Polycystic ovary syndrome (PCOS) is something quite different to suffering from multiple ovarian cysts and having polycystic ovaries. Polycystic ovaries are ovaries covered with very small follicles in which the egg develops. In each menstrual cycle, follicles grow on the ovaries. Within those follicles eggs develop, one of which will reach maturity faster than the others and will be released into the fallopian tubes, which happens during ovulation. The remaining follicles will degenerate, but in the case of polycystic ovaries, they are much larger than normal. There are also series of undeveloped follicles that appear in clumps. The majority of women who suffer from PCOS will grow these small cysts on their ovaries, and this is why the condition is called polycystic ovary syndrome. These cysts are not harmful but they do lead to hormonal imbalances; a woman with PCOS produces excessive quantities of male hormones called androgens. However, the development of multiple cysts is not the only symptom of PCOS. [1]
On the other hand, polycystic ovaries, not polycystic ovary syndrome, are not particularly troublesome and in many cases, and they do not affect fertility. The problem starts when these cysts cause a hormonal imbalance, and this leads to a series of other symptoms. These symptoms are the difference between suffering from polycystic ovary syndrome and having polycystic ovaries.
A woman can have polycystic ovaries without having PCOS, but the vast majority of women with PCOS do have polycystic ovaries. However, it is possible to be diagnosed with the PCOS without having polycystic ovaries, because many PCOS symptoms are the result of high levels of androgens.
What is polycystic ovary syndrome?
Polycystic ovary syndrome is a hormone imbalance that can cause irregular periods, unwanted hair growth, and acne.
PCOS is a common condition, yet many doctors are not sufficiently enlightened about it to be able to readily make a diagnosis. It seems that women are failing to describe all their symptoms at consultation, as well. Given that, it is easy to understand why they are likely to experience such seemingly unrelated problems as facial hair, acne, and irregular periods. The symptoms of this complex condition are there because of a hormonal imbalance.
There are varieties of approaches to treatment, which may differ over time depending on the needs of the individual patient. Practitioners of orthodox medicine frequently advise taking contraceptive pills and even other hormone preparations. These preparations can work to great effect and are discussed by many doctors. However, these therapies do not provide a cure for PCOS. In fact, PCOS is a common problem among young women, where almost one out in ten has PCOS. [2]
What are the signs and symptoms of PCOS?
Young women with PCOS commonly have one or more signs:
- Irregular periods that come every few months, not at all, or too frequently. [1,2]
- Irregular ovulation [1,2]
- Problems when trying to get pregnant and recurrent miscarriages [3]
- Problems in later stages of pregnancy, such as gestational diabetes mellitus, hypertensive disorders of pregnancy, preterm delivery, and birth of small for gestational age infant [4]
- Hair growth on the face or other parts of the body (a condition called hirsutism),
- Acne and other skin problems such as seborrhea, androgenic alopecia and, in severe cases, signs of virilization, patches of dark skin on the back of neck and other areas, called acanthosis nigricans [5]
- Problems with weight gain or trouble losing weight [6] Up to 60% of women with PCOS are overweight or obese. [7]
- Insulin resistance: Up to one-third of women with PCOS will show impaired glucose tolerance by the age of 30 and every year up to 10% of them will develop type 2 diabetes. [8]
- Diabetes: Women with PCOS may be seven times more likely to develop diabetes because of problems with blood sugar imbalance they experience. [7]
If you have some or all of the above signs, you might have PCOS. There can be other reasons why you might have one or more of these signs, but only your health care provider can tell for sure.
What causes PCOS?
PCOS is caused by an imbalance in the hormones that act as chemical messengers in your brain and your ovaries. Many girls also have increased levels of insulin from the pancreas, and PCOS usually happens when the insulin levels are too high. [8] This results in extra testosterone production by the ovaries. The pituitary gland in your brain makes the hormones such as the luteinizing and follicle stimulating hormones, called LH and FSH. After getting the signal from the hormones LH and FSH, the ovaries make estrogen and progesterone, which are the female sex hormones. All normal ovaries also make a little bit of the androgen testosterone — a male sex hormone.
With PCOS, LH levels are often high when the menstrual cycle starts and the levels of LH are higher than FSH levels. Because the LH levels are already quite high, the surge that sets off the chain reaction causing ovulation does not happen at all. Without this LH surge, ovulation does not occur and periods are irregular (as one of the symptoms of polycystic ovary syndrome).
The pancreas is an organ that makes the hormone insulin. High levels of insulin can cause the ovaries to make more testosterone as well. Having PCOS means that the ovaries are not getting the right hormonal signals from your pituitary gland. Without these signals, you will not ovulate and your period may be irregular, or you may not have a period at all. [1,2,7,8] In addition, most women with PCOS present with increased circulating levels of free fatty acids (FFAs), which have been shown to cause insulin resistance. [9]
PCOS diagnosis
Your healthcare provider will ask you many questions about your menstrual cycle and your general health. Then he or she will probably do a complete physical examination. You will most likely need to have a blood test to check your hormone levels, blood sugar, and cholesterol. Your healthcare provider may also want you to have an ultrasound of your uterus and ovaries.
The term “polycystic ovaries” means that there are lots of tiny cysts, or bumps, inside of the ovaries. Some young women with PCOS have these cysts but many others do not. Even if you do have them, they are not harmful and in the majority of cases, they do not need to be removed. [1,2]
Acne and extra hair on your face and body can happen if your body is making too much testosterone, and since skin-cells and hair follicles are extremely sensitive to slight increases in testosterone, it is a common problem in young women with PCOS. Many adolescents with PCOS have higher levels of the hormone insulin in their blood, which causes patches of darkened skin on the back of your neck, under your arms, and in your groin area.
Will polycystic ovary syndrome affect the ability to have children?
Women with PCOS have a normal uterus and healthy eggs, but still many women with PCOS have trouble getting pregnant, while some have no trouble at all. If you are concerned about your fertility future, you could talk to your doctor about all the new options available. You could include medications to lower your insulin levels and help you ovulate when planning to get pregnant.
While you cannot cure PCOS, you can treat it instead. A healthy lifestyle is very important, including healthy eating and daily exercise.,
There are excellent long-term medications to help you manage irregular periods, hair growth, and acne as common symptoms of PCOS. You could ask your doctor about the various options, including hormone treatment and insulin-sensitizing medications.
How to correct your hormonal imbalance
Over the last few years, research into the nutritional approach to PCOS has revolutionized the treatment of this problem. As women with PCOS lose weight, hormone levels start to return to normal, testosterone levels fall, serum insulin levels go down, SHBG levels go up and the symptoms of PCOS diminish. Therapy improves the condition with significant improvements in the growth of excess hair, as the women lose weight. Along with the weight-loss comes a remarkable change in ovarian function.
The effect of a low-carbohydrate, ketogenic diet on the polycystic ovary syndrome was remarkable: a significant improvement in weight, percent free testosterone, LH/FSH ratio, and fasting insulin in women with obesity and PCOS was noted. Out of five women who completed the study, two women who had previous infertility problems got pregnant. [9]
In several studies, results were so dramatic that doctors now suggest that changing a woman’s diet should be the first move if she is overweight and failing to conceive.
One study found that 11 out of 12 women who had been overweight and not ovulating conceived naturally after reducing their weight due to PCOS. [10] In general, women with high levels of luteinizing hormone in the first half of their menstrual cycle seem to have a greater risk of miscarriage, so miscarriages are more likely to occur in women with PCOS because of the high levels of LH.
The most common form of treatment and correcting hormonal imbalance for PCOS is the birth control pill. Birth control pills contain hormones, so even if you are not sexually active, your doctor might prescribe them. The birth control pill is a great solution because it contains the hormones that your body needs to treat your PCOS and correct your hormonal imbalance. By taking the birth control pill either continuously or in cycles, you can:
- Successfully correct the hormonal imbalance,
- Lower the level of testosterone (which will in turn deal with acne and hair growth),
- Regulate your menstrual periods,
- Lower the risk of endometrial cancer,
- Prevent an unplanned pregnancy if you are sexually active.
It is important to discuss with your doctor whether this medicine is right for you, because you may ovulate while on this medication. Therefore, you will also need to use birth control if you are sexually active and do not want to get pregnant. You should not drink alcohol if you are taking metformin.
Sometimes women need to receive treatment with both metformin and birth control pills at the same time.
Multivitamins and minerals could also help to make sure that you are getting a little bit of everything. Chromium is an extremely important mineral if you have PCOS; it helps encourage the formation of the glucose tolerance factor. [12] This is a substance released by the liver and required to make insulin more efficient. However, it would be the best to talk to your doctor about your problem; he or she will recommend the best treatment available, and the best way to correct your hormonal imbalance of PCOS, according to your symptoms and your needs.
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