PCOS is a common disorder among the female population.
What is polycystic ovary syndrome?
The appearance of multiple cysts in the ovary is called polycystic ovary syndrome or PCOS. It is a consequence of a hormonal and metabolic variation caused by altered ovulation, in which the ovaries or the female adrenal glands produce more male hormones than average (hyperandrogenemia). This hormonal alteration can lead to irregular menstruation or lack of ovulation (anovulation), obesity, unwanted hair growth (hirsutism) and, sometimes, difficulties in achieving pregnancy. It usually begins during adolescence and can be mild or severe.
Having polycystic ovary syndrome is not the same as having polycystic ovaries. The latter (OP) is a gynaecological alteration that may or may not be accompanied by symptoms. At the same time, PCOS is a hormonal condition characterised by three features: obesity (overweight women), anovulation (absence of ovulation, and therefore, of regular periods, with a tendency to be late) and hyperandrogenism (increase in male hormones).
Who is affected?
Polycystic ovary syndrome is considered one of the most frequent alterations among women since it affects 10% of them of reproductive age. It is usually diagnosed between the ages of 20 and 30, although it also affects adolescents and, on occasion, may even present signs in stages before puberty.
It often seems to affect women whose mother or sister already has PCOS. Likewise, conditions such as diabetes, high blood pressure, high cholesterol, and being overweight or obese are common in people with this syndrome.
What are the causes of PCOS?
In a normal hormonal cycle, the pituitary gland sends the hormones LH (luteinising) and FSH (follicle stimulating) to the ovaries. The LH surge is the signal that tells the ovaries to ovulate or release an egg and triggers the production of estrogen and progesterone, the female sex hormones. On the other hand, the ovaries in a normal state also produce a little bit of testosterone, the male sex hormone.
On the other hand, when a woman suffers from PCOS, her LH levels are already high, so the increase does not occur, and the ovaries do not receive the necessary signal to release the egg. Instead, the unreleased eggs often remain in the ovaries, surrounded by a small amount of fluid. Some young women with PCOS have many cysts, while others have few. In any case, they are not harmful and do not need to be removed.
Also, high insulin levels can cause the ovaries to produce more testosterone.
What are your symptoms?
Symptoms of PCOS often begin after the start of menstrual periods. The signs can be very diverse and vary for each woman. Some of the most common are:
Menstrual irregularities. They can manifest as amenorrhea (lack of menstruation); oligomenorrhea (long cycles, greater than 35 days); polymenorrhea (short cycles, less than 24 days); or hypermenorrhea (very abundant periods).
Hirsutism. Excess hair on the face or other areas of the body is known as hormone-dependent (upper lip, neck, abdomen, forearm…, which are characteristically male locations)
Lack of ovulation (infertility).
The increased production of androgens causes acne,
hirsutism and alopecia (hair loss).
Dark skin spots. They appear on the back of the neck, under the arms, or in the groin. High insulin levels are often responsible for these spots, known as acanthosis nigricans.
Also, many patients have high blood pressure, dyslipidemia (alteration of blood cholesterol levels) and overweight/obesity.
The fundamental criteria to define a patient as a carrier of PCOS are anovulation and menstrual irregularity caused by hyperandrogenism. Not all manifestations have to be present.
What complications can it cause?
Some frequent complications of PCOS are, according to the Spanish Association of Polycystic Ovary Syndrome:
- Difficulty achieving pregnancy naturally. Typically treatment is needed to accomplish this and, sometimes, resort to assisted reproduction.
- Previous abortions. Women with PCOS have between 30% and 40% of early abortions in the first trimester and a higher incidence of repeated abortions.
- Depression, anxiety, affectation of self-esteem. They mainly affect adolescents who suffer from the syndrome.
In the long term, polycystic ovary syndrome increases the chances of suffering from high blood pressure, premature arteriosclerosis, cardiovascular diseases, breast cancer, endometrial cancer and type II diabetes mellitus. Women with PCOS often have higher insulin levels.
How is PCOS diagnosed?
To diagnose polycystic ovary syndrome, it is necessary to perform, in addition to a physical examination, blood tests on the patient to check hormone levels (estrogens, LH, FLH, testosterone…). It is also necessary to confirm that there are no other alterations, and that is why a glucose test is performed to check the level of sugar in the blood, tests to check the levels of lipids and prolactin, thyroid function tests, and, if considered necessary, a pregnancy test.
Sometimes a vaginal ultrasound or pelvic laparoscopy is also done. In any case, to confirm the diagnosis, the Spanish Association of Polycystic Ovary Syndrome indicates that at least two of the following symptoms must occur:
- Irregular or absent cycles.
- Clinical and biochemical hyperandrogenism.
- Increased testosterone in the blood or signs of virilisation such as alopecia, body fat distribution around the abdomen, or hirsutism.
- Cysts in the ovaries.
What is the most appropriate treatment?
Polycystic ovary syndrome is a chronic disease that has no cure but whose symptoms can be alleviated or eliminated with different treatments, which are closely related to lifestyle habits: following a balanced diet and performing regular physical exercise to lose weight; the help of hormonal and antiandrogen treatments to reduce some of the symptoms of this syndrome; taking insulin-sensitizing drugs in the case of patients with high insulin levels or start any fertility treatment in women who have difficulty becoming pregnant.
All these measures are detailed in the Cinfaconsejos section.
Ten tips for living with polycystic ovary syndrome
Polycystic ovary syndrome is a chronic disease that has no cure, but leading a healthy lifestyle and taking care of your diet, among other recommendations, can help mitigate or eliminate the symptoms:
- Consult your gynaecologist.
If you have irregular periods, you should go to your usual specialist, who, with a simple examination, analysis, and ultrasound, can help you with an appropriate diagnosis for your case.
- A healthy lifestyle is your best ally.
Lifestyle modification to a healthier style is crucial in restoring ovulatory cycles in women with PCOS.
- Take care of your diet.
Most experts recommend a low glycemic index diet since this syndrome is related to a greater or lesser degree with an increase in insulin in the blood. Therefore, if you suffer from PCOS, reduce your intake of foods such as potatoes, honey, sugar or pure glucose, rice, bread and pasta as much as possible. Also, avoid butter, fatty cheeses and red meats, caffeine and sugary drinks, soft drinks and non-natural juices. Instead, eat more carbohydrates with fibre, such as legumes, whole grains, fruits, and vegetables. And it is also convenient to eat lean white meats and nuts, fish and fats of vegetable origin, such as olive oil or nuts.
- Watch your sugar levels.
Given the relationship between polycystic ovary syndrome and high insulin levels and the increased risk of developing diabetes, in the case of patients with high insulin levels, drugs such as metformin help reduce them, as well as used to regularise periods, help lose weight and prevent type 2 diabetes.
- Try to control your weight.
Even in small amounts, weight loss can help alleviate hormonal changes and PCOS-related health problems such as diabetes, high blood pressure, or high cholesterol. To achieve this, watch the size of the portions you eat; take your time eating and chewing slowly, and bet on light snacks between meals -a fruit or yoghurt- to prevent the blood sugar level from falling too low and eliminate the feeling of anxiety.
- Do physical exercise.
In addition to helping you control your weight and make you feel better, physical activity helps reduce blood sugar and cholesterol levels. Choose the cardiovascular workout that you like the most -walking, swimming, cycling and do it on a regular and sustained basis. The ideal would be an aerobic exercise program for 20-60 minutes 3-5 times a week.
- Don’t smoke.
Banish tobacco from your life because it is a risk factor for diabetes and other chronic diseases associated with polycystic ovary syndrome, such as hypertension.
- Hormones under control.
Oral contraceptive treatments contain hormones that help the body correct hormonal imbalance, lower testosterone and regulate menstrual periods, as well as reduce the risk of endometrial cancer. They can also help fight acne, although the effects of birth control pills wear off after stopping.
- Combat some symptoms.
Antiandrogens block the action of male hormones, so they help reduce the symptoms of androgen typical of this symptom, such as alopecia or acne. For example, excess hair can be combated with a drug called spironolactone, although there are also alternative treatments such as hair removal or bleaching.
- Stay positive.
If you have trouble losing weight, try not to despair, be consistent in your resolutions and increase the amount of exercise even if you don’t see the results in the short term. Maintaining a healthy lifestyle benefits your body from the first moment. Also, if you desire to be a mother, do not lose hope because there are women with polycystic ovary syndrome who become pregnant spontaneously and others who need fertility treatments with artificial insemination or in vitro. Still, many manage to be mothers.