Definition and Overview
Polycystic ovarian syndrome (PCOS) is a condition characterized by the presence of cysts in the ovaries, preventing a woman of childbearing age to become fertile and get pregnant. It is one of the most common modern reproductive problems of women around the world.
Unlike boys, girls already produce a lot of eggs during birth. These are the eggs that she would ever need in her lifetime. The moment that a girl begins menstruating, her body is ready for reproduction. This means that her pair of ovaries, which are found on each side of her lower body, can now release eggs into the fallopian tubes in a process called ovulation.
These eggs would wait for the male’s sperm to fertilize one of them. If fertilization, or the meeting of the egg and sperm cells, happens, the egg then travels to the uterus (womb) where the zygote is expected to become a fetus and then a full-grown baby. In the meantime, the womb prepares itself for the release of the egg and fertilization by thickening its walls called the endometrium. If the egg is not fertilized, the endometrium or the uterine lining breaks down, and the girl menstruates.
For women to become fertile, however, it requires certain hormones, especially progesterone, which is responsible for breaking the cysts, which are fluid-filled sacs that contain the eggs. The main problem with women with PCOS is they tend not to have enough of this hormone, which prevents them from ovulating and becoming fertile, as well as menstruating.
PCOS is not as simple as not having menstruation. As a syndrome, it is often linked to different complications, including but not limited to diabetes, hypertension, and elevated cholesterol level.
Causes of Condition
Until now, it is not clear what causes PCOS, but many doctors have subscribed to certain assumptions.
First, PCOS is an endocrine and metabolic disorder because it relates to hormonal imbalances. The body requires hormones, which regulate various areas. For instance, the hormones produce by the thyroids help control basal (body) temperature while those from adrenal glands regulate blood pressure and heart rate, among others.
PCOS is commonly associated with insulin, progesterone, and androgen. Insulin is a hormone produced by the beta cells of the pancreas, a small organ located near the spleen. Insulin is responsible for delivering glucose, or blood sugar to cells where it is metabolized or used as a fuel. Women who have PCOS are often insulin resistant, which means their cells do not recognize insulin and accept blood sugar. In turn, the body is forced to produce more insulin, and the cycle continues.
The female body also produces sexual hormones including progesterone and androgen. Progesterone is a hormone that allows the release of the eggs and is responsible for maintaining a pregnancy. On the other hand, androgen is a male hormone that is produced by the female body in small amounts. It is needed to prevent bone loss, improve sexual satisfaction and drive, and regulate sexual organs. PCOS women can have too much of the androgen and very less of progesterone, leading to a hormonal imbalance.
Some also believe that PCOS is hereditary, although the degree of severity can still vary.
Obesity is also often tied to PCOS since it usually occurs as soon as women put on a significant amount of excess weight. Obesity has been known to alter certain body processes such as hormone production.
- Irregular or lack of menstrual periods
- Hirsutism (excess hair growth in various parts of the body)
- Acne, which can be mild to severe
- Acanthosis negricans (dark or pigmented skin that normally appears in the folds or creases of the body especially the neck area)
- Central obesity (fat that accumulates in the abdominal area)
- A thin, visible line that usually runs from the pelvic area to the abdomen
- Obstructive sleep apnea (stopping of breaths while asleep)
- Painful menstrual periods or abdominal cramps
- Presence of cysts in the ovaries
- High levels of androgens
- Difficulty in conceiving children or infertility
- Depressive symptoms
- Increased level of glucose in the blood
- Excessive weight gain and difficulty shedding excess pounds
- Acne or oily skin
- Buildup of dandruff on the scalp
- Hair loss or thinning of hair
- Pain in the pelvis
- Presence of skin tags
Some of the symptoms can be very mild that women will never know they already have the condition. There are also women who have PCOS but are still able to produce children.
Who to See and Treatments Available
Usually, there are three reasons why women with PCOS see their doctor, who can be a gynecologist or an endocrinologist:
- The symptoms may be severe that they change the person’s physical appearance.
- Complications such as increased blood glucose or cholesterol levels are present.
The patient wants to conceive.
PCOS can also be diagnosed in many ways such as:
Physical exam – experienced doctors can already have some suspicions by merely looking at the change in the woman’s physical appearance
- Blood tests to diagnose hormonal imbalances
- Pelvic exam or vaginal ultrasound to detect the presence of cysts in the ovaries
PCOS cannot be cured, but over the years, treatments have significantly improved at keeping the symptoms at bay. For instance, birth control pills such as Metformin or Clomid are provided to help regulate women’s hormones and eventually enhance ovulation. With close doctor supervision, the woman has a higher chance of getting pregnant.
Some of the medications are meant to control other symptoms such as hair growth, acne, and increased levels of cholesterol and sugar.
More often than not, however, these medications are complemented with a healthier lifestyle. In fact, some doctors recommend a lifestyle modification before drugs are provided.
One of the best ways to manage PCOS is to control obesity. Maintaining a healthy diet, keeping oneself active, and exercising can already contribute to weight loss. Women with PCOS are advised to avoid eating too much processed food and sugar that can worsen insulin resistance.
Bulun SE, Adashi EY. The physiology and pathology of the female reporductive axis. In: Kronenberg HM, Melmed S, Polonsky KS, Larsen PR, eds. Williams Textbook of Endocrinology. 12th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 17.
Lobo RA. Hyperandrogenism: Physiology, etiology, differential diagnosis, management. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 40.
Radosh L. Drug treatments for polycystic ovary syndrome. Am Fam Physician. 2009;79:671-676.