PCOS Explained: Signs, Causes, and How to Manage It

While Polycystic Ovarian Syndrome (PCOS) can happen at any age after puberty, most women still do not find out they have this condition until they are in their 20’s and 30’s, when they start trying to have a baby. PCOS is the most common form of female infertility. PCOS not only affects the female reproductive system but has wide-ranging impacts on other areas of the body, from metabolic and cardiovascular systems to mental health.

Who is affected by PCOS?

Around 6 to 13% of women of reproductive age are affected by this condition.¹ So far, the exact cause is unknown but genetics do seem to play a part, as you have an increased risk of having the condition if your mother, sister or aunt suffer from it. A specific gene that causes the condition has not yet been identified. Having excess body weight also seems to be a risk factor for developing the condition.

There are a few theories as to what might be going on in the body to cause PCOS. The problem may be in the ovary itself, or with other glands that produce excess hormones. It could be an issue in part of the brain that controls hormone production or potentially insulin resistance in general that is responsible.²

How is it diagnosed?

PCOS is a hormonal condition, with imbalances in two main hormones, testosterone and insulin, although several other hormones play a role. An excess of androgens (testosterone is one of these) stops the release of eggs from the ovary, but doesn’t stop the eggs from being produced. This results in a buildup of many (“poly”) immature eggs contained in small cysts (“cystic”) on the surface of the ovary, hence the name polycystic ovarian syndrome.

PCOS has three common features used by doctors to form a diagnosis:

1. Irregular periods.
2. Higher levels of androgen hormones.
3. Many partly formed eggs in the ovary.

The role of hormones and their influence on PCOS symptoms

Testosterone – produced by the ovaries. In PCOS the ovaries make too much of this and this excess is what causes most of the symptoms such as acne and excess hair growth.

Insulin – the hormone responsible for control of blood glucose. In PCOS, the body can’t use insulin normally (called ‘insulin resistance’) and blood glucose levels become too high. High insulin levels cause the ovaries to produce too much testosterone leading to weight gain, irregular periods and problems with fertility. Weight gain further feeds the cycle causing the body to produce even more insulin.

Luteinising hormone (LH) and follicle-stimulating hormone (FSH) – these two hormones are important for ovulation. PCOS causes an imbalance in these. High LH stimulates the ovaries to make androgens and abnormal FSH can affect how the follicle (egg) develops.

Estrogen and progesterone – PCOS disrupts the normal balance of these two hormones resulting in irregular periods and infertility.

Common symptoms

Some women don’t have any symptoms or their symptoms are few and/or mild. Often they don’t realise they have the condition until they have trouble getting pregnant or are gaining weight for no reason.

• oily skin and acne which can be severe and continue past the teenage years on the face, chest, back
• hair thinning or hair loss similar to male pattern baldness
• overweight and hard to lose weight
• excess hair (hirsutism) on face, chest, stomach, arms, buttocks
• irregular or no periods, or too frequent periods
• heavy bleeding during periods
• infertility
• many undeveloped eggs in ovary
• excess thickening of uterus lining
• anxiety
• depression
• body image distress
• low self esteem
• skin darkening in neck folds, groin, armpits, under breasts
• skin tags on neck, armpits.

Other health conditions associated with PCOS

It is important to seek medical help if you think you may have some of the symptoms of PCOS because left untreated, this condition can lead to serious health issues such as:

• diabetes
• obesity
• high blood pressure
• high cholesterol
• cardiovascular disease
• endometrial hyperplasia
• endometrial cancer
• sleep apnoea
• eating disorders
• anxiety
• depression.³

Managing PCOS

While it is a condition that can’t be cured, PCOS can be managed with a variety of treatment options. Changes to lifestyle like improving diet and increasing exercise to lose and manage weight, taking medicines to control periods, lower androgen levels and improve acne, can all improve symptoms. There are other treatments for infertility, high cholesterol and weight loss. Talk to your doctor if you have any of the symptoms listed above. Like many chronic conditions, early intervention is key to managing PCOS.