Polycystic Ovary Syndrome (PCOS): Causes, Symptoms, Diagnosis, Treatment, and Prevention

Contents

• What is PCOS?
• What is PCOD? Is it the Same as PCOS?
• What are the Causes of PCOS?
• What are the Symptoms of PCOS?
• All About PCOS Diagnosis
• What is Included in the Treatment of PCOS?
• What Complications Can PCOS Cause?
• Is PCOS Prevention Possible?
• The Impact of PCOS on Periods
• The Relationship Between PCOS and Pregnancy
• Conclusion
• Don’t Have Time To Read? 
• FAQs

What is PCOS?

PCOS or Polycystic Ovary Syndrome is a metabolic and hormonal disorder that affects women of reproductive age. In women with PCOS, the ovaries produce more than the normal amount of male hormones called androgens (specifically testosterone), resulting in a hormonal imbalance. It is to be noted that females also produce androgens normally, although in smaller amounts. 

As a result of this hormonal imbalance in PCOS, the ovaries are unable to release eggs (a process called ovulation), which causes irregular menstrual cycles. The excess androgen levels may also cause other symptoms of PCOS including fertility issues, skin darkening, acne, unwanted facial hair, weight gain, hair loss, etc.

The problems with ovulation can also cause numerous small, fluid-filled sacs to develop on the ovaries in PCOS. These sacs are called cysts and give the condition PCOS (“Polycystic Ovary Syndrome”) its name.

However, not all women with PCOS have these ovarian cysts. Further, not all cases of ovarian cysts are cases of PCOS. The presence of ovarian cysts is not a compulsory condition to be diagnosed with PCOS. 
 

We will read more about the diagnosis of PCOS later in the blog. 

What is PCOD? Is it the Same as PCOS?

Now, we know that “PCOS” stands for Polycystic Ovary Syndrome. However, what is PCOD? Further, what is the difference between PCOD and PCOS? “PCOD” stands for Polycystic Ovary Disease. PCOD is an older terminology, which is now being replaced by the term “PCOS” in most instances. 

It is to be noted that “PCOS” and “PCOD” are names of the same condition and there is no difference between the two, in terms of causes, symptoms, diagnosis, treatment, and prevention. 

Let’s have a look at the causes of PCOS. 
 

What are the Causes of PCOS?

Experts are still unclear about what exactly causes PCOS. Research on the causes of PCOS is ongoing and it is believed to be an outcome of a combination of genetic and environmental factors. The most significant contributing factors or possible causes of PCOS include:
 

1. Genetics

Some studies suggest that genetics or heredity can be one of the primary reasons for PCOS. If you have a sister or mother with this condition, there is a chance that you may get it too. Experts suggest that not one, but many genes may contribute to the development of PCOS.
 

2. Insulin Resistance

Many individuals with PCOS have insulin resistance. Insulin is a hormone produced by your pancreas, to help move glucose from the bloodstream into the cells, where it will be used as an energy source. When your body becomes resistant to insulin, your cells lose the ability to take up the glucose from the blood, which causes increased blood glucose (sugar) levels. 

This, in turn, triggers the pancreas to produce more insulin to stabilize blood sugar levels. This increases the level of insulin in your blood (hyperinsulinemia), which may lead to excess production of androgens in the body, and contribute to the development of PCOS.
 

3. Excess Androgen Levels

The ovaries produce the female hormones estrogen and progesterone along with a small amount of androgens (male hormones). In PCOS, your ovaries produce an abnormal amount of androgens, creating a hormonal imbalance. 

High levels of androgen can cause difficulties with ovulation during each menstrual cycle and as a result, lead to menstrual irregularities along with other androgen-related PCOS symptoms such as weight gain around the abdomen and unwanted hair growth on the body and face.

4. Low-Grade Inflammation

Many studies suggest that women with PCOS may develop low-grade inflammation, which is a chronic response to disease, injury, or foreign bodies that produces a steady yet low level of inflammation throughout the body. 

If you are obese and have high abdominal fat, the adipose (fat) tissue may show an increased secretion and release of proinflammatory cytokines. These proinflammatory cytokines can cause low-grade inflammation in your body. Various studies suggest that long-term low-grade inflammation stimulates the ovaries to produce more androgens and may lead to PCOS.

Let’s move on to the symptoms of PCOS. 

What are the Symptoms of PCOS?

PCOS does not present the same set of symptoms in every affected woman. The signs and symptoms of PCOS vary from person to person. You may have PCOS and none of its associated symptoms or you may have several of the PCOS symptoms. The most commonly observed symptoms of PCOS are:
 

1. Cysts

In PCOS, your ovaries may develop cysts, which are sac-like pockets filled with fluid. Cysts can be visible on ultrasound. These ovarian cysts give the condition PCOS its name.

However, not every woman with PCOS will have these cysts. The presence of ovarian cysts is not a mandatory criterion to be diagnosed with PCOS. 
 

2. Irregular Periods 

Irregular periods are among the early signs of PCOS, as well as one of the most common. In PCOS, you may have infrequent, prolonged, or missed periods. Hence, you may have fewer than 9 periods a year, more than 35 days between periods, or not have periods at all.

You can read more about the relationship between PCOS and periods later on in the blog. 
 

3. Heavy Bleeding

Since PCOS results in menstrual irregularities, your uterine wall lining may keep building up for a long period of time without shedding, due to the hormonal imbalance. Thus, when you do get a period, it could result in heavy bleeding.
 

4. Obesity

Weight gain is one of the most visibly apparent symptoms of PCOS. About 80% of women with PCOS gain weight and may experience difficulty in losing weight. As androgens (male hormones) trigger the weight gain in PCOS, it is mainly focused around the abdomen, where men tend to carry their weight. 
 

5. Infertility

PCOS is one of the most common causes of infertility. The decreased frequency or complete lack of ovulation makes pregnancy difficult. 

However, this does not mean that women with PCOS cannot get pregnant. With effective treatment and lifestyle changes, PCOS can be managed and those with the condition can get pregnant. 

We will deal with this topic in detail in the later sections of the blog. 
 

6. Abnormal Hair Growth

While all women have vellus hair or thin hair (peach fuzz) on their faces, women with PCOS may develop thick, dark, or coarse facial hair and excessive hair growth on their arms, back, abdomen, and chest. 

This condition is called hirsutism and is due to excessive androgens in women with PCOS. It is among the early signs of PCOS.

Androgens are male hormones that stimulate male characteristics including deepening of the voice, male-pattern baldness, increase in muscle mass, and facial hair growth. Androgens cause most of the hair and skin-related PCOS symptoms such as hair loss, acne, and unwanted hair growth. 

It is to be noted that PCOS is not the only cause of hirsutism, but it is one of the most common causes. Around 70% to 80% of PCOS patients develop hirsutism.
 

7. Acne

Excess androgens in PCOS can also cause acne, especially on the face, back, and chest. The high androgen levels stimulate the production of oil in the skin. 

When this excess oil in your skin and the dead skin blocks the hair follicles, it results in acne. If the acne is due to PCOS, you may continue to develop it well past your teenage years.

8. Female Pattern Hair Loss

The extra androgen production in PCOS causes the hair on the head to start thinning. This hair loss is medically termed androgenetic alopecia and is commonly known as female-pattern baldness.

In men and women, around 10% of testosterone is converted into dihydrotestosterone (DHT). Once DHT is released into the bloodstream, it can link to the receptors on hair follicles on the scalp, resulting in the shrinking of the follicles, visible hair thinning, and hair fall. 

Unlike complete baldness seen in male pattern hair loss, women with PCOS experience typical thinning of hair and shorter hair. Hair thinning in PCOS can also expose a large area of your scalp.
 

9. Headache

The hormonal imbalance in PCOS may lead to frequent headaches in some women with the condition.
 

10. Skin Darkening

In PCOS, dark patches may develop on your skin, especially in areas with skin folds such as on the neck, armpits, groin, and under the breast. This condition is known as acanthosis nigricans and is considered to develop due to insulin resistance and hyperinsulinemia (high blood insulin levels) in PCOS.
 

11. Skin Tags

One of the lesser-known symptoms of PCOS is skin tags, which are little flaps of extra skin on your neck and armpits. These tags usually appear in the same areas as acanthosis nigricans and may be caused by insulin resistance seen in PCOS. 
 

All About PCOS Diagnosis

If you think you are experiencing any of the symptoms of PCOS, it is advisable to consult a doctor without delay. There is no single test to diagnose PCOS. Your doctor may use the following steps for the diagnosis of PCOS:

• Discuss symptoms such as irregularities in your menstrual cycle and weight changes, along with your medical history and family history. 
• Perform a physical examination for observing symptoms such as excessive hair growth, skin darkening, skin tags, and acne. 
• Undertake a pelvic examination to inspect for any masses, growth, swollen ovaries, or abnormalities in your reproductive organs.
• Order blood tests to check for higher-than-normal levels of androgens. The doctor may also prescribe tests for glucose tolerance, cholesterol levels, and triglyceride levels. The results of these tests can help rule out other possible causes of PCOS-like symptoms.
• Perform a pelvic ultrasound to check the size of the ovaries, the thickness of the lining of the uterus (endometrium), and the presence of cysts in your ovaries. 

The Rotterdam criteria are typically used to confirm the diagnosis of PCOS. According to its guidelines, other potential causes of your symptoms need to be ruled out and you need to meet at least 2 of the 3 criteria to be diagnosed with PCOS:
 

1. Irregular or missed periods (indicating ovulatory dysfunction)
2. Signs of excess androgen such as acne and excessive hair growth or blood test results confirming high androgen levels.
3. Cysts on one or both ovaries seen on scans.

What is Included in the Treatment of PCOS?

PCOS is a chronic (life-long) condition that cannot be completely or permanently cured. It can only be managed effectively throughout life. The treatment for PCOS varies based on the medical history of the individual. If you have any symptoms that may be PCOS-related, it is advisable to consult a doctor at the earliest so you can get diagnosed and begin treatment. 

PCOS is one of the most common causes of infertility, and many women may not even know that they have PCOS until they are trying to get pregnant. Thus, the treatment for PCOS often depends on whether or not the woman wants to get pregnant. However, some treatment modalities can be applied to anyone with PCOS, irrespective of whether they want to get pregnant or not. These options include:
 

Lifestyle Changes

Lifestyle changes are among the most important aspects of the management of PCOS. Adopting a healthy and balanced diet, getting regular physical activity, and maintaining a healthy weight can play an important role in managing PCOS.

Even a small reduction in your weight (about 5%) can contribute to restoring hormonal balance in your body and managing PCOS better. Weight loss can also help your body use insulin more efficiently and lower blood glucose levels, which may help you ovulate.
 

Insulin-Sensitising Medication

Metformin, a drug used to treat diabetes, is also used as a part of the treatment protocol for PCOS. It works by reducing insulin resistance or increasing the insulin sensitivity of your cells. Once insulin resistance is controlled, some women with PCOS may see improvements in their menstrual cycles.
 

1. Treatment Options if You do Not Want to Get Pregnant 

A. Hormonal Birth Control

Hormonal methods of birth control can be in the form of pills (called oral contraceptive pills or birth control pills), patches, shots, vaginal rings, or intrauterine devices (IUDs). Hormonal birth control uses a combination of estrogen and progestin to decrease androgen production and regulate estrogen levels in the body. Hormonal birth control can help regulate your periods and improve PCOS symptoms such as acne and excess hair growth. 
 

2. Treatment Options if You Want to Get Pregnant Immediately or in The Future

A. Medications to Induce Ovulation

Your doctor may prescribe medications to induce ovulation if you wish to conceive. These medications can help the ovaries release eggs normally. Ovulation-inducing drugs such as clomiphene and letrozole are taken orally, while gonadotropins are given by injection. Metformin may also be used to improve ovulation and treat infertility in those with PCOS. 
 

B. In Vitro Fertilisation (IVF)

In vitro fertilization (IVF) is a technique through which mature eggs are retrieved from the ovaries of a woman and fertilized with the partner’s sperm in a laboratory. The fertilized eggs are transferred into the uterus where they may grow into a healthy pregnancy. IVF is an option for women with PCOS when medication doesn’t help with ovulation.

Along with these modalities, lifestyle changes, including a balanced diet and regular physical activity are also advised for those trying to get pregnant with PCOS. A healthy diet and increased physical activity can promote weight loss, help your body use insulin, and lower blood glucose levels, and thus may help you ovulate.
 

Is PCOS Prevention Possible?

Can PCOS be prevented? Unfortunately, no. There is no proven way to prevent PCOS. This is mainly because most cases of PCOS are genetically inherited, although researchers don’t completely understand the exact mechanism of its inheritance. 

If you have a mother or sister with PCOS, you are more likely to develop the condition. However, having an increased genetic likelihood of PCOS does not necessarily mean that you will definitely have PCOS, since it may only develop if other risk factors are present in some cases. These risk factors include a poor diet, lack of exercise, stress, obesity, and any type of Diabetes. 

Although PCOS cannot be prevented, you can take steps to reduce the severity of symptoms and chances of developing PCOS-related complications. These precautionary steps include having a balanced diet, exercising regularly, keeping a check on your weight with diet and exercise, and getting your health assessed regularly. 

What Complications Can PCOS Cause?

If you have PCOS and it goes undiagnosed and untreated for long, you are prone to develop complications such as:
 

1. Infertility

In PCOS, the excess amount of androgens produced interferes with the formation and release of eggs from the ovaries. Unpredictable ovulation results in irregular menstrual cycles and can also lead to problems with getting pregnant.
 

2. Type 2 Diabetes

Prediabetes and Type 2 Diabetes are two of the most common long-term complications of PCOS. Women with PCOS develop insulin resistance, which means that their cells do not respond well to insulin and do not take in glucose from the blood. 

This leads to increased blood glucose levels, which can trigger the pancreas to produce more insulin to stabilize the blood glucose levels. Over time, consistently high blood glucose levels can lead to Type 2 Diabetes.

3. Metabolic Syndrome

Metabolic syndrome is a cluster of risk factors that occur together and increase the risk of heart disease. The insulin resistance and obesity commonly associated with PCOS may increase the chances of developing metabolic changes such as:

• Increased abdominal weight
• Low level of high-density lipoprotein (HDL) or “good cholesterol”
• Increase in triglyceride levels
• High blood sugar levels
• High blood pressure

4. Heart Disease

The androgen levels, insulin resistance, and increased insulin levels in PCOS trigger weight gain predominantly in the abdominal region since this is where men tend to carry their weight. This belly fat, called visceral fat, surrounds the internal organs and poses serious health issues such as heart disease.

The high insulin levels associated with PCOS also increase the risk for high triglycerides, inflammatory markers, high blood pressure, and atherosclerosis. These factors can increase your risk of a heart attack or stroke.
 

5. Endometrial Cancer

In women with a normal menstrual cycle, the estrogen hormone causes the thickening of the endometrium (the lining of the uterus which is shed every month through menstruation in non-pregnant women). 

In PCOS, there is no ovulation, the endometrial lining is not shed, and is exposed to higher amounts of estrogen. This causes the endometrium to grow thicker than normal and increases the chance of the development of cancer cells, particularly endometrial cancer. 
 

6. Pregnancy-Related Complications

If you had PCOS and got pregnant, the condition can increase your risk of pregnancy-related complications such as gestational diabetes, pregnancy-related high blood pressure, pre-eclampsia, preterm birth, and chances of cesarean delivery. 

You can read about these complications in detail in the later sections of this blog. 

Note: Untreated PCOS may also result in complications like: 

• Sleep disorders such as sleep apnea
• Mental health issues such as depression and anxiety
• Inflammation and damage to the liver, a condition called nonalcoholic steatohepatitis. 

The Impact of PCOS on Periods

As PCOS affects ovulation, one of its symptoms is irregular periods. Not every woman with PCOS has irregular periods, but it is a common symptom of the condition. In PCOS, you can get regular periods, delayed periods, or no periods at all.

The length of a menstrual cycle is generally about 28 days, but it can also vary between 21 days to 35 days. Menstrual cycles shorter than 21 days and longer than 35 days are termed irregular. Generally, in women, every month a follicle (a fluid-like sac) ruptures to release an egg (ovum) from either of the ovaries. However, this does not happen in women with PCOS. 

In PCOS, the ovaries produce more than the normal amount of male hormones called androgens, and as a result of this hormonal imbalance, the follicle may not mature or may not release eggs. Problems with ovulation lead to irregular menstrual cycles in PCOS. 

If your menstrual cycle is disturbed in PCOS, you may experience:

• A sudden change in the menstrual cycle length
• Less than eight menstrual cycles per year
• Bleeding or spotting between your periods
• Getting your periods after you have reached menopause

Treating Irregular Periods in PCOS

Irregular periods are a symptom of PCOS. To treat or regularize irregular periods in PCOS, the condition has to be managed. Irregular periods can be treated with:
 

A. Medications to Induce Ovulation

As already discussed, ovulation medications such as clomiphene and gonadotropins manage hormonal levels in women with PCOS and help them ovulate. Metformin may also help with improvement in ovulation. With normal ovulation, menstrual bleeding should get normalized too. 
 

B. Hormonal Contraceptives

As already established, hormonal contraceptives are one of the most commonly used treatment modalities for PCOS and can help regularize periods too. Hormonal contraception is available in the form of pills, implants, intrauterine devices, and vaginal rings. 

Birth control pills contain estrogen and progestin hormones, which decrease androgen production and regulate estrogen levels in the body. 
 

C. Insulin-Sensitising Medication

Metformin, a drug used to treat diabetes, is also used in the treatment of PCOS. It works by reducing insulin resistance and the production of androgen in the ovaries. This can improve the function of your ovaries and help in getting your periods back on track.
 

What is the Relationship Between PCOS and Pregnancy?

If you have PCOS, pregnancy can be more difficult for you as compared to women without the condition. This is due to the high androgen levels and irregular ovulation seen in PCOS. Those with PCOS may also be at a higher risk of developing complications during or after pregnancy. 

In some cases, women do not even realize that they have PCOS until they start trying for pregnancy and face problems. It can also be a challenging task to plan and detect a pregnancy in PCOS due to irregular ovulation and periods.
 

1. Problems Faced by Women With PCOS While Taking Home Pregnancy Tests

A. False Negatives

Pregnancy tests are done to detect the presence or absence of the pregnancy hormone known as human chorionic gonadotropin (hCG). In women with PCOS, early pregnancy tests may often show false negative (indicating that there is no pregnancy when there is) results due to low levels of hCG in the urine, which can make it difficult for the test to detect pregnancy. 

If you have PCOS, this can happen if you take the test earlier than your ovulation period, likely when you ovulated later.
 

B. False Positives

Some women with PCOS undertake fertility treatment that causes a detectable level of hCG, leading to a false positive on the pregnancy test (showing a positive pregnancy when there is none). 

Since women with PCOS are more prone to early miscarriage as well, they may initially test positive on the pregnancy test and later experience a negative test result.

However, this does not mean that PCOS patients cannot get pregnant. Women with PCOS can get pregnant, although it may take longer and be a more difficult process when compared to pregnancy in women without PCOS.
 

2. How to Get Pregnant with PCOS?

If a woman with PCOS has been trying for a pregnancy for almost a year and is not able to conceive, they should consult a doctor at the earliest and work as per their suggestions. Some of the ways that can help someone with PCOS get pregnant include:
 

A. Lifestyle Changes

Adding a few changes to your lifestyle such as managing weight, consuming a healthy balanced diet, exercising daily, and taking steps to handle stress may help improve your body’s hormonal balance, regulate your menstrual cycles, and assist in pregnancy. 
 

B. Anti-Androgen Medication

In PCOS, your body produces higher than normal levels of sex hormones, mostly androgens, which makes it difficult for your body to conceive. Anti-androgen medications are drugs prescribed by doctors to overcome the impact of high androgen levels. These medications include spironolactone, cyproterone, and flutamide.
 

C. Ovulation Medication

Ovulation medications such as clomiphene and gonadotropins manage hormonal levels in women with PCOS and help them ovulate. Ovulation-inducing drugs work by stimulating the ovaries to produce multiple eggs in a menstrual cycle. 
 

D. In Vitro Fertilisation (IVF)

If treatment with medications and lifestyle changes do not work for pregnancy, your doctor may suggest that you undergo in vitro fertilization (IVF). In IVF, eggs are removed from the ovaries of a woman and monitored outside the body, in a laboratory. The egg is fertilized with the partner’s sperm in a laboratory and the resulting embryo is implanted in the woman’s uterus.
 

E. Surgery

A surgical procedure called laparoscopic ovarian drilling (LOD) is performed to direct laser or electric energy on ovarian membranes and destroy the tissue that is promoting the production of androgens. However, this procedure is not very commonly used today for treating PCOS and infertility.
 

3. PCOS And Pregnancy-Related Complications

When women with PCOS get pregnant, the condition may cause complications during pregnancy. Some of the PCOS-related pregnancy complications include:
 

A. Miscarriage

Women with PCOS are at a higher risk of suffering a miscarriage than women without PCOS. Various factors are cited to be responsible for leading to miscarriage, including:

• Irregular menstrual cycles leading to longer exposure of the egg to hormones that can damage it.
• Insulin resistivity and high insulin levels leading to poor egg quality.
• High androgen levels leading to improper implantation and possible early pregnancy loss.

B. Preeclampsia

Preeclampsia refers to a sudden increase in blood pressure readings of a pregnant woman after the 20th week of pregnancy. If left untreated, it can lead to a severe form of the condition called eclampsia, which can cause seizures, blindness, and even coma. 

If the pregnant woman experiences severe symptoms of preeclampsia, immediate delivery becomes a necessary step to save the lives of the mother and the baby.
 

C. Pregnancy-Related High Blood Pressure

This condition is also referred to as gestational hypertension and usually occurs in the second half of the pregnancy. If not treated at the right time, consistently high blood pressure can lead to preeclampsia and further affect the delivery time of the baby.

D. Gestational Diabetes

Gestational diabetes is a type of diabetes that often develops during the time of pregnancy in women who were not diabetic before. It usually goes away on its own after the delivery of the baby. 

However, a woman with gestational diabetes and her child can be at an increased risk of developing Type 2 Diabetes later in life due to increased insulin resistance.
 

E. Preterm Birth

Preterm birth refers to the birth of the baby occurring before 37 weeks of pregnancy. Experts believe that preterm birth may be because women with PCOS are at a higher risk of developing preeclampsia, which causes the need for premature delivery.
 

F. Cesarean Delivery

Women with PCOS may carry babies that are larger than the expected size for their gestational age. PCOS can also lead to other complications during labor and delivery, thus creating a need for a Cesarean or C-section delivery. 
 

Conclusion

Polycystic Ovary Syndrome or PCOS is a serious but manageable hormonal disorder. If you or anyone you know has symptoms that could be PCOS-related, it is advisable to consult a doctor at the earliest for prompt diagnosis and treatment.