Polycystic Ovary Syndrome Symptoms, Causes and Treatment

What is polycystic ovary syndrome?

Polycystic ovary syndrome (PCOS) is a common gynecological disorder affecting a woman’s hormone levels. Indeed, women need a good understanding of polycystic ovary syndrome symptoms, causes and treatment so they can take measures to stay free of PCOS or treat it and avoid its complications.

An Italian physician Anthonio Vallisneri first described polycystic ovary syndrome symptoms in 1721 (1)

PCOS occurs during childbearing years of 15 to 44. About 2.2 to 26.7% of women in this age group have PCOS (2). It affects ovaries responsible for estrogen and progesterone production. These hormones regulate the menstrual cycle. The ovaries also produce a small amount of androgens.

Ovaries release eggs each month, known as ovulation, which are to be fertilized by a man’s sperm. Follicle stimulating hormone (FSH) and luteinizing hormone (LH) control ovulation.

FSH stimulates the ovary to produce a follicle, an egg-containing sac. The LH stimulates the ovary to release a mature egg.

So, PCOS is a syndrome or group of symptoms affecting the ovaries and ovulation.

PCOS has three main features. They include:

• High male hormone levels
• Cysts in the ovaries
• Skipped or irregular periods

As the name suggests, PCOS is the growth of many small, fluid-filled sacs inside the ovaries. Actually, theses sacs are follicles, each of which contains an immature egg. In PCOS, the eggs never mature enough to stimulate ovulation.

When ovulation fails, levels of progesterone, estrogen, FSH and LH change such that the levels of estrogen and progesterone become lower than normal. On the other hand, levels of androgen become higher than usual.

High levels of male hormones alter menstrual cycle. Therefore, women with PCOS have fewer menstrual periods than normal.

Further, women that have PCOS produce abnormally high amounts of male hormones, causing a hormone imbalance. As a result of this, affected women skip menstrual periods and find it difficult to get pregnant.

Also, PCOS causes baldness and growth of hair on the face and body. Additionally, it contributes to heart disease and diabetes.

However, diabetes drugs and birth control pills can help improve polycystic ovary syndrome symptoms and treat hormone imbalance.

You know what? Many women who have PCOS do not know it. A study revealed that 70% of women with PCOS were undiagnosed (3).

What are the polycystic ovary syndrome causes?

Doctors do not know exactly the causes of PCOS. However, it is believed that high levels of male hormones stop the ovaries from normal hormone and egg production.

Also, experts link insulin resistance, genes and inflammation to excess androgen production, as explained below.

Insulin resistance

Evidence shows that about 70% of women with PCOS have insulin resistance. This means that their cells are unable to use insulin (4). The pancreas produces insulin, a hormone that helps the body use glucose from foods for energy.

However, when cells cannot use insulin properly, the body demands more insulin. This makes the pancreas to make more insulin to compensate. High insulin levels stimulate ovaries to produce more male hormones.

Obesity causes insulin resistance. Both conditions increase the risk for type 2 diabetes (5).

Genes

PCOS is hereditary. There is likelihood of PCOS in a woman whose family member had the condition. In fact, studies show that it runs in families (6).

Also, there is evidence that many genes, not just one, contribute to PCOS (7).

Inflammation

PCOS contributes to increased levels of body inflammation. Also, being overweight may cause inflammation.

Studies show that higher androgen levels cause excess inflammation (8).

What are the polycystic ovary syndrome symptoms?

Common symptoms of PCOS vary. Some women start experiencing symptoms about the time of their first period. Others may find they have PCOS after they discovered they could not get pregnant. Yet others discover they have this condition after they have gained a lot of weight.

The most common PCOS symptoms include:

Heavy menstrual bleeding

The monthly menstrual periods can be heavier than normal. This is because the lining of the uterus builds up for a longer period of time.

Irregular menstrual periods

The uterine lining does not shed every month due to lack of ovulation.

There is evidence that some women that have PCOS do get fewer than eight periods a year (9).

Acne

Male hormones can cause the skin to be oilier than normal.

Additionally, male hormones can cause breakouts on the face, chest and upper back.

Darkening of the skin

Dark patches of skin can occur in body creases like those under the breasts, on the neck and in the groin.

Male-pattern baldness

Scalp hairs may get thinner and fall out.

Headache

In some women, hormone changes can cause headache.

Weight gain

It is important to note that up to 80% of women who have PCOS are overweight or obese (10).

Hair growth

More than 70% of women with PCOS grow hair on their face and body. Also, they grow hair on their back, belly and chest (10). This is called hirsutism.

How does PCOS affect your body?

If a woman has higher androgen levels than normal, it affects her fertility and other areas of her health. In other words, other polycystic ovary syndrome sequelae include: infertility, metabolic syndrome, sleep apnea, endometrial cancer and depression.

Metabolic syndrome

About 80% of women with PCOS are overweight or obese (11). PCOS and obesity increase your risk for high blood pressure, low HDL (good) cholesterol, high LDL (bad) cholesterol and high blood glucose.

So all these factors together make up what is known as metabolic syndrome. They increase your risk for diabetes, stroke and heart disease.

Infertility

PCOS is one of the major causes of infertility in women (12).

Ovulation should occur before you can get pregnant. So if you do not ovulate regularly, it means you don’t release as many eggs to be fertilized.

Endometrial cancer

The uterine lining sheds during ovulation. However, the lining can build up if you do not ovulate every month.

As a result of thickened lining of the uterus, you may have an increased risk for endometrial cancer (13).

Depression

Hormonal changes and symptoms such as unwanted growth of hair can affect your emotions negatively.

Many women with PCOS may experience anxiety and depression (14).

Sleep apnea

Sleep apnea causes repeated breathing pauses during the night, thereby interrupting sleep.

It occurs more commonly in overweight women, especially those with PCOS.

Obese women with PCOS have 5 to 10 times higher risk for sleep apnea than those without PCOS (15).

How PCOS can be diagnosed

Typically, doctors diagnose PCOS in women that have two of these symptoms: high androgen levels, cysts in the ovaries and irregular menstrual cycles (16).

Your doctors may want to find out if you also experience symptoms like weight gain, acne, face and body hair growth.

A pelvic exam will be done to check for any problems with the ovaries and other reproductive organs. Your doctor will insert gloved fingers into your vagina and check for any growths in the uterus or ovaries.

Blood tests help check for high levels of male hormones. Your doctor may also ask for blood tests to check your insulin, triglyceride and cholesterol levels. Also, this may help your doctor assess your risk for conditions like diabetes and heart disease.

In addition, an ultrasound may be used to check for abnormal follicles and other problems with the uterus and ovaries.

PCOS and pregnancy

Women with PCOS find it difficult to get pregnant because PCOS interrupts the normal menstrual cycle. Research shows that 70 to 80% of women with PCOS find it difficult to conceive (17).

This gynecological problem can elevate the risk for pregnancy complications. For example, women with PCOS are more likely to deliver premature baby than women without the condition.

Also, women with PCOS are at a greater risk for gestational diabetes, high blood pressure and miscarriage (18).

However, with fertility treatments that improve ovulation, women with PCOS can get pregnant. Also, you can improve your odds of a healthy pregnancy by lowering your blood sugar levels and losing weight.

How PCOS can be treated

PCOS can be treated with change in lifestyle and diet

Lifestyle changes like exercise, diet and weight loss are important treatment options for PCOS.

For example, loss of 5 to 10% of your body weight can regulate menstrual cycle and improve polycystic ovary syndrome symptoms (19). Also, weight loss improves cholesterol levels, reduce diabetes and heart disease risks and lower insulin.

Therefore, any diet that causes loss of weight may help your condition. However, some foods are more beneficial than others.

For example, studies show that low-carbohydrate diets are more effective in lowering insulin levels and reducing weight. Learn more about good nutrition.

Also, a low glycemic index diet regulates the menstrual cycle better than a regular weight loss diet (20). A low glycemic index diet gets most carbohydrates from whole grains, vegetables and fruits.

Further, studies show that 30-minute moderate-intensity exercise three days a week help women with PCOS lose weight. It is important to note that exercise-induced weight loss also improves insulin levels and ovulation (21).

In fact, when exercise is combined with a healthy diet, you lose more weight than either intervention alone. This also lowers your risk for heart disease and diabetes (22).

Additionally, there is evidence that acupuncture helps improve polycystic ovary symptoms, but more research should be done (23).

PCOS can be treated with medications and surgery

Common medical treatments for PCOS include metformin, birth control pills, clomiphene, Eflornithine electrolysis, laser hair removal and ovarian drilling.

Metformin

Metformin is a drug for the treatment of type 2 diabetes. It is also used to treat PCOS by improving levels of insulin.

A study revealed that taking metformin in addition to dietary modification and exercise lowers blood sugar, restores normal menstrual cycle and improves weight loss, much better than changes to exercise and diet alone (24).

Birth control pills

If you take progestin and estrogen daily, they will help restore a normal hormone balance, protect against endometrial cancer, relieve symptoms such as excess hair growth and regulate ovulation.

These hormones come in a patch, pill or vaginal ring.

Hair removal medicines

Some treatments will help to remove unwanted hair or stop it from growing. For example, eflornithine (vaniga) cream is used to slow hair growth.

Also, Laser hair removal and electrolysis are used to remove unwanted hair on the face and body.

Clomiphene

Clomiphene or clomid is a fertility drug that helps women with PCOS to get pregnant. The only downside is the risk for multiple pregnancy and births (25).

Surgery

Your doctor may want to use surgery as an option to improve fertility, especially if other treatments fail.

A surgeon may perform ovarian drilling by making tiny holes in the ovary with a thin heated needle or laser to restore normal ovulation.

Conclusion

PCOS makes it harder to get pregnant by disrupting a woman’s menstrual cycles. Also, unwanted polycystic ovary syndrome symptoms such as hair growth on the face and body may occur due to high levels of male hormones.

Doctors first recommend lifestyle interventions for PCOS. These interventions often work well. For example, weight loss helps improve polycystic ovary syndrome symptoms, and hence the odds of getting pregnant.

Aerobic exercise and diet are very effective in losing weight. However, if lifestyle changes do not work, medicines are an option.

For example, metformin and birth control pills can help restore normal menstrual cycles and relieve PCOS symptoms.

So, try to see your doctor if you missed periods but not pregnant and you have PCOS symptoms. Also, speak to your doctor if you have been trying to get pregnant for more than 12 months without success.

Diabetes symptoms such as excess thirst or hunger, unexplained weight loss and blurred vision call for your doctor’s attention.

Finally, plan regular visits with your primary care doctor if you have PCOS. You will need regular tests to check for high blood pressure, diabetes and other possible complications.

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