Signs and Symptoms of PCOS
PCOS does not have a one-size fits all list of symptoms, as every PCOS patient is unique. Women may have one, two, or many symptoms of PCOS. Many women with PCOS will struggle with their weight and be overweight or obese, but some will not. Common symptoms of PCOS include:
- Irregular, abnormal, or absent periods
- Weight gain/obesity
- Increased acne and body hair growth
- Depression
- Infertility
- Loss or thinning of scalp hair
- Spotting between cycles
- Heavy or very light periods
- Ovarian cysts
- Acanthosis nigricans – darkening of the skin behind the neck, under the arms, and on the inner thighs
Causes of PCOS
The cause of PCOS has not been completely determined, although genetics likely play a role. A family history of diabetes, obesity, irregular menses, or hirsutism is common.
PCOS and Hormones
The majority of patients with PCOS have a higher-than-normal amount of luteinizing hormone (LH) in relation to follicle-stimulating hormone (FSH) produced by the pituitary gland (a small gland located at the base of the brain). Additionally, numerous studies have linked high blood levels of the hormone insulin with PCOS.
Elevation in the amount of LH produced decreases the chances that an egg will develop and be released. The ovary continues to produce estrogen as well as excess male hormones, including testosterone. Continual estrogen production stimulates the growth of the uterine (endometrial) lining. In females who ovulate regularly and do not have PCOS, estrogen is counterbalanced by progesterone which is released after ovulation. Progesterone stabilizes the endometrial lining.
However, for patients with PCOS who have ovulation issues, progesterone is not produced normally. Without progesterone to counterbalance it, unopposed estrogen causes the development of a thickened and irregular endometrial lining that can result in abnormal bleeding, hemorrhage, or changes that eventually lead to the development of uterine cancer.
Excessive production of male hormones further disrupts the menstrual cycle and causes acne as well as male pattern hair growth in areas including the face, chest, abdomen, and lower back as well as hair loss in the front and top of the head.
PCOS, Insulin Resistance, and Obesity
Up to 80% of women with PCOS have some degree of insulin resistance, which results in the release of higher amounts of insulin into the blood than normal. Insulin stimulates ovarian as well as adrenal androgen secretion, further worsening hair abnormalities and acne. Excessive levels of androgens and insulin can affect metabolism and weight. Ultimately, insulin resistance can develop into actual diabetes. Women with PCOS often experience problems with weight control, frequently observing that they gain weight easily but experience significant difficulty losing weight.
Unfortunately, obesity has significant adverse effects on PCOS by worsening insulin resistance and glucose intolerance and increasing the amount of active male hormones. Numerous studies have demonstrated that even a 10% weight loss can have a significant, positive effect on the PCOS metabolic and hormone profile, including improvement in insulin resistance, reduction of male hormone levels, and improvement in menstrual cycle regulation.
How PCOS Is Diagnosed
Both the symptoms as well as the long-term health consequences of PCOS can be altered through a combination of lifestyle changes and medical management. All preteens, teenagers, and woman with irregular menses, in combination with either abnormal hair growth or acne, should see their physician and request an evaluation for PCOS. Children may present as early as age 10 with hair growth or the disorder may not manifest until the 20s or 30s, often in association with weight gain.
A physical exam should include an assessment of height and weight with BMI (body mass index) calculation, as well as blood pressure. Signs of excess hair, male pattern baldness, obesity, and may be visualized. Appropriate laboratory testing includes measurement of fasting blood sugar, insulin, FSH, LH, DHEAS, total testosterone, TSH, prolactin, and lipid profile.
Treatment for PCOS
Unfortunately, there is no cure for PCOS, but there are many things that can be done to help manage the condition and its symptoms. Therapy for PCOS is typically determined by your goals in terms of desire for pregnancy or treatment of abnormal hair growth, acne, or obesity. Educating yourself about your health and actively participating in your care is essential for getting your PCOS under control. Regulation of the menstrual cycle is essential in avoiding long-term complications of heavy or prolonged uterine bleeding and endometrial hyperplasia/cancer.
Diet
The cornerstone of PCOS therapy involves lifestyle changes incorporating dietary modifications and exercise. As noted, weight reduction of even 10% has been demonstrated to improve insulin resistance, reduce blood levels of male hormones, and improve lipid abnormalities. A high fiber, reduced carbohydrate diet has been beneficial to many PCOS women in achieving weight loss. Counseling with a nutritionist who has an interest in treating PCOS is recommended.
Exercise
Exercise has been demonstrated to improve insulin sensitivity as well as weight loss. Be sure to consult with your physician before starting any exercise regimen. For most patients, your doctor will likely recommend aerobic exercise in which your heart rate is accelerated between 120-140 beats per minute for 45 to 60 minutes daily.
Medications
Insulin-sensitizing agents such as Metformin have become an increasingly common element in the treatment regimen of PCOS. Metformin has been used to treat diabetes mellitus for more than 40 years and is currently the most widely used sugar-lowering agent for women with PCOS.
Metformin indirectly improves insulin resistance by decreasing the production of glucose by the liver. In comparison with diet alone, metformin added to a low-calorie, reduced carbohydrate diet has been demonstrated to result in a greater reduction in body weight, abdominal fat, hirsutism, insulin resistance, and androgen levels.
The combination of weight loss and the use of Metformin may allow women who are not ovulating but desire pregnancy, to become ovulatory and conceive. Specific medications are available to stimulate ovulation for PCOS women who wish to conceive, including clomiphene citrate, letrozole (both taken orally), and gonadotropins (FSH or FSH/LH hormones) that are given by injections under the skin surface.
Fertility Treatment for PCOS
If medications and other therapies are unsuccessful in aiding conception, patients with PCOS may potentially be successful through fertility care. The most common fertility treatment for patients with PCOS is in vitro fertilization (IVF), which involves stimulating the ovaries, retrieving an egg, and fertilizing it with sperm in a petri dish. The fertilized egg becomes an embryo and is then transferred to your uterus in the hopes of implantation occurring. In some cases, patients with PCOS may need a donor egg to achieve pregnancy.
