caused by several factors that interact with one another, resulting in a set of symptoms. These include insulin resistance, high testosterone levels, and an irregular menstrual cycle. In insulin resistance, there is too much insulin; as a result, androgen production will increase. Excess androgen leads to ovulation problems—ovulation is a process when the ovary releases eggs. Other sources also say that heredity plays a role in women with PCOS.

Common signs and symptoms include:

  • Menstrual problems such as no bleeding, infrequent, heavy, or unpredictable periods;
  • Infertile;
  • Obesity. Four out of five PCOS patients are obese;
  • Hirsutism means women have too much hair on their face, chest, stomach, or upper thighs. More than 7 out of 10 women with PCOS are affected by hirsutism;
  • Severe acne or acne that starts after puberty and doesn't clear up with the usual treatments;
  • Oily skin;
  • Acanthosis nigricans or patches of thickened, velvety, darkened skin;
  • Ovaries with fluid-filled sacs.

Most standards consider that a woman has PCOS if she has fulfilled two criteria: chronic anovulation (absence of eggs), clinical or biological hyperandrogenism (excessive hormones), and polycystic ovary morphology without the additional disease. However no single test can diagnose PCOS, but the following are done based on symptoms.

  • Pelvic exam. A pelvic exam checks for lumps, growths, and other changes in reproductive organs.
  • Bloodwork. Blood tests measure hormones. This testing can rule out menstruation difficulties or high androgens that mimic PCOS. Fasting cholesterol and triglyceride levels may also be checked. Glucose tolerance tests examine the body's sugar response (glucose).
  • Ultrasound. An ultrasound scans the ovaries and uterine lining, where a probe is inserted inside the uterus. 

Treatment

PCOS treatments vary. Each woman's treatment is based on symptoms, health issues, and pregnancy plans.

To manage periods, a doctor may recommend the following:

  • Combination of contraceptives. Combination estrogen-progestin pills control estrogen and reduce androgen production. 
  • Progestin. Progestin can regulate periods and prevent endometrial cancer if taken for 10 to 14 days every 1 to 2 months. 

To address ovulation problems, the following can be prescribed:

  • Clomiphene, an oral anti-estrogen that is taken at the start of the period.
  • Letrozole, a breast cancer drug that can stimulate the ovaries.
  • Metformin for insulin resistance
  • Gonadotropins as injectable hormones.

To address excessive hair growth or improve acne:

  • Birth control pills to decrease androgen production, causing excessive hair growth and acne
  • Spironolactone, a drug that prevents the effects of androgen on the skin, including excessive hair growth and acne.
  • Eflornithine to slow down facial hair growth.

Keep weight in a reasonable range. When you lose weight, your insulin and androgen levels can go down. It may also make ovulation happen again. Join a weight loss program and consider having a nutritionist-dietician for weight goals. Similarly, limiting carbohydrates is instrumental in controlling the symptoms. Insulin levels might go up if you eat a lot of carbs. Choose complex carbohydrates, which raises blood sugar level more slowly. Fruits, vegetables, whole grains, cooked dry beans, and peas are all excellent sources of complex carbs.

Another way of control is exercise. Blood sugar levels can be lowered by working out. By becoming more active every day and going to the gym frequently, PCOS patients may be able to stop insulin resistance. Being active could also help with weight control and keep from getting diabetes.

References

Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

The American College of Obstetricians and Gynecologist (2022). Polycystic Ovarian Syndrome (PCOS). Retrieved November 1, 2022, from https://www.acog.org/womens-health/faqs/polycystic-ovary-syndrome-pcos.

Mayo Clinic (2022). Polycystic Ovarian Syndrome (PCOS). Retrieved November 1, 2022, from https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

 

Last Updated: February 21, 2024