PCOS, short for Polycystic Ovarian Syndrome, stands as one of the most prevalent hormonal disorders affecting females of reproductive age on a global scale (1). It is a metabolic dysfunction of the ovaries that impacts approximately 5% to 15% of women worldwide. In this blog post we will dive into what PCOS is, its potential causes, common symptoms, diagnosis, and available treatment options to help individuals navigate this often complex and misunderstood condition.
What is PCOS?
According to the World Health Organization, PCOS is a hormonal condition that can cause hormonal disturbances, irregular periods and multiple cysts in the ovaries.
The Science Behind PCOS
Let us back track a bit. Women are born with all of the eggs they will ever have. The greatest number of eggs one would have is before they are born, at 20 weeks gestation (approximately 6 to 7 million). This number drops significantly at birth to 1 to 2 million and continues to decline from infancy all the way through menopause.
Eggs within the ovary undergo growth and development in response to a cascade of hormonal fluctuations across the body. The brian communicate with the ovaries, prompting growth and maturation of a follicle- a fluid-filled sac housing an egg. Upon reaching optimal size, the brain triggers the ovary to release the egg, a process known as ovulation.
In PCOS, hormonal communication is disrupted, resulting in irregular or absent periods. Follicle Stimulating Hormone (FSH) is dispersed among multiple follicles, impeding the proper growth and development of individual follicles. Consequently, the failure of one egg to mature and release occurs, which is crucial for conception. These accumulating follicles in the ovaries manifest a distinctive appearance on ultrasound imaging, this leading to the term "polycystic" ovary syndrome.
What Causes PCOS?
The exact cause of PCOS remains unknown, but several factors may contribute to its development, including:
Hormonal Imbalances
Fluctuations in insulin and androgen levels can disrupt the normal function of the ovaries and lead to the symptoms associated with PCOS.
Genetics
PCOS tends to run in families, suggesting a potential genetic predisposition to the disorder
Insulin Resistance
Many women with PCOS also have insulin resistance, a condition where they body's cells do not respond effectively to insulin, leading to elevated insulin levels
PCOS Symptoms
PCOS symptoms can often be overlooked due to their nature, but it is important to watch for and document these symptoms if you suspect you have PCOS. Symptoms include (2):
Missed periods, irregular periods, or very light periods
Ovaries that are large or have many cysts
Extra body hair, including the chest, stomach or back
Weight gain, especially around the belly
Acme or oily skin
Male-pattern baldness or thinning hair
Infertility
Small pieces of extra skin on the neck or armpits, also known as skin tags
Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts
Diagnosing PCOS
If you suspect you may have PCOS, it is important to speak with your OBGYN or Fertility specialist. Your doctor will be able to order the appropriate tests to evaluate if you have PCOS and then would be able to curate a treatment plan to help restore hormonal equilibrium.
Because PCOS is a cluster of symptoms and it is not a one-size-fits all, it may look different to you than to someone else. PCOS is diagnosed based on the presence of two out of the three following:
Irregular/Absent Menstrual Cycle
Cycles exceeding 35 days or no menstrual cycle at all
Elevated Androgen Levels
Blood tests revealing increased levels of testosterone
Typically women with elevated testosterone present with increased facial hair, male pattern baldness, acne, and increased abdominal fat
Polycystic Ovaries on an ultrasound scan
An OBGYN would be able to evaluate these signs/ symptoms through a set of blood tests and an ovarian ultrasound. It is possible for your OBGYN to conduct further diagnostic tests to rule out other potential conditions that may mimic PCOS, such as hypothyroidism, hyperprolactinemia, and nonclassical adrenal hyperplasia.
Other abnormal hormonal lab values that could be tested include:
Estrogen
Luteinizing Hormone (LH)
Insulin
Anti-Mullerian Hormone (AMH)
Treatment Options for PCOS
While there is no cure for PCOS, various treatment options are available to help manage symptoms, improve reproductive health, and reduce the risk of long-term complications. These include:
Lifestyle Modifications to reduce stress and inflammation throughout your body
Diet: the Mediterranean Diet has gained popularity as a means to manage PCOS due to its anti-inflammatory properties and reduction of chronic inflammation (3). This includes foods such as health fats like olive pils, walnuts, and full fat cheeses. You can also increase protein intake with salmon and reduce red meat consumption.
Sleep: aim for 7 to 8 hours a sleep
Exercise: moderate cardio and strength training is ideal to build and strengthen your muscles. However, it is not necessary to stress out your body with high intensity interval training workouts.
Acupuncture
Therapy/Mindfulness
Medications can help regulate your hormones and reduce symptoms and restore your menstrual cycle
Hormonal birth control may be used if you are not trying to conceive.
If you are trying to conceive, your doctor may try to trigger ovulation induction.
Women with PCOS have a hormonal imbalance. The brain is releasing too little FSH for the amount of follicles that are available inside the ovary. This prevents an egg from growing and developing. The goal is to increase FSH production for an egg to grow and eventually ovulate.
Medications include Clomid, which tells the brain there is not enough estrogen and increases FSH production and Letrozole, which eats up estrogen throughout the body, signaling the brain to release more FSH.
Fertility Treatments and PCOS
For individuals struggling with infertility due to PCOS, there are a number of options available. In addition to the ovulation induction medications listed above, a fertility specialist may advise assisted reproductive technologies such as intrauterine insemination or in-vitro fertilization (IVF).
If you suspect you may have PCOS and you are experiencing symptoms associated with PCOS, it is crucial to meet with a medical professional for a thorough evaluation, timely diagnosis, and personalized treatment recommendations tailored to meet your individual needs and concerns. Take the time to track and document your symptoms as these are important factors your doctors will consider when deciding next steps including testing and diagnosis.
There is a wealth of information to explore regarding PCOS and its influence on reproductive health. If you're seeking personalized guidance, our Patient Empowerment Coaches can help. Through our Grain Fertility Premium Member Program, you can benefit from one on one support to address all of your questions and concerns. We can help you track your symptoms, prepare for appointments, and answer questions you may have.
Do not hesitate to reach out and take proactive steps towards managing your PCOS and optimizing your reproductive well-being. Your journey matters to us and we are committed to empowering you every step of the way.
Citations:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
Barrea L, Arnone A, Annunziata G, Muscogiuri G, Laudisio D, Salzano C, Pugliese G, Colao A, Savastano S. Adherence to the Mediterranean Diet, Dietary Patterns and Body Composition in Women with Polycystic Ovary Syndrome (PCOS). Nutrients. 2019 Sep 23;11(10):2278. doi: 10.3390/nu11102278. PMID: 31547562; PMCID: PMC6836220.
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