The reproductive system is an essential part of the continuation of the human population. But, it is actually a very complex system and when it goes wrong… boy your body can let you know about it. September is polycystic ovary syndrome (PCOS) awareness month – so, what exactly is PCOS, and are there any treatments?
What is PCOS?
PCOS is caused by an imbalance in the sex hormones in people who have ovaries. It affects 6 to 12 percent of US women of reproductive age and is one of the most common causes of female infertility.
The ovaries, fallopian tubes, uterus, and vagina are all part of the female reproductive system. The ovaries contain immature eggs that are stored in follicles, which are tiny fluid-filled structures. The ovaries are under the influence of hormones produced by the brain, which are carefully balanced.
During the early part of the menstrual cycle, follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are secreted into the bloodstream and race toward the ovaries. This is the signal to inform the ovaries to start developing some of the immature eggs, and these follicles start to expand.
During this egg maturation, estrogen is released from the ovaries. When this estrogen hits a certain level, FSH production ceases and the brain sends LH to the ovaries, which causes the follicle to open and release an egg. This process is called ovulation.
The egg will then make its jolly old way down the fallopian tube and will wait for fertilization by a sperm cell. If the egg is not fertilized, the lining of the uterus is shed – this can often seem like the uterus is punishing you. The huge fluctuation of hormones is what might cause you to cry at Mufasa’s death in The Lion King, crave a huge amount of chocolate, and experience vaginal bleeding and painful cramps.
For people with PCOS, this hormonal dance is off balance: large amounts of LH in the blood can cause the follicles not to mature and stops ovulation. Sometimes, the immature follicles do not dissolve back and can form fluid-filled sacs, or cysts.
If your aim is to get pregnant, the disruption to ovulation can make this goal difficult.
How do you get diagnosed with PCOS?
For a PCOS diagnosis, often you need to have at least two of the following symptoms:
- Polycystic ovaries. As you might have guessed from the title of the syndrome, the ovaries of people with PCOS tend to show signs of cysts. Cysts are often found on the ovaries as part of the menstrual cycle, these are classed as functional and often disappear after a few months. Ovarian cysts can be diagnosed with a transvaginal ultrasound scan.
- Irregular or lack of periods. For people with PCOS, periods can be a bit irregular. They may last many days, occur more than 35 days apart, or you might have a complete lack of them.
- High levels of male hormones. An excess of androgen can cause physical symptoms like excess body or facial hair, acne, or male pattern baldness.
What are the other symptoms of PCOS?
Sometimes, a large amount of insulin can be produced with LH, which can cause excess production of testosterone. This can lead to:
- Weight gain and retention
- Abnormal hair growth
- Increased risk of type 2 diabetes
What causes PCOS?
The true cause of PCOS is unknown. However, there have been some breakthroughs in the past few years. One study found that prenatal exposure to the growth factor anti-Müllerian hormone (AMH) could be linked to developing PCOS in later years.
It may also be hereditary, as children of parents with PCOS may have an increased risk of illness.
Sometimes, coming off hormonal birth control can cause PCOS-like symptoms:
“When one comes off the Pill, it might take some time for the normal menstrual cycle to re-establish itself. Up to six months is not uncommon and is usually not a cause for concern. On the other hand, symptoms of increased androgen levels should not be present in someone who doesn’t have PCOS or similar underlying diagnosis,” Associate Professor Alex Polyakov of Melbourne University – Senior Gynaecologist and fertility specialist – told IFLScience.
“Appearance of such symptoms should prompt further testing and evaluation to exclude PCOS and other conditions which may present as PCOS (thyroid dysfunction, increased prolactin levels, many others).”
What can help treat PCOS?
PCOS cannot be cured, but there are ways that the symptoms can be managed.
One is lifestyle changes. It is reported that in overweight individuals, losing up to 5 percent of their body weight can lead to an improvement in PCOS.
“Excessive weight is a major feature of PCOS in a significant proportion of PCOS sufferers. It is both the cause and the consequence of the condition. Insulin resistance and high androgen levels are linked to obesity and can be greatly improved by weight loss. These improvements in turn often ameliorate symptoms of PCOS, such as infrequent periods and physical and biochemical manifestations of elevated androgen levels,” Polyakov explained.
However, weight loss strategies should always be undertaken following consultation with a healthcare provider.
Hormonal birth control can also help with some of the symptoms. “While on the Pill, symptoms of PCOS are usually controlled and in fact, being on the Pill is one of the strategies to treat, but not to cure, PCOS. Therefore, coming off the Pill may unmask previously undiagnosed PCOS and it requires appropriate testing to arrive at the diagnosis and to formulate an appropriate treatment strategy. Being on the Pill, even for a long time does not cause PCOS,” Polyakov said.
For fertility improvements, there are a few medications that can be tried. Some medications can help encourage the monthly release of an egg from the ovaries. Other drugs, such as the diabetes drug metformin, can be used to lower insulin and blood sugar levels and provide other fertility-stimulating benefits.
For unwanted hair growth and loss, drugs can be prescribed to block the "male hormones" and suppress the production of these in the ovaries.
Finally, there is a minor surgery that can be implemented if the person does not respond to medications. This is called laparoscopic ovarian drilling and involves doctors making a small cut in the stomach and passing a microscope into the abdomen. The ovaries are then treated with a laser or heat and the tissues that produce the male hormones are destroyed. This can sometimes correct any hormonal imbalance and restore function to the ovaries.
The content of this article is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of qualified health providers with questions you may have regarding medical conditions.
All “explainer” articles are confirmed by fact checkers to be correct at time of publishing. Text, images, and links may be edited, removed, or added to at a later date to keep information current.