What is PCOS?
Polycystic ovary syndrome (PCOS) is a common hormonal imbalance caused due to excess of male hormones “Androgens” in women of reproductive age. It is estimated that between 5% and 10% of women in the United States have PCOS, and many of them may not even know it. In this comprehensive guide, we will explore the signs and symptoms of PCOS and discuss the importance of early diagnosis and treatment. We’ll also provide answers to some of the most commonly asked questions about PCOS.
What are the First Signs of PCOS/ PCOS Symptoms?
The first signs of Polycystic Ovary Syndrome (PCOS) are-
- Irregular periods: Women with PCOS may experience irregular menstrual cycles, which means that their periods may occur at unpredictable intervals, be lighter or heavier than usual, or last longer than usual. This is because PCOS can cause hormonal imbalances that interfere with the regular functioning of the menstrual cycle.
- Difficulty Conceiving: Another common symptom of PCOS is difficulty getting pregnant, which is related to the irregular menstrual cycles mentioned above. PCOS can make it harder for women to ovulate, which is necessary for conception. Women with PCOS may need to seek fertility treatment in order to conceive.
- Excess hair growth (Hirsutism): PCOS can cause excess production of androgens, which are male hormones that are also present in women. This can lead to excessive hair growth in unexpected places on the body, such as the face, chest, and back. This is known as hirsutism and can be a source of embarrassment and anxiety for women with PCOS.
- Acne-prone skin: Women with PCOS may also have acne-prone skin, which is related to the excess production of androgens. Androgens can cause the sebaceous glands in the skin to produce more oil, leading to clogged pores and the development of acne.
- Overweight/Obese: Women with PCOS are also more likely to be overweight or obese, which is in part due to the hormonal imbalances associated with the condition. Obesity can make the symptoms of PCOS worse and increase the risk of other health problems, such as diabetes and heart disease.
- Mood Disorders: Anxiety and Depression: Women with PCOS are also at higher risk of developing mood disorders such as anxiety and depression. The hormonal imbalances associated with PCOS can affect the production of neurotransmitters in the brain, which can lead to changes in mood and behaviour.
How is PCOS Diagnosed?
Diagnosing PCOS can be challenging because the symptoms can be subtle and vary widely between individuals. A diagnosis is typically made based on a combination of symptoms, a physical exam, and blood tests to measure hormone levels. A doctor may also perform an ultrasound to look for cysts on the ovaries.
What Causes PCOS?
The exact cause of PCOS is not known, but it is assumed to be caused due to a combination of genetic and environmental factors. Insulin resistance and high levels of androgens are believed to play a role in the development of PCOS.
How is PCOS Treated?
The PCOS treatment depends on the individual’s symptoms and goals. Some of the common PCOS treatment options are:
- Lifestyle changes: Eating a healthy diet and getting regular exercise can help manage symptoms and improve overall health.
- Medications: Birth control pills, anti-androgen medications, and insulin-sensitizing drugs may be prescribed to manage symptoms.
- Fertility treatments: Women who are trying to conceive may need to undergo fertility treatments such as ovulation induction or in vitro fertilization.
- Surgery: In rare cases, surgery may be needed to remove cysts from the ovaries.
Also Read: PCOS Treatment in India
Can PCOS Cause Weight Gain?
Yes, PCOS women have a higher tendency to gain weight because of the associated hormonal imbalance. They also find it more difficult to lose weight.
Insulin resistance is a major cause of this obesity. The body has difficulty in keeping the blood sugar under check and therefore, produces more insulin to do so. Over time, the insulin levels are high and this contributes to weight gain as insulin promotes fat storage mostly around your belly also termed as PCOS Belly. Also, whenever there is increase in weight, the symptoms of PCOS become worse. Thus, it is a vicious cycle. More than half of PCOS women are obsessed.
However, with regular exercise and eating healthy meals, it is very much possible to lose weight which also improves the symptoms of PCOS.
What is Best PCOS Diet?
One of the most common questions asked by PCOS patients is about diet. Diet and exercise play a significant role in the treatment of PCOS. A healthy PCOS diet consists of the following
- Healthy natural unprocessed foods like whole grains, nuts, fresh fruits and vegetables
- High fibre foods like spinach, apples, broccoli
- Green leafy vegetables like spinach, kale, asparagus, sarson
- Fruits like apple, orange, raspberries, blueberries, cherries
- Whole grains like bajra, jowar, ragi, millet
- Fish like tuna, salmon
- Healthy fats like olive oil, coconut oil
- Nuts like walnuts, almonds and apricots
The aim is to choose such food items which do not cause a rapid rise in blood sugar levels. Such foods are said to have low GI Index. Drinks like aloe vera juice, green tea, apple cider vinegar and ginger lemon water are good for PCOS.
Can PCOS Cause Cancer?
No, Polycystic ovaries are not cancers. The association between polycystic ovaries and breast and ovarian cancer is uncertain. However, PCOS is associated with a 2.5-fold increased risk of Endometrial cancer. In PCOS, there is hormonal imbalance and anovulation. this leads to chronic exposure to the unopposed action of estrogen. This may cause endometrial hyperplasia and endometrial cancer later on in life.
However, with proper medication and treatment and regular follow-ups, cancer is not a cause for concern in PCOS.
What Happens if Polycystic Ovaries Left Untreated?
Polycystic ovaries are not life-threatening. PCOS is a metabolic disease and with proper treatment, it can be kept under control. However, if the symptoms and hormonal imbalance is not controlled, it may lead to long-term complications.
Uncontrolled PCOS may lead to deranged blood sugar levels and the development of Diabetes Mellitus. PCOS also leads to impairment in lipid levels. This leads to atherosclerosis and cardiovascular or heart disease and high blood pressure later on in life.
Because PCOS patients have anovulation and there is unopposed estrogen hormone in the body, the uterine lining becomes thickened. It may lead to the development of uterine cancer.
However, with proper diet and exercise and treatment with medications, all these hormonal imbalances and metabolic impairments can be controlled and PCOS patients can lead a healthy life.
Is Polycystic Ovaries Normal?
Polycystic ovaries is a very common condition. When ultrasound is done in the general population, as many as 20-22% of ladies may have polycystic ovaries but no other associated symptoms.
However, there is another subset of women who have polycystic ovaries on ultrasound and also have other symptoms like irregular menstrual cycles, acne, facial hair or infertility. This is known as a polycystic ovarian syndrome or PCOS. It is seen in 6-12%of young women. Teenage girls who have irregular menstrual cycles, and acne excess facial and body hair should be screened for PCOS by hormonal tests and ultrasound.
Do Polycystic Ovaries Get Worse With Age?
Certain features of PCOS get worse with age however few symptoms of PCOS may improve with age. As a PCOS woman grows older, the testosterone levels decline and so the menstrual cycles may become regular. However, elevated insulin levels may cause the development of type 2 Diabetes and cardiovascular disease. As women enter menopause, abdominal obesity or belly fat, dyslipidaemia, an increase in LDL levels and increased insulin resistance is seen. Such changes are also experienced by PCOS women. Because the PCOS woman has been exposed for a longer number of years to insulin resistance and dyslipidemia, therefore, some studies show an increased risk of metabolic abnormalities and heart disease and diabetes in PCOS women.
Can Polycystic Ovaries Cause Pain?
No, polycystic ovaries are never a cause of pain. It is important to understand that the “cysts “in polycystic ovaries are not actually cysts. They are simply antral follicles. When a child is born, she has many potential eggs at birth nearly one million. But these are not visible to the naked eye and 99% of these potential eggs never mature and simply disintegrate. Only a few of this progress further and develop a very very minute cavity called “antrum” and thus are called antral follicles. They can now be seen on ultrasound. The size of these antral follicles is very small is around 2-9mm. These antral follicles have the potential to develop into a mature eggs. However, not all antral follicles grow and release eggs. In one menstrual cycle, only one follicle grows to become the dominant follicle.
In a normal ovary, there are 8-10 antral follicles (AFC-Antral Follicle Count). But in PCOS the AFC count is more than 12 per ovary.
Several studies later revealed that the AFC count may be as high as 25 or more in PCOS. However, these antral follicles are not large cysts and the term “polycystic” is misunderstood.
The antral follicles referred to as “cysts” are less than 10mm and are not painful at all.
Can Polycystic Ovaries be Seen on Ultrasound?
Yes, polycystic ovaries can be seen on ultrasound. Polycystic ovaries are characterized by bulky ovaries which have an increased ovarian volume of more than 10ml. They have the presence of many antral follicles (more than 12). These antral follicles are very tiny around 2-9mm in size and have a minuscule cavity. On ultrasound, they appear as tiny black dots in the ovary. The arrangement of these follicles also follows a characteristic pattern. Usually, follicles are arranged in the periphery of the ovary all around and give the appearance of a “STRING OF PEARLS“ pattern.
Also Read: PCOS in Hindi
Can Polycystic Ovaries Burst?
No, polycystic ovaries never burst. As already explained, the “cysts” in polycystic ovaries are not truly cysts but are small antral follicles. They measure only 2-9mm and have a very small cavity called an antrum. Therefore, these only cause hormonal imbalance and are otherwise harmless and never rupture. The risk of rupture is only with larger ovarian cysts. The larger the cyst, usually more than 8-10cm, the more the risk for rupture.
Should I be Worried About Polycystic Ovaries?
The incidence of PCOS is around 5-10% in young females. It is a common hormonal disorder with metabolic side effects. However, with a combined holistic approach of healthy lifestyle modifications and medicines. it can be controlled. It is not a life-threatening condition and should not be a cause for worry and stress, since it is known that worry and stress are factors that worsen the symptoms of PCOS.
Therefore, whenever there are symptoms like irregular periods or excessive hair growth on the face, acne tests should be done. These include blood tests and an ultrasound. Once the diagnosis of PCOS is made, medicines are started along with dietary changes and regular exercise to keep the symptoms under check. Thus, with a timely diagnosis, treatment is possible and there is no cause for concern.
Also Read: PCOD vs PCOS