PCOS is a hormonal disorder and affects around 1 in 5 women of child bearing age. The exact cause of PCOS is unclear however, increased androgen and insulin levels appear to play a role. It is known that obesity exacerbates the condition by worsening insulin resistance and increasing androgen levels. Women with PCOS are also more at risk of developing type 2 diabetes and heart disease.
Each woman with PCOS may present with a variety of symptoms including:
- Menstrual irregularities
- Difficulties or inability to get pregnant
- Hirsutism (excessive facial and body hair)
- Hair loss
- Acanthosis nigricans (darkened and thickened patches of skin)
Women have two ovaries which produce the hormones estrogen, progesterone and testosterone. The ovaries grow cyst-like structures each month called follicles. Eggs are developed in these follicles but only one will become a fully mature egg and be released every month, which is called ovulation. In women with PCOS, the ovaries produce the follicles but the eggs don't mature, meaning ovulation doesn't take place, and become harmless fluid-filled sacs, called cysts, that stay on your ovaries.
You can have PCOS without having these immature follicles/cysts on your ovaries. Conversely, women with polycystic ovaries do not necessarily have PCOS and additional clinical evidence of the syndrome is needed before it can be diagnosed.
The diagnosis of PCOS is one of exclusion, meaning that your doctor will need to look at all your symptoms and rule out any other possible causes. To make a diagnosis, blood tests are carried out to measure hormonal levels as well as a transvaginal (internal) ultrasound.
There is no consensus on the criteria to diagnose PCOS. Two consensus groups, the Rotterdam Consensus Group and the Androgen Excess and PCOS Society, have devised different criteria. However, PCOS is most commonly defined by the Rotterdam criteria which states that a woman needs to meet two of the following criteria to be diagnosed:
- Oligoovulation, which means less than 6-9 periods a year, and/or anovulation i.e. not ovulating.
- Clinical and/or biochemical hyperandrogenism.
- Polycystic ovaries on ultrasound, which are more than 12 follicles in one or both ovaries and/or ovarian volume of more than 1 cubic centimetre.
Women with PCOS produce higher levels of androgens than normal which can lead to PCOS symptoms. Androgens are a group of hormones which originate from the ovaries and adrenal glands in women. Despite often being considered as male hormones, all women make androgens including testosterone. Men produce more androgens than women and they are responsible for male characteristics, such as facial and bodily hair growth, and muscle development. However, women with PCOS produce higher levels of androgens than normal which can led to skin problems and the development of some male characteristics.
Another key hormone is insulin which is made by the pancreas. Insulin allows your body to use sugar (glucose) from carbohydrates in the food you eat for energy immediately or stores it for later and converts excess amounts into fat.
Insulin helps to keep our blood sugar levels balanced. It also increases testosterone levels, which women need small amounts of, however too much can lead to hormonal imbalances and cause excessive hair growth, menstrual and skin problems. If you regularly eat sugary foods and high GI processed carbohydrates, your body will release so much insulin that it will begin to lose its sensitivity to it. Unfortunately, women with PCOS can have this reduced insulin sensitivity, called insulin resistance, because of the condition.
Women with PCOS produce higher levels of androgens than normal which can led to skin problems and development of some male characteristics
Insulin resistance means that the cells are literally resistant to normal levels of insulin - they just don't hear the signals and don't respond as quickly. As your cells think there is a reduction of insulin, your body tries to keep your blood sugars normal by releasing larger and larger amounts of insulin to move glucose into the cells. Your body basically stops producing the correct amounts of insulin and blood sugar levels rise. This process results in compensatory hyperinsulinemia, an excessively high level of insulin in the blood which can damage cells and lead to all sorts of problems, such as weight gain, hormonal imbalances, type 2 diabetes and cardiovascular disease.
If you've been diagnosed with PCOS you may be wondering what you need to do now to regain and maintain your health. In order to manage your own symptoms successfully you will most likely need to:
- Have a good understanding of PCOS and what causes it – knowledge truly is power
We have a range of articles on specific symptoms with information on causes and treatment approaches using current and relevant research literature. If you're newly diagnosed or want to know more about how to manage your individual symptoms, these articles can be a good place to start and you can find them under the 'Managing Symptoms' tab at the top of the page. The articles on PCOS & Exercise and PCOS & Nutrition are recommended for the management of all symptoms.
The Positive PCOS Blog also has regularly updated articles and information on health and wellbeing matters for women with PCOS.
- Make informed decisions about your treatment and be actively involved in the process
Again, this requires you to know your stuff on PCOS to liaise with medical practitioners and other health professionals effectively, make the best use of resources available, and make an informed decision about your treatment. Learn more about how you can prepare for medical appointments to ensure you get the most out of them.
- Take action
The next step is to use all the information and knowledge you acquire to willingly make changes to improve your PCOS symptoms. In order to make lifestyle changes, in addition to any other treatment, you will need to be proactive. You can check out Positive PCOS Tips, which has a range of healthy tips for getting on top of your symptoms, and remember to follow us on Twitter, Facebook and Pinterest for regular inspiration!