PCOS (Polycystic Ovary Syndrome) is the main cause of anovulatory infertility in women. It can lead to other unwanted conditions like anxiety, depression, liver disease, and type 2 diabetes. An even bigger issue? In many women, PCOS goes undiagnosed for years. How can medical providers and women be more proactive in identifying signs and getting the right treatment for PCOS? Let’s look at what the research says.
Is Polycystic Ovary Syndrome a Disease?
According to the CDC, 6%-12% of women of reproductive age have PCOS. About 50% of those end up with Type 2 Diabetes by age 40. PCOS can contribute to diseases like diabetes, endometrial cancer, or heart disease, but in itself is a condition that’s hormonal, reproductive, and metabolic in nature. Since it tends to be so complex, it can be difficult to diagnose right away.
Symptoms of PCOS
Despite the name, the common thread that links polycystic ovary syndrome patients isn’t the presence of ovarian cysts. What’s mainly prevalent is excess androgens, which are a set of sex hormones present in both males and females, but contribute to male traits. Second, PCOS consists of a lack of healthy ovulation.
Other symptoms of PCOS can include:
Irregular or absent menstruation
Hair thinning; male-pattern hair loss
Excess body hair growth
Facial hair growth
Infertility
Weight gain or difficulty losing weight
Acne or skin irritation
Cysts in or on the ovaries (although the presence of cysts isn’t required for diagnosis)
An early sign of PCOS is when an adolescent girl has irregular periods for more than two years after their first period. It’s normal for girls’ bodies to take time to adjust to a normal cycle, but persistent irregularities could indicate PCOS-linked hormonal imbalances.
What is the Main Cause of PCOS?
There is no single known cause in medicine yet. However, there are four main theories of what may lead to PCOS:
Genetic predispositions
Insulin resistance
Fetal exposure to male hormones in the womb
Inflammation
Perhaps medical experts can reveal further causes of PCOS if the focus is put less on cysts and more on hormonal factors in women with PCOS. Endocrinologist Dr. Jerilynn Prior, founder of the Centre for Menstrual Cycle and Ovulation Research, validates this in over 40 years of PCOS research.
The 4 Types of PCOS
Like many other conditions that affect females specifically, the understanding of PCOS is still limited in the healthcare system today. As of now, there are four main “types” of polycystic ovarian syndrome— all can exhibit similar symptoms and vary from woman to woman.
The type generally indicates the dominant underlying cause of a patient’s PCOS. Women can have one or a variety of types. Differentiating which type of PCOS is present can help form a proper treatment plan.
NOTE: Not all clinicians agree that there are four types.
Insulin Resistant PCOS
PCOS is largely associated with insulin resistance. This is when high levels of insulin in the body aren’t being efficiently used by the muscles, liver, and fat, resulting in too much glucose in the blood.
Insulin-resistant PCOS patients often struggle with being overweight, having sugar cravings, and experiencing brain fog. They also tend to have high androgen levels which can cause thick body hair, acne, and male pattern baldness.
Adrenal PCOS
Excess stress can raise levels of DHEAS, a type of androgen. Symptoms lean more toward inflammatory PCOS, like fatigue, skin issues, and IBS. Adrenal PCOS is often associated with regular levels of testosterone and high DHEAS.
Note: Any woman with PCOS can experience worse symptoms during stressful periods. Work with your healthcare team to achieve a balanced, healthy lifestyle.
Inflammatory PCOS
Chronic inflammation in the female body is often seen in patients with PCOS. Inflammatory stress promotes excess androgens which then interfere with normal ovulation. Symptoms of inflammatory PCOS are usually joint pain, headaches, skin irritation, cramps, and fatigue.
“Post-Pill” PCOS (Temporary PCOS)
After a woman stops taking the birth control pill, androgen levels surge dramatically as estrogen and/or progesterone levels fall. This sudden change in hormones can cause PCOS-like symptoms— but is usually temporary and reversible.
Ovulation has been suppressed with the use of the pill, and it can take time for a woman’s ovary function to return to normal. These PCOS-like symptoms include acne, irregular periods, high LH: FSH ratio, and sometimes, ovarian cysts.
Note that the medical community seems to disagree on whether the birth control pill causes PCOS or simply that stopping birth control resembles PCOS symptoms.
Curious about PCOS? Listen to experts discuss lifestyle, diagnosis, and treatment on these Fempower Health’s PCOS podcast episodes.
PCOS Treatment
Treating PCOS requires a multi-faceted approach. Because it can affect multiple systems and functions in the body, individualized treatment plans are developed and must take into consideration a woman’s lifestyle, PCOS “type”, and her fertility plans. In addition to primary medical exams, hormone testing is often done to determine proper diagnosis and treatment.
Medication or Hormonal Treatment
Depending on a woman’s hormone levels, certain medications or hormone replacement therapies might be necessary. These include progesterone, birth control pills, Spironolactone, or Metformin.
**Always talk to your doctor before trying a new medication or treatment option.
Lifestyle Changes
Nutrition, exercise, and stress management can help relieve and mitigate symptoms of PCOS. Some women can overcome their condition with the help of hormonal and lifestyle changes, returning their hormones to normal levels.
Listen to this podcast episode with Martha McKittrick on PCOS and Nutrition.
Mental Health Care
It’s psychologically difficult living with PCOS. The risk of infertility, body changes, and serious diseases can be hard to cope with for many patients. Getting mental health care is also recommended for many PCOS patients to deal with non-physiological factors.
Listen to the podcast episode with Dr Gretchen Kubacky on PCOS and Mental Health.
What Happens if PCOS is Left Untreated?
PCOS can become a serious problem in women who are left untreated or misdiagnosed. In addition to an increased risk of cancers and type 2 diabetes, the biggest concern of untreated PCOS is the development of heart disease. But women with PCOS aren’t all doomed— with proper medical care and lifestyle improvement, these risks can be managed.
Resources for Women with PCOS
If you or someone you care about has PCOS, seek attention from a medical doctor, endocrinologist, and mental health professional to manage symptoms. Getting treatment early on will help you improve your quality of life and prevent long-term side effects.
Listen to the Fempower Health Podcast episode where endocrinologist Dr. Jerilynn Prior explains how PCOS is a hormonal condition— and what women can do to get help.
More on PCOS:
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