Polycystic ovary syndrome (PCOS), symptoms, causes and treatment

Because PCOS can affect fertility, some fear that they will never be able to give birth with it. However, there have been cases of people who gave birth even though they have PCOS.

While PCOS can affect fertility, being diagnosed with it does not mean absolute infertility. With the right treatment and management plan, you still have your chances at childbirth and motherhood.

 What is polycystic ovarian syndrome (PCOS)?

Polycystic ovarian/ovary syndrome (PCOS) is a hormonal disorder that mostly affects females in their reproductive age. PCOS diagnosis can be complicated.

However, people with this condition typically experience no or infrequent menstrual cycles and an excess of male androgen, which can affect fertility.

PCOS is a disorder of hormones (hormonal imbalance) that affects people between 22 to 44 years. Many don't know they have this condition as it is not life-threatening.

The prevalence of PCOS has been reported to be highly variable; it ranges from 2.2% to 26.7%. A study shows that up to 70% of people with PCOS haven't been diagnosed.

PCOS affects a person's ovaries (the organ responsible for releasing the female eggs and producing the hormones estrogen and progesterone). It affects the ovaries to cause the following:

• Formation of cysts in the ovaries
• high levels of male hormones
• irregular or skipped periods

 Understanding PCOS and fertility (hormonal imbalance)

PCOS affects the ovaries and ovulation and thus can mostly affect fertility. With Polycystic ovarian syndrome, fluid-filled sacs grow inside the ovaries. The word "Polycystic" actually means "many cysts" in the ovaries.

The sacs are follicles. In this case, the follicles contain immature eggs, which seldom mature enough to trigger ovulation. This means a person with PCOS is likely to miss out on ovulation even if they menstruate.

Since there is no ovulation, mature eggs will not be released into the infundibulum in readiness for fertilization from the male sperm cell.

Also, with the absence of ovulation, the levels of the hormones- progesterone, estrogen, follicle-stimulating hormone, and the luteinizing hormone are typically altered.

Progesterone and estrogen hormones become lower than usual, while androgen hormones (particularly testosterone) become higher. Androgen hormone is a male hormone that women also have in small amounts. However, in the case of PCOS, it is released in large amounts.

A high level of the male hormone androgen disrupts the menstrual cycle; thus, women with PCOS usually experience irregular or fewer periods than usual.

 Causes of polycystic ovarian syndrome (PCOS)

Health experts can't tell the exact causes of PCOS. The general idea has been that high levels of male hormones prevent the ovaries from making eggs and producing hormones normally.

However, certain factors have been associated with it, including:

 1. Excess Androgen

With PCOS, there is excess production of androgen, which can result in acne and hirsutism (excess hairs on the body).

 2. Genes

Research has shown that polycystic ovarian syndrome can be hereditary, i.e., certain genes might be linked to PCOS.

 3. Excess insulin

Insulin is the hormone the pancreas produces that allows cells to use sugar (glucose), their primary energy source.

Diabetes is typically caused by cells' resistance to insulin, which increases blood sugar levels and further triggers the production of insulin.

Up to 70% of women with PCOS experience insulin resistance. Excess insulin might cause an increase in androgen production, which could cause difficulty with ovulation.

 4. Inflammation

People with PCOS typically experience increased levels of inflammation in their bodies. Obesity has been linked with inflammation, and studies have linked inflammation to higher levels of androgens.

 Common PCOS symptoms

For most people, they start experiencing symptoms of PCOS around the time of their first period. Others, however, notice much later, years after they have gained much weight, experienced severe acne, and have trouble getting pregnant.

Some of the most common PCOS symptoms include:

• Irregular periods: This is a very common symptom of PCOS because, when there is no ovulation, the uterine lining is most likely not going to shed every month. In such a case, the woman might see her period less than eight times in a year.
• Heavy bleeding: Women with PCOS also experience heavy menstrual flow. This is because the uterine lining doesn't shed regularly and can build up for an extended period, thus causing heavy bleeding when it finally sheds.
• Weight gain: Studies have linked PCOS with weight gain. Up to 80 percent of women diagnosed with PCOS are obese or overweight.
• Acne: Acne is another common symptom of PCOS. Women with PCOS have higher than normal levels of the male hormone in their blood, and the male hormones make the skin oilier and can cause breakouts in areas of the body like the chest, face, and upper back.
• Excess growth of hair: Excessive hair growth on parts of the body (called hirsutism) is one of the PCOS symptoms. About 70 percent of women with PCOS have excess hair on their bodies as well as facial hair.
• Darkening of the skin: Sometimes, PCOS also presents with the formation of dark patches in body creases, such as creases in the groin, on the neck, and underneath the breast.

 PCOS treatment

The treatment of PCOS focuses mostly on managing individual PCOS symptoms. For instance, while some PCOS patients develop acne and hirsutism, others might have obesity and experience difficulty getting pregnant.

Treatment usually targets specific symptoms that concern an individual, and treatment here typically involves the use of medication and lifestyle changes.

 PCOS treatment using medications

Doctors most often prescribe medications to PCOS patients either to help regulate the menstrual cycle or to assist in ovulation. In some other cases, medicines may be prescribed to reduce excessive hair growth, and acne breakouts.

Here are some types of medications that may be prescribed for PCOS patients:

 1. Combination birth control pills

Combination birth control pills like Levofem contain progestin and estrogen and are meant to regulate the estrogen hormone and decrease the production of androgen. By regulating hormones, they also control the menstrual cycle.

Another good effect of hormone regulation is a reduction in the risk of endometrial cancer, excess hair growth, acne, and the correction of abnormal bleeding.

 2. Metformin

Metformin is one of the common drugs usually prescribed for women with PCOS, as it helps induce ovulation.

Metformin is actually a medication for type 2 diabetes. It helps to lower insulin levels by improving insulin resistance.

If you also have diabetes (which is commonly linked with PCOS patients), this drug will help manage the condition while at the same time helping with weight loss.

 3. Clomiphene

Clomiphene is an oral anti-estrogen medication that is taken during the first part of the menstrual cycle. It helps with ovulation.

 4. Spironolactone

Spironolactone is mostly a treatment that targets excessive hair growth as it blocks the effects of androgen on the skin. However, just like other medications, it has side effects.

One of the side effects is that it can cause congenital disabilities. Thus, spironolactone might not be prescribed for a pregnant woman or a woman who is planning to get pregnant.

 5. Progestin therapy

While taking progestin for 10–14 days every one to two months can help regulate the menstrual cycle and protect against endometrial cancer, it doesn't improve androgen levels. Also, it won't prevent pregnancy like the combination birth control pills.

If you wish to prevent pregnancy as well, your doctor might prescribe a progestin-only minipill or a progestin-containing intrauterine device.

 Lifestyle changes for treating PCOS

Another helpful treatment plan that doctors usually prescribe for women with PCOS is a lifestyle change. This change typically starts with your diet.

Your doctor will most likely recommend that stick to a low-calorie diet combined with regular exercising activities. Studies have shown that weight loss might improve PCOS symptoms in people with PCOS.

 1. Choose healthier foods

Diet is crucial to the management of health conditions like PCOS. Foods that contain high amounts of carbohydrates tend to increase insulin levels.

Also, avoid foods that contain refined sugar; sticking with complex carbs might be better as they don't raise blood sugar levels quickly. Talk to your doctor to help you draft the best dietary plan.

 2. Maintain a healthy weight

With PCOS, you have to watch your weight. Excessive weight gain and obesity are two of the most common symptoms that women with PCOS experience.

Losing weight can help reduce the levels of androgen and insulin hormones, thereby increasing the chances of ovulation.

Consider subscribing to weight-loss and weight-management programs. A dietician might also help you attain your weight loss goals.

 3. Be active. Avoid a sedentary lifestyle

Exercise can help a lot, especially in lowering blood sugar levels. If you have been diagnosed with PCOS, you should consider developing an exercise routine.

Having an exercise routine may be helpful in treating or even preventing insulin resistance, which can prevent the development of diabetes and keep weight under control.