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PCOS stands for Polycystic Ovary Syndrome, and every woman who has started menstruating should be familiar with it. It affects a large number of women around the world, and many may not even know it. Experts do not know the exact cause, but it may also be related to insulin resistance. Learn about PCOS, its symptoms, types, complications and diagnosis.
PCOS – what exactly is it?
PCOS or Polycystic Ovary Syndrome is a female disease that affects the levels of female hormones. It affects at least 7% of adult women, and research shows that 5% to 10% of women between the ages of 18 and 44 may suffer from the syndrome in the United States. As a result, it is the most common endocrine abnormality among women of childbearing age in the United States. Although we present statistics from the USA, PCOS applies to women from different parts of the world and they should definitely know the necessary information about it. [1] [2]
In 2012, the syndrome affected about 116 million women worldwide, representing 3.4%. In countries such as the USA, Great Britain, Australia, Greece or Spain, the incidence of PCOS according to the NIH (National Institute of Health) diagnostic criteria is at the level of 6% – 9%. A much more frightening fact is that globally the incidence of PCOS is variable, its values can be between 2.2% and 26%. A 2012 study points to the fact that many women live with this syndrome without being diagnosed. That is why it is crucial to raise awareness of it and point out its symptoms and possible risks. [2] [3] [4] [5]
Polycystic ovaries refer to a condition in which there are many fluid-filled sacs inside the ovaries. These are follicles containing an immature egg. The term “polycystic” itself is a combination of the words “poly” in the sense of “many” and “cyst”. Some of the women suffering from this syndrome have cysts on their ovaries. However, the name can also be considered partly misleading, as many women with PCOS do not have cysts. Therefore, it may not apply to all women. In this article we will introduce you to the types of PCOS and their differences. [2] [6]
PCOS was first described by I. F. Stein and M. Leventhal about 80 years ago in a work called Amenorrhea associated with polycystic ovaries. It has been described as oligo-amenorrhea and polycystic ovary syndrome, which are variably associated with obesity, acne and hirsutism, i.e. increased hair, for example on the face. The syndrome has been dealt with by experts for many years, but currently only its symptoms can be treated. [9] [10] [11]
Symptoms of PCOS
PCOS has several symptoms that may indicate its presence. They can occur during the first menstruation in puberty, but this is not the rule. PCOS can also develop later, for example with weight gain. The symptoms of PCOS should be known to women of all ages so that it can be diagnosed early. In addition, the symptoms of PCOS are usually more severe in the case of obesity. It is important to add that the symptoms listed below may manifest to varying degrees, and not all of them. It is possible that some women with PCOS only have problems with menstruation or conception. [7] [8]
1. Irregular menstruation
Deviations from regular menstruation are the most common manifestation of the syndrome. Prolonged or irregular periods can manifest themselves, for example, by more than 35 days between periods, less than 9 menstruations per year, or difficult periods. This symptom is manifested in laboratory values by high levels of luteinizing hormone. You can also observe the symptom on yourself, so if in doubt, it is not a bad idea to seek an expert. [7] [12]
2. Hyperandrogenism
The second symptom is a physical manifestation, which you can also observe on the body. The term itself refers to the increased secretion of androgens – male sex hormones. This symptom is manifested by higher levels of testosterone and androstenedione when measured in the laboratory. Clinical examination reveals acne, hirsutism, acanthosis nigricans skin disease and androgenetic alopecia (a form of hair loss). Simply put, due to the increased production of male sex hormones, women with PCOS already experience acne, hair growth, hair loss and specific skin diseases. These symptoms and delayed periods may indicate the occurrence of PCOS. [7] [12] [13] [14]
3. Polycystic ovaries
The third symptom of the disease, unlike the previous ones, is visible with the help of an ultrasonograph. It is manifested in the way that your ovaries can enlarge and contain 12 or more follicles in 1 ovary. [7] [12]
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PCOS phenotypes
The Rotterdam criteria divided PCOS into 4 phenotypes because it can be manifested as different diseases [12]:
- Classic polycystic ovary PCOS (Frank or classic ovary PCOS) – their manifestations include polycystic ovaries, hyperandrogenism and chronic anovulation.
- Classic non-polycystic ovary PCOS – Manifestations of this type are hyperandrogenism, chronic anovulation, but normal ovaries.
- Non-classic ovulatory PCOS – the difference between the previous types is that the manifestations are hyperandrogenism, polycystic ovaries, but a regular menstrual cycle.
- Non-classic mild or normoandrogenic PCOS – the last type indicates its difference in the name, its manifestations are chronic anovulation, polycystic ovaries, but the difference is androgens in the norm.
Causes of PCOS
Unfortunately, the exact and unambiguous causes of PCOS are not entirely clear. PCOS is associated with the inability of normal egg production, and scientists believe that higher levels of androgens are causing these problems. One reason for the spread of PCOS may be a genetic predisposition. Another reason, according to scientists, is the higher level of androgenic hormones associated with excessive inflammation. For this reason, women suffering from PCOS encounter increased inflammation in the body. An interesting fact is that women with PCOS have been found to have some type of inflammation at a low level, and this is what causes the production of androgens in polycystic ovaries.
The last important factor is insulin resistance, as up to 70% of women with PCOS also suffer such resistance. It is the resistance of cells to respond properly to insulin in the bloodstream. The pancreas then produces more insulin, resulting in higher production of male hormones. Insulin resistance can be optimized by changing your lifestyle. This will improve your insulin sensitivity and prevent more serious complications. [2] [7]
Would you like to learn more about insulin resistance and insulin sensitivity? Read the article – Insulin Sensitivity – How to Increase It and Prevent Insulin Resistance.
In addition to these factors, there is another potential impact that may need to be considered. It turns out that the ethnic factor may play a role in PCOS. The incidence varies among white women – 6.5% in Spain, 6.8% in Greece or only 4.7% in Alabama in the USA. According to a 2016 study, different environmental factors (lifestyle, diet and physical activity) could also be the reason. The study states that PCOS and type 2 diabetes occur more common in women in the UK among women of Asian descent. It might be interesting to see if this only applies to women of Asian descent living in the UK or in general. It is up to scientists to clarify why the incidence is lower in Alabama and whether it is related to lifestyle and the environment. [16]
In addition to scientifically proven facts, a lot of PCOS-related myths are spread that are good to know. Here’s 5 myths that are not exactly true [17]:
- You’ve caused PCOS yourself – the causes of PCOS are not known, but there are several factors that can affect the development of PCOS. One of them is genetics, so if you have PCOS in your family, you are more likely to be affected.
- PCOS is a rare syndrome – the exact numbers change and some women may not even know about the syndrome. However, in our opinion, the reported data on the number of women with PCOS do not represent a “rare” disease.
- PCOS only affects overweight women – obesity worsens the symptoms of PCOS and it is also true that many women with PCOS are overweight. PCOS is associated with an inability to use insulin, and thus with weight gain. This fact is probably a source of myth, but PCOS affects women of all weights.
- You will get rid of PCOS if you lose weight – there is no cure for PCOS and the treatment is aimed at managing the symptoms. On the other hand, it is true that PCOS is associated with hormone levels. A healthy lifestyle and a proper diet will help you regulate hormone levels, such as insulin.
- You can’t get pregnant with PCOS – PCOS affects your ovaries and your ability to get pregnant, but there are medications that can stimulate ovulation. It is therefore best to consult fertility treatment with your doctor. It is definitely best to consult options and solutions with an expert.
PCOS and hormones
The link between hormone levels and PCOS is no surprise. Hormonal imbalances have been found in several women with the syndrome. Imbalance was found for 4 hormones [15]:
- Testosterone – that’s right, testosterone is not just a men’s hormone, because it is also produced in small amounts by women. Higher levels of this primarily “male” hormone are a problem in women.
- Luteinizing hormone (LH) – LH is a hormone that primarily stimulates ovulation in a woman’s body, but elevated LH levels result in extraordinary effects on the ovaries.
- Sex hormone binding globulin (SHBG) – a hormone with a long name reduces the effect of testosterone, and low levels of SHBG have been found in women with PCOS.
- Prolactin – a hormone that stimulates the mammary glands and milk production, and increased prolactin levels have been found in some women with PCOS.
PCOS and other complications
PCOS is a disease that can also bring several other problems with itself. Hormonal imbalances caused by PCOS or high androgen levels may cause a higher risk of further complications. [18]
- Fertility problems – cysts in the ovaries affect ovulation and irregular ovulation causes not so many eggs to be released. PCOS affects the chances of getting pregnant and 70 to 80% of women with the syndrome have these problems. The percentage is high, but at the same time it does not mean that you cannot get pregnant with PCOS. Experts will definitely point you to the possibilities of promoting fertility. [2] [18]
- Metabolic Syndrome and Insulin Problem – Metabolic syndrome is a number of symptoms that increase the risk of diabetes or cardiovascular disease. MS factors are high blood pressure, high cholesterol levels or high blood sugar levels due to insulin resistance. You can also increase your insulin sensitivity with a proper diet and exercise, as resistance can grow into diabetes. If you have problems with hormone levels, it is definitely advisable to consider improving your lifestyle, which can help prevent more serious health consequences. [2] [18]
PCOS can be associated with several health complications, such as anxiety and depression, endometrial carcinoma, or sleep apnea. [2]
Diagnosis and treatment of PCOS
Diagnosis of PCOS can begin with a consultation with a doctor who will verify your menstrual cycle and weight changes. Subsequently, hair growth, acne and insulin resistance are monitored. Then your doctor may recommend other tests, such as ultrasound, gynecological examinations (pelvic exam) and blood tests. During a gynecological examination, the doctor will manually examine the reproductive organs. Blood test results are focused on hormone levels, and your doctor may recommend additional tests for cholesterol, triglycerides, and sugar levels. Ultrasound verifies the appearance of the ovaries and the lining of the uterus. Diagnosis of PCOS is necessary in these ways, because there is not yet a single unambiguous test that can unambiguously determine PCOS. The doctor must determine the occurrence of the syndrome. PCOS has symptoms that you may notice, but instead of googling, it is best to see your doctor. You are definitely interested in when it is advisable to look for an expert in case of concern. See your doctor if you have delayed menstruation but you’re not pregnant or if you are unable to become pregnant for 12 months. Another possibility is the observation of PCOS symptoms or diabetes symptoms, such as weight loss, thirst and blurred vision. [2] [19]
There is currently no cure for PCOS and treatment is focused on managing symptoms. PCOS may manifest itself with several or only one symptom, so symptomatic treatment may vary. First and foremost, overweight women are advised to reduce weight, which can help improve the condition. In addition, there are drugs to regulate excessive hair growth and to induce a regular period. Menstruation can also be caused by irregular use of a progestogen. The treatment of PCOS also includes the treatment of fertility in the form of medication or surgery, by laparoscopic ovarian drilling. Medicine is an area that is constantly advancing, so it is not a shame to believe that scientists will discover better ways to treat PCOS. [20]
Polycystic Ovary Syndrome is a condition that medicine has not yet clearly cured. It is possible to address its symptoms and improve the quality of life of women who suffer from it. There are factors that are thought to affect PCOS. According to scientists, it may be genetic, but it may also be related to insulin resistance. We believe that you have learned everything you need about PCOS. Do you want your friends to know about the syndrome? Feel free to support the article by sharing.
[1] Uche Anadu Ndefo, Angie Eaton, Monica Robinson Green – Polycystic Ovary Syndrome – A Review of Treatment Options With a Focus on Pharmacological Approaches – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/#b5-ptj3806336
[2] Stephanie Watson – Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment – https://www.healthline.com/health/polycystic-ovary-disease
[3] R.Vidya Bharathi, S.Swetha, J.Neerajaa, J.Varsha Madhavica, Dakshina Moorthy Janani, S.N.Rekha, S.Ramya, B.Usha – An epidemiological survey: Effect of predisposing factors for PCOS in Indian urban and rural population – https://www.sciencedirect.com/science/article/pii/S1110569016301510#:~:text=World%20Health%20Organization%20(WHO)%20estimates,to%20as%20high%20as%2026%25.
[4] Wendy M. Wolf, Rachel A. Wattick, Olivia N. Kinkade, Melissa D. Olfert – Geographical Prevalence of Polycystic Ovary Syndrome as Determined by Region and Race/Ethnicity – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6266413/
[5] Wendy A March, Vivienne M Moore, Kristyn J Willson, David I W Phillips, Robert J Norman, Michael J Davies – The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria – https://pubmed.ncbi.nlm.nih.gov/19910321/
[6] Polycystic Ovary Syndrome (PCOS) – https://www.webmd.com/women/what-is-pcos#1
[7] Polycystic ovary syndrome (PCOS) – https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,fail%20to%20regularly%20release%20eggs.
[8] Symptoms -Polycystic ovary syndrome – https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/symptoms/
[9] Robert L. Rosenfield, David A. Ehrmann – The Pathogenesis of Polycystic Ovary Syndrome (PCOS): The Hypothesis of PCOS as Functional Ovarian Hyperandrogenism Revisited – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045492/
[10] Ricardo Azziz, Eli Y Adashi – Stein and Leventhal: 80 years on – https://pubmed.ncbi.nlm.nih.gov/26704896/
[12] Samer El Hayek, Lynn Bitar, Layal H. Hamdar, Fadi G. Mirza, Georges Daoud – Poly Cystic Ovarian Syndrome: An Updated Overview – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4820451/
[13] Hyperandrogenism – https://medical-dictionary.thefreedictionary.com/Hyperandrogenism
[14] Androgenetic alopecia – https://ghr.nlm.nih.gov/condition/androgenetic-alopecia#:~:text=Androgenetic%20alopecia%20is%20a%20common,a%20characteristic%20%22M%22%20shape.
[15] Causes – Polycystic ovary syndrome – https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/causes/
[16] V. De Leo, M. C. Musacchio, V. Cappelli, M. G. Massaro, G. Morgante, F. Petraglia – Genetic, hormonal and metabolic aspects of PCOS: an update – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4947298/
[17] 5 Myths About Polycystic Ovary Syndrome (PCOS) – https://www.pennmedicine.org/updates/blogs/fertility-blog/2020/march/five-myths-about-pcos
[18] What Are the Complications of PCOS? – https://www.webmd.com/women/complications-pcos
[19] Polycystic ovary syndrome (PCOS) – https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443#:~:text=There’s%20no%20test%20to%20definitively,growth%2C%20insulin%20resistance%20and%20acne.
[20] Treatment – Polycystic ovary syndrome – https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/treatment/