PCOS: Symptoms, Causes, and Treatments

PCOS: symptoms, causes, and treatments

What Is PCOS?

PCOS, often referred to as Polycystic Ovarian Syndrome, is a prevalent endocrine disorder affecting women, especially the ones in their reproductive age, that is usually characterised by a variety of symptoms and associated health risks around the reproductive areas.

While there is not an exact number when it comes to its prevalence in Australia, PCOS affects around 8 to 13 percent of reproductive-aged women globally, and almost 70 percent of the affected women remain undiagnosed, making it among the most common endocrine disorders in this specific demographic.

PCOS disrupts the hormonal balance that usually starts during adolescence, but the symptoms may fluctuate over time. While normally, ovaries produce eggs and hormones like oestrogen and progesterone that regulate the menstrual cycle. However, in PCOS, ovaries may develop multiple small cysts and produce excess androgens, often referred to as “male hormones”, caused by a hormonal imbalance.

Causes of PCOS

The exact cause of PCOS remains inconclusive as of now, but several factors are more likely to contribute to its development, which as follows:

Genetic Factors

Genetic predisposition appears to play a crucial role, with PCOS occuring more commonly in women with a family history of the condition, particularly families that have either sisters or a mother and a daughter. 

Meaning that female family members are highly susceptible to PCOS if they have another close female relative, such as a mother or a sister, who has one. A study in 2016 that focuses around families with twin sisters results in a conclusion that there is a strong contribution of familial factors to PCOS, in which twin sisters, in this case, have an increased probability to be susceptible to one.

Insulin Resistance

Insulin resistance is a significant factor that causes PCOS, with a majority of women with PCOS exhibit higher levels of insulin (hyperinsulinemia) to compensate for this resistance, contributing to an enhanced androgen production by the ovaries. 

A study links that insulin resistance, which causes hyperinsulinemia, affects around 65 to 70 percent of women with PCOS, with the majority of them being obese women who have a Body Mass Index (BMI) above 30, suggesting that there’s a correlation between insulin resistance and PCOS, specifically around obese patients.

Symptoms of PCOS

the most common symptoms of PCOS
Symptoms of PCOS

The occurrence of symptoms caused by PCOS usually differs from one woman to another. However, there are a number of symptoms that can be commonly found among individuals who have PCOS:

  • Irregular Periods
    Irregular periods are one of the symptoms that are highly prevalent among women with PCOS. Although the exact studies regarding the prevalence are still unclear, one study estimates that around 80 percent of women diagnosed with PCOS experience irregular periods.
    This symptom can be manifested in several ways that differ from one woman to another. Some women might either experience regular periods (every 28 days), prolonged periods (every 30 to 40 days), or don’t experience periods at all.
  • Excess of Androgens (Hyperandrogenism)
    Androgens are a group of steroids present in both males and females. Androgens are essential for male sexual development and function, from increasing the growth of muscle, hair growth in facial and body areas, and sperm production.
    In females, although they are present in much lower levels in comparison to their male counterparts, androgens still play an important role in regulating a number of bodily functions, from sebum production (skin oil), sex drive, to bone health, according to one research.
    In PCOS, it causes endocrine dysfunction in the ovaries or the adrenal glands, leading to the production of androgens to become highly excessive, causing hyperandrogenism. This can lead to unwanted hair growth on different areas of face and body (commonly known as hirsutism), or even male-pattern baldness among women.
  • Skin Issues
    PCOS also causes multiple skin issues that correlates with the excessive amount of androgens. Androgen excess can contribute to the development of acne and oily skin. It causes other skin issues such as the occurrence of skin tags and also skin darkening around different areas of the body such as the neck, under the arms, or breasts.

In addition to these, there are also other common symptoms related to PCOS such as sudden thinning hair and irregular body weight changes.

Health Implications of PCOS

PCOS also carries several health risks that are affecting multiple areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences. Here are some of them:

  • Infertility in women
    Polycystic Ovary Syndrome (PCOS) is strongly correlated with infertility in women, primarily due to its impact on ovulation. Women with PCOS frequently experience irregular or absent menstrual cycles, which indicates inconsistent or absent ovulation, making it difficult to conceive naturally.
    A study highlights that the prevalence of infertility is significantly higher in women reporting PCOS compared to those who do not report the condition. For example, in a large community-based cohort study, infertility was reported by 72% of women with PCOS, compared to 16% of women without PCOS, underscoring the significant impact of this syndrome on fertility.
    Additionally, the typical symptoms of PCOS, including menstrual irregularity and hyperandrogenism, are key factors in the reduced fertility rates observed in affected women, making PCOS a critical target for interventions aiming to improve reproductive outcomes in this population.
  • Metabolic & cardiovascular Issues
    Insulin resistance increases the risk of metabolic and cardiovascular issues. Another condition that is associated with PCOS is metabolic syndrome, which contributes to both diabetes and heart disease.
    A study has proven female adolescents with PCOS have a higher risk of MetS (metabolic syndrome), with obese adolescents having an even higher risk of MetS after matching for their BMI, although not as significant with the ones who have a normal weight. The study also suggests that females who have PCOS have risks linked with cardiovascular-related outcomes.
  • Endometrial cancer
    Some women with PCOS develop a condition called endometrial hyperplasia in which the lining of the uterus becomes too thick. This condition increases the risk of endometrial cancer. One research suggests that women with PCOS have an increased risk of developing endometrial up to 2.7 fold, in which anovulation caused by prolonged exposure of the endometrium to unopposed oestrogen becomes its major factor. 
  • Sleep disorders
    Women with PCOS also may be at higher risk of sleep disorders, such as sleep apnea. One study shows that sleep disturbance among women who have PCOS is highly prevalent and there’s also a linkage between sleep disturbance and cardiovascular risk factors.
    Another study shows that women with PCOS had reduced melatonin concentrations, a hormone involved in regulating sleep-wake cycles, in their ovarian follicles.

Treatments Options for PCOS

While there are no specific cures to PCOS, there are several treatments that may prevent the underlying health risks and issues that are correlated to PCOS.

A Change in Lifestyle

A significant change to the lifestyle might help mitigate the health risks correlated with PCOS. A balanced diet rich in fruits, vegetables, whole grains, and lean protein is a good start, as it can improve insulin sensitivity and aid in weight management. Limiting processed foods, sugary drinks, and unhealthy fats is also crucial. Consulting a registered dietitian can help create a personalised plan to the diets.

One study has shown that dietary weight loss among women with PCOS resulted in significant improvement in a number of factors that are beneficial, from increasing the probability of menstrual regularity, reducing BMI, waist circumference, and hirsutism scores, which eventually reduce the symptoms of PCOS.

Besides regular diet, regular physical activities are essential for managing PCOS, specifically for the ones who are overweight or obese. Plan at least 30 minutes of moderate-intensity exercise almost everyday of the week. Exercising helps improve insulin sensitivity, promote weight loss, which lessen the health risks caused  by PCOS. Other relaxation techniques such as meditation, deep breathing, and yoga can also help in managing stress, which is one of the catalysts for PCOS symptoms.

Medications to Manage Symptoms

Medications can address specific symptoms and hormonal imbalances associated with PCOS. There are some common options, such as birth control pills that help regulate menstrual cycles, reduce androgen levels, and can reduce risks of acne and unwanted hair growth.

Anti-androgen medications such as spironolactone can also help block the effects of androgens, helping to reduce acne severity and excess hair growth (hirsutism), according to one study. And lastly, another medication such as metformin, which is typically used for treating type 2 diabetes, can help to improve insulin sensitivity and aid in weight management and ovulation regulation.

However, if women patients want to try to conceive sometimes in the future, there are also a number of medications. One of them is clomiphene, which is usually the first-line treatment for ovulation induction in PCOS. An oral medication, clomiphene stimulates the ovaries to release mature eggs, which increase the probability of conception. Another possible medication is letrozole, commonly used as treatments for breast cancer, which can stimulate ovulation in women with PCOS who usually are not responding well to clomiphene. 

One study has shown that both clomiphene and letrozole are proven to be effective, although letrozole is associated with higher live-birth and ovulation rates among infertile women with the polycystic ovary syndrome compared to clomiphene.

Cannabinoids

Cannabinoids may also help in treating PCOS, although the research regarding the effects of cannabinoids remain inconclusive as of now and require further studies to prove its efficacy. 

One research study suggests that there are a number of potential benefits from cannabinoids that might help PCOS patients, such as regulating insulin signalling, metabolic regulation, and anti-inflammatory effects that might reduce the symptoms of PCOS.

However, there  may be side effects when using cannabinoids, as one study has indicated. According to the study, cannabinoid-containing medical products have several common side effects that affect multiple systems around the body. Some of them might correlate with patients who have PCOS, which as follows:

  • Central nervous system effects such as dizziness, drowsiness, euphoria, impaired coordination, cognitive impairment.
  • Psychiatric effects such as anxiety and paranoia.
  • Cardiovascular effects such as increased heart rate and low blood pressure.
  • Respiratory effects such as coughing and bronchitis.
  • Gastrointestinal effects such as dry mouth, nausea, and diarrhoea.

With several potential side effects that might negatively affect the health of the patients, it is wise to always take precautions and engage with  appropriately qualified health practitioners regarding the use of cannabinoids.

A Requirement of Further Research Towards PCOS Treatments

In conclusion, PCOS, with its complex, diverse symptoms and underlying hormonal imbalances between patients, necessitates a comprehensive approach to management and care. By combining lifestyle modifications like a proper, balanced diet and regular daily exercise with medical interventions tailored to each of the individual needs, women with PCOS are able to effectively manage their symptoms and gradually improve their overall well-being. 

Furthermore, staying up-to-date on emerging treatment options and research advancements might help patients to actively participate in their healthcare decisions. PCOS itself, although complex, is a relatively manageable condition, and with a multifaceted approach that prioritises healthy diets and an open communication between patients and medical experts in regards to proper treatments, patients with PCOS can lead fulfilling and healthy lives for the foreseeable future.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

Written by

Priyom holds a Ph.D. in Plant Biology and Biotechnology from the University of Madras, India. She is an active researcher and an experienced science writer. Priyom has also co-authored several original research articles that have been published in reputed peer-reviewed journals. She is also an avid reader and an amateur photographer.

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