What is PCOS? Understanding Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common health problem caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries release eggs each month as part of the menstrual cycle. In women with PCOS, the egg may not develop as it should or it may not be released during ovulation as regularly.

PCOS can lead to missed or irregular menstrual periods, ovarian cysts, and issues with fertility. Many women discover they have PCOS in their 20s or 30s, when they have problems getting pregnant or have gained weight. However, PCOS can affect girls and women of all ages after puberty. Early diagnosis and treatment can help manage symptoms and reduce the risk of long-term health problems.

PCOS Symptoms: Recognizing the Signs

Symptoms of PCOS vary significantly from woman to woman, and not every woman will experience the same symptoms or severity. Often, PCOS symptoms become noticeable around the time of the first menstrual period during puberty, but they can also develop later in the reproductive years. Diagnosis of PCOS typically involves meeting at least two out of three criteria:

• Irregular Periods: Infrequent, irregular, or prolonged menstrual cycles are a hallmark of PCOS. This can manifest as having fewer than nine periods a year, periods occurring more than 35 days apart, or periods that are abnormally heavy or last longer than usual. The irregularity in periods is due to infrequent or absent ovulation. This ovulatory dysfunction can also lead to difficulty in conceiving.
• Excess Androgen: Elevated levels of androgens, often referred to as “male hormones,” can lead to physical signs. Hirsutism, which is excessive hair growth on the face, chin, or body (in a male-like pattern), is a common symptom. Other signs of excess androgen can include severe acne that doesn’t respond to typical treatments and male-pattern baldness or thinning hair. Blood tests can confirm high androgen levels.
• Polycystic Ovaries: The term “polycystic ovaries” refers to ovaries that are enlarged and contain numerous small follicles, which appear as cysts on ultrasound. These follicles are immature eggs and, due to hormonal imbalances, they may not mature and be released regularly during ovulation. It’s important to note that while polycystic ovaries are a diagnostic criterion, not all women with PCOS have cysts on their ovaries, and some women without PCOS can develop ovarian cysts.

It’s also important to note that the severity of PCOS symptoms can be exacerbated by obesity. Women who are overweight or obese may experience more pronounced symptoms and face a higher risk of complications.

When to Seek Medical Advice

If you are concerned about irregularities in your menstrual cycle, are experiencing difficulty getting pregnant, or notice signs of excess androgen such as new hair growth in unwanted places, acne, or thinning hair, it is essential to consult with a healthcare provider. Early evaluation is crucial for accurate diagnosis and timely management.

PCOS Causes: Unraveling the Complexities

While the precise cause of PCOS remains unknown, research points to several interconnected factors that likely play a critical role in its development:

• Insulin Resistance: Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels. Insulin resistance occurs when cells become less responsive to insulin, leading to a buildup of glucose in the blood. To compensate, the body produces more insulin. Excess insulin can trigger the ovaries to produce more androgens. Insulin resistance is also associated with weight gain and can manifest as dark, velvety skin patches (acanthosis nigricans), often found in skin creases like the neck, armpits, and groin.
• Low-Grade Inflammation: Inflammation is the body’s natural response to injury or infection. Chronic low-grade inflammation, a persistent but subtle inflammatory state, has been observed in women with PCOS. This type of inflammation is thought to stimulate polycystic ovaries to produce androgens, potentially contributing to both reproductive and cardiovascular issues.
• Heredity: Genetics are believed to play a significant role in PCOS. Women with a family history of PCOS, particularly mothers or sisters with the condition, have a higher risk of developing it themselves. Research is ongoing to identify specific genes that may be linked to PCOS susceptibility.
• Excess Androgen Production: Elevated levels of androgens are a core feature of PCOS. While the causes mentioned above can contribute to androgen excess, the ovaries themselves may also overproduce androgens in PCOS. High androgen levels disrupt the normal menstrual cycle, preventing ovulation and contributing to symptoms like hirsutism and acne.

PCOS Complications: Understanding Long-Term Health Risks

PCOS is not just a reproductive disorder; it’s associated with an increased risk of various long-term health complications. These complications are often linked to the hormonal imbalances and metabolic disturbances characteristic of PCOS and can significantly impact a woman’s overall health and well-being:

• Infertility: PCOS is one of the most common causes of female infertility. Irregular ovulation or lack of ovulation makes it difficult to conceive naturally.
• Gestational Diabetes and Pregnancy Complications: Women with PCOS have a higher risk of developing gestational diabetes during pregnancy. They are also at increased risk for pregnancy-induced hypertension and preeclampsia, premature birth, and miscarriage.
• Nonalcoholic Steatohepatitis (NASH): NASH is a severe form of liver inflammation caused by fat accumulation in the liver. PCOS increases the risk of NASH, which can lead to liver damage and cirrhosis.
• Metabolic Syndrome: This cluster of conditions includes high blood pressure, elevated blood sugar, abnormal cholesterol levels, and excess abdominal fat. PCOS significantly increases the risk of metabolic syndrome, which in turn raises the risk of cardiovascular disease.
• Type 2 Diabetes and Prediabetes: Insulin resistance, common in PCOS, increases the risk of developing type 2 diabetes. Prediabetes, a condition where blood sugar levels are higher than normal but not yet diabetic, is also more prevalent in women with PCOS.
• Sleep Apnea: This sleep disorder, characterized by repeated pauses in breathing during sleep, is more common in women with PCOS, particularly those who are overweight or obese.
• Mental Health Disorders: Women with PCOS have a higher incidence of depression, anxiety, and eating disorders. Hormonal imbalances and the challenges of managing PCOS symptoms can contribute to these mental health issues.
• Endometrial Cancer: Irregular periods and lack of ovulation can lead to thickening of the uterine lining (endometrium). Over time, this can increase the risk of endometrial cancer.

Obesity is frequently associated with PCOS and can worsen many of these complications. Maintaining a healthy weight through diet and exercise is crucial for managing PCOS and reducing the risk of long-term health problems.

It is important to emphasize that PCOS is a manageable condition. Early diagnosis, lifestyle modifications, and appropriate medical treatments can help women with PCOS effectively manage their symptoms, improve their quality of life, and reduce their risk of developing these associated health complications.

By Mayo Clinic Staff

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Sept. 08, 2022

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