Cory Ruth, a registered dietitian and women’s health expert, first started noticing irregular periods in her teens.
“I remember always feeling like something was off. In high school, we learned that you get a period every 28 days and that’s that,” she says. “That was never the case for me.”
However, Ruth wasn’t sure what exactly was wrong.
As Ruth got older and decided to become a dietitian, another student in one of her classes was discussing polycystic ovary syndrome (PCOS), a condition that affects the endocrine, reproductive and metabolic systems. One of its hallmark signs? Unpredictable or irregular periods.
The symptoms seemed familiar to Ruth, and by the time she was in her mid-20s, she was diagnosed with PCOS by her OB-GYN.
PCOS is a chronic condition with life-long symptoms that can be serious, in both a physical and emotional sense. There is no cure for PCOS, nor is the cause of the condition clear, but treatments do exist to help individuals manage their PCOS symptoms and improve both their health and quality of life.
[READ: Signs of a Hormonal Imbalance.]
What Is PCOS?
PCOS is a common condition that is characterized by multiple small cysts in the ovaries, high levels of male hormones called androgens and irregular menstrual cycles. PCOS impacts the endocrine, reproductive and metabolic systems and affects up to 13% of women of reproductive age.
However, despite being fairly common, the World Health Organization estimates that up to 70% of affected people remain undiagnosed worldwide and many struggle with diagnosis.
In the female reproductive system, ovaries contain ovarian follicles, which are little sacs filled with fluid containing premature eggs. These eggs mature and are released during menstruation.
However, for some people, large amounts of follicles grow on the outside of the ovaries and cause them to become polycystic. Ovarian follicles may also fail to develop and release eggs properly, resulting in irregular periods. The ovaries can also produce an excess of androgens, a group of male reproductive hormones that can result in symptoms like acne or excess hair. These conditions characterize the hormonal imbalance known as PCOS.
What Causes PCOS?
What exactly causes PCOS remains unknown. Rather than being a single disease with one cause, PCOS most likely has a variety of causes.
“It’s probably many different causes that result in similar symptoms — irregular menstrual cycles, excess androgens and polycystic ovaries,” says Dr. Hugh Taylor, chief of OB-GYN at Yale-New Haven Hospital.
A few contributing risk factors that may be involved in PCOS are:
— Genetics. PCOS appears to have some kind of genetic element to it as it often runs in families.
— Inflammation. Chronic inflammation has been linked to PCOS in recent research. “We think inflammation plays a role and it may irritate the ovaries. It’s less well-defined, but in women with PCOS we do see low-grade inflammation,” says Taylor.
— Environmental factors. How environmental factors play into PCOS is less well understood, but androgen exposure in early life or as a fetus may increase the chances of someone developing PCOS.
[Losing Weight With PCOS: Expert Diet Tips for Polycystic Ovary Syndrome]
The relationship between PCOS and weight
It’s a common misbelief that obesity causes PCOS. While research reports that the majority of people with PCOS are either overweight or obese, obesity is not a cause of PCOS.
PCOS itself contributes to weight gain through insulin resistance and high androgen levels.
“Having PCOS does make you more prone to gain weight. For many people, gaining weight can exacerbate symptoms,” Taylor says.
It is also a common misconception that only people who have overweight or obesity have PCOS. Those who fall under the category of being a healthy weight or even underweight can still — and do — have PCOS.
“There are lots of people who are thin who have PCOS, and that is because it’s something that’s inherent to the ovaries,” says Dr. Chandra C. Shenoy, a gynecologist and reproductive endocrinologist at the Mayo Clinic in Rochester.
Types of PCOS
Although there are not specific medical categories of PCOS, the four most commonly proposed types of PCOS are:
— Insulin-resistant PCOS. This type refers to PCOS that involves insulin resistance as a main component. With insulin resistance, the body’s cells don’t react to insulin the way they normally should. Instead of sugar being converted into energy, the ability to regulate blood sugar is impaired. According to research studies, 65% to 70% of women with PCOS are insulin-resistant. This type is associated with weight gain, high blood pressure and symptoms that worsen or improve depending on weight.
— Inflammatory PCOS. This type is associated with persistent, low-grade inflammation and is connected to symptoms like headaches, acne and joint pain among other symptoms. It’s important to note that insulin-resistance and high androgen levels can also increase inflammation, making the division between these types unclear.
— Adrenal PCOS. This type is associated with high levels of DHEA, a hormone within the larger group of androgens that is created in the adrenal glands. Studies show that some people with PCOS have higher levels of DHEA. People are said to have this type of PCOS if they display DHEA as the main androgen with heightened levels in hormone testing, as opposed to other androgens like testosterone.
— Pill-induced PCOS: Pill-induced PCOS refers to cases where people who have been on the birth control pill and then stop taking it experience PCOS-like symptoms, such as elevated androgen levels, weight gain and irregular menstrual cycles. These post-pill symptoms typically resolve after an adjustment period, but it’s important to consult with your provider if symptoms persist.
[What Is Insulin and What Does Insulin Do?]
Symptoms and Signs
PCOS symptoms can begin around puberty, after the first menstrual cycle, though some may not notice symptoms until later in adolescence or during their 20s.
Common symptoms of PCOS include:
— Irregular or unpredictable periods, a classic early symptom for most people with PCOS
— Obesity or difficulty maintaining a healthy weight
— Acne or oily skin
— Skin tags, which are soft skin growths that most commonly appear on the neck, armpits, chest or thighs and are completely harmless
— Excessive facial hair or body hair on the chest, back, thighs or belly button-area
— Hair loss, hair thinning or male-pattern hair loss
— Infertility or subfertility
Though a few significant symptoms are used to determine a diagnosis, you do not have to have every symptom listed to have PCOS.
“PCOS can present in different ways or have different effects on different people’s lives,” Shenoy says.
How Is PCOS Diagnosed?
Diagnosing PCOS can sometimes be difficult. This is because PCOS is a diagnosis of exclusion, meaning that before a PCOS diagnosis can be made, the possibility of other health conditions that can cause PCOS symptoms must be eliminated.
A PCOS diagnosis is based on patients exhibiting at least two of the following three clinical signs:
— Polycystic ovaries. Polycystic ovaries feature fluid-filled sacs with a distinct appearance. “There’s a classic appearance of a ring of cysts on the outside of the ovaries. This is not just having random cysts on the ovaries. It’s a distinct, PCOS-appearing ovary,” says Taylor.
— Irregular periods. In PCOS, periods may be irregular — more than 35 days or less than 21 days between cycles — or absent completely.
— Excess androgens. Excess androgens can manifest as symptoms like acne or excess hair growth on the face, chest or belly button. Excess androgen can also be detected via lab evidence showing elevated levels of testosterone or other androgen hormones.
In order to determine if you fit the diagnostic criteria and display at least two of the three key symptoms, a practitioner may perform tests:
— Physical exam. Physicians will generally perform physical exams to check for common signs of PCOS like acne and excess facial or body hair. Your provider will also ask you about your symptoms, your menstrual regularity and any weight changes.
— Internal ultrasounds. These tests may be performed to detect the presence of polycystic ovaries.
— Blood tests. Blood tests check for elevated androgen levels. Blood tests may also be used to check for insulin-resistance, blood sugar levels, ovulation-related hormone levels and cholesterol levels.
PCOS can be diagnosed by a few types of health care professionals, including gynecologists, endocrinologists and reproductive endocrinologists.
Related Health Conditions
PCOS may put you at an increased risk for other health problems.
These conditions include:
— Type 2 diabetes or prediabetes
— Problems with fertility, miscarriage or preterm birth
— Obstructive sleep apnea
— Endometrial or uterine cancer
— Depression, anxiety or other mood disorders
— Poor body image and eating disorders
— High-risk pregnancies and gestational diabetes
Because of these related health risks, people with PCOS may undergo screening for aforementioned complications associated with PCOS more frequently every three to five years.
[Health Screening Tests Every Woman Should Have]
Treatments for PCOS
While there is no cure for PCOS, there are treatments available to manage its symptoms and help prevent associated health conditions.
“Treatments are usually aimed at what an individual patient’s goal is,” Shenoy says.
Available treatments range from medications to lifestyle changes to surgical procedures. It’s important to consult with your physician before starting any of these treatments, as some are not suitable if you are pregnant or planning on becoming pregnant.
Treatments to regulate menstrual cycles
Irregular periods are one of the major symptoms of PCOS — studies show that 75% to 85% of women with PCOS have menstrual dysfunction. However, there are treatments available that help make periods more regular:
— Birth control pills. Birth control pills are a typical first-line treatment for PCOS as they are inexpensive, easy to use and cover a variety of PCOS symptoms. Birth control pills regulate menstrual cycles and balance hormones. They contain reproductive hormones like estrogen or progesterone, or both, in the case of combination birth control pills. These pills can also help with acne, excess facial hair and lowering the risk of endometrial cancer. Alternatively, other forms of hormonal birth controls such as birth control shots, patches, vaginal rings or IUDs may also be prescribed. In the case that birth control pills alone are not effective in regulating cycles, anti-androgens like spironolactone are commonly used to help block male hormone action.
— Progestin therapy. Progestin is a synthetic form of the reproductive hormone called progesterone that helps control the menstrual cycle. In progestin therapy, patients take progestin for only part of their cycle to induce a period by thickening the lining of the uterus. Once patients finish the prescribed days of progestin, the uterine lining sheds, producing a period.
— Metformin and other insulin-sensitizing medications. For people with PCOS who have insulin resistance, metformin and other insulin-sensitizing medications can help regulate periods by promoting ovulation through decreasing levels of insulin and blood sugar and reducing androgen production.
[Read: Binge Eating Before Your Period]
Treatments for acne and excessive hair growth
— Oral medication to treat acne. Physicians may prescribe medications like isotretinoin — also known as Accutane — oral antibiotics and anti-androgens like spironolactone to treat acne. Anti-androgens can also improve excessive hair growth. Because birth control pills help regulate hormones, they may often also be prescribed to treat acne in PCOS cases.
— Topical acne treatments. Topical treatments can also treat acne. These include over-the-counter treatment options like benzoyl peroxide and salicylic acid as well as prescription retinoids and topical gels.
— Laser hair removal and electrolysis. For those experiencing excessive hair growth, laser hair removal or electrolysis can help. Laser hair removal utilizes concentrated light to remove unwanted hair. Electrolysis removes excess hair by damaging the hair root with an electric current.
— Hair removal topical creams and traditional hair removal methods. Hair removal topical creams can also help manage excessive hair growth. Additionally, a cream called eflornithine — sold under brand names like Florexa and Vaniqa, among others — can be used to slow hair growth. Other traditional hair removal products like tweezing, shaving and waxing can also be used.
Fertility treatments for PCOS
PCOS is one of the most common causes of infertility
or subfertility — studies estimate that between 70% and 80% of people with PCOS experience infertility. Fertility can be a challenge with PCOS, but there are treatments to help promote fertility, and many people with PCOS still do get pregnant.
Oral ovulatory stimulant medications are typically prescribed first before trying other treatments as they are effective, inexpensive and easy to use.
Fertility treatments include:
— Clomiphene (Clomid). Clomiphene is an oral ovulatory stimulant and is often the first medication doctors prescribe to PCOS patients struggling to get pregnant. This medication stimulates egg development and ovulation by increasing the production of ovulation-related hormones.
— Metformin. Metformin is an oral insulin-sensitizing medication that can promote ovulation and increase the chances of pregnancy. It can be taken alone or is sometimes prescribed alongside clomiphene.
— Letrozole (Femara). Letrozole is another oral ovulatory stimulant that can help stimulate egg development and ovulation to increase fertility.
— Gonadotropins. Gonadotropins are often used for patients who do not see results after taking oral ovulatory stimulants like metformin, clomiphene or letrozole. This medication is administered via subcutaneous injection to encourage follicular growth and ovulation.
— In vitro fertilization (IVF). IVF is the next treatment that is used when other ovulatory stimulants have not been effective in treating infertility. This treatment involves harvesting a patient’s eggs, fertilizing them in a lab, and returning the fertilized eggs — embryos — to the uterus in order for them to grow. IVF can be completed with you and your partner’s sperm and egg or with an egg or sperm donor.
— Ovarian drilling. “In this surgical procedure, small holes are drilled into the ovary, and that disrupts some of the irregular cysts on the outside of the ovary which may promote ovulation,” Taylor says. While the treatment can be effective, other treatments are usually favored because of ovarian drilling’s invasive approach and high cost.
Lifestyle Changes to Treat PCOS
While treatments like oral or topical medications can be helpful in managing PCOS symptoms and improving fertility, there are also lifestyle changes you can make to help improve your PCOS symptoms, reduce your risk for associated conditions and improve your quality of life.
Weight management
For many people, weight loss can improve their PCOS symptoms and can help prevent other related health risks that come with PCOS, like type 2 diabetes. Losing weight is also helpful in improving fertility for those with PCOS.
Weight loss can help lower insulin levels, blood sugar levels and androgen levels, all of which can help improve PCOS symptoms.
Weight loss medications — like Mounjaro or Ozempic — may be helpful.
Physical activity
Staying physically active plays an important role in managing PCOS symptoms.
Regular physical activity provides a range of health benefits for those with PCOS, including:
— Regulation of blood sugar levels
— Lowered insulin levels
— Lowered androgen level
— Improved sleep
— Improved fertility
— Reduced risk of developing conditions associated with PCOS like Type 2 diabetes or heart disease
— Weight management
“The best exercise for PCOS is the one that you like and the one that you’re going to be more consistent in getting in,” Ruth says.
Sleep hygiene
Making sure you’re getting enough sleep can also help improve PCOS symptoms, as good sleep can improve hormonal balances and reduce inflammation.
“Good sleep is really the foundation of good hormonal health,” Ruth explains. You can improve your sleep by creating a bedtime routine to help you wind down before bed and minimizing screen time before sleep.
[How to Relieve Stress and Calm Your Nerves]
Managing stress
Managing stress can also help improve PCOS symptoms. “For some with PCOS, stress will negatively impact them more than others,” Ruth says.
Stress causes increased production of a hormone called cortisol, which can worsen PCOS symptoms like mood swings and fatigue. “The importance of working on your stress levels can’t be understated — decreasing stress is only ever going to be a good thing,” Ruth says.
You can manage stress in many ways, like developing a self-care routine and incorporating destressing, relaxing activities that you enjoy into your daily life. Taking care of your mental wellbeing is critical with PCOS.
“Many people benefit from counseling, support and medication,” says Dr. Eli Reshef, a reproductive endocrinologist and infertility specialist at the Advanced Fertility Center of Chicago.
Diet
Studies show that most people who have PCOS are insulin resistant, which can cause high blood sugar levels.
Because high blood sugar can worsen insulin resistance, increase the production of androgens in your body and further worsen PCOS symptoms, managing blood sugar levels with diet can help manage PCOS symptoms.
“How we eat can have a big impact on how symptoms like irregular periods, facial hair, weight gain, acne, hair loss, fatigue and cravings show up, and how they can be managed,” Ruth says.
The three nutrients that can help to stabilize blood sugar are:
— Fiber. Fiber-rich foods to incorporate into your diet include fruits, low-starch vegetables, beans, whole grains, nuts and seeds.
— Lean proteins. Lean proteins like fish, eggs, chicken and turkey breast, beans and legumes are best as they are low in saturated fats.
— Healthy fats. Foods rich in healthy fats can also help manage blood sugar levels and PCOS symptoms. Healthy fats include avocado, oils like olive oil or walnut oil, seeds and nuts.
On the other hand, there are certain foods that can cause blood sugar to spike and worsen PCOS symptoms.
Foods to avoid or limit include:
— Sugary foods and drinks like cookies, cake, sodas, energy drinks and sweetened beverages
— Highly-processed foods like chips and white bread
— Fried foods like french fries or fast foods
— Fatty or processed meats like bologna, hot dogs or fatty-cuts of meat
Even if you don’t have insulin-resistant PCOS, regulating blood sugar levels through diet can help improve PCOS symptoms, as high blood sugar can raise insulin levels and further contribute to hormonal imbalances and increased inflammation.
“Blood sugar dysregulation can make PCOS symptoms worse, even if you are someone who isn’t insulin resistant or struggling with weight,” says Ruth. “This is because there’s still that huge connection from what we’re eating — and our blood sugar — and our hormones, like insulin and androgens.”
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What Is Polycystic Ovary Syndrome (PCOS)? Causes, Symptoms and Treatments originally appeared on usnews.com
Update 07/19/24: This story was published at an earlier date and has been updated with new information.
