Everything You Need to Know About PCOS

Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder that typically impacts reproductive-aged women and people with female reproductive organs. PCOS affects an estimated 8–13% of reproductive-aged women around the world, and up to 70% remain undiagnosed due to various barriers to care and education. Below, we’ll dive into the signs and symptoms of PCOS, treatment options and how to live with this condition. 

What is PCOS?

So, what exactly is PCOS? In simple terms, Polycystic Ovary Syndrome is a hormonal disorder that’s often accompanied by several challenging symptoms–some you can observe and some you don’t see. One of the core symptoms of PCOS is anovulation, which means you do not regularly ovulate. For some women, it means having irregular periods, periods that come too frequently, or no periods at all.

Types of PCOS

Managing Polycystic Ovary Syndrome (PCOS) can often feel overwhelming, particularly when trying to understand its various forms. To provide greater clarity, below we have outlined three subtypes of PCOS.  

Insulin-resistant PCOS

This form of PCOS is the most common and is characterized by the body’s inability to properly use insulin, a hormone that regulates sugar levels in your blood. Insulin resistance impacts energy levels and can lead to Type II diabetes. You might notice weight gain, especially around your midsection, and struggle with excessive hunger.

Inflammatory PCOS

This type triggers a chronic inflammatory response in your body, which can wreak havoc in multiple ways, from fatigue to headaches. Elevated oxidative stress markers, such as C-reactive protein (CRP), are common indicators of inflammatory PCOS. You may be more prone to unexplained rashes or migraines.

Adrenal PCOS

Stress by itself can be a cause of PCOS, especially in Adrenal PCOS. Instead of your ovaries overproducing androgens, your adrenal glands are doing the heavy lifting here, usually triggered by stress. This can result in increased levels of DHEAS or cortisol, hormones related to stress. A 2016 study found that a small subgroup of patients in the study also had adrenal disorders, meaning their bodies were producing more adrenal hormones than normal.

Causes of PCOS and Risk Factors

PCOS is a complicated, multi-factorial disorder, and the exact causes are not entirely known, but researchers believe several factors contribute to its development, such as insulin resistance and inflammation. Many of those same factors can elevate your risk of getting PCOS.

Hormonal imbalances

Women with PCOS often have higher levels of androgens (male hormones) than normal. This imbalance can prevent the ovaries from releasing eggs, leading to irregular menstrual cycles and the formation of cysts in the ovaries. The disrupted hormonal cycle also affects other organs and systems, leading to several symptoms. It’s like a domino effect, where one hormonal glitch knocks over several different processes in your body.

Insulin Resistance (IR)

Many women with PCOS have insulin resistance, which is when the body’s cells do not respond appropriately to insulin, a hormone that regulates blood sugar. As a result, the pancreas produces more insulin than usual. IR, along with metabolic syndrome, is a precursor to Type II diabetes and can lead to weight gain, especially around the midsection in what is usually called “PCOS belly.”

Obesity

PCOS and obesity share a complex dynamic–While PCOS can affect women of any size, obesity is linked to more severe symptoms. Excess body fat, especially around the abdomen, can exacerbate insulin resistance and hormonal imbalances. PCOS can also make it more challenging to lose weight–more women with PCOS report multiple failed weight loss attempts than those without.

Inflammation

Some research indicates that chronic (i.e., ongoing) low-grade inflammation is common in people with PCOS. This inflammation may stimulate the ovaries to produce more androgens, contributing to symptoms like weight gain and insulin resistance. We are not 100% sure there is a direct link, and more research is needed.

Genetics

PCOS tends to run in families, suggesting that there may be a genetic predisposition. If your mom or sister has PCOS, you might be more likely to develop it, too. According to a study published in the National Center for Biotechnology Information, women with a family history of PCOS have a 30-40% chance of developing it themselves.

PCOS Symptoms

As the name of the condition suggests, women with PCOS usually have multiple small cysts on the ovaries. Sometimes, these cysts remain stable, grow in size or number, become inflamed, or rupture, which is usually painful. PCOS does not just affect the ovaries. Other symptoms of PCOS include irregular periods, skin and hair issues and hormonal imbalances. Additionally, cardiovascular problems, obesity, and hypertension are also more common in women with PCOS, making it vital to get a timely and accurate diagnosis.

Irregular periods

Due to anovulation, you might have heavy periods, very few periods, or none at all. An irregular menstrual cycle can also lead to painful periods as the tissue that lines the uterus can build up each month you miss your period. When you finally have a period, the backed-up blood and tissue may cause heavier bleeding and pain. 

Weight gain

Weight fluctuations and PCOS share a complicated relationship. While not every person with a BMI of 25+ (classified as “overweight”) develops PCOS, carrying extra weight can exacerbate symptoms and might even increase your risk. Insulin resistance is a major factor in weight gain–research shows that IR affects between 65-70% of women with PCOS. 

Acne & Oily Skin

Elevated levels of androgens may contribute to issues with hair and skin, including oily and acne-prone skin. PCOS acne may be more stubborn and challenging to cure than other acne. 

Hirsutism

This is the clinical term for excessive hair growth, usually characterized by coarse, thick hair on the face, chest, and back. Hirsutism may appear like male-patterned hair growth because it’s also due to elevated androgens. An estimated 65-70% of women with PCOS also have hirsutism, as opposed to the 4-11% of women overall.

Hair loss

Conversely, androgens can also contribute to thinning hair, hair loss, or even an oily scalp. Excess androgens transform into another hormone called dihydrotestosterone (DHT). DHT binds to the receptors on hair follicles, causing them to shrink and stop producing new hair. Additionally, hair can become more brittle, dry and frizzy. 

Infertility

Anovulation is a critical issue in women with PCOS and one of the main reasons PCOS reduces fertility. ~90-95% of women with anovulatory infertility (meaning they cannot get pregnant because they are not ovulating) seeking treatment have PCOS. Most women with PCOS also have reduced levels of follicle-stimulating hormone (FSH), a hormone that stimulates egg growth in the ovaries and controls the menstrual cycle, among other duties. 

Understanding the PCOS Diagnosis Process

The first step in managing PCOS symptoms is getting a diagnosis. PCOS can be challenging to diagnose as it shares similarities with other hormonal and endocrine disorders. Your healthcare provider will examine several diagnostic criteria to come to a conclusion. The most important thing is clearly communicating any signs and symptoms you’ve noticed at home and noting family and personal medical history.

A Comprehensive Assessment

When diagnosing PCOS, doctors don’t usually rely on just one criterion—they assess a combination. According to the Rotterdam criteria, for instance, you need to meet at least two out of these three conditions to get a PCOS diagnosis:

• Irregular menstrual cycles: Less frequent periods due to anovulation.
• Elevated androgen levels: Seen through symptoms or blood tests.
• Polycystic ovaries: Confirmed via ultrasound.

PCOS Treatments

While a PCOS diagnosis can be overwhelming, the good news is that there are various treatment options to help manage the symptoms. Currently, there is no cure for PCOS, but symptom management can significantly increase your quality of life.

Lifestyle changes

Incorporating a balanced diet and regular physical activity can make a tremendous difference. Research shows that even a 5% reduction in weight can positively impact PCOS symptoms. Focus on foods with low glycemic index and ensure consistent exercise to keep those blood sugar levels in check. You may also want to look into an anti-inflammatory diet and incorporate stress-relief techniques into your daily or weekly routines to lower the presence of stress levels. 

Medication

Hormonal birth control is often the first-line treatment for PCOS. It’s frequently prescribed to help regulate menstrual cycles and prevent the formation of new cysts. Metformin is another medication that may be useful for treating insulin resistance in PCOS. This medication enhances your body’s ability to take in glucose, helping combat insulin resistance. Studies have shown that metformin usage can improve various aspects of PCOS management.

Fertility treatments for those trying to conceive

Infertility is another major concern for women with PCOS. Certain treatment options might be more suitable if you’re trying to conceive. One such method is ovulation Induction. Medications like clomiphene citrate, gonadotropins or letrozole can assist in inducing ovulation, thereby increasing your chances of pregnancy.

We’re the PCOS specialists–let us help you navigate this journey

If you suspect you have PCOS, seeking medical advice sooner rather than later can make a big difference. A proper diagnosis can bring peace of mind and open doors to effective treatment options that can manage and mitigate the condition’s impact on your life.

The providers at Genesis are knowledgeable, experienced and compassionate when working with PCOS patients. We understand it can be a frustrating and confusing condition, and we’re committed to helping you find ways to manage your symptoms so you can get back to doing the things that make you happy and fulfilled. Do not hesitate to contact us to request an appointment today. We believe in empowering patients through education and a collaborative doctor-patient relationship, ensuring you receive the best care tailored to your individual needs.

PCOS FAQ

You may still have questions or concerns about PCOS–what it is, signs and symptoms, treatment options, etc. Below are common questions patients often ask to help you as you navigate this journey. 

Question	Answer
What is PCOS?	PCOS, or Polycystic Ovary Syndrome, is a hormonal disorder that affects women, often causing irregular periods, excess male hormones, and small cysts on the ovaries.
How is PCOS Diagnosed?	PCOS is diagnosed through a combination of symptoms, blood tests to check hormone levels, and an ultrasound to look for cysts on the ovaries.
Is PCOS genetic?	PCOS can run in families, so if a close relative has it, your chances of having PCOS may be higher. However, the exact cause=al relationship is still unclear.
What are the first signs of PCOS?	Early signs of PCOS often include irregular periods, excessive hair growth (on the face or body), acne, and weight gain.
Is PCOS an autoimmune disease?	No, PCOS is not considered an autoimmune disease. It’s primarily a hormonal disorder.
Can you get pregnant with PCOS?	Yes, you can get pregnant with PCOS, but it may be more difficult due to anovulation. Treatments are available to help improve fertility
Does PCOS cause weight gain?	Perhaps–weight gain is a common symptom of PCOS, particularly around the abdomen. However, excess weight is also a risk factor for PCOS, making the relationship challenging to understand.
Does PCOS Cause Acne?	Yes, PCOS can cause acne due to higher levels of male hormones, which lead to oily skin and breakouts.
Can you have PCOS and endometriosis?	Yes, it is possible to have both PCOS and endometriosis, although they are separate conditions with different symptoms.
Will a hysterectomy cure PCOS?	No, a hysterectomy will not cure PCOS because it’s related to hormone imbalances, which aren’t resolved by removing the uterus.