Symptoms, Causes, and Effective Management Understanding Polycystic Ovary Syndrome (PCOS)

An In-Depth Look at Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) is a common hormonal imbalance affecting millions of women, particularly those of reproductive age. Despite being one of the most prevalent endocrine disorders, PCOS is often misunderstood. In this article, Dr Simon Nothman offers insights into PCOS, detailing the symptoms, possible complications, and the role of lifestyle changes in effectively managing the condition.

What is PCOS, and What Are the Common Symptoms?

PCOS, or Polycystic Ovary Syndrome, is a hormonal condition that often causes the development of multiple small cysts on the ovaries, though not all women with PCOS have these cysts. Common symptoms of PCOS vary between individuals and may include:

• Menstrual Irregularities: Women with PCOS frequently experience irregular menstrual cycles, sometimes with fewer than nine periods per year.
• Elevated Androgen Levels: Higher levels of androgens, often called male hormones, can lead to issues such as excessive hair growth (hirsutism), severe acne, and male-pattern baldness.
• Weight Gain: Many women with PCOS struggle with weight gain, particularly around the abdomen.
• Skin Conditions: Dark patches of skin (acanthosis nigricans) around the neck, armpits, and groin may develop due to insulin resistance, a key component of PCOS.

Health Complications Linked to PCOS

If left untreated, PCOS can contribute to a range of long-term health problems. These may include:

• Infertility: PCOS is one of the most common causes of infertility due to its impact on ovulation.
• Increased Risk of Type 2 Diabetes: Insulin resistance, commonly associated with PCOS, can increase the risk of developing type 2 diabetes.
• Endometrial Cancer Risk: Irregular periods can lead to the thickening of the uterine lining, which may increase the risk of endometrial cancer.
• Metabolic Syndrome: A collection of conditions such as high blood pressure, obesity, and high cholesterol that increase the risk of cardiovascular disease.

What Causes PCOS?

While the exact cause of PCOS is still unclear, several contributing factors have been identified:

• Foetal Androgen Exposure: Some studies suggest that exposure to excess androgens in utero could increase the likelihood of developing PCOS in later life.
• Insulin Resistance: This is both a cause and a result of PCOS. Elevated insulin levels can increase androgen production, exacerbating insulin resistance.
• Genetic Factors: PCOS often runs in families, indicating that genetics play a role in its development.

Hormonal Imbalances in PCOS

The primary hormonal imbalance in women with PCOS is an excess of androgens, which are typically considered male hormones but are present in all women. Elevated androgen levels are responsible for many of the physical symptoms of PCOS, such as acne and excess facial hair.

Additionally, women with PCOS often experience elevated oestrogen levels, which, when not balanced by progesterone, can lead to the long-term health risks associated with the condition. Women with PCOS often have a degree of insulin resistance. This increases the risk for diabetes and other conditions later in life but is also involved in the over-production of androgens. This explains the great importance of lifestyle interventions in many women with PCOS.

How PCOS Affects the Body

PCOS affects various aspects of a woman’s health, including:

• Reproductive Health: It can interfere with ovulation, leading to irregular menstrual cycles and difficulties conceiving.
• Skin and Hair: Androgen imbalances may result in acne and male-pattern hair growth.
• Metabolic Health: PCOS increases the risk of metabolic syndrome, a precursor to heart disease, diabetes, and stroke.
• Pregnancy Risks: Women with PCOS may face a higher risk of complications during pregnancy, including gestational diabetes and preeclampsia.

How Is PCOS Diagnosed?

PCOS is diagnosed based on the presence of at least two out of three criteria (the Rotterdam criteria):

1. Irregular or absent ovulation.
2. Elevated androgen levels.
3. Polycystic ovaries are visible on an ultrasound.

A physician like Dr. Simon Nothman may consider additional factors, including medical history and symptoms, to make a comprehensive diagnosis.

What’s the Difference Between PCO, PCOD, and PCOS?

• PCO (Polycystic Ovaries): This refers to ovaries that contain multiple cysts but may not present the hormonal imbalances or symptoms associated with PCOS.
• PCOS: This is the broader syndrome that includes not just cysts on the ovaries but also other symptoms such as irregular periods, fertility issues, and metabolic disturbances.
• PCOD (Polycystic Ovarian Disease): This older term is less commonly used but is sometimes incorrectly used as a synonym for PCOS.

How PCOS Impacts Fertility and Menstrual Cycles

PCOS is one of the most common causes of infertility in women. Most women with PCOS ovulate irregularly, or in some cases, not at all, making conception more challenging. Predicting ovulation becomes difficult, further complicating efforts to conceive.

Can Weight Loss Improve PCOS Symptoms?

While PCOS cannot be “cured,” even modest weight loss (5-10% of body weight) can significantly reduce symptoms. Weight loss can help restore regular ovulation, improve insulin sensitivity, and lower androgen levels, thus reducing the symptoms associated with PCOS.

The Role of Lifestyle Changes in Managing PCOS

Lifestyle changes are critical to managing PCOS. Regular exercise, a balanced diet, and a healthy weight can significantly reduce symptoms and lower the risks associated with the condition. Physical activity also improves insulin sensitivity, which helps prevent type 2 diabetes and cardiovascular diseases.

Is There a Diet Best Suited for Managing PCOS?

Because PCOS is closely linked to insulin resistance, diet plays a key role in managing the condition. Here are some dietary tips:

• Reduce Sugar Intake: Reducing sugar helps stabilise insulin levels and control weight.
• Opt for Low-Glycaemic-Index (GI) Foods. These foods are digested more slowly, preventing insulin spikes and promoting better metabolic function.
• Increase Fibre Intake: Fibre-rich foods help slow the absorption of sugar, aiding in the management of insulin levels.
• Include Anti-Inflammatory Foods: Leafy greens, tomatoes, and fatty fish can help reduce chronic inflammation, often present in women with PCOS.

In short, focusing on whole, fresh foods and minimising processed options is ideal for managing PCOS symptoms.