What is PCOS in Women? Understanding Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common health problem affecting women of reproductive age. Women with PCOS may have infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries may develop numerous small collections of fluid — called follicles — and fail to regularly release eggs. Understanding what PCOS is, its symptoms, causes, and potential complications is crucial for women’s health.

PCOS is a hormonal disorder common among women of reproductive age. Many women discover they have PCOS when they are experiencing problems getting pregnant or are having irregular periods. In fact, the term “polycystic ovary syndrome” refers to the multiple small cysts (fluid-filled sacs) that can form in the ovaries. However, it’s important to note that not all women with PCOS have cysts, and some women without PCOS can develop ovarian cysts. The syndrome is characterized by a hormonal imbalance that can lead to a range of symptoms and long-term health issues.

While the exact cause of PCOS is not fully understood, early diagnosis and management can help minimize long-term complications, such as type 2 diabetes and heart disease. Lifestyle modifications, including weight loss, are often recommended as part of the treatment plan.

Symptoms of PCOS in Women

PCOS symptoms can vary significantly from woman to woman. For some, symptoms are mild, while others experience more severe manifestations. Often, symptoms become noticeable around the time of the first menstrual period during puberty. However, in some cases, PCOS can develop later in the reproductive years.

Diagnosis of PCOS typically involves identifying at least two of the following key symptoms:

• Irregular Menstrual Cycles: Infrequent, irregular, or prolonged menstrual periods are hallmark signs of PCOS. This can manifest as having fewer than nine periods a year, with cycles longer than 35 days, or periods that are abnormally heavy or last for an extended duration. These irregularities are often due to infrequent or absent ovulation, which is the release of an egg from the ovary. Difficulty conceiving is a frequent concern for women with PCOS due to these ovulation issues.

• Elevated Androgen Levels: Increased levels of androgens, often referred to as “male hormones,” can lead to physical signs like hirsutism (excessive hair growth on the face, chin, or body, following a male-like pattern). Other androgen-related symptoms may 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: An ultrasound of the ovaries might reveal them to be enlarged and contain numerous small follicles (cysts) around the edges. These follicles contain immature eggs and may not function normally, leading to irregular ovulation. While polycystic ovaries are a diagnostic criterion, it’s important to remember that not every woman with PCOS will have visible cysts on an ultrasound, and the presence of cysts alone is not sufficient for a PCOS diagnosis.

It’s 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 for PCOS Symptoms

If you are concerned about irregularities in your menstrual cycle, are experiencing difficulties in getting pregnant, or notice signs of excess androgen, it is essential to consult with a healthcare provider. These signs include new, unwanted hair growth on your face or body, persistent acne, and thinning hair. Early consultation can lead to timely diagnosis and management, improving both short-term symptoms and long-term health outcomes.

Causes of Polycystic Ovary Syndrome

The precise cause of PCOS remains elusive, but research points to several contributing factors that likely interact to cause the condition. These factors include:

• Insulin Resistance: Insulin is a hormone produced by the pancreas that helps regulate blood sugar levels by allowing cells to use glucose for energy. Insulin resistance occurs when cells become less responsive to insulin, leading to elevated blood sugar. To compensate, the body produces more insulin. High insulin levels can trigger the ovaries to produce more androgens. This excess androgen production contributes to ovulation problems and other PCOS symptoms. Insulin resistance is also associated with conditions like dark patches of skin (acanthosis nigricans), increased appetite, and weight gain.

• Low-Grade Inflammation: Inflammation is the body’s response to injury or infection. Chronic low-grade inflammation, a persistent, mild 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 hormonal imbalances and cardiovascular issues.

• Heredity and Genetics: Family history plays a significant role in PCOS. Research indicates that certain genes may predispose individuals to developing PCOS. Having a mother or sister with PCOS increases a woman’s likelihood of also developing the condition, suggesting a genetic component.

• Excess Androgen Production: PCOS is characterized by an overproduction of androgens by the ovaries. Elevated androgen levels disrupt the normal menstrual cycle and ovulation. The excess androgens prevent the regular development and release of eggs from the follicles. Furthermore, high androgen levels are directly responsible for symptoms like hirsutism and acne, which are commonly experienced by women with PCOS.

Potential Complications of PCOS

PCOS can increase the risk of developing several serious health complications over time. These potential long-term health issues underscore the importance of early diagnosis and ongoing management of PCOS. Complications associated with PCOS include:

• Infertility: Irregular ovulation or failure to ovulate are primary features of PCOS, making it a leading cause of infertility in women.

• Pregnancy Complications: Women with PCOS have a higher risk of gestational diabetes (diabetes during pregnancy) and pregnancy-induced hypertension (high blood pressure). They are also at an increased risk for miscarriage and premature birth.

• Nonalcoholic Steatohepatitis (NASH): This severe form of liver inflammation is caused by fat buildup in the liver. PCOS is a risk factor for NASH.

• Metabolic Syndrome: This cluster of conditions includes high blood pressure, high blood sugar, abnormal cholesterol or triglyceride levels, and excess abdominal fat. Metabolic syndrome significantly elevates the risk of cardiovascular disease. PCOS increases the likelihood of developing metabolic syndrome.

• 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 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 infrequent ovulation can lead to a buildup 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 is often a crucial part of managing PCOS and reducing the risk of long-term health problems.

By Mayo Clinic Staff

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