Patients visit their OB/GYN for multiple reasons, including weight gain and infertility. However, it must be understood that these could be the external manifestations of an underlying problem – numerous cysts in their ovaries. This condition is called Polycystic Ovary Syndrome (PCOS). In this article, we delve deep into what this condition is about, its symptoms, tell-tale signs, and how it can be confirmed clinically.

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What is PCOS?

Polycystic Ovary (ovarian) Syndrome (PCOS) is the most common hormonal disorder in women of reproductive age, causing enlarged ovaries with small cysts on the outer edges.

What are hormones?

Hormones are chemicals produced by glands that balance the functions within the human body. They help control functions in the body, such as growth, energy, sexual function, reproduction, digestion, and temperature. An imbalance of two hormones, insulin, and androgens, in a woman’s body, causes PCOS.

PCOS & hormones

The excessive production of male hormones called androgens caused due to the increased levels of insulin in the body makes the ovaries work abnormally. So, the ovaries function and symptoms improve if the hormone levels are controlled.

What do the ovaries do?

The ovaries are small, oval-shaped organs located in the pelvis that play a significant role in conception. They produce an egg each month. When the egg is mature, it is released from the ovary (ovulation) and pushed down the fallopian tube to be fertilized. The development of the eggs is affected if the woman has PCOS, which hinders conception.

An ultrasound image of the ovaries in some women will show multiple follicles; these are partially formed eggs within the ovaries that have not developed properly. This is caused by increased levels of male hormones in the body.

What causes PCOS?

  1. Raised levels of testosterone: The increased levels of male hormone in a woman can prevent the ovaries from releasing eggs regularly during the menstruation cycle.
  2. Raised levels of prolactin and luteinizing hormone: Raised levels of both these hormones in a female body also hinder regular ovulation.
  3. High insulin levels: High levels of insulin in blood cells lead to excessive androgen secretion that interferes with the ability of ovaries to ovulate.
  4. Obesity: Women who are above normal weight are at higher risk. This is because weight gain leads to insulin resistance, which causes the production of more estrogen by fatty tissues causing ovulation disruption. These women must adopt a healthy lifestyle that leads to steady weight loss and maintenance.


Signs & symptoms of PCOS

It is not necessary that one would have all the symptoms, and the severity of the symptoms may also change from person to person. These signs also change at different stages depending on the age group. Symptoms of PCOS may include:

Issues related to periods & fertility –

  1. No periods or periods that are irregular/heavy.
  2. Immature ovarian eggs that do not ovulate.
  3. Multiple cysts on the ovaries.
  4. Difficulty in becoming pregnant.

Changes in hair, skin & body –

  1. Excess facial and/or body hair (hirsutism)
  2. Scalp hair loss (alopecia)
  3. Acne on the face and/or body that can be severe
  4. Darkened skin patches (acanthosis nigricans)
  5. Weight gain

Mental & emotional health problems –

  1. Mood changes
  2. Depression
  3. Anxiety
  4. Low self-esteem

Other related health conditions –

  1. Sleep apnoea (a sleep disorder in which abnormal breathing occur during sleep)
  2. Increased risk of diabetes, with earlier onset
  3. Sexual health challenges
  4. Increased risk of cardiovascular disease

Identifying PCOS

A diagnosis of PCOS may be required when at least two of the following three criteria are met:

  1. Irregular periods or no periods
  2. Higher levels of androgens are present in the blood (hyperandrogenism), which can be identified by a blood test or symptoms like excess facial or body hair growth, scalp hair loss, and acne.
  3. Polycystic ovaries are visible on an ultrasound, which means more than 20 follicles, underdeveloped eggs, are visible on one or both ovaries. The size of one or both ovaries is increased (more than 10ml).

Irregular periods and hyperandrogenism need to be present for a diagnosis of PCOS. Several other conditions that could cause similar symptoms must be checked by a doctor and ruled out before a correct diagnosis of PCOS.

Diagnosis & tests

Medical history & examination – Doctors would review a patient’s medical history and assess her physical symptoms, weight, and BMI (body mass index) as part of the diagnosis.

Blood tests – To assess the levels of androgens in the body. Mainly, tests for testosterone and free androgen index (FAI) are for diagnosing hyperandrogenism (high androgen levels). Tests might also be done to assess the levels of other reproductive hormones like oestradiol (estrogen, the primary female sex hormone), follicle-stimulating hormone (FSH), luteinizing hormone (LH), as they can also affect periods. Blood tests to reject different conditions that have comparative manifestations to PCOS may gauge the degrees of thyroid-stimulating hormone (TSH), prolactin, hormones identified with adrenal function.

“When testing for PCOS, some other assessments that help in knowing the risk of a patient developing cardiovascular disease and diabetes are important as there could be links between PCOS, Insulin resistance, and Obesity.”

Ultrasound – A Pelvic Scan is used to provide a clear image of the uterus, ovaries, and the pelvis. This shows whether there are any follicles or cysts on the ovaries and whether any of the two ovaries has enlarged. It is likewise valuable to evaluate the lining of the womb (endometrium), which may get thickened if periods are unpredictable, which is a hazard factor for uterus cancer. There are two types of ultrasound scans.

  1. Transvaginal ultrasound
  2. Abdominal ultrasound

Transvaginal ultrasounds are performed only when women have been sexually active. It is a painless test with no radiation. It uses a pen-shaped probe with an ultrasound sensor on the tip, inserted into the vagina. This provides a much clearer picture than an abdominal ultrasound.

In an ultrasound, the ovaries are viewed from the outside through the abdominal wall.

When testing for PCOS, some other assessments that help determine the risk of a patient developing cardiovascular (heart) disease and diabetes are essential as there could be links between PCOS, insulin resistance, and being overweight. Tests to assess these risks include a cholesterol blood test, blood pressure, glucose metabolism, or tolerance blood test.

Testing adolescents for PCOS – In adolescents, during the first few years after the periods (menstruation) commence, it is difficult to diagnose PCOS as menstrual cycles could be irregular for many unrelated reasons. Generally, in the first year, periods are often irregular, and by the second year, it settles typically into a regular pattern.

However, in young women with PCOS, this does not occur. Instead, the menstural cycle are either very close together (fewer than 21 days) or far away (more than 45 days), which suggests PCOS might be the cause if such an irregularity continues even after three years.

Bottom line

Any woman who has trouble getting pregnant or has been experiencing any of the symptoms mentioned above should get herself checked for PCOS. While there can be several reasons for not being able to conceive, not all of them are related to PCOS; getting diagnosed can undoubtedly increase the chances of fertility. In any event, it can encourage treatment by narrowing down the list of probable causes. And it is not always a question of childbirth. Getting a doctor’s help on PCOS can help prevent any other kinds of complications in the future, and live a healthier and happier life.

“Blood tests are performed to check levels of testosterone and free androgen index(FAI) to diagnose hyperandrogenism”

To know more about PCOS, please use the following links:
  1. Top 10 FAQs for women with PCOS

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