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What is PCOS? Problem to be Solved or Worry for a Lifetime?

PCOS stands for Polycystic Ovary Syndrome. It is a hormonal disorder that affects women of reproductive age (commonly between 15 to 45). In women with PCOS, a hormonal imbalance occurs as the ovaries produce an abnormal amount of male hormones called androgens, which are usually produced in smaller amounts in females. 

This hormonal imbalance interferes with the normal functioning of the ovaries and the process of ovulation gets disturbed. The ovaries are unable to release eggs regularly, causing irregular menstrual cycles. 

The problems with ovulation may also result in the development of numerous small, fluid-filled sacs on the ovaries. These sacs, called cysts, give the condition PCOS (“Polycystic Ovary Syndrome”) its name. However, it is not necessary that everyone with PCOS will have cysts in the ovaries.

The excess androgen levels in PCOS may also cause other symptoms, which you can read about in the later sections of the blog. 

PCOS is a chronic (lifelong) condition so it cannot be permanently cured. However, it is possible to live a healthy and fulfilling life with PCOS. PCOS can be treated and managed with medication and lifestyle changes. 

PCOS is also referred to as “PCOD” or “Polycystic Ovary Disease”. However, the term PCOD is an older terminology, which is now being replaced by the term “PCOS” in most instances. It is to be noted that PCOS and PCOD are names of the same condition. 

Now, it is known that there is a hormonal imbalance in PCOS. But what results in this hormonal imbalance? What are the causes or factors behind PCOS? Let’s find out. 
 

Explained: What Causes PCOS?

The easy answer to “why PCOS happens”? Nobody knows for sure. The exact cause of PCOS is not yet fully understood and is still being researched. While it is known that a combination of genetic, hormonal, and environmental factors contribute to the development of PCOS, the specific mechanisms and interactions that lead to the condition are not fully established. 

Ongoing research is focused on identifying the genes and hormonal imbalances associated with PCOS, as well as investigating the role of environmental factors such as diet and lifestyle. Let us have a detailed look at the contributing factors behind PCOS.
 

1. Family History and Genetics

Family history and genetics play a vital role in the development of PCOS. Studies have shown that women who have a family member (for example, a sister or mother) with PCOS are more likely to develop the condition. 

Ongoing research is focused on identifying several genes that may be associated with PCOS, including genes involved in the regulation of hormones such as insulin and androgens, as well as genes involved in the development of ovarian cysts. However, more research is needed to fully understand the genetic basis of PCOS.

It is important to note that having a family history of PCOS does not guarantee that you will develop the condition. Environmental and lifestyle factors also play a role in the development of PCOS.
 

2. Insulin Resistance and High Blood Insulin Levels

Insulin resistance is considered to be a significant contributor to PCOS. Many, but not all women with PCOS develop insulin resistance. Insulin, a hormone produced by your pancreas, helps your cells take in glucose from the bloodstream and use it as an energy source. 

In insulin resistance, your cells lose the ability to respond appropriately to insulin and do not take in glucose from the blood, resulting in a rise in blood glucose (sugar) levels. To stabilize the increasing blood sugar levels, your pancreas produces more and more insulin. This increases the level of insulin in your blood (hyperinsulinemia) drastically, which may lead to excess production of androgens in the body, and contribute to PCOS.

Higher levels of insulin in the blood can lead to increased fat storage and weight gain and can also affect the ovaries, leading to the formation of cysts and disrupting the menstrual cycle.

3. Excess Androgens

In women, the ovaries produce the female hormones estrogen and progesterone along with a small amount of male hormones called androgens. In PCOS, the ovaries produce excessive levels of these androgens, creating a hormonal imbalance. 

Excess androgens are considered to play a key role in the development of PCOS. Androgens can interfere with ovulation by preventing the development of a mature egg in the ovary each month. Androgens can also affect metabolism and insulin resistance.

Why there is excess androgen production in PCOS is not fully understood, but it is believed to be related to a combination of genetic, hormonal, and environmental factors. Insulin resistance can contribute to PCOS by further increasing the production of androgens.

It’s important to note that not all women with PCOS have high levels of androgens and not all women with high levels of androgens will have PCOS. 

Excess androgens can also lead to PCOS symptoms such as the growth of thicker, darker facial and body hair, acne, and hair loss on the scalp. Read more about these symptoms in the later sections of the blog. 
 

4. Low-Grade Inflammation

Studies suggest that women with PCOS may develop inflammation. Inflammation is a natural response of the body to injury or infection, but when it becomes chronic (long-lasting), it can lead to a variety of health problems. 

In PCOS, women develop low-grade inflammation, which is a chronic immune response that produces a steady yet low level of inflammation throughout the body. The low-grade inflammation is thought to contribute to the development of insulin resistance as well, thus having a cumulative effect on PCOS. 

Obesity is a known risk factor for inflammation and women with PCOS often have a higher body mass index (BMI) than women without the condition. If you are obese and have high abdominal fat, the adipose (fat) tissue may show an increased secretion and release of proinflammatory cytokines. Proinflammatory cytokines can cause low-grade inflammation in your body. 

Various studies suggest that long-term low-grade inflammation stimulates the ovaries to produce more androgens and may lead to PCOS. Inflammation can also lead to the formation of cysts and disrupt the menstrual cycle. It is important to note that not all women with PCOS have low-grade inflammation, but it is a common feature of the condition. 
 

Spotlight: What are the Signs and Symptoms of PCOS?

There is a reason why PCOS is called a “syndrome”. PCOS is a group of symptoms that occur together. These symptoms are complex, and may not present the same way in everyone with PCOS. The signs and symptoms of PCOS may vary from person to person. 

Someone may have PCOS and none of its associated symptoms, somebody may have a few PCOS symptoms, while someone else may present with each listed symptom. It is also possible for some symptoms to be more severe in one person than in another. In addition, symptoms can change over time, and some may improve or disappear with age, pregnancy, or weight loss.

Let’s have a look at the common symptoms of PCOS.
 

1. General PCOS Symptoms

A. Cysts

As the name of the condition suggests, cysts are one of the most common symptoms of PCOS. These small, fluid-filled sacs called cysts that develop on the ovaries, are small follicles that contain immature eggs. 

In a normal menstrual cycle, one of these follicles matures and releases an egg every cycle, while the others die off. In women with PCOS, the ovaries are unable to release the eggs, so the follicles stay on the ovaries and become cysts. These cysts can be seen on an ultrasound. 

It is important to note that these cysts are not cancerous and do not cause any harm. Also, not all women with PCOS have ovarian cysts, and ovarian cysts may be found in women without PCOS as well. Hence, the presence of cysts is not the only diagnostic criterion for PCOS.
 

B. Weight Gain

About 80% of women with PCOS gain weight and may experience difficulty in losing weight. Unintended weight gain may be classified among the early symptoms of PCOS. The hormonal imbalance in PCOS can lead to an increase in appetite and cravings for high-calorie foods, which can contribute to weight gain. 

The weight gain triggered by androgens is mainly focused around the abdomen, where men tend to carry their weight. Further, insulin resistance and increased blood insulin levels in those with PCOS can also lead to weight gain, especially in the abdominal area.

The chronic low-grade inflammation seen in PCOS may also contribute to the development of obesity and metabolic disorders. Lastly, many women with PCOS experience fatigue, which can make it difficult to engage in regular physical activity, leading to weight gain over time. 

However, it is important to note that weight gain is not always a symptom of PCOS, and some women with PCOS may have a healthy weight or be underweight, a condition known as lean PCOS.
 

C. Headaches

Women with PCOS may experience frequent headaches due to high levels of androgens and insulin resistance. Living with PCOS often comes with a lot of stress and anxiety as well, which can contribute to headaches. 
 

2. Periods: PCOS Symptoms

A. Irregular Periods

Infrequent, prolonged, or missed periods are among the most frequently reported symptoms of PCOS. In fact, if you consult a doctor about menstrual irregularities, they may discuss and consider PCOS as one of the first probable causes. 

If you have irregular periods, you may have fewer than 9 periods in a year, a gap of more than 35 days between periods, or have no periods at all.

The menstrual irregularities are due to excess androgens, which can disrupt the normal functioning of the ovaries and cause problems with ovulation, leading to irregular periods. Additionally, the ovarian cysts formed in PCOS can also affect ovulation and menstrual regularity. 
 

B. Heavy Bleeding

Heavy bleeding during periods, a condition called menorrhagia, is also one of the symptoms seen in PCOS. Due to hormonal imbalance and ovulation problems in PCOS, your endometrium (uterine wall lining) may keep building up for a long time without shedding. When you do get a period, this may cause heavy bleeding.

There can be other causes of heavy bleeding apart from PCOS. So if you are experiencing heavy bleeding, consult a doctor at the earliest to determine the cause and begin treatment. 
 

3. Pregnancy: PCOS Symptoms

A. Infertility

Infertility is one of the most serious symptoms or consequences of PCOS. In fact, PCOS is one of the most common causes of infertility. Many women find out they have PCOS only when they try to conceive and are unable to. 

As is expected, the decreased frequency or complete lack of ovulation in PCOS makes it difficult to plan or sustain a pregnancy. When there is no egg released from the ovary, there is no fertilization with a sperm cell, so there is no conception. 

Other factors involved with PCOS, such as obesity and insulin resistance can also affect fertility by increasing the risk of miscarriage and gestational diabetes. Further, when someone with PCOS is able to get pregnant, the condition increases the chances of pregnancy-related complications as well. 

The good news is that, while PCOS may make it more difficult for a woman to conceive, pregnancy is not impossible if you have PCOS. Women with PCOS are advised to consult a doctor if they have trouble getting pregnant. They can help manage symptoms and discuss the best treatment options, which may include lifestyle changes, medications, and assisted reproductive technologies.
 

4. Skin: PCOS Symptoms

A. Acne 

Since PCOS affects hormonal balance in the body, it can show up in the form of several skin-related symptoms as well. One of the most commonly observed skin symptoms in PCOS is acne. 

In PCOS, acne can be observed on the face, chest, and back. Excess androgens in PCOS are responsible for increased sebum production. This excess oil combines with dead skin and leads to clogged pores and acne. 
 

B. Skin Darkening 

Many women with PCOS also report developing dark, velvety patches on the skin, especially on the neck, armpits, groin, and under the breast. This condition is known as acanthosis nigricans. 

Acanthosis nigricans is considered to be caused by insulin resistance and elevated insulin levels, which is commonly seen in women with PCOS. Increased insulin levels may lead to an increase in skin pigmentation and changes in the skin’s texture. 
 

C. Skin Tags 

Skin tags, little flaps of extra skin on the neck and armpits, are one of the less common skin-related PCOS symptoms. These tags typically appear in the same areas as acanthosis nigricans. 

Again, an increase in insulin resistance and high blood insulin levels in PCOS can lead to skin changes, such as the growth of skin tags. 
 

5. Hair: PCOS Symptoms

A. Excess Hair (Hirsutism)

Like it affects the skin, the hormonal imbalance in PCOS also affects the hair characteristics in women. One of the most commonly visible and distressing symptoms of PCOS is the development of unwanted facial hair, along with excessive hair growth on the chest, abdomen, back, and arms. This condition is also called hirsutism.

While women normally have vellus hair or thin hair (peach fuzz) on their faces, those with PCOS develop thick, dark, or coarse hair, as seen in men. This is because hair growth in PCOS is caused by excess androgen (male hormone) levels. 

High androgen levels in women can lead to an increase in hair growth in male-pattern areas, such as the face, chest, and back, while causing a reduction in hair growth in female-pattern areas, such as the head. 
 

B. Hair Thinning and Hair Loss (Alopecia)

As seen in the section above, women with PCOS are more likely to have excess hair in some body areas while experiencing hair loss on the head. 

The excess androgens in PCOS cause the hair follicles to shrink and produce finer, shorter, and fewer hairs. Thus, in PCOS, the hair on your scalp may get thinner and you may lose patches of hair. This hair loss is medically termed androgenetic alopecia.

If you think you are experiencing one or more PCOS-related symptoms, you should consult a doctor at the earliest for prompt diagnosis and management of the condition. 
 

Prevention of PCOS: Is it Possible?

Now that we have discussed the causes and symptoms of PCOS, you may be wondering if PCOS can be prevented. Are there any steps you can take proactively to ensure you do not get PCOS? Unfortunately, there is no proven way yet to prevent PCOS. 

As you saw in the section on the causes of PCOS, most PCOS cases are genetically inherited, although the exact mechanism of its inheritance is still not completely understood. If a woman has a mother or sister with PCOS, she is more likely to develop the condition. 

However, having an increased likelihood of developing PCOS does not mean that you will definitely have PCOS. In many cases, even after having a genetic predisposition, PCOS may only develop if other risk factors, such as a poor diet, lack of exercise, stress, obesity, or Diabetes (Type 2 Diabetes or Gestational Diabetes), are present. Hence, you should always strive to maintain healthy lifestyle habits. 

Though PCOS cannot be prevented, you can take precautionary steps to reduce the severity of symptoms and prevent PCOS-related complications such as Type 2 Diabetes, metabolic syndrome, heart disease, and infertility. These steps include following a balanced diet, exercising regularly, maintaining a healthy weight with diet and exercise, managing stress, and getting your health assessed regularly. 

Conclusion

PCOS is a serious condition whose exact cause is not known, although genetic and environmental factors are considered to play a role. Though PCOS cannot be prevented or permanently cured, it can be managed so that you can live a healthy and fulfilling life. Contact a doctor today if you observe any PCOS-related symptoms.