Polycystic ovarian syndrome (PCOS), as it stands for is a scary diagnosis, although certainly not an uncommon one. PCOS affects approximately 6 to 12 percent of U.S. women, making it one of the most common endocrine system disorders, according to the Centers for Disease Control and Prevention (CDC). “During a regular monthly cycle, many immature eggs develop in the ovaries and one mature egg is released and picked up by the fallopian tube during ovulation,” explains Laurence Jacobs, MD, Director of the PCOS Center of Excellence at Fertility Centers of Illinois. “For women with PCOS, the hormones needed for an egg to fully mature are not present, preventing ovulation from occurring and causing multiple small cysts to form on the ovaries.”
And although the condition has been known since the 1930s, it’s still pretty misunderstood. “We do know that women with PCOS can have an excess of male hormones (androgens), ovaries with more than average small resting eggs, and, in its more severe form, insulin resistance,” says Anate Brauer, MD, a reproductive endocrinologist at the Greenwich Fertility and IVF Centers and assistant professor of OBGYN at NYU School of Medicine. “These imbalances lead to irregular ovulation and therefore irregular periods, as well as abnormal hair growth, acne, and potentially diabetes and heart disease.”
Whether you’ve recently received a diagnosis or believe you might have symptoms that show signs of PCOS, here are some of the hallmarks of the condition, according to the doctors who treat it.
Because this condition gets in the way of ovulation, preventing it from happening regularly, one of the first signs of PCOS is often irregular or absent periods. “A normal menstrual cycle lasts 28 days, plus or minus seven days, so if your cycle falls out of this range, you have periods too frequently, or for eight days or more, you have irregular cycles,” says Dr. Jacobs. While having irregular periods is frustrating, for sure, it’s not always a cause for concern. In fact, as many as 30 percent of women have irregular periods.
According to Dr. Brauer, it not necessarily harmful, as a woman only needs to have three to four periods a year to sufficiently shed her uterine lining. However, she explains that women with PCOS who never get periods, nor do they take medication to induce a period, may be at risk of future endometrial cancer caused by constant build-up of the lining of the uterus. “If you have PCOS and would like to regulate your periods, a birth control pill is one of the best methods to do so,” she says. “Women who do not get any periods at all and do not want to be on a daily pill, can speak with their doctor about using periodic progesterone supplementation in order to induce a period every 90 days or so.”
Lack of ovulation
Ovulation is the process that typically occurs each month, as the egg becomes maturely developed enough to be fertilized by the sperm. In women with PCOS, however, this does not happen every month — or sometimes at all. Without ovulation, as you know, pregnancy is not possible. “Confirm whether or not you are ovulating by tracking your periods and using ovulation prediction kits for a few months,” suggests Dr. Jacobs. “If you aren’t ovulating and are planning on starting a family, it is advised to seek the guidance of a fertility specialist first, as regular ovulation can be induced through medication as well as lifestyle changes.”
If you’ve been trying to conceive for over a year with no success, you are technically described as “infertile,” although this doesn’t mean that it’s impossible for you to achieve a pregnancy. “Thankfully, there are excellent medications such as femara and clomiphene citrate to help induce ovulation in women with PCOS,” explains Dr. Brauer. “These oral medications work by masking the brain from seeing excess estrogen and kick-starting it into making the appropriate hormones required to grow an egg that will eventually ovulate with the hopes of getting fertilized and making a baby.”
Acne and excess hair growth or balding
Due to an excess of androgen, a male hormone, women with PCOS can experience acne, typically on their body and face, as well as excess facial or body hair, explains Dr. Jacobs. While rare, some women even experience male-pattern baldness. “Treatment options for acne, excessive hair growth, and balding are abundant and focus primarily on lowering male hormones,” he says. “It would be best to speak with a professional who has treated patients with PCOS for these issues.”
Weight gain or obesity
Due to the metabolic challenges that often result from PCOS, many sufferers have difficulty losing weight. For this reason, obesity is one of the common signs of PCOS. “A healthy diet, regular exercise, and positive lifestyle changes can make a big difference in reducing symptoms, triggering ovulation, and dropping weight,” says Dr. Jacobs. “Make it a goal to get active for 30 minutes at least three times a week to start, to load up on veggies, fruits, hormone-free meat, wild-caught fish, legumes, 100-percent whole grain, antioxidant-rich produce such as berries, folate-rich veggies like spinach, unsaturated vegetable oils such as walnuts and avocado, and a half cup of beans to your daily diet.”
Anxiety and depression
Unfortunately, there are psychological consequences of PCOS, which is why Mark Trolice, MD, reproductive endocrinology and infertility specialist at My Fertility CARE: The IVF Center in Winter Park, FL, believes that clinicians should screen all women for risk factors. In fact, one study, published in the Journal of Behavioral Health Services & Research, found that for all nine mental health disorders measured by the Brief Symptom Inventory (a standard tool for evaluating mental health), women with PCOS had significantly higher levels of mental distress than the general population.
For those women suffering with PCOS, Sherry Ross, MD, OBGYN and Women’s Health Expert at Providence Saint John’s Health Center in Santa Monica, CA, says that it is best to include a knowledgeable team of experts, including a gynecologist and a nutritionist. “The good news is there are great treatments to control the symptoms caused by PCOS and adapting certain lifestyle behaviors to help avoid some of the long-term medical diseases,” she adds.