Understanding Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome or PCOS is a multifaceted condition that primarily impacts the ovaries and hormone production in women with particular focus on androgen hormones (male hormones) and insulin, which is critical for blood sugar regulation. One of the main symptoms of having PCOS is the development of numerous cysts, or benign, fluid-filled sacs, on the ovaries. Although called "cysts," they are actually immature follicles that have failed to regularly release eggs, referred to as anovulation.

The ovarian changes caused by PCOS are often associated with higher-than-normal levels of androgens and can lead to a variety of problematic symptoms, such as acne, excess hair growth on the face and body (hirsutism) and irregular menstrual cycles. While the precise cause of PCOS is still unclear, it is widely thought that both genetics and environmental factors, such as diet and lifestyle, can be major contributors to the condition.

What causes PCOS?

The causes of PCOS are complex to identify and not yet fully understood, indicating the need for more research and in-depth studying on the origins of the syndrome. However, the following factors are known to be connected to the development of PCOS:

• Insulin resistance
  Insulin resistance, or an abnormal response in the body that results in elevated levels of glucose in the blood, is prominent in many cases of PCOS. When cells in the body become less responsive to insulin, the pancreas compensates by producing more of this hormone. Excessive insulin may lead to increased androgen production in the ovaries, which exacerbates symptoms of PCOS and increases the risk of developing type 2 diabetes.
   
• Excess androgen hormones
  Androgens are typically present in women at low levels, but with PCOS, these hormones are often elevated. High levels can disrupt the menstrual cycle and are the primary cause of excessive hair growth and acne commonly experienced with PCOS.
   
• Inflammation
  Chronic low-grade inflammation is typically observed in women with PCOS. This inflammation is thought to be both a cause and effect of insulin resistance and may play a role in the development of cardiovascular risk factors like high blood pressure.
   
• Genetics
  The connection between PCOS and genetics appears to be strong and is demonstrated by a high likelihood of the syndrome also occurring in the sisters and mothers of affected women. The specific gene differences associated with PCOS are continually studied with hopes of providing more insight and furthering the development of more targeted treatments in the future.

What are the symptoms of PCOS?

PCOS symptoms are different from person to person. This variability often delays diagnosis, as many women may not realize that their symptoms are interconnected to the condition. Some of the most commonly experienced symptoms from PCOS include the following:

• Irregular menstrual cycles
  A main symptom of PCOS is irregular periods. Women may experience prolonged cycles that exceed 35 days or infrequent cycles occurring less than eight times a year.
   
• Excessive hair growth
  Another key indicator of PCOS is hirsutism, which is excessive hair growth in areas where men would typically grow hair, such as the face, chest and back, due to elevated levels of androgen hormones.
   
• Acne and oily skin
  A surge in androgens can also exacerbate skin issues, causing an onset of persistent acne or oily skin, mostly on the face, chest and upper back.
   
• Weight gain and obesity
  Many women with PCOS find it challenging to manage their weight and may experience weight gain specifically around the abdomen, also referred to as “PCOS belly”. This type of fat distribution is associated with a higher risk for developing metabolic-related conditions, too, like heart disease and diabetes.
   
• Difficulty getting pregnant
  Since PCOS causes irregular and dysfunctional ovulation, it is found to be a leading cause of infertility issues in women. Anovulation prevents the regular release of eggs from the ovaries, making conception difficult without medical intervention.
  
  Women with PCOS who wish to conceive may find fertility treatments to be an effective solution. Ovulation induction with medications, such as clomiphene citrate, letrozole or gonadotropins, can stimulate the ovaries to release eggs. Assisted reproductive technologies like IVF are another option for those who do not respond to the less invasive treatments. Surgical procedures may also be considered in some cases.
   
• Darkened skin patches
  A darkening and thickening of skin folds, called acanthosis nigricans, is often observed in women with PCOS and is also linked to insulin resistance. It is typically noticed on the armpits, groin area and neck.

How is PCOS diagnosed?

Diagnosing PCOS can be challenging, and there is no single definitive test for the disorder. Healthcare providers utilize a combination of physical examination, symptom assessment, medical history and laboratory testing. The presence of two out of three key markers for the condition typically confirms a diagnosis: irregular ovulation with abnormal menstrual cycles, high androgen hormone levels detected with blood testing and polycystic ovaries verified with an ultrasound scan.

“PCOS is diagnosed at several different ages, and so it’s something you could be diagnosed with later in life—not just in your twenties or thirties,” says Emily Dolan, MD, Gundersen Health System, Internal Medicine. “It is estimated that 6-12% of women are affected by PCOS, but that’s probably an underestimation, and it’s likely much more common than that.”

What are the complications of PCOS?

If PCOS remains unaddressed and unmanaged, it can lead to several long-term health complications, such as infertility, increased risk for endometrial cancer, mental health issues and other conditions associated with weight gain from PCOS, including diabetes, high blood pressure and sleep apnea. These complications can have a significant impact on a woman's physical, reproductive and mental health.

How to manage PCOS

There is currently no cure for PCOS, but a range of treatments are available to help alleviate symptoms and minimize the risk of complications. PCOS treatment plans can be tailored to address specific concerns, such as menstrual irregularity, fertility issues, hirsutism, acne and metabolic complications. 

Adopting healthy lifestyle habits is highly recommended for managing PCOS. A balanced diet rich in whole foods and regular physical activity can naturally help regulate menstrual cycles, improve insulin sensitivity and support weight loss. 

Medications like hormonal contraceptives and insulin-sensitizing agents like metformin can also be prescribed to help regulate menstruation, reduce high androgen levels in the body and improve the insulin resistance commonly associated with PCOS.

“PCOS can be easily managed with medications or simple lifestyle changes,” says Dr. Dolan. “If you’re diagnosed, know that you have the support of your primary care provider to help manage your symptoms.”

PCOS is a hormonal disorder with a wide range of symptoms that can significantly impact a woman's quality of life, fertility and long-term health. While the condition is chronic and incurable, simple management strategies can help to mitigate symptoms and reduce the risk of associated complications. It's crucial for women experiencing signs and symptoms of PCOS to talk with their Gundersen primary care provider or gynecologist as early on as possible. With appropriate care and lifestyle modifications, many women with PCOS can lead healthy, fulfilling lives.