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PCOS: Understanding Symptoms, Causes, and Treatments

Polycystic ovary syndrome (PCOS) is a very common hormonal disorder, affecting up to 12% of U.S. women of childbearing age. But not everyone is aware of the symptoms, long-term effects, and how PCOS can best be managed.

As an obstetrician-gynecologist (OB-GYN), I believe it’s important that all people with a uterus be given the facts about PCOS. The disorder can cause irregular periods and make it harder to get pregnant. However, not all of the problems posed by PCOS are related to reproduction. PCOS can also make a person with a uterus more prone to serious health problems.

If you or someone you know are looking to learn more about PCOS, these seven things may be a great place to start.

1. PCOS can trigger a variety of symptoms.

Common symptoms of PCOS are:

  • Irregular periods, light periods or missed periods. Some patients may have unscheduled prolonged bleeding.
  • Ovaries that are large or have many cysts — this is where the name polycystic comes from.
  • PCOS is characterized by the absence of ovulation (when the ovaries release an egg each month) and high levels of certain hormones, called androgens. This can cause a cluster of symptoms that may affect reproductive function and lead to other side effects.
  • Excess hair on their face, chin, or other areas of the body
  • Acne on the face, chest, and upper back
  • Thinning hair or hair loss on the scalp
  • Excess body weight
  • Dark skin patches, especially around the neck, groin, or under the breasts
  • Skin tags in the armpits or neck

2. PCOS may have multiple causes.

While the exact cause of PCOS isn’t fully understood, experts suspect that a few key factors are involved.

  • Increased androgen hormones, or male hormones — All people with a uterus make small amounts of androgen. However, those with PCOS produce more androgen than is typical. High levels of androgen can stop ovulation and cause other common PCOS symptoms like extra hair growth and acne.
  • Insulin resistance — the hormone that controls how food is changed into energy may also be at play. It’s produced by the pancreas. When you are resistant to it, your blood sugar levels go up, making your body make more insulin. This in turn causes male hormone levels to increase, causing issues with ovulation. Signs of insulin resistance include dark patches on skin.

3. Certain people may be more prone to the disorder.

PCOS can occur in people with a uterus any time after puberty, and all races and ethnicities may be affected. But having excess body weight or having a mother or sister with PCOS may put someone at higher risk. It’s also most common to be diagnosed in their 20s or 30s, simply because that’s when many patients see their doctor for problems with getting pregnant.

4. Many people with PCOS experience infertility.

PCOS is the most common cause of anovulatory infertility or fertility that stems from the absence of ovulation. The condition doesn’t make it impossible to get pregnant, though. Some of my patients with PCOS are able to conceive naturally, and many others are able to do so after making lifestyle changes or undergoing treatment.

I love celebrating these pregnancies with my patients who have PCOS. But we also take time to discuss the possible complications that can occur. People with PCOS are more likely to experience problems during their pregnancies, including gestational diabetes, preeclampsia, pregnancy-induced high blood pressure, preterm birth, or the need for a cesarean section. They’re also more likely to miscarry or have babies that need to spend time in the neonatal intensive care unit (NICU).

But with collaboration and careful monitoring, there are steps we can take to help have the healthiest pregnancies possible.

5. PCOS can raise the risk of long-term health problems.

The effects of PCOS can be lifelong. Too much glucose and insulin in the blood, which occurs in more than half of people with PCOS, can increase the risk for type 2 diabetes and metabolic syndrome. They may also be more likely to experience:

  • Obstructive sleep apnea.
  • Excess body weight.
  • Heart disease and high blood pressure.
  • Mood disorders, such as depression or anxiety.
  • Endometrial hyperplasia, when the endometrium — the lining of the uterus — becomes too thick which in turn can become endometrial cancer.

6. There’s no single test for PCOS.

I consider the possibility of PCOS when a patient mentions that they’re having trouble getting pregnant or are experiencing abnormal or missed periods. But these symptoms alone don’t add up to a diagnosis. In fact, confirming a diagnosis typically involves multiple steps, these include:

  • Complete health history, including menstrual history and family health history
  • Physical exam to look for skin changes, acne, or abnormal hair growth
  • Blood test to check male hormone levels, sugar levels, and other hormones that could cause abnormal menstrual cycles
  • Pelvic ultrasound to look for cysts

Once we’ve gathered all of this information, we can determine the right diagnosis. If a patient is experiencing irregular periods, high androgen levels, and/or cysts on their ovaries, and other conditions have been ruled out, I’ll diagnose them with PCOS.

7. PCOS can be managed.

There’s no cure for PCOS, but symptoms can be managed. Lifestyle changes and treatments can go a long way toward managing symptoms, improving the chances for pregnancy, and reducing the risk for long-term complications.

I like to work with my patients to come up with personalized treatment plans. Together we’ll discuss options, including:

  • Losing excess weight, if that is needed. For some, this may be enough to restore ovulation and make their periods more normal, increasing the chance for pregnancy.
  • Physical activity. Regular exercise is a known mood booster. For patients who are experiencing depression, it really can make a difference.
  • Infertility treatments. Medications such as Clomiphene and/or Letrozole may restore ovulation and increase the chances of conceiving.
  • Hormonal contraceptives. For people with a uterus who don’t want to become pregnant, hormonal birth control can make their periods more regular.
  • Insulin-sensitizing agents. Drugs like Metformin can reduce insulin resistance and address a number of PCOS symptoms, including excess weight, high cholesterol, and irregular periods.
  • Anti-androgen medicines. These drugs prevent the body from making androgen hormones or limit the effects of androgens, like excessive hair growth.
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