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Polycystic Ovarian Syndrome - Often Missed and Under Diagnosed

Polycystic ovarian syndrome is frequently undiagnosed, with one in ten women having PCOS but up to 50% of women with the disorder going undiagnosed and untreated.  Even the name of the disease is a misnomer, causing more confusion regarding an already confusing disorder.

 

So, what is PCOS?  

 

Polycystic ovarian syndrome is a hormonal disorder common among women of reproductive age. People with the disease may have infrequent or prolonged menstrual periods or excess androgen, or male hormone, levels. The ovaries may develop numerous small collections of fluid known as follicles or small cysts on the outer edges.  No expat cause of PCOS is know, but some factors are suspected to lead to PCOS, such as excess insulin resulting in insulin resistance (this can cause an increase in androgen production and an rise in blood sugar levels resulting in the increased production of insulin), low-grade inflammation, hereditary, and excess androgen (this can cause hirsutism and acne).


 

What are the symptoms of PCOS?

 

People with PCOS typically have irregular or missed periods caused by the lack of ovulation.  Some people may develop cysts on their ovaries, but many do not.  Some very common symptoms of PCOS include:

 

  • Weight gain and obesity that are extremely difficult to manage. Bloating can also occur.

  • Increased fatigue and low energy.  Related issues (e.g. poor sleep or insomnia) may contribute to this fatigue.

  • Sleep problems, specifically poor sleep or insomnia.  PCOS has been linked to sleep apnea, which causes a person to stop breathing for short periods of time during their sleep.

  • Hirsutism (unwanted hair growth), specifically on the face, arms, chest, back, abdomen, thumbs, and toes.  This unwanted hair growth is due to hormonal changes in androgens.

  • Thinning hair or hair loss on the head that may increase in middle age.

  • Headaches, which are due to hormonal changes related to androgens.

  • Infertility is common among those with PCOS; however, some women with PCOS are able to conceive naturally while others may need assistance through fertility treatments.

  • Acne or oily skin, the development of skin tags, and darkened patches of skin.  This increased acne problem is caused by hormonal changes in androgens.

  • Mood changes, specifically mood swings, anxiety, and depression.

  • Pelvic pain and heavy bleeding with periods.  This pelvic pain may occur even when the period is not occurring.

 

 

What are some complications of PCOS?

 

Polycystic ovarian syndrome can cause and lead to many complications due to different symptoms and traits.  For example, infertility, miscarriage or premature birth, and abnormal uterine bleeding are common among those with PCOS.  Also, gestational diabetes, Type II diabetes, pre diabetes, and metabolic syndrome (i.e. many conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that cause a significant increase in one’s risk of cardiovascular disease) are all a result of the unmanageable weight gain.  Severe liver inflammation caused by fat accumulation can also occur as a result of obesity and low-grade inflammation.  Other complications include sleep apnea, anxiety, eating disorders, depression, and endometrial cancer (i.e. cancer of the uterine lining).  Furthermore, obesity can cause these complications to significantly worsen.

 

 

What are the treatments for PCOS?

 

There is no definitive test to diagnose PCOS, but a physical exam, and pelvic exam, an ultrasound of the ovaries, blood tests, and genetic tests may be used to find a diagnosis.  In addition, if one is diagnosed with PCOS, there may be some additional tests for complications, including blood pressure, glucose tolerance, cholesterol and triglyceride levels, anxiety, depression, and sleep apnea.  Treatment of PCOS is more about treating the symptoms than the condition itself, as there is no true cure for PCOS.  Weight loss may be recommended as well as certain medications such as combination birth control pills and specific medications in order to reduce excessive hair growth or aid in ovulation.

 

 

Sources:

https://www.pcosaa.org/pcos-symptoms/

https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439

https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

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