Understanding Polycystic Ovarian Syndrome (PCOS)

Facial hair, irregular periods, and weight gain, oh my!

If you’re experiencing these and other symptoms of PCOS, you might be surprised to find that lifestyle changes can make a big difference in the severity of both the symptoms and complications you experience. Here’s everything you need to know.

Polycystic Ovarian Syndrome (PCOS) is an imbalance of the reproductive hormones affecting as many as 1 in 10 women during their reproductive years. PCOS can wreak havoc on your body, leading to infertility and other serious health problems. ¹

What is PCOS or Polycystic Ovarian Syndrome?

Women suffering from PCOS are experiencing an imbalance between three primary hormones: androgens (the male hormones), progesterone, and insulin. Because each of these hormones regulates different body processes, the imbalance can affect a multitude of functions and systems.

The onset of Polycystic Ovarian Syndrome typically hits sometime after puberty, but in many cases, women aren’t diagnosed with the syndrome until they’re in their 20s or 30s. In fact, many women don’t seek out diagnosis or treatment until they’re ready to start a family and begin to realize that conception is difficult. OBGYNs and fertility specialists most commonly diagnose PCOS.

What causes Polycystic Ovarian Syndrome?

As is the case with many conditions, the exact causes of Polycystic Ovarian Syndrome are unknown. What we do know is that certain factors seem to increase your risk of developing PCOS, including:

• Inflammation. Women who have PCOS tend to show signs of low-grade inflammation throughout the body, which stimulates androgen production by polycystic ovaries.
• Overproduction of insulin. Patients who produce excess insulin might experience increased production of androgen as well, inhibiting ovulation.
• Too much androgen. Women who develop PCOS have increased androgen levels.
• Heredity. Some research indicates a potential relationship between certain genes and the development of PCOS.
• Obesity. Many women with PCOS are overweight, and losing weight often helps reduce the symptoms which may indicate a relationship between weight and the development of PCOS.

What are the signs and symptoms of Polycystic Ovarian Syndrome?

It’s important to take a look at symptoms from two perspectives: women with PCOS will likely suffer from the symptoms of PCOS but may also suffer the symptoms of other, coexisting conditions related to PCOS such as diabetes, depression, or metabolic syndrome. For this reason, very few women are able to look at the list and say, “Check! That’s me!” Instead, you’ll find that you might have just one symptom or you might have all of these symptoms and then some seemingly unexplained issues that aren’t listed here but may still be related.

The most common symptoms of Polycystic Ovarian Syndrome include excessive hair growth including facial hair, irregular menstrual periods, weight gain, and acne.

What complications can occur as a result of PCOS?

Just like diabetes can lead to neuropathy, untreated Polycystic Ovarian Syndrome can lead to other health conditions that are serious or even life-threatening. Some of the conditions that sometimes occur secondary to PCOS are:

• Gestational diabetes ,Type 2 diabetes, or prediabetes
• Infertility, miscarriage, or premature birth
• Abnormal uterine bleeding or endometrial cancer
• Eating disorders, depression, or anxiety
• Metabolic syndrome
• Non-alcoholic steatohepatits
• Sleep apnea

Because these complications are serious, diagnosis and treatment are key for women with signs and symptoms of Polycystic Ovarian Syndrome. Managing the disease can help prevent serious complications.

How is Polycystic Ovarian Syndrome diagnosed?

There is no test for PCOS, but your provider with gather information through a variety of examinations and tests to look for hormonal imbalance, cysts on the ovaries, and the physical signs and symptoms of PCOS. Some of the most common tests that are done include lab tests to measure hormone levels in the blood; ultrasound to visualize the ovaries and identify ovarian cysts; and physical examination.

Here’s what you can expect. You’ll schedule a consultation appointment with your OBGYN or primary care provider. During that appointment, you’ll be asked questions about your medical history, family history, and current complaint (the signs and symptoms you’re experiencing that have led you to seek care).

Your healthcare provider will perform a physical examination, in some cases including a pelvic exam, and then order tests that will help support or rule out a diagnosis of PCOS. Whether you can complete those tests the same day or a different day will depend on the soonest available appointment, the need for fasting, and other factors.

Once your provider receives the results from the tests he or she ordered, they’ll be able to determine whether you’re suffering from Polycystic Ovarian Syndrome or not. In some cases, more testing is required.

How is Polycystic Ovarian Syndrome treated?

The first line of treatment for PCOS is lifestyle changes. Women who are overweight often experience more severe symptoms and complications, and even a small reduction in body weight can make a big difference. Women who have PCOS often find it challenging to lose weight, so working with your provider, a health coach, or a nutritionist can be helpful. Some of the programs that women with PCOS have success with include low-carb diets and intermittent fasting.

Low-carb diets are generally rich in protein, fats, and plenty of colorful fruits and vegetables. By eliminating highly processed flours and sugars, patients are often able to lose weight quickly and effectively, which in turn motivates them to keep at it.

Intermittent fasting is a weight loss strategy that requires you to confine your consumption of calories to a small window each day and then fast (while drinking plenty of fluids) during the fasting window. Common schedules include 23/1, which requires 23 hours of fasting followed by a one-hour eating window, and 16/8, which requires sixteen hours of fasting followed by an eight-hour eating window.

Studies have found that intermittent fasting is an effective weight-loss method for people of all weights and body mass indexes. ²

When weight loss is unsuccessful or inadequate, medications may be prescribed. It’s also important to note that treatment must also address any comorbidities, like type 2 diabetes or metabolic syndrome. For this reason, many patients are prescribed a multifaceted treatment plan that includes lifestyle changes, ongoing medical oversight and evaluation, and sometimes ongoing treatments or medications.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3737989/[↩]
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6128599/[↩]