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Polycystic Ovary Syndrome (PCOS) – Causes and Management

Medically reviewed by Dr. Sadaf Iftikhar, MBBS, FCPS—Written by Dr. Ramisha Farooq, MBBS. Updated on September 1, 2022.

Polycystic ovary syndrome or PCOS is a hormonal and reproductive disorder, that causes fluctuations in the normal menstrual cycle. In some women, it involves the formation of cysts in the ovaries of females during their childbearing age, while most women don’t have cysts. Polycystic ovary syndrome is a very common but treatable cause of infertility. Everyone 1 in 10 women has it.

Main features of polycystic ovary syndrome

PCOS is a group of symptoms that affect ovulation. Its three main features are:

  • Cysts in the ovaries
  • High levels of male hormones
  • Irregular menstrual cycle

These three features are also used by doctors to diagnose PCOS in a female.

Symptoms of polycystic ovary syndrome

  • Irregular menstrual cycle
  • Secondary amenorrhea
  • Menstrual cramps
  • Pain during ovulation
  • Pain due to ovarian cysts in the pelvis
  • Mood disorders like PMS
  • Excessive hair growth on the face, chin, chest, and all other parts of the body where men usually have hair
  • Weight gain
  • Excess skin in armpits and neck called skin tags
  • Darkening of skin in the neck area, groin, and beneath breasts
  • Hair loss or thinning of hair
  • Male-pattern baldness
  • Prone to acne
  • More prone to headaches specifically migraine

Types

Polycystic ovary syndrome has four types, with each type having different symptoms and course of action in the body:

  • Insulin resistant PCOS
  • Post-pill PCOS
  • Inflammatory PCOS
  • Adrenal PCOS

Causes of polycystic ovary syndrome

There are no known causes of why a woman might get PCOS but given below are some changes that take place in the body and are responsible for some of the symptoms of polycystic ovary syndrome:

  • High androgen levels: Ovaries produce excessive amounts of androgens, that are responsible for hirsutism, menstrual abnormalities, and acne breakouts.
  • Excess production of insulin: Due to increased resistance to the action of insulin in the body, the blood sugar levels keep rising and in return promote more insulin production. High insulin levels cause the production of more androgens and thus changes in the menstrual cycle.
  • Formation of ovarian cysts: Many small fluid-filled cysts grow inside the ovaries, containing mature eggs that fail to reach maturation, thus an absence of ovulation. This lack of ovulation disturbs normal levels of FSH, LH, progesterone, androgens, and estrogen. The altered levels of female hormones and excessive male hormones are responsible for disruption in the menstrual cycle.

Risk factors

Some of the women are more at risk of developing PCOS than others, the risk factors are:

  • Genetic causes
  • Family history
  • Obesity
  • Insulin resistance

Complications

Polycystic ovary syndrome is a very common condition and can be easily managed but it can cause several complications which are:

  • Infertility
  • Diabetes type 2
  • Weight gain or difficulty to lose weight
  • Sleep apnea in women who have PCOS and are obese
  • The metabolic syndrome includes high blood pressure, high blood sugar, high cholesterol
  • Depression and anxiety
  • Chronic migraine
  • Miscarriages or premature birth
  • Endometrial or ovarian cancer

Polycystic ovary syndrome and infertility

Due to the formation of several small cysts on the ovaries, eggs don’t release and fertilization fails to take place. Thus, females often have trouble getting pregnant. But a fertility specialist can help by prescribing you a few medications and regulating your menstrual cycle. PCOS is a leading cause of infertility in females but can be easily treated.

Diagnosis of polycystic ovary syndrome

Polycystic Ovary Syndrome is diagnosed by conducting a few tests, taking a detailed history of symptoms, and doing a pelvic examination:

  • Physical examination is conducted to look for hirsutism, metabolic syndrome, skin tags, and acne.
  • On pelvic examination, swollen or enlarged ovaries can be indicative of polycystic ovary syndrome.
  • The hormonal profile is conducted that will show deranged hormonal levels.
  • Thyroid profile is also so important to rule out possible thyroid disease.
  • Lipid profile may show high LDL and low HDL levels.
  • A pelvic ultrasound will show cysts on the ovaries.

Treatment of polycystic ovary syndrome

Medical treatment:

Polycystic ovary syndrome cannot be treated but the symptoms can be managed. Some of the options are:

  • Oral contraceptive pills for regulation of the menstrual cycle
  • Metformin for improvement in insulin levels
  • Over-the-counter painkillers for menstrual cramps.
  • Excedrin for migraines.
  • Anti-androgen medications can be used to reduce symptoms produced due to excess androgens like male pattern baldness and hirsutism.
  • Clomiphene is a drug prescribed by fertility specialists to females with PCOS, who need help to get pregnant.

Surgical treatment:

Surgical treatment is only an option for those females who fail to get pregnant despite all sort of medical treatment:

  • Ovarian drilling is a procedure in which small holes are made in the ovaries to rupture the cysts and allow normal ovulation. This is only durable for 6 to 8 months, as the new cysts are formed by then.
  • In vitro fertilization can be done if fertility medications do not work.

Home remedies

Major lifestyle modifications to combat the development of any complication:

  • Try diet and aerobic exercise to lose weight.
  • Yoga and other relaxing therapies can help with mood disorders.
  • Get enough sleep.
  • Hot oil massages are also very relaxing.

PCOS diet

  • Avoid processed and refined foods like white flour, baked goods, and refined carbs.
  • Increase intake of a high-fiber diet.
  • Eat enough proteins.
  • Consume dry fruits, they contain a high amount of HDL.
  • Drink plenty of water.
  • Take smaller, frequent meals throughout the day.
  • Limit alcohol intake.
  • Supplements like inositol are helpful in the improvement of symptoms.

When to consult a doctor?

If you skip your period for a longer time than usual and the symptoms are affecting your quality of life, you should talk to your doctor and get help.

PCOS awareness

Polycystic ovary syndrome is a serious hormonal disorder that affects the metabolic and reproductive health of a female. Every 1 in 10 women is affected by PCOS and is a leading cause of infertility in females. It can cause lifelong complications including serious life-threatening conditions if not promptly and adequately managed.

September is celebrated as PCOS Awareness month and females are educated about the hazards of untreated conditions and encouraged to get help regarding the management of its symptoms before they cause serious complications.

FAQ

Can someone with PCOS get pregnant?

Yes, females with PCOS have trouble conceiving but after getting a little help from the fertility specialist they can easily get pregnant.

Will removing ovaries stop PCOS?

No, because ovaries are only responsible for hyperandrogenic symptoms in PCOS. And the removal of ovaries can only help with these symptoms. Other problems like insulin sensitivity and adrenal symptoms will remain as it is.

What are the first signs of PCOS?

The first signs of PCOS can be irregular menstruation and excessive hair growth.

Last medically reviewed on September 1, 2022.