Frequently referred to as PCOS, polycystic ovary syndrome is a hormonal disorder that impacts women. The causes of PCOS aren’t fully understood. Still, experts believe that insulin resistance and hormonal imbalances both contribute to the disorder. Symptoms commonly experienced by women with this condition include irregular periods, resistance to insulin, excessive hair on the body and face, and infertility.
Approximately 5-10% of women of reproductive age suffer from polycystic ovary syndrome. It’s the hormone disorder most likely to impact women and is a common cause of infertility. PCOS can affect women as early as age 11. There aren’t any clear diagnostic criteria for PCOS, and the most common symptoms don’t always seem like they’re related to the disorder. Many women don’t receive an official diagnosis until they’re past their 20s or even in their 30s. The condition seems to be hereditary. If a woman has a sister or sisters with PCOS, she is two times as likely to be diagnosed with the same condition.
Even though experts have not determined the diagnostic criteria for polycystic ovary syndrome, women diagnosed with the condition typically demonstrate two of the following symptoms:
- Failure to ovulate
- High production of male hormones
The word polycystic translates to “many cysts.” When a woman has PCOS, her ovary does not release eggs. Fluid builds around the eggs, which causes sacs or cysts to form. Even though this symptom helped name the disorder, there are women diagnosed with polycystic ovary syndrome that do not have polycystic ovaries.
Even though androgens are often referred to as male hormones, it’s typical for a woman’s adrenal glands and ovaries to produce these in small quantities. Unfortunately, creating an excess of these hormones, like testosterone, a woman may experience a wide range of frustrating symptoms, including weight gain, excessive body and facial hair, and acne.
When a woman’s hormones are imbalanced, her menstrual cycle may also be disrupted. This disruption can lower the number of eggs that are released or keep a woman from ovulating at all. Women that do not ovulate are unable to become pregnant.
When women have PCOS, it’s typically for ovaries to be enlarged. Ovaries can be triple their typical size. When eggs aren’t released during ovulation, those eggs can stay in the ovary as small sacs that are filled with fluid. This can cause many cysts to develop. When they are viewed through an ultrasound, they look like beads on a string. In most cases, when a woman suffering from PCOS undergoes an ultrasound, cysts can be seen.
Failing to menstruate or ovulate can also cause the body to produce less progesterone. This can cause a condition called endometrial hyperplasia, in which the uterus lining is overgrown. It can increase the risk of endometrial cancer. When women suffering from polycystic ovary syndrome do conceive, they’re far more likely to miscarry or experience other complications, such as gestational diabetes.
A Resistance To Insulin
Many experts believe that resistance to insulin is one of the factors that causes PCOS. Bodies rely on glucose to produce energy. It’s transported via insulin. If someone is insulin resistant, their body will try to address this by producing more insulin. Many experts think that an excess of insulin can lead to increased androgen production, which causes many of the symptoms of PCOS.
Most women with PCOS are insulin resistant. Unusual blood lipid levels and weight gain are also common symptoms. It’s most likely to see insulin resistance in women that are not ovulating and are obese. Because of this, women with PCOS are at increased risk for type 2 diabetes, heart disease, and hypertension, as well as several other health conditions.
There are many symptoms experienced by women suffering from polycystic ovary syndrome. These symptoms can change over time and may become pronounced. In many cases, it can be challenging to see a link between these symptoms, which is one of the reasons the condition can be challenging to diagnose. Many women do not seek treatment for these issues until they are trying to conceive, which is why the condition is more likely to be diagnosed in women that are of childbearing age.
- Some of the more common symptoms associated with PCOS include:
- Unusual uterine bleeding, failure to menstruate, or erratic menstrual periods
- Enlarged or polycystic ovaries
- Pain in the pelvis
- Excessive growth of hair in the body and face
- Obesity or significant weight gain, particularly when the fat is distributed in the body’s center.
- Skin tags, acne, or discoloration of the skin
- Deepened voice
- Thinning hair or baldness
- Complications that can be caused by PCOS include:
- Resistance to insulin
- Heart disease
- Sleep apnea
- If a woman with PCOS becomes pregnant, she may experience complications such as pre-eclampsia, gestational diabetes, or miscarriage.
- Endometrial cancer
Testing for PCOS can be challenging, mainly because there is no formal consensus on the diagnostic criteria. In most cases, medication professionals will look at symptoms, clinical findings, laboratory tests, and medical history when making a diagnosis.
Other tests will likely be ordered to rule out other potential causes of these symptoms. As an example, a tumor in the ovaries can increase the production of androgens, as can a condition called adrenal hyperplasia.
Several hormonal tests can be used when a woman is being evaluated for PCOS.
Luteinizing hormone (LH): Women with PCOS will have elevated levels
Follicle-stimulating hormone (FSH): Low to normal levels
Testosterone: Typically, elevated
Estrogens: Normal to elevated
Androstenedione: Levels may be elevated
Human chorionic gonadotropin (hCG): Pregnancy test. The results will be negative unless the patient is pregnant.
Anti-Mullerian hormone (AMH): Increased levels are common in women with PCOS.
Additional tests may be ordered to rule out other possible causes of these symptoms, including:
Cortisol: Test for Cushing syndrome
Thyroid-stimulating hormone (TSH): Test for thyroid dysfunction
17-hydroxyprogesterone: Test for congenital adrenal hyperplasia
Prolactin: Test for hyperprolactinemia
IGF-1: Test for excess growth hormone, or acromegaly
DHEAS: Testing for adrenal tumors. This test is more likely to be ordered if a woman is showing extreme hair growth.
It’s also possible that blood tests will be ordered so that a woman’s health can be accurately assessed before treatment, including:
Lipid profile: This test can determine the risk of heart disease. High cholesterol levels and elevated triglycerides are both warning signs. Women with PCOS are at increased risk for heart disease, which is why early testing is important
Insulin: Insulin levels are often abnormal in women with PCOS