Understanding PCOS: A Comprehensive Guide
Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects people with ovaries, often during their reproductive years. It is characterized by a combination of symptoms that can impact physical health, emotional well-being, and fertility. One of the most common endocrine and metabolic disorders in women of reproductive age (Lim et al., 2019). The worldwide prevalence of PCOS ranges from 4 to 21%, depending on the diagnostic criteria used. In this blog post, we will explore what PCOS is, its causes, symptoms, diagnosis, treatment options, and lifestyle changes that can help manage the condition.
What is PCOS?
PCOS is a complex metabolic that affects approximately 4-21% of women of reproductive age. The name "polycystic ovary syndrome" comes from the presence of multiple small cysts on the ovaries, which can be detected through ultrasound. However, not everyone with PCOS has cysts, and the condition can manifest in various ways.
Causes of PCOS
The exact cause of PCOS is still not fully understood, but several factors are believed to contribute to its development:
Hormonal Imbalance: Women with PCOS often have elevated levels of androgens (male hormones, like testosterone), which can disrupt the normal ovulation process.
Insulin Resistance: Many individuals with PCOS have insulin resistance, meaning their bodies do not respond effectively to insulin. This can lead to higher insulin levels, which may increase androgen production and contribute to symptoms (Barber et al, 2016).
Genetics: PCOS tends to run in families, suggesting a genetic component. If a close relative has PCOS, the likelihood of developing the condition may increase.
Inflammation: Some studies have indicated that low-grade inflammation may play a role in the development of PCOS, potentially affecting insulin sensitivity and hormone levels (Gonzolaz, F., 2013).
Symptoms of PCOS
PCOS symptoms can vary widely among individuals, but common signs include:
Irregular Menstrual Cycles: This can manifest as infrequent periods, prolonged periods, or skipped periods altogether.
Excess Androgen Levels: Symptoms may include acne, oily skin, and excessive hair growth (hirsutism) on the face, chest, and back.
Weight Gain: Many individuals with PCOS experience weight gain or have difficulty losing weight, which can exacerbate other symptoms.
Thinning Hair: Some may experience hair thinning or male-pattern baldness.
Skin Changes: Dark patches of skin (acanthosis nigricans) may develop, particularly in areas such as the neck, armpits, and groin.
Fertility Issues: PCOS is one of the leading causes of infertility due to irregular ovulation and chronic insulin resistance causing cellular damage to oocytes (WHO, 2023).
Diagnosis of PCOS
Diagnosing PCOS typically involves a combination of questions about your symptoms and menstrual cycles, a physical exam, lab tests of blood sugar, insulin, and other hormone levels. You may also have an ultrasound to look for cysts on your ovaries. According to the Rotterdam criteria, developed in 2003, diagnosis of PCOS requires at least 2 out of the 3 following: clinical or biochemical androgen excess, oligo ovulation or anovulation, polycystic ovaries on ultrasound.
Medical History: The doctor will ask about menstrual cycles, weight changes, and any symptoms related to excess androgen levels. Family history of PCOS or related conditions may also be discussed.
Physical Examination: A physical exam may include checking for signs of excess hair growth, acne, or weight gain. The doctor may also measure blood pressure and body mass index (BMI).
Blood Tests: Blood tests can help measure hormone levels, including androgens and insulin, as well as rule out other conditions that may cause similar symptoms, such as thyroid disorders.
Ultrasound: A pelvic ultrasound may be performed to check for the presence of cysts on the ovaries. However, it’s important to note that not everyone with PCOS will have cysts, and the presence of cysts alone is not sufficient for a diagnosis
impact of PCOS
Anovulatory infertility: failure to conceive due to lack of egg being released from the ovary. PCOS accounts for up to 80% of anovulatory fertility (WHO, 2023).
Pregnancy related risks: Gestational diabetes, pregnancy -induced hypertension, preecclampsia, pre – term birth and cesarean delivery.
Metabolic impacts: Obesity, insulin resistance, type 2 diabetes, increased cardiovascular risk factors.
Psychological well – being: Women with PCOS are more likely to suffer from anxiety and depression, PMDD, body image issues and eating disorders (Brutocao et al, 2018).
Treatment Options for PCOS
While there is no cure for PCOS, various treatment options can help manage symptoms and reduce the risk of complications. Treatment plans are often tailored to the individual’s specific symptoms and health goals:
Lifestyle Changes: Adopting a healthy diet and regular exercise can significantly improve symptoms. Weight loss, even a small amount, can help regulate menstrual cycles and improve insulin sensitivity.
Medications:
Hormonal Birth Control: Birth control pills can help regulate menstrual cycles, reduce androgen levels, and improve symptoms such as acne and hirsutism.
Anti-androgens: Medications like spironolactone can help reduce hair growth and acne by blocking the effects of androgens.
Insulin Sensitizers: Metformin is commonly prescribed to improve insulin sensitivity and can help with weight management and menstrual regularity.
Fertility Treatments: For those experiencing infertility, treatments such as ovulation induction medications (like clomiphene citrate) or assisted reproductive technologies (like in vitro fertilization) may be recommended.
Cosmetic Treatments: For cosmetic concerns like excessive hair growth, options include laser hair removal, electrolysis, and topical treatments.
Acupuncture: Regular acupuncture treatments can promote ovulate, regulate the menstrual cycle, increase egg quality as well as reduce insulin resistance (Li-Yan et al, 2021).
Supplements/Vitamins: Inositol is great supplement for reducing androgens and improving ovarian function in people with PCOS (Fedeli et al, 2024). Consult your healthcare professional for more specific supplements to take for your unique case of PCOS :)
Lifestyle Changes to Manage PCOS
In addition to medical treatments, certain lifestyle changes can play a crucial role in managing PCOS:
Balanced Diet: Focus on a diet rich in whole foods, including fruits, vegetables, lean proteins, and whole grains. Reducing refined carbohydrates and sugars can help manage insulin levels.
Regular Exercise: Aim for at least 150 minutes of moderate-intensity aerobic activity each week, such as brisk walking, cycling, or swimming. Incorporating strength training exercises at least twice a week can also be beneficial for improving insulin sensitivity and promoting weight loss.
Weight Management: If overweight, even a modest weight loss of 5-10% of body weight can help improve symptoms and regulate menstrual cycles. Working with a healthcare provider or a registered dietitian can help create a personalized weight management plan.
Stress Management: High stress levels can exacerbate PCOS symptoms. Techniques such as mindfulness, yoga, meditation, and deep-breathing exercises can help reduce stress and improve overall well-being.
Sleep Hygiene: Prioritizing good sleep habits is essential. Aim for 7-9 hours of quality sleep each night, as poor sleep can negatively impact hormonal balance and insulin sensitivity.
Regular Monitoring: Regular check-ups with a healthcare provider can help monitor symptoms and adjust treatment plans as necessary. Keeping track of menstrual cycles, weight, and any symptoms can provide valuable information for managing PCOS.
Acupuncture: Acupuncture can reduce androgens, manage stress, promote ovulation, improve egg quality and reduce insulin restistance. Acupuncture for PCOS is a great addition to your self care on your PCOS journey.
By implementing these lifestyle changes alongside medical treatments, individuals with PCOS can better manage their symptoms and improve their overall health. If you have any specific questions or need further information, feel free to ask!
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Sources:
1) Barber, T. M., Dimitriadis, G. K., Andreou, A., Franks, S. (2016, June 1). Polycystic ovary syndrome: Insight into pathogenesis and a common association with insulin resistance. Clinical Medicine. https://www.sciencedirect.com/science/article/pii/S1470211824026848.
2) Brutocao C, Zaiem F, Alsawas M, Morrow AS, Murad MH, Javed A. Psychiatric disorders in women with polycystic ovary syndrome: a systematic review and meta-analysis. Endocrine. 2018 Nov;62(2):318-325. doi: 10.1007/s12020-018-1692-3. Epub 2018 Jul 31. PMID: 30066285.
3) Fedeli V, Unfer V, Dinicola S, Laganà AS, Canipari R, Monti N, Querqui A, Galante E, Laurenzi G, Bizzarri M. Inositol Restores Appropriate Steroidogenesis in PCOS Ovaries Both In Vitro and In Vivo Experimental Mouse Models. Cells. 2024; 13(14):1171. https://doi.org/10.3390/cells13141171
4) González F. Inflammation in Polycystic Ovary Syndrome: underpinning of insulin resistance and ovarian dysfunction. Steroids. 2012 Mar 10;77(4):300-5. doi: 10.1016/j.steroids.2011.12.003. Epub 2011 Dec 8. PMID: 22178787; PMCID: PMC3309040.
5) Jia, Li-Yan, Feng, Jia-Xing, Li, Juan-Li, Liu, Fang-Yuan, Xie, Liang-zhen, Luo, Shou-Juan, Han, Feng-Juan, The Complementary and Alternative Medicine for Polycystic Ovary Syndrome: A Review of Clinical Application and Mechanism, Evidence-Based Complementary and Alternative Medicine, 2021, 5555315, 12 pages, 2021. https://doi.org/10.1155/2021/5555315
6) World Health Organization. (May 2023). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome#:~:text=PCOS%20can%20cause%20hormonal%20imbalances,condition%20and%20cannot%20be%20cured.
