When I was younger, I was told that I have a very severe hormonal imbalance. That was it. In those days, period and everything relating to it was still very taboo. It just wasn’t something that was discussed in depth, not even by the doctor.
It took decades before a doctor finally sat me down and said you have PCOS. I also had fibroids, but we will talk about that in another article. I had no idea exactly what any of it meant. He explained to me as best as he could, but that was before the explosion of the internet and social media.
It took many, many, many more years for me to figure out how to navigate it. And I am still learning. For those of you who are now hearing it for the first time, allow me to explain.
Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that affects individuals with ovaries, typically during their reproductive years. It is characterized by a combination of symptoms and physical changes, often involving multiple small cysts on the ovaries, though not all individuals with PCOS have these cysts. PCOS can lead to a range of health issues, including menstrual irregularities, infertility, metabolic problems and other complications.
Causes of PCOS
The exact cause of PCOS is not fully understood, but several factors are believed to contribute to its development:
Hormonal Imbalance: PCOS involves an imbalance of reproductive hormones, including elevated androgens (male hormones) and insulin, which disrupt normal ovulation.
Genetics: PCOS can run in families, suggesting a hereditary link. Women with a mother or sister who has PCOS are more likely to develop the condition.
Insulin Resistance: A majority of individuals with PCOS experience insulin resistance, where the body’s cells become less responsive to insulin. To compensate, the body produces more insulin, which stimulates the ovaries to produce more androgens.
Inflammation: Chronic low-grade inflammation has been observed in many people with PCOS. This inflammation contributes to insulin resistance and higher androgen levels.
Symptoms of PCOS
Symptoms of PCOS can vary widely but typically include:
Menstrual Irregularities: This can include missed periods, irregular cycles, or heavy menstrual bleeding due to lack of regular ovulation.
Excess Androgens: Elevated male hormones can lead to hirsutism (excessive hair growth on the face and body), acne and male-pattern baldness.
Polycystic Ovaries: Enlarged ovaries with numerous small, fluid-filled follicles surrounding the eggs may be visible via ultrasound, although this is not present in every case.
Weight Gain: Many individuals with PCOS struggle with weight gain or find it difficult to lose weight despite efforts.
Infertility: Difficulty conceiving due to irregular ovulation, or the absence of ovulation is a common concern for individuals with PCOS.
Skin Changes: Darkening and thickening of the skin, particularly in areas such as the neck, groin and under the breasts (acanthosis nigricans), are common due to insulin resistance.
Complications of PCOS
If left untreated or poorly managed, PCOS can lead to several long-term complications, including:
Infertility: Persistent anovulation (lack of ovulation) can hinder conception.
Metabolic Syndrome: A cluster of conditions such as high blood pressure, high blood sugar and unhealthy cholesterol levels, which significantly increases the risk of heart disease.
Type 2 Diabetes: Due to insulin resistance, individuals with PCOS are at a much higher risk of developing type 2 diabetes.
Obstructive Sleep Apnea: Especially common in overweight individuals, this condition affects breathing during sleep and can lead to further health complications.
Endometrial Cancer: The absence of regular ovulation results in a buildup of the uterine lining, increasing the risk of endometrial cancer.
Mental Health Issues: Anxiety, depression and eating disorders are more prevalent in individuals with PCOS, possibly due to the emotional burden of dealing with physical symptoms and fertility issues.
Diagnosis of PCOS
The diagnosis of PCOS typically involves several approaches:
Medical History and Physical Exam: A healthcare provider will discuss symptoms, family history and perform a physical examination to assess physical signs such as excess hair growth, acne, or obesity.
Blood Tests: These tests measure hormone levels, including androgens, insulin, and other reproductive hormones.
Ultrasound: Pelvic ultrasounds are used to examine the ovaries for cysts and assess the thickness of the endometrium (lining of the uterus).
Treatment of PCOS
While there is no cure for PCOS, a variety of treatments are available to manage symptoms, prevent complications and support fertility.
1. Lifestyle Modifications
Diet: A well-balanced, low-glycemic diet rich in fruits, vegetables, lean proteins, and whole grains helps manage weight and insulin resistance. Avoiding processed foods and added sugars can further reduce symptoms.
Exercise: Regular physical activity is essential to improve insulin sensitivity and promote weight loss. Incorporating both aerobic exercises and strength training can significantly improve overall health.
Weight Loss: For overweight individuals, even modest weight loss (5-10% of body weight) can restore normal ovulation and improve insulin sensitivity.
2. Medical Treatments
Hormonal Birth Control: Oral contraceptives help regulate menstrual cycles, lower androgen levels, and alleviate symptoms like acne and hirsutism.
Anti-Androgens: Medications such as spironolactone can reduce symptoms like unwanted hair growth and acne by blocking the effects of male hormones.
Metformin: Often used to manage insulin resistance, Metformin helps regulate blood sugar levels and may also restore normal menstrual cycles in some individuals.
Fertility Treatments: Medications such as Clomiphene citrate and Letrozole are used to induce ovulation in those trying to conceive. In more complex cases, assisted reproductive technologies (ART) like in-vitro fertilization (IVF) may be necessary.
Surgical Options: Laparoscopic ovarian drilling (LOD) is a procedure that can be used to trigger ovulation in individuals who do not respond to medications.
3. Natural and Complementary Approaches
Herbal Supplements: Herbs such as Vitex (Chaste Tree) and Berberine may support hormone balance and reduce insulin resistance, but it is essential to consult with a healthcare provider before starting these.
Acupuncture: Some studies suggest that acupuncture can improve insulin sensitivity and restore hormonal balance, although more research is needed in this area.
4. Mental Health Support
Counselling: Therapy or counselling can help address the emotional and psychological impact of living with PCOS, including feelings of depression, anxiety, or low self-esteem.
Support Groups: Engaging in online or in-person support groups allows individuals to share experiences and coping strategies, providing a sense of community and understanding.
5. Supplement Support
Inositol, Omega-3 Fatty Acids, Vitamin D, Magnesium, N-Acetylcysteine (NAC), Zinc, Vitamin B Complex, Iron and L-Carnitine: These supplements have been shown to help manage insulin sensitivity, reduce inflammation and improve metabolic health in individuals with PCOS. However, supplements should always be taken under medical supervision to ensure safety and efficacy.
Polycystic Ovary Syndrome (PCOS) is a complex condition that requires a personalized, multifaceted approach for effective management. By understanding the symptoms, causes, and treatment options, individuals with PCOS can take proactive steps to improve their health. Through a combination of lifestyle changes, medical interventions and mental health support, it is possible to manage symptoms and reduce the risk of long-term complications, leading to a higher quality of life.
This article is part of a series on the menstrual cycle and menstrual health:
For Part One on the Menstrual Cycle, click here.
For Part One on Menstrual Disorders, click here.
This article is for informational purposes only and is not meant to offer medical advice.