Polycystic Ovarian Syndrome (PCOS): Causes, Symptoms & Treatment

Polycystic ovarian syndrome, also known as PCOS, is a hormonal condition that affects women’s hormonal levels. Due to this, women may experience irregular periods, excess hair growth, acne, and infertility.

Polycystic Ovarian Syndrome is a hormonal imbalance caused by the ovaries producing excess male hormones. For instance, in women with PCOS, the ovaries produce elevated levels of androgens, leading to an imbalance in their reproductive hormones. This causes her reproductive hormones to become imbalanced. Women with PCOS often have erratic menstrual cycles, missed periods, and unpredictable ovulation. In addition, small cysts may develop on their ovaries due to a lack of ovulation. However, despite the name “polycystic,” they do not need cysts on their ovaries to have PCOS.

Ovulation happens when a fully developed egg is released from the ovary. This happens so that a male sperm can fertilize it. If the egg is not fertilized, it is sent out of the body during the menstrual period. A woman doesn’t make enough of the hormones needed to ovulate in some cases. When ovulation doesn’t happen, the ovaries may develop many small cysts. These cysts produce hormones called androgens.

Women with PCOS often tend to have high levels of androgen, which causes more problems with a woman’s menstrual cycle. Thus, treatment for PCOS is usually done with medication.

What Role Do Hormones Play in PCOS?

When women have PCOS, their reproductive hormones are unbalanced, leading to problems with their ovaries, such as not having their period on time or not getting it.

The hormones that play a role in Polycystic ovarian syndrome include:

• Androgens: Although typically associated with males, women also produce these hormones. Women with PCOS frequently experience higher levels of androgens.
• Insulin: This hormone regulates blood sugar, but in women with PCOS, their bodies may not respond to insulin as effectively.
• Progesterone: With PCOS, the body may not have enough of this hormone. As a result, women may experience prolonged periods of amenorrhea.

Causes

The exact cause of PCOS is unknown. However, most experts think that several factors play a role, including genetics,

• High Levels of Androgens: Androgens are sometimes called “male hormones, and all women make small amounts of androgens. Women with PCOS have more androgens than usual. In women, an increase in androgen levels can disrupt the ovulation process, hindering the release of an egg each cycle while also contributing to excessive hair growth and acne.
• High Insulin Levels: Insulin plays a key role in transforming the nutrients from food into usable energy for the body. Insulin resistance happens when the body’s cells no longer respond effectively to insulin. As a result, the insulin blood levels become higher than usual. Insulin resistance is common among women with PCOS, particularly those who are overweight, lead a sedentary lifestyle, follow an unhealthy diet, or have a family history of diabetes.
• Genetics: In some cases, PCOS is also linked to heredity.

Symptoms and Signs

• Irregular Periods: A lack of ovulation may cause irregular periods, preventing the uterine lining from shedding every month.
• Heavy Bleeding: Because the uterine lining accumulates over a longer period, the menstrual flow tends to be heavier than normal.
• Hair Growth: More than 70% of the women with PCOS grow hair on their face and body (arms, chest, belly, and back).
• Hair thinning: Hair loss in specific areas of the scalp or balding tendencies can be observed among those with PCOS.
• Acne: Elevated male hormones increase oil production in the skin, leading to breakouts on the face, chest, and upper back.
• Obesity: Around 80% of women with PCOS experience weight gain and face challenges in shedding extra pounds.
• Hyperpigmentation: Acanthosis nigricans, manifested as dark patches of skin, tends to develop in body folds such as the neck, armpits, groin, and under the breasts.
• Fertility issues: Polycystic ovary syndrome (PCOS) is the most common reason for infertility in individuals assigned female at birth, as it often disrupts regular ovulation and hinders successful conception.
• Skin Tags: Skin tags are small, soft flaps of extra skin commonly found in areas like the armpits or neck.

Can PCOS Cause a Miscarriage?

While PCOS can raise the likelihood of specific pregnancy complications, many women and individuals assigned female at birth (AFAB) with PCOS successfully carry pregnancies to full term. Potential pregnancy-related complications for those with PCOS include:

• Gestational diabetes, preeclampsia, and high blood pressure.
• Preterm birth (before 37 weeks) or C-section delivery due to factors like obesity, diabetes, or high blood pressure.

How Does PCOS Affect the Body?

• Metabolic Syndrome: As many as 80 percent of women with PCOS are either overweight or obese. Both obesity and PCOS increase the risk for
• High blood sugar
• High blood pressure
• Low HDL “good” cholesterol
• High LDL “bad” cholesterol: These factors are known as metabolic syndrome, and they elevate the risk for:
  • Stroke
  • Diabetes
  • Heart disease

Sleep Apnea

This condition leads to frequent pauses in breathing throughout the night, disrupting sleep. Overweight women, particularly those with PCOS, are more likely to experience sleep apnea. The likelihood of sleep apnea is 5 to 10 times greater in women who have both obesity and PCOS than in those who don’t have PCOS.

How to Avoid Miscarriage with PCOS

While it is not always possible to prevent a miscarriage, women with PCOS can take proactive steps to reduce the risk and increase the chances of a healthy pregnancy. While factors such as genetic or chromosomal abnormalities are uncontrollable, the following strategies can enhance pregnancy outcomes:

1. Preconception Care and Planning

Before trying to conceive, consulting a healthcare provider with expertise in fertility is essential. They can review your health and PCOS situation, provide customized recommendations, and propose effective treatments to increase your chances of a successful pregnancy.

2. Maintain a Healthy Weight

Maintaining a healthy weight can support hormone balance and improve insulin sensitivity, both of which are important for effectively managing PCOS. Engaging in regular, moderate activities like walking or swimming can help manage weight, lower stress, and support hormone balance.

3. Nutrition and Supplements

A nutritious diet that includes whole grains, leafy greens, lean proteins, and healthy fats can help maintain hormonal balance and promote overall well-being. Prenatal vitamins containing folic acid, iron, and vitamin D are essential, as they help prevent neural tube defects and support both the mother’s and the baby’s health.

4. Monitor and Manage Blood Sugar Levels

Keeping blood glucose levels stable is crucial for lowering the risk of complications like gestational diabetes, which can raise the likelihood of miscarriage. Consistently monitoring blood sugar levels and collaborating with a healthcare provider to develop a personalized plan, including dietary changes, physical activity, or insulin adjustments, is essential for effective management.

5. Limit Stress

While stress doesn’t directly cause miscarriage, it can negatively impact overall health and exacerbate PCOS symptoms. Practicing stress management methods, such as yoga, meditation, or deep breathing, can enhance emotional well-being and alleviate physical tension during pregnancy.

6. Avoid Harmful Substances

It is important to quit smoking and excessive alcohol consumption, as they can greatly raise the risk of miscarriage and other pregnancy-related complications. Limiting or eliminating caffeine consumption is also advisable, as it has been linked to higher risks of pregnancy loss and low birth weight.

7. Early Prenatal Care and Regular Monitoring

Regular visits to an experienced healthcare provider, such as a gynecologist or endocrinologist, are critical for those with PCOS. Early and consistent prenatal care allows for early detection of potential complications, such as gestational diabetes or preeclampsia, and facilitates prompt intervention to manage these risks.

8. Fertility Treatments and Ovulation Induction

If you experience irregular menstrual cycles or have trouble ovulating, your doctor may suggest fertility treatments, including medications to stimulate ovulation. These treatments can assist in regulating menstrual cycles and enhance your chances of conceiving and sustaining a pregnancy.

By following these steps, you can enhance the chances of a successful pregnancy while managing the unique challenges of PCOS. However, it’s important to remember that every pregnancy is different, and the support of a healthcare team is crucial for the best possible outcome.

Diagnosis

In most cases, doctors can diagnose PCOS after an examination. They may take blood tests or perform an ultrasound to help with the diagnosis.

The doctors will:

• Talk about the symptoms and medical history.
• Ask about the family’s medical history.
• Check weight and blood pressure.
• Conduct a pelvic exam to check for enlarged ovaries or any abnormal growths in the uterus.
• Conduct blood tests to assess hormone and glucose levels.
• Use a pelvic ultrasound to examine the ovaries for cysts and evaluate the thickness of the uterine lining.

Natural Remedies and Diet

Although PCOS cannot be cured, adopting healthy lifestyle changes can significantly help in managing its symptoms.

• Regular exercise and maintaining a healthy weight can improve insulin sensitivity and hormone balance.
• A balanced diet rich in whole foods, lean proteins, complex carbohydrates, and healthy fats is recommended.
• Foods with a low glycemic index can help regulate blood sugar levels.

It’s important to understand that PCOS symptoms vary from person to person. Some women may not experience all symptoms, and their severity can range from mild to severe. Suppose you have signs and symptoms of PCOS. In such cases, it’s best to consult a gynecologist or endocrinologist. They will review your medical history, conduct a physical examination, and may recommend blood tests or an ultrasound to aid in diagnosis.

Complications

PCOS can lead to several health problems, including:

• Difficulty getting pregnant (infertility)
• Diabetes during pregnancy or high blood pressure caused by pregnancy
• Miscarriage or early delivery
• Nonalcoholic steatohepatitis, a serious liver inflammation caused by fat buildup in the liver
• Metabolic syndrome, which includes high blood pressure, high blood sugar, and unhealthy cholesterol or triglyceride levels. This raises the risk of heart and blood vessel disease
• Type 2 diabetes or prediabetes
• Sleep apnea
• Depression, anxiety, and eating disorders
• Cancer of the uterine lining (endometrial cancer)

Obesity is common in people with PCOS and can make these complications worse. If you notice symptoms of PCOS, visit a doctor early. Early diagnosis and treatment can help reduce the risk of these complications.

Frequently Asked Questions