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Some Signs and Symptoms of PCOS The following are some of the signs and symptoms a woman with PCOS may experience
Insulin Resistance (IR) - Insulin is the hormone that’s responsible for delivering dietary glucose (carbohydrates) into the cells for energy use. Insulin is also responsible for directing the liver to continue or discontinue the production of glucose. If the level of glucose in the cells is sufficient, insulin levels drop, signaling the liver to slow down glucose production. Insulin resistance is a condition in which the cells of the body do not recognize or are not sensitive to insulin. When the cells are not sensitive to insulin, which is what occurs in PCOS, the body has to compensate by producing more insulin. High insulin levels lead to high testosterone levels (male hormone) which in turn decreases ovulation. If there is no ovulation, then pregnancy cannot occur. The elevated insulin leads to hypertension, increased triglycerides, and decreased HDL-cholesterol (the good cholesterol) all of which increase the risk of heart disease. In the early state the body will compensate by causing the cells in the pancreas to produce more insulin, a condition known as Syndrome X. With time pancreas cells will wear out and substantially decrease sufficient insulin production resulting in a condition known as type II diabetes mellitus. If you have been diagnosed with insulin resistance or have a history of IR or diabetes in your family and are experiencing other PCOS symptoms, consider meeting with a specialist to determine if you have PCOS. Weight Gain - Many women with PCOS struggle with obesity often finding it difficult to lose weight, even with a dramatic decrease in their food intake. Women with PCOS are at high risk for impaired glucose/insulin metabolism and diabetes. With insulin resistance, higher insulin production leads to greater glucose entry into the cells, which is unused and stored as fat causing those with PCOS to gain weight even with normal to moderate food intake. Insulin resistance and increased levels of androgens in PCOS sufferers lead to android obesity, a condition where fat is stored in the abdomen giving the patient an apple shape. An appropriate diet regimen can help you manage this condition and minimize its risk factors. Hormones - Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone. For reasons unknown, in PCOS the hormones get out of balance. One hormone change triggers another, which triggers another, and so on, causing a vicious circle of out-of-balance hormones. Balance can be achieved with the help of a combination of prescriptions, diet and exercise, which can be determined by your doctor. Polycystic Ovaries - Ovaries are considered polycystic when twelve or more follicles in at least one ovary are seen by an ultrasound. These follicles are small 2-10 mm, fluid-filled, egg-containing sacs. In PCOS, the follicles can bunch together to form cysts, although not every woman with PCOS will experience polycystic ovaries. Many believe that the ovarian manifestation is a result of lack of ovulation which can be contributed to many factors. Lack of ovulation can be due to elevations in insulin levels in women suffering with PCOS which contribute to the formation of cysts in the ovaries. About 8-25% of normal women can demonstrate this ultrasound finding. Women who are not ovulating will produce higher estrogen levels and Luteinizing hormone levels which further increase the levels of testosterone and other androgens. The higher androgens will further halt the growth of the follicle (egg) and lead to increase in the number of small follicles, creating a vicious cycle. Surgery can remove problematic cysts, but cysts may return. When diagnosed with PCOS, monitoring and controlling insulin levels in addition to ultrasounds can provide a long-term solution to ovarian cysts. Infrequent or absence of menstrual cycle - Primary Amenorrhea is defined as the absence of a period after age sixteen. Absent or infrequent menstrual cycles is a chief indicator of PCOS. Young women experiencing more than three consecutive missing cycles should meet with a specialist to determine if the cause is PCOS. Long-standing absence of periods increases the risk of cancer in the lining of the uterus up to 20%. Anovulation (lack of ovulation) - Women who do not ovulate regularly have a hormonal imbalance between estrogen and progesterone which leads to irregular, heavy bleeding or no bleeding at all. Heavy bleeding can also be associated with a variety of gynecological changes such as ovarian cysts, uterine polyps, and uterine fibroids. Typically, a pelvic ultrasound and or a hysteroscopy (placing a telescope like probe in the uterus) can rule out most conditions. A specialist can determine the best testing and treatment for you. Infertility - Around 70% of women diagnosed with PCOS have trouble ovulating, which leads to infertility. Several studies have found that starting a diet and exercise regimen increases fertility in women with PCOS. Weight loss as little as 5% has shown to be a consistent factor in improving a woman's fertility and PCOS symptoms. Hair Loss - Hair loss around the scalp is referred to as androgenic alopecia and is usually due to increased levels of male hormones (androgens), which can cause the hair to become progressively thinner. Hair loss can occur as a result of a pregnancy, drugs, fever, and acute response to stressful event. Hair Growth - Excessive hair growth on the face, breasts, nipples and abdomen. It can also be manifested in darkening and coarsening of the hair, mustache and chin areas, as well as on the breasts. This hair growth is due to excessive production of male hormones, which are naturally produced by the female body. The excess male hormones include: testosterone, DHEAS, 17-hydroxyprogesterone. These hormones may be completely normal in the serum but have high activity in the skin. Excess amounts of androgens (male hormones) can lead to the development of male hair pattern, enlargement of the clitoris, deepening of the voice and increased muscle mass. Excess hair or hirsutism can be associated with medications like methyltestosterone, anabolic agents like Nilevar or Anavar, phentoin, diazoxide, danazol, cyclosporine, and minoxidil. The excess hair will often lead to irregular menses. Skin Conditions - Acne can be found at any age and is due to excessive amounts of androgens or male hormone production. Up to 60% of women with acne can have normal levels of testosterone in the blood. The sebaceous glands in the skin produce an oil that is sensitive to testosterone which can lead to overreaction and block the pores, causing more acne than average. PCOS women often also experience unexplained dark patches on the skin around the neck, groin, underarms or skin folds, increases in dandruff, or thick lumps of skin the size of a raisin called skin tags, often found in the arm pit, bra line or on the neck. Women who seek treatment for PCOS usually see an improvement in their skin condition. Fatigue or Sleep Apnea - Sleep Apnea may be caused by insulin resistance in the system or an increased body mass index (BMI) which makes sleep uncomfortable. Fatigue is just as common and may be related to insulin resistance or low thyroid function (hypothyroidism) either of which can cause reduced energy levels. Studies have shown that regular exercise increases energy and reduces fatigue. Consistent exercise is especially important to health management in women with PCOS. Thyroid Disorder - Studies show a link between PCOS and an under-active thyroid, a condition known as hypothyroidism, Hashimoto’s Disease or chronic lymphocytic thyroiditis. For this reason, women who have been diagnosed with PCOS should undergo routine thyroid function testing. Cardiovascular Disease - Cardiovascular disease refers to several diseases that affect the heart or blood vessels. There is substantial evidence that the increased lipids and insulin resistance associated with PCOS can result in an increase in cardiovascular disease. The following are found to be increased in patients with PCOS:
Despite its devastating effects, cardiovascular disease can be prevented and reversed. A cardiologist will help monitor cholesterol, triglycerides and other heart health indicators and create a plan to improve levels. A specialist can help you determine the best ways to reduce your stress and create a diet plan for better heart health. Skin Conditions - Acne can be found at any age and is due to excessive amounts of androgens or male hormone production. Up to 60% of women with acne can have normal levels of testosterone in the blood. The sebaceous glands in the skin produce an oil that is sensitive to testosterone which can lead to overreaction and block the pores, causing more acne than average. PCOS women often also experience unexplained dark patches on the skin around the neck, groin, underarms or skin folds, increases in dandruff, or thick lumps of skin the size of a raisin called skin tags, often found in the arm pit, bra line or on the neck. Women who seek treatment for PCOS usually see an improvement in their skin condition. High Blood Pressure - Women with PCOS often suffer from high blood pressure, elevated levels of “bad cholesterol”, and hypertension are serious risk factors in developing coronary heart disease which, in turn, can lead to heart attack or stroke. Making sure to check your blood pressure regularly, and consult with your doctor when hypertension is present. High cholesterol (Hyperlipidemia) - Increased low-density lipoproteins (LDL) cholesterol. Considered the "bad" cholesterol, LDL is a marker for risk of heart attack and stroke. Women with PCOS should pay special attention to their cholesterol levels and blood pressure, as both of these markers of heart disease are more prevalent in PCOS women. Metabolic Syndrome - This condition is seen in up to 40% of those who have insulin resistance and in 85% with type II diabetes. The syndrome by definition will include 3 or more of the following:
Other Heart-Related Conditions - PCOS puts women at nearly double the risk for plaque deposits in the arteries of the heart known as atherosclerosis which greatly increases the risk of heart attack or stroke. Depression, anxiety and mood swings - It’s unclear whether depression and/or anxiety are due to the hormonal imbalances seen in PCOS or a natural response to the weight gain, excessive hair growth, acne, and infertility that come with the condition. It’s vital to a normal healthy life to manage your PCOS symptoms, so you can manage your moods. Related Conditions
Infertility - Polycystic Ovarian Syndrome is one of the leading causes of infertility in women. Affecting six to ten percent of women between age twenty and forty, it’s the most common reproductive syndrome for women of child-bearing years. Because women with PCOS often have irregular menstrual cycles (a condition known as oligomenorrhea) or sometimes lack periods at all (called amenorrhea), their lack of egg production compounded by an inhospitable environment in their ovaries which may contain many small cysts, makes achieving pregnancy difficult. Experts also suspect that elevated hormone, insulin, and glucose levels may interfere with proper egg implantation or egg quality, all of may decrease the chance of conception.
Miscarriages - While statistics show that 15% of all pregnancies will end in miscarriage within the first twelve weeks, the rate seems to be about double that for women with PCOS, possibly due to insulin resistance and elevated Plasminogen activator inhibitor (PAI-1). Studies have shown Metformin to reduce insulin levels and Plasminogen Activator inhibitor and therefore decrease the risk of miscarriages. Lean Women - It’s a common misconception that all women with PCOS are overweight. The truth is about 30% are normal weight. Some are underweight. And some have normal insulin levels. Because symptoms vary from woman to woman, don’t assume because you’re not overweight that you’re not a candidate for PCOS. It’s important to seek diagnosis from a physician familiar with Polycystic Ovary Syndrome. Lesbians - There is a higher risk of PCOS in homosexual women. One study, for instance, looked at 618 women seeking help with infertility and found that out of 618, 254 were homosexual women and 364 were heterosexual women. After extensive testing, researchers discovered that 32% of the heterosexual women had polycystic ovaries as opposed to 80% of the homosexual women, while 14% of the heterosexual women had full-blown PCOS compared to 38% of the lesbians. Menopause - The onset of menopause does not necessarily signal the end of PCOS symptoms. Menopause occurs when the female ovaries stop producing eggs. Other factors Insulin resistance can continue to create symptoms. Symptoms like unwanted hair growth and increase in weight due to insulin resistance can worsen if they are not addressed. Adolescence - PCOS is a growing problem with adolescent girls who often experience the full range of symptoms older women do, including irregular periods or a complete absence of them. The development of pubic hair before the age of 8 may signal early symptoms of PCOS. Obesity in adolescents can also lead to increased testosterone and an increased risk of metabolic syndrome. During puberty, the increase in Luteinizing hormone secretion may be exaggerated in adolescents with PCOS which can amplify the production of testosterone from their ovaries. Adolescents with PCOS symptoms should be tested like adults in order to control the symptoms early without suffering the future consequences. |
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