Polycystic ovarian syndrome, more commonly known as PCOS, is a very common condition of the ovaries. It has a variety of signs and symptoms, but very specific criteria for diagnosis. It’s not uncommon for a patient, or two, to ask me daily if it’s possible they have PCOS. However, I love when my patients ask me questions about their health or voice their concerns to me, rather than take the word of “Doctor Google” or a well-meaning friend or family member. The symptoms of PCOS are so common to many other conditions (or just life), that it’s not unreasonable for many people to wonder if they have it. Also, PCOS can increase the risk of other more serious conditions and it important to begin taking steps to reduce risk as early as possible. Let’s dive into some of the important details.
1. What are the signs and symptoms of PCOS?
The most common symptom of PCOS that prompts me to evaluate a patient for PCOS is irregular periods. It’s common to not have completely predictable, but monthly periods. However, if you are skipping months without a period that should prompt an evaluation for PCOS. Keep in mind that it is typical for periods to be irregular during the first couple of years after the first period, and I would be cautious of diagnosing a newly menstruating person with PCOS unless test results are very convincing. Persons with PCOS are not ovulating regularly due to abnormal levels of hormones from the pituitary gland (part of the brain) and the ovaries causing the ovaries not to function normally. It’s not completely known what triggers these abnormalities.
Other common symptoms of PCOS are increasing or worsening acne, and hair growth on the face, chest, abdomen that seems excessive. Thinning of hair from the head is also a symptom of PCOS, and like acne and unwanted hair growth, it is a result of excess androgens (typically referred to as male hormones), such as testosterone, being produced by the ovaries. While being overweight or obese is not directly caused by PCOS, people who are overweight or obese have a higher risk of PCOS and may have more difficulty losing weight.
A common sign of PCOS is polycystic ovaries. The term “polycystic ovaries” however, is a misleading description of what is seen on ultrasound. What this term refers to is the “cystic” appearance of the ovaries and not the presence of ovarian cysts. Typically, every month one follicle, which is where an egg or oocyte is stored, grows larger in response to changing hormones and eventually that egg is released from the follicle; this process is called ovulation. In PCOS because of a dysfunction of the ovaries, one follicle isn’t capable of growing large enough to result in ovulation and instead many follicles grow a little larger to where there can be seen on ultrasound giving the ovaries a “cystic” appearance. Having a cyst on the ovary is common and not associated with PCOS.
2. How is PCOS diagnosed?
There are a number of expert groups with published criteria for diagnosing PCOS,and—thankfully—they are all in agreement. To be diagnosed with PCOS, a person must have at least two of the following three signs or symptoms:
Irregular periods caused by irregular ovulation; that is, other causes have been ruled out.
Elevated androgen levels either found on blood tests or evidenced by symptoms such as acne, excess hair growth or male-pattern balding.
The appearance of polycystic ovaries on ultrasound.
Having only one of the above criteria is not enough to diagnose PCOS.
3. What are the possible long-term effects of PCOS?
Having PCOS increases a person’s risk for several complications. Most of my patients are concerned about the risk of infertility. If you’re not ovulating regularly it will make getting pregnant more difficult. Having PCOS does not automatically mean a person is unable to ever get pregnant, they are some lifestyle modifications that can help and if necessary, medications are available to help promote ovulation.
The lining of the uterus can build up in those who do not have regular periods because they are not ovulating. When this happens, it can lead to heavy, prolonged periods due to the lining becoming thicker over several months. An abnormally thickened uterine lining is also a risk factor for precancerous tissue and cancer of the uterus. It is very important that if you are having a period less than 8 times a year that you get evaluated by a health provider.
Some people with PCOS are insulin resistant. Insulin is a hormone that is released by the pancreas in response to glucose (sugar). If a person does not respond normally to insulin, requiring the body to produce high levels of insulin, they have insulin resistance and have a higher risk of developing type 2 diabetes. People with PCOS, who are both overweight and have insulin resistance may be at increased risk of heart disease.
4. Is there a cure for PCOS?
The cause of PCOS is not yet completely known and there is no definitive cure for PCOS, however, it can be managed.
5. How can I manage PCOS?
The good news is that though they are many unpleasant symptoms and serious risks of having PCOS, there are also many management options. While we can’t cure PCOS, we can work together to minimize the risks of the disease. Not everyone diagnosed with PCOS is overweight or obese, but those who are can achieve significant improvement in their PCOS symptoms by losing as little as 5% of their body weight. Weight loss helps treat insulin resistance and often promotes ovulation and the return of regular periods. I always encourage my patients to utilize the knowledge of nutritionists, personal trainers, and their physicians to help them achieve weight loss goals; a support system is key!
For my patients with PCOS, who are having infrequent periods my main concern is reducing their risk of uterine cancer. We often do this with the help of hormonal birth control or other progesterone therapy to keep the lining of the uterus thin. Not all birth control or hormone therapy will result in a monthly period, but they will all minimize the risk of uterine cancer. In years past, Metformin, a medication used to treat diabetes, was a standard treatment for PCOS, but not any longer. Metformin is still very helpful for people with proven insulin resistance to reduce the risk of developing diabetes and it may help with weight loss, though it is not recommended to be used for this reason alone.
Infertility caused by PCOS is typically due to not ovulating and as we discussed earlier, weight loss, if appropriate can promote ovulation and improve the chances of getting pregnant naturally. There are also medications that can be given to induce ovulation in persons with PCOS, helping them to get pregnant.
Here’s the takeaway lesson: PCOS is very common, can be easily diagnosed and managed. Any and all questions should be discussed with your trusted and friendly health professional.
About the Author
Dr. Candice Fraser is a Diplomate of the American Board of Obstetrics and Gynecology and the founder of Trinity Medical Care NY PLLC. Dr. Fraser’s passion is to provide excellent, comprehensive health care to the women of New York City. She loves developing relationships with her patients, allowing them to actively participate in their medical care.