What is Polycystic Ovarian Syndrome (PCOS)?
Polycystic ovarian syndrome (PCOS) is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can affect a women’s menstrual cycle, fertility, cardiac function, and appearance.
Hormones involved in PCOS include:
- Androgens. All females make androgens (also referred to as “male hormones”), but there are often higher levels of androgens in women with PCOS. The excess androgens are produced mostly by the ovaries, but the adrenal glands can also be involved. Excess androgens are responsible for many PCOS symptoms including acne, unwanted hair, thinning hair, and irregular periods.
- Insulin. This hormone allows the body to absorb glucose (blood sugar) into the cells for energy. In PCOS, the body isn’t as responsive to insulin as it should be. This can lead to elevated blood glucose levels and cause the body to make more insulin. Having too much insulin can cause the body to make more androgens.
- Progesterone. In PCOS, a lack of progesterone contributes to irregular periods.
Symptoms of PCOS
Symptoms of PCOS may begin shortly after puberty, but can also develop during the later teen years and early adulthood. Because symptoms may be attributed to other causes or go unnoticed, PCOS may go undiagnosed for some time.
Women with PCOS typically have irregular or missed periods as a result of not ovulating. Although some women may develop cysts on their ovaries, many women do not.
Other symptoms include:
- Weight gain. About half of women with PCOS will have weight gain and obesity that is difficult to manage.
- Fatigue. Many women with PCOS report increased fatigue and low energy. Related issues such as poor sleep may contribute to the feeling of fatigue.
- Unwanted hair growth (also known as hirsutism). Areas affected by excess hair growth may include the face, arms, back, chest, thumbs, toes, and abdomen. Hirsutism related to PCOS is due to hormonal changes in androgens.
- Thinning hair on the head. Hair loss related to PCOS may increase in middle age.
- Infertility. PCOS is a leading cause of female infertility. However, not every woman with PCOS is the same. Although some women may need the assistance of fertility treatments, others are able to conceive naturally.
- Acne. Hormonal changes related to androgens can lead to acne problems. Other skin changes such as the development of skin tags and darkened patches of skin are also related to PCOS.
- Mood changes. Having PCOS can increase the likelihood of mood swings, depression, and anxiety.
- Pelvic pain. Pelvic pain may occur with periods, along with heavy bleeding. It may also occur when a woman isn’t bleeding.
- Headaches. Hormonal changes prompt headaches.
- Sleep problems. Women with PCOS often report problems such as insomnia or poor sleep. There are many factors that can affect sleep, but PCOS has been linked to a sleep disorder called sleep apnea. With sleep apnea, a person will stop breathing for short periods of time during sleep.
How is PCOS diagnosed?
There is no definitive test for PCOS. To make a diagnosis, your doctor will review your medical history and symptoms and perform tests to rule out other possible conditions. Your doctor will perform a physical and pelvic examination to look for signs of PCOS, such as swollen ovaries or a swollen clitoris.
Blood tests to measure sex hormone levels are typically ordered, as well as:
- thyroid function tests to determine how much of the thyroid hormone your body produces
- fasting glucose tests to measure your blood sugar levels
- lipid level tests to assess the amount of cholesterol in your blood
A vaginal ultrasound allows your gynecologist to create real-time images of your reproductive organs. A pelvic laparoscopy is a surgical procedure in which your doctor makes a small incision in your abdomen and inserts a tiny camera to check for growths on your ovaries. If growths are present, your doctor may take a small tissue sample (biopsy) for further examination.