PCOS is a common disorder that leads to an imbalance of hormones. This can cause issues with menstruation and fertility.
This article is pending medical review.
Written by Alizeh Ahsan and Lea Dörner
Reviewed by Sophie Oppelt and Darina Obukhova
Edited by Juliëtte Gossens
Polycystic ovarian syndrome, also referred to as PCOS, is a common hormonal reproductive disorder. It affects 7 to 15% of women in their reproductive age (1, 2).
People who are affected have imbalances in hormones that control the menstrual cycle and the development of reproductive organs (such as the uterus and ovaries). For example, somebody with PCOS starts making a lot more luteinizing hormone (LH). Most affected people also have an excess of (mainly) testosterone. While healthy ovaries also make testosterone, the ovaries of people with PCOS make much more of it. This can lead to symptoms such as excess hair growth. And as the name of the syndrome already suggests, these hormonal imbalances typically lead to polycystic ovaries (3).
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What Are Polycystic Ovaries?
Now you might be wondering: what are polycystic ovaries?
Monthly, during ovulation, most healthy people with ovaries release a mature egg from their ovaries for possible fertilization. This is part of the menstrual cycle.
But in people who have polycystic ovarian syndrome, lots of small cysts can form within the ovaries. Cysts are small sacs of fluid. These cysts might measure somewhere between 7 and 10 mm in diameter (0.3 to 0.4 inches) (4). The cysts contain immature eggs that make ovulation more difficult. This might also lead to amenorrhea (not menstruating) or having an irregular menstruation. The ovaries might also increase in size because of the cysts (3).
Many people have polycystic ovaries. That doesn't necessarily mean you have PCOS. But it's more likely that you have PCOS if you have polycystic ovaries. Some people with PCOS don't have polycystic ovaries at all. In that case, they do have other signs of PCOS, such as an irregular menstruation and high testosterone levels.
What Could Cause PCOS?
The cause of polycystic ovarian syndrome (PCOS) are imbalances in the levels of the sex hormones. The menstrual cycle and the development of reproductive organs (uterus and ovaries) are controlled by different hormones, the sex hormones (5). Because they’re so important for the health of the reproductive system, any abnormalities can have significant consequences.
People with PCOS typically have higher levels of androgens. Androgens are hormones such as testosterone. They are usually only present in high levels in most men and people with testicles. Most women and people with ovaries usually only make small amounts of these hormones. When you make too much of them, it interferes with the menstrual cycle and prevents ovulation. (6)
But scientists are still unsure about what exactly causes these imbalances. It’s unlikely that there is one single cause. It’s more likely that different genes are involved. It’s also possible that some lifestyle factors play a role in this.
Researchers think that genes are involved, because a family history of PCOS is a risk factor for developing PCOS. That means that if you have family members with PCOS who are genetically related to you, you have a higher risk of PCOS (2, 7).
Recent studies have also shown that PCOS is related to issues with how insulin is processed by the body. Insulin is a very important hormone that is involved in metabolism and controlling blood sugar levels. That’s why people with diabetes and people with obesity have a higher risk for PCOS. The relationship between weight and PCOS is not completely clear yet, because it’s also possible that having PCOS makes you more likely to gain weight. (5-7)
Symptoms and Complications of PCOS
PCOS can cause different symptoms that can vary from person to person. They can occur alone or in combination.
Cysts in the ovaries are a common result of PCOS, as we explained earlier. If they grow large, this can give discomfort or pain as they’re pushing into other organs.
In addition, the elevated levels of sex hormones result in irregularities in your menstrual cycle because ovulation is prevented. You might get your period irregularly or even experience a complete absence of menstruation (amenorrhea).
The lack of ovulation also prevents fertilization. This can make becoming pregnant challenging. In some cases, PCOS leads to infertility. (3, 4, 6)
In addition to reproductive effects, PCOS can cause acne, weight gain, increased hair growth on the body and face (hirsutism), and high blood pressure (4, 7). PCOS is also associated with a low level of inflammation throughout the body. This can lead to metabolic disorders such as diabetes, and diseases of the heart and blood vessels (7).
Diagnosis of PCOS
Diagnosis of PCOS in adults involves meeting at least two of the following criteria:
Irregular or no menstruation
Elevated androgen (testosterone) levels
First and foremost, you should consult with your doctor about the regularity of your menstrual cycle. You can ask yourself the following questions beforehand:
Have I had my periods regularly lately?
How long is my cycle usually?
Have I been missing any periods?
Different apps can help you keep track of your menstrual cycle patterns and make finding answers to those questions easier. Of course, you can also write the dates of your cycle down into a notebook or your calendar if you’re uncomfortable with using apps (for example because of reproductive legislation in your area, such as abortion bans).
Because PCOS can be caused by genetic factors, your doctor will likely also ask if you have any genetically related family members who were diagnosed with PCOS.
To determine if you have elevated androgen levels, your doctor may take a blood sample and test your hormone levels. In addition to sex hormones, other hormones may also be evaluated to rule out other conditions.
Your doctor might also advise ultrasound or other imaging tests, to see if you have polycystic ovaries. But polycystic ovaries can also develop if you don’t have PCOS. This means that having polycystic ovaries doesn’t necessarily mean you have PCOS. (7, 8)
It’s important to note that diagnosis of PCOS in teens can be challenging. Symptoms such as acne or irregular menstruation are often normal in this age group. Going through puberty can also cause swelling or cysts of the ovaries. In such cases, teens might be at risk of developing PCOS. Your doctor might advise regular check-ups and monitoring of symptoms to see if they develop further. (8)
Treatment of PCOS
People at risk of PCOS, or those with a confirmed diagnosis, can often manage the condition through education, adopting healthy lifestyle practices, and medication.
Education and Community
Education about PCOS is essential, because a diagnosis often comes with concerns and questions. If anything is unclear to you, let your doctor know! Because many people have PCOS, peer support groups are available in several countries. You can join one to connect with others who have PCOS. This might help you find support as you’re dealing with difficult parts of your diagnosis, including fertility issues. (9)
It’s important to adopt healthy habits for anyone, but especially if you’re dealing with a disorder that can throw off your metabolism. Staying active by moving your body every day and adding fruits, vegetables and fiber to your diet can help with this (7, 8, 10). If you're unsure about how to do this, a dietician in your region could help you.
It’s also a good idea to try to build some muscle, because muscle tissue makes your body more sensitive to insulin (13). This can decrease your risk of diabetes. If you’re not sure how, ask your doctor or physiotherapist for recommendations.
If you have PCOS, you might need medication for treatment. You and your doctor can evaluate together if you need these. Issues associated with PCOS vary from person to person. That means you might need different treatment from somebody else with PCOS.
Hormonal treatments are sometimes used. These medications can regulate the menstrual cycle, reduce androgen levels, improve acne, and help with fertility. One example of a hormonal medication is the well-known birth control pill (combined oral contraceptive). This pill contains estrogen and progestin (8, 11). These hormones can help with many of the symptoms of PCOS. Your doctor can evaluate if the pill is suitable for you. And if you’re not ovulating, you might need extra medication to help with this if you want to become pregnant.
If you have PCOS and you have insulin resistance, your doctor might also advise treatment for this. A drug that is often used for this is metformin. Metformin lowers your blood sugar levels and is also used in the treatment of type 2 diabetes. (12)
PCOS is a syndrome that affects many women, girls, and other people with ovaries. The manifestation of symptoms and complications varies among people. That’s why treatment options might differ. It’s a good idea to talk to your doctor regularly if you have PCOS or you think you might have PCOS, so you can get the best treatment. There’s lots of different ways to treat the syndrome, so there’s bound to be something that works for you!
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