What is PCOS (Polycystic ovary syndrome)?

What is Polycystic ovary syndrome (PCOS)?

PCOS is the most common endocrine condition affecting women of a reproductive age (15 – 49 years, WHO). The reports vary but it is said to affect between 5-20% of women in that age group worldwide; that’s between 1 in 6 and 1 in 20 women.

Although the name suggests the presences of cysts on the ovaries, this is in fact not the cause, but rather one of the potential symptoms of the condition. These ‘cysts’ are not in fact true cysts, rather follicles that have not matured into ovulation.

The cause of PCOS and the hormonal imbalances associated with this condition are still largely unknown. It is thought to be a genetic condition that is triggered or exacerbated by environmental conditions. The hormonal imbalances seen in PCOS are thought to be responsible for the severity and type of symptoms.

What are the symptoms of PCOS?

It’s important to remember that PCOS shows up differently for everyone. Some women may experience all the symptoms listed below, and others only a few. Because PCOS seems to be impacted by our environment as you go through different stages in your life, some symptoms may vary in severity.

Some of the more common symptoms of PCOS include:
– Acne
– Irregular periods
– Excess facial and body hair
– Insulin resistance
– Anxiety and depression
– Infertility
– Weight gain and difficulty losing weight
– Alopecia (hair loss)

What else do we know about PCOS?

Other conditions associated with PCOS are:

Insulin resistance
It is thought that 65-80% of women with PCOS have insulin resistance. This is one of the reasons women with PCOS struggle to lose weight. Elevated insulin levels also stimulate the ovaries to produce excess testosterone which causes excess hair growth, acne, and irregular periods. Women with PCOS are also more susceptible to developing diabetes because of this insulin resistance.

Cardiovascular disease
Evidence suggests that elevated androgens, insulin resistance and low sex hormone-binding globulins result in increased risk factors for cardiovascular disease, particularly high blood pressure, elevated LDL cholesterol, decreased HDL cholesterol.

Infertility
Caused due to anovulation. It is important to note that women with PCOS have successful pregnancies all the time, it often just takes a little longer due to irregular ovulation.
Psychological disorders
PCOS has been linked to increased rates of anxiety and depression, although the cause has not yet been confirmed. It is thought to be closely linked to other PCOS symptoms including acne, hirsutism, infertility and difficulty losing weight.

Pregnancy complications
Gestational diabetes, pregnancy-induced hypertension and pre-eclampsia and premature births are more common in women with PCOS. This is thought to be caused by hyperandrogenism, insulin resistance and metabolic abnormalities.

Currently there is no cure for PCOS, and although all the above sounds very doom and gloom it is important to remember that PCOS is manageable through lifestyle changes. The good news is that most symptoms can be controlled through a healthy diet, supplements, exercise, adequate sleep and stress management. This will also help reduce your risk of developing other conditions and risks associated with PCOS.

If you think you may suffer with PCOS it is important to ask your GP for a diagnosis to rule out other conditions and start managing your symptoms straight away. For more information on how PCOS is diagnosed and what to ask you GP for, read my blog post on diagnosing PCOS.

 

 

 

 

 

 

References:

1. Azziz R, Carmina E, Chen Z, et al. (2016) Polycystic ovary syndrome. Nature Reviews Disease Primers;2.
2. International PCOS Network (2018) International evidence-based guideline for the assessment and management of polycystic ovary syndrome 2018. [Free Full-text]
3. Marshall, J. C., & Dunaif, A. (2012). Should all women with PCOS be treated for insulin resistance? Fertility and sterility, 97(1), 18–22. doi: 10.1016/j.fertnstert.2011.11.036
4. McCartney, C. R., & Marshall, J. C. (2016). CLINICAL PRACTICE. Polycystic Ovary Syndrome. The New England journal of medicine, 375(1), 54–64. doi:10.1056/NEJMcp1514916
5. National Institute for Health and Care Excellence. (2018). Polycystic ovary syndrome. Retrieved from https://cks.nice.org.uk/polycystic-ovary-syndrome
6. RCOG (2014) Long-term Consequences of Polycystic Ovary Syndrome. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk
7. Rotterdam ESHRE/ASRM-Sponsored PCOS consensus workshop group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome (PCOS). (2004) Human Reproduction; 19:41–7.
8. Spritzer PM, Marchesan LB, Santos BR, et al. (2019) Prevalence and characteristics of polycystic ovary syndrome in Brazilian women: protocol for a nation-wide case control study. British Medical Journal Open;9: e029191. doi:10.1136/ bmjopen-2019-029191
9. Yu, H.F., Chen, H.S., Rao, D.P. et al. (2016) Association between polycystic ovary syndrome and the risk of pregnancy complications: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) (51), e4863.