What is PCOS? - Everything You Need to Know about Polycystic Ovary Syndrome

Medically reviewed by Mary Ahern MS, RDN, RYT March 07, 2024| Written by Zenda Nel

What is PCOS? - Everything You Need to Know about Polycystic Ovary Syndrome

There are only a few things as devastating for a woman to hear as that she won't be able to have children. These words often bring with them a sadness that never truly leaves, and nothing ever makes up for it. This is how it has been for countless women over the ages, and the most common reason for that unwelcome message is a diagnosis of PCOS.

PCOS stands for polycystic ovary syndrome which affects women of childbearing age (15 to 44). 

PCOS is one of the most common causes of infertility. PCOS affects6-12% of women in the US and8-13% of women worldwide. It is estimated that7–10 million American women have the condition. 

PCOS occurs among women of all races and ethnicities. Though it usually starts during adolescence; it is not necessarily diagnosed at that stage. So, women only discover that they have PCOS when they fail to get pregnant and visit a doctor to find out why.

Polycystic ovary syndrome is not seen as one disease; rather it’s a set of symptoms.

For instance, PCOS can cause hormonal imbalances, especially increased levels of androgens - a group of male hormones that may result in acne, hair growth, or dark patches of skin in body folds or creases like the armpits or under the breasts. 

PCOS is a chronic condition that cannot be cured, but the symptoms can be treated with medications. Lifestyle changes can also improve symptoms, as well as the resulting infertility.

How Does PCOS Cause Infertility?

Under normal conditions, a woman's ovary releases a mature egg during ovulation. When the male sperm reaches it, fertilization takes place.

In PCOS, a woman's ovaries produce an abnormal amount of androgens. Androgens are male sex hormones that women also carry, but usually in small amounts. The androgens are produced by cysts on the ovaries. These cysts develop when ovulation doesn't occur due to a lack of other hormones. 

It's important to know that not all women with PCOS have cysts on their ovaries, and not all women who have cysts have PCOS. 

Women with PCOS often produce too much androgens, which can interfere with a woman’s ovulation cycle. However, this doesn’t happen in all women with PCOS, and some experience no problems with fertility

What are the Symptoms of PCOS?

Although PCOS is not uncommon, it's not easy to diagnose. PCOS is characterized by various symptoms, but all of them may not be present in one individual. 

In other words, a young woman may have a number of the PCOS symptoms, only one, or all of them.

Diagnosis is further complicated by the fact that some of the symptoms may have other causes. For instance, a teenager's acne can be caused by other conditions. 

Symptoms of PCOS are:

  • Irregular menstrual cycle – More than normal periods; fewer than normal or sometimes no period at all.
  • Large ovaries, or ovaries with cysts on them
  • Infertility
  • Hirsutism - excessive hair growth on body parts where men usually have hair, including on the face, chest, and back.
  • Acne, usually on the face, chest, and upper back
  • Thinning hair or hair loss on the scalp (male-pattern baldness)
  • Weight gain or problems losing weight
  • Dark and/or thick skin patches on the back of the neck, under the breasts, in the armpits
  • Skin tags – tiny pieces of skin that lift from the rest of the skin, usually in the armpits, groin, or neck area

What Causes PCOS?

The cause of PCOS is unknown. It runs in families, so there seems to be a genetic connection. 

Since PCOS is characterized by high levels of androgens and insulin, experts also suggest a link between these factors with this health condition. Lastly, excess weight, insulin resistance, and low-grade inflammation have all been implicated as potential causes of PCOS.  

1. The Androgen Link

Women who are diagnosed with PCOS present higher than normal levels of androgens. Androgens are sex hormones produced by both genders. But males produce higher levels of androgens, especially testosterone. 

Interestingly, women typically producemore androgens than estrogens but these are both in low quantities.

Androgen plays a role in the sexual development of both males and females. The hormone has to do with the onset of puberty, body development, and reproductive health.

In men, androgens are responsible for the deepening of the voice, hair growth on the face, chest, underarms, and genitals, as well as sperm. In women, the hormone plays an important role in menstruation, conception and pregnancy, and the growth of pubic and underarm hair.

Women diagnosed with PCOS have higher than normal levels of androgens, which lead to some of thesymptoms mentioned above.

2. The Insulin Link

Insulin is a hormone that facilitates glucose uptake by the body's cells for use as energy. And so, it controls the blood sugar levels that fluctuate when we eat or drink - especially something sweet or starchy. 

Insulin resistance is when the cells do not respond normally to insulin by not absorbing glucose. As a result, the blood sugar levels remain abnormally high. 

Many women with PCOS have insulin resistance. 

What are the Four Types of PCOS?

As mentioned earlier, PCOS is a complicated set of syndromes with no clear cause. So, several fertility clinics andfacilities tend to divide PCOS into four types: Insulin-resistant PCOS, Post-pill PCOS, Inflammatory PCOS, and Adrenal PCOS.

1. Insulin-resistant PCOS

Insulin-resistant PCOS occurs when the body's cells become resistant to the effects of insulin, which can lead to hormonal imbalances associated with PCOS. When cells resist insulin, the pancreas secretes more insulin which leads to elevated insulin levels in the bloodstream. 

This can trigger increased production of androgens which can disrupt ovarian function. This in turn may result in irregular periods, the development of ovarian cysts, and potentially infertility. 

2. Inflammatory PCOS

Inflammatory PCOS may be the result of hormonal imbalances caused by ongoing inflammation in the body. An underlying disease or food sensitivity may cause chronic inflammation. This can lead to an imbalance of hormones which may increase androgens in the body. 

Inflammatory PCOS often presents with frequent headaches, infections, and skin allergies. 

3. Post-pill PCOS

Oral contraceptives can play a role in a woman's risk of developing PCOS. If you suddenly stop taking oral contraceptive pills you put yourself at risk of developing post-pill PCOS-like symptoms. 

After stopping with the pills, the ovaries may produce excessive androgen, depending on the type of hormone-suppressing pill you take. Essentially, quickly coming off certain types of hormonal birth control pills may induce symptoms that mimic PCOS. Additionally, going onto hormonal birth control can mask some PCOS symptoms that only become apparent after you stop taking the pill. 

Some common post-pill PCOS symptoms include excessive hair growth, irregular periods, and acne. 

4. Adrenal PCOS

Adrenal glands release stress hormones for you to better handle any situation. And so, befitting its name, Adrenal PCOS develops when a woman's body reacts to stress with increased production of DHEAS - an androgen that forms in the adrenal glands.

So, in Adrenal PCOSadrenal glands, and not the ovaries, are the source of androgens. 

Women who live under a lot of stress are at risk of developing this kind of PCOS. 

How Do You Know You Have PCOS? 

A doctor will diagnose you with PCOS if you have at least two of these PCOS symptoms:

  1. Irregular periods or no periods.
  2. Higher than normal androgen levels determined by blood tests or physical indications of excessive male hormones i.e. excess hair on the face and body.
  3. Small cysts on the ovaries.

Can PCOS be Treated?

PCOS is a complicated set of syndromes for which one treatment approach is not possible. So, the treatment consists ofa combination of lifestyle changes and medications to alleviate and manage the symptoms associated with PCOS. 

1. Lifestyle Adjustments

a. Weight Management

Most women with polycystic ovary syndrome demonstrate some level of insulin resistance. So, it's necessary to follow a diet that addresses this issue. Researchers say an appropriate diet should be the first line of defense, especially if the woman also carries excess weight. 

High androgen levels can also exacerbate weight problems seen in PCOS. Following a balanced diet low in calories can help. Research has shown thatlosing 5% weight can improve POCS-related problems, including insulin resistance, high levels of androgens, and reproductive system dysfunction.

Going on a diet to lose weight is helpful, but a much better option is to maintain a healthy body weight by eating the right food for insulin resistance by managing blood sugar. Foods that keep blood sugar low include lean proteins, healthy fats, and plenty of fiber! This is discussed in more detail below.  

You can also check out ourDietitian-Backed Tips to Lose Weight Fast.

b. Diet to Manage Insulin Resistance

To fight insulin resistance, a diet high in whole grains and complex carbohydrates high in fiber is your first line of defense. High-fiber foods tend to have a low glycemic index (GI), which helps with glucose levels. 

Fiber-rich food includes whole grains, fruit (including the skins), vegetables, nuts, and legumes. 

You can also increase your daily fiber intake throughfiber powders. This may be particularly helpful if you’re going on a diet and want to eat only a fixed amount of calories/day.  

But whatever your diet may be, you should try to limit high glycemic-indexed foods like 

  • Bread and pastries made with white flour
  • Pasta
  • Processed sugar
  • Packaged cereals
  • White rice 
  • Fruits high in sugar like mango, banana, and grapes

Researchers also advise women with PCOS to limit their intake of saturated fats for both their weight management and to combat insulin resistance. 

So, it’s best to choose skim milk, lean beef, and skinless chicken over their alternatives.

c. Exercise

Exercise is an important aspect of a healthy lifestyle. A lack of physical activity contributes to weight gain, worsens insulin resistance, and can contribute totype 2 diabetes. In addition, lack of exercise can also contribute to poor heart health and a compromised immune system.

Exercise is associated with an improvement in insulin sensitivity. Both aerobic exercises like walking/jogging and resistance training like weightlifting can help control blood sugar levels. 

Some experts suggest that acombination of both types of exercise may be more effective than doing just one of them alone.

A systematic review of studies on the effect of exercise on the reproductive functions of women with PCOS found that physical activitycan improve reproductive functions and reduce infertility.

2. Medical Treatment 

Medication focuses on managing the symptoms of PCOS and can include: 

  • Birth control medicines (contraceptive pills) to help regulate the menstrual cycle
  • Medication to treat acne or excessive hair growth
  • Fertility therapies
  • Medicines to address insulin resistance 

How Does PCOS Affect Quality of Life?

PCOS comes with several otherlong-term health problems that may take a shocking toll on a woman’s physical and emotional well-being. Additional health concerns that women with PCOS have to deal with include the following: 

1. Diabetes 

Women with PCOS tend to be overweight, which increases the likelihood of developing diabetes. Shockingly, more than half of women with PCOS develop type 2 diabetes by age 40. 

In several cases,dietary changes may help a woman manage her early diabetic symptoms i.e. prediabetic state.

2. Gestational Diabetes

During pregnancy, women with PCOS are at increased risk for developing diabetes during her pregnancy, which is dangerous for her and her baby. 

They are both also at risk of developing type 2 diabetes later in life.

Though research is still ongoing, you can read this article formeasures to prevent gestational type-2 diabetes in most people.

3. Heart Disease 

Women with PCOS are at greater risk of having high blood pressure than women of the same age who don't have PCOS. High blood pressure is a leading cause of heart disease and stroke. 

So, if you are suffering from PCOS a good idea is to monitor your blood pressure.

Related Article: Tips to reduce the risk of high blood pressure. 

Also, women with PCOS often haveraised LDL (bad) cholesterol levels - another risk factor for heart disease and stroke.

4. Sleep Apnea 

This disorder causes a person to stop breathing during sleep. The sleep interruptions are brief and can become life-threatening if the person is very overweight and doesn't get treatment for the condition. 

This too raises the risk of heart disease andtype 2 diabetes.

5. Endometrial Cancer Risk

Women with PCOS are up to5 times more likely to develop endometrial cancer compared to other women. Bouts of depression and anxiety, the specter of endometrial cancer, diminished sexual satisfaction, weight gain, acne, and hair loss all conspire to eat away at a woman's quality of life.

While there’s no way to completely prevent cancer, improving diet can certainly helpreduce the risk of cancer.

6. Mental Health Issues

The physical and emotional implications of PCOS have long been misunderstood by the medical profession, a mistake that is nowacknowledged. For example, healthcare professionals couldn’t measure how upsetting it is for a woman to have a beard, a symptom that is hard to hide.

The latestresearch evidence indicates that women diagnosed with PCOS have a higher risk for mental health issues like depression, anxiety, personality disorder, and schizoaffective disorder.

A study by the Taipei Veterans General Hospital that involved more than 18,000 women has revealed a disturbing correlation between PCOS and anincreased risk of suicide attempts. The study found that PCOS patients were8 times more likely to attempt suicide than women without the condition.

Final Thoughts

Polycystic ovary syndrome and the women suffering from it have long been misunderstood. It may be because the symptoms vary among individuals and are seemingly unrelated. 

For example, a doctor who treats an overweight woman for sleep apnea may not consider a PCOS diagnosis, and a psychiatrist who treats someone for anxiety and depression may not suspect that PCOS is the underlying condition.

Although PCOS is the most frequent of all endocrine disorders among women of reproductive age, the medical profession doesn't fully understand it. As a result, many women do not receive timely diagnosis and adequate treatment.

This unfortunate situation is changing, though. Researchers are urging healthcare professionals to be aware of the different symptoms and to thoroughly investigate the possibility of POCS. It’s because an early diagnosis can help women recover and not suffer the worst consequences.