Polycystic ovary syndrome, also known as PCOS, is a hormonal imbalance stemming from the ovaries. It’s currently estimated that roughly 10% of all women have PCOS, though many may not realize it. If you have been diagnosed with PCOS or think you may have it, here’s everything you need to know about women’s health and living with polycystic ovarian syndrome.

Causes of PCOS

While the exact cause of PCOS is still unknown, it is known that there are several factors that are thought to play a role in its development.

Increased Levels of Androgen

If the ovaries produce excess male hormones, it can lead to difficulties with ovulation. Specifically, this can mean eggs won’t develop on a regular basis, and they can experience difficulty being released from their follicles. This leads to irregular menstrual periods and difficulty conceiving.

High androgen levels also lead to acne and hair growth, which are two common symptoms of PCOS.

Insulin Resistance

Insulin is made in the pancreas and allows your body’s cells to use sugar as their primary energy supply. When cells begin to develop insulin resistance, blood sugar levels can increase, which can cause your body to make additional insulin in an attempt to lower blood sugar levels again. If the body has too much insulin, it can cause the body to produce too much androgen, which can lead to trouble ovulating.

Heredity

Current research suggests that PCOS may be a heritable trait. If you have a family history of PCOS, there is a chance you may be more likely to have it.

Symptoms of PCOS

There is a wide range of PCOS symptoms you can potentially experience. These include things like:

• Irregular periods
• Abnormally heavy periods
• Excessive hair growth on the face and body
• Acne
• Difficulty conceiving
• Pregnancy complications
• Weight gain or obesity
• Trouble losing weight
• Acanthosis nigricans (darkening of the skin)
• Ovarian cysts
• Insulin resistance
• Thinning hair
• Skin tags
• Hypothyroidism

Not all people with PCOS will experience every symptom, but the most common symptoms are an irregular period, excess hair growth, acne, weight gain or trouble losing weight, and difficulty getting pregnant. The diagnostic criteria for PCOS are based on androgen levels, cystic ovaries, and irregular periods.

PCOS Complications

In addition to the symptoms you may encounter while living with PCOS, there is also a risk of serious health problems. For example, people living with PCOS are at a higher risk of developing type 2 diabetes, high blood pressure, heart problems such as cardiovascular disease or coronary artery calcification, and uterine cancer.

In addition, PCOS can potentially lead to endometrial cancer due to the irregular shedding of the uterine lining, sleep disorders such as sleep apnea, mood disorders like depression or anxiety, and nonalcoholic steatohepatitis (NASH), and nonalcoholic fatty liver disease (NAFLD).

How to Diagnose PCOS

There are three criteria for a PCOS diagnosis, and to be confirmed as having PCOS, you must have at least two of them.

• Irregular Menstrual Cycles: If the gap between your periods is less than 21 days or more than 35 days, it’s considered irregular. However, with PCOS, it will be far more likely that your periods are further apart, not closer together.
• Hyperandrogenism: You produce above-average levels of androgen. This can be determined via a blood test.
• Polycystic Ovaries: This can be determined via a pelvic ultrasound. However, if you are currently taking hormonal birth control, cysts may not appear on the ultrasound.

PCOS in Adolescents

While PCOS is primarily associated with adult women, it can actually develop as early as a girl’s first menstrual cycle, and it’s suspected to be a condition one is born with. Diagnosing PCOS in girls and teens can be difficult because so many of the different symptoms already occur naturally in puberty, like hair growth, acne, and weight gain. Plus, irregular menstrual cycles are common in girls who have just started getting their periods, and it can take two to three years for a cycle to become regular. Because of this, PCOS can’t be diagnosed in girls until that time has passed.

How to Treat PCOS

While there is currently no cure for PCOS, you can still manage the symptoms. Treatments can vary depending on whether or not you want to or are currently trying to conceive.

General PCOS Treatments

• Birth Control Pills: Birth control may help regulate your period and make your period lighter if you experience extremely heavy flow. Birth control pills can also reduce acne, hair growth, and androgen levels. They’re also key in managing the development of ovarian cysts.
• Insulin-Sensitizing Agents: Medications such as metformin are known to reduce acne and hair growth, make it easier to lose weight, lower cholesterol, make periods more regular, and can slightly reduce infertility issues. It may take four to six months of use to see natural ovulation.
• Anti-Androgens: Medications such as Flutamide, Spironolactone, and Cyproterone can be used to lower androgen levels in the body, leading to reduced body hair growth and acne. However, anti-androgens can potentially cause birth defects, so they’re typically prescribed alongside birth control pills.

PCOS Treatments For If You Want to Become Pregnant

• Letrozole: Originally a breast cancer treatment, this medication is known to stimulate the ovaries and induce ovulation for women with PCOS. Studies suggest it may be more effective than other similar medications.
• Metformin: A medication originally for type 2 diabetes, Metformin can improve insulin resistance and lower insulin levels in the body, which helps regulate menstrual cycles and improve ovulation rates. Metformin can be especially effective when used in combination with Clomiphene.
• Clomiphene: A selective estrogen receptor modulator (SERM) that blocks estrogen receptors in the brain, which causes the release of a hormone that stimulates egg development and ovulation.

Pregnancy and PCOS

Because PCOS affects fertility, pregnancy is a big concern for many people with PCOS who want to have children. In addition to medications that you can take to improve ovulation, there are also other options available.

If medications are not working for you, you may want to consider a medical treatment such as in vitro fertilization (IVF). This stimulates the ovaries to produce multiple eggs, which are collected during a procedure. Once the eggs are fully mature, they are introduced to sperm to form an embryo, and then it’s reintroduced to the womb where it will hopefully implant itself in the uterine lining.

In addition to IVF, you can also potentially try intrauterine insemination (IUI). This method is preferred for women who have found effectiveness with medications that stimulate ovulation. IUI places sperm directly into the uterus, drastically reducing the distance required for it to travel to find the egg and increasing the chances of successful conception.

Another potential option is ovarian drilling, also known as laparoscopic ovarian diathermy. It’s a minimally invasive surgery where a surgeon breaks through the outer layer of the ovaries to reduce the amount of tissue that produces androgens, leading to increased fertility rates.

Pregnancy Complications Due to PCOS

PCOS can increase the risk of certain pregnancy complications. These include things such as:

• High blood pressure
• Gestational diabetes
• Premature birth
• Miscarriage

Babies born to women with PCOS also tend to be larger than babies born to women without PCOS, which can increase the risk of requiring a C-section. This is thought to be due to the increased testosterone the baby receives from its mother.

Diets for Managing PCOS Symptoms

One common way of managing PCOS symptoms is by following particular diets. There are several types of diets that can assist in managing symptoms, so you have the freedom to choose one that fits your lifestyle best.

1. Anti-Inflammatory Diet

Current studies show that inflammation can lead to worsening PCOS symptoms, so an anti-inflammatory diet can be helpful in preventing that. An anti-inflammatory diet consists of omega-3 fatty acids, vitamin C, and polyphenols. So foods that are good for avoiding inflammation are things like salmon, tuna, and other fish, citrus fruits and bell peppers, whole grains, olive oil, and dark chocolate.

Foods that cause inflammation include things such as red meat, processed meat, bread and pasta, deep-fried foods, high-sugar foods, and trans fats.

2. Low-Carb Diet

There are multiple low-carb diets, such as the Atkins diet or the ketogenic diet, that can assist in balancing hormone levels in the body. When trying a low-carb diet, you want to focus on meat, dairy, and non-starchy fruits and vegetables.

3. Mediterranean Diet

The Mediterranean diet is inspired by the diet of the countries in that area, and it has been linked to reduced risk of heart disease, type 2 diabetes, and some cancers. The Mediterranean diet focuses on foods like fruits, vegetables, beans, legumes, nuts, whole grains, extra virgin olive oil, fish rich in omega-3 fatty acids, natural cheese, and yogurt. The diet avoids things like sugary foods and red meat.

Regardless of which diet you choose, intuitive eating can also help lead to results with PCOS. When choosing a diet to manage your PCOS symptoms, work with one of our registered dietitians who specializes in intuitive eating to decide which one is best for you and your lifestyle!

Dietary Supplements for PCOS

In addition to dietary changes and medications, you can also use dietary supplements to help ensure you’re getting the nutrients required. These are some supplements that may help with PCOS symptoms.

• Berberine: Research suggests that berberine can help with weight gain, blood sugar, hormonal balance, and cholesterol. One study comparing berberine with myoinositol and metformin found that berberine may even be more effective.
• Inositol: Inositol has a lot of benefits, from improving insulin levels and sensitivity to helping improve ovulation and pregnancy rates.
• Vitamin D: It’s common for women with PCOS to have a vitamin D deficiency, and a supplement can help you replenish your vitamin D levels better than just through diet alone.
• Omega-3 Fatty Acids: For improved insulin resistance and balanced cholesterol levels, omega-3 fatty acids can be helpful.
• Magnesium: Research suggests that higher magnesium levels can lower blood sugar, insulin resistance, and testosterone levels in women with PCOS.
• Zinc: Multiple studies have found that women with PCOS often have low zinc levels, and getting enough zinc is important for insulin resistance, cholesterol, and it can even affect period pain levels.

While any of these supplements can potentially help manage your PCOS symptoms, it’s important not to start them without consulting a doctor first. Dietary supplements can potentially be dangerous when taken in too large doses, so it’s important to work with your doctor to discover how much you need.

Living Your Best Life With Polycystic Ovary Syndrome

Polycystic ovarian syndrome is a complex and often misunderstood condition, but with the right knowledge and support, it is manageable. From understanding the root causes and recognizing symptoms to exploring treatment options and lifestyle adjustments, taking a proactive approach to your health can make a significant difference in how you experience and control PCOS. While there is currently no cure, advancements in medicine, nutrition, and fertility treatments offer a wide range of tools to help manage symptoms and improve overall quality of life.

If you suspect you may have PCOS or are struggling with symptoms, don’t hesitate to speak with your healthcare provider.

PCOS FAQ

When Does PCOS Develop?

PCOS symptoms typically start around the time a girl has her first menstrual cycle, but they can also begin later in life, as well. However, it’s likely that people are born with the condition and only discover it later in life. Many people only realize they have PCOS when they are trying to conceive.

How Common is PCOS?

Currently, it’s estimated that one in ten women has PCOS, and up to 70% of women with PCOS are undiagnosed.

Can PCOS be cured?

No, there is currently no cure for PCOS. However, symptoms can be managed and lessened through diet, medications, and lifestyle changes.

Can I have PCOS even if I don’t have ovarian cysts?

Yes, you only need two out of the three diagnostic criteria. Ovarian cysts are not required for diagnosis if you have both irregular menstrual periods and hyperandrogenism.

Does PCOS go away after menopause?

PCOS symptoms may change or improve after menopause, but the underlying hormonal imbalance does not go away entirely.