Helping you understand the signs and symptoms of PCOS Polycystic Ovary Syndrome

As a member of the female clan, dealing with weight gain, hair in annoying places, those pesky spots and painful and oddly timed periods seems as though it just comes with the territory. But these and other problems may just be being caused by a condition called Polycystic Ovary Syndrome which will hence forth be called PCOS as it’s much easier to type and spell.

It’s vital that if a woman does have PCOS then she gets diagnosed as it can impact her ongoing health and her chances of having a family in the future. So, if you are concerned then speak to your medical professional to get the right diagnosis. Which we will go through later in the article.

How common is PCOS?

There appears to be a wide range of figures for PCOS. From 4.4% to 15% of women of reproductive age. The reason that there is such a range is to do with the different criteria which are used namely the NIH and Rotterdam criteria – specifically the change from 2 of 2 criteria to 2 of 3 criteria increased the variability and interpretation of diagnosis. This is why the prevalence figures are so different. This study titled Criteria, prevalence, and phenotypes of polycystic ovary syndrome does a great job of going through this you can find it here

The table below is from that article and shows the global prevalence of PCOS

What is PCOS

PCOS is a health condition which impacts about 10 million people across the world. The mechanism or why it happens is currently unknown; but is considered to be a hormonal problem.

There is a body of evidence suggesting a strong link to genetics and environmental factors causing PCOS.

It is one of the main causes of infertility in women and can cause physical, emotional and mental health challenges.

Believe it or not; not all suffers of PCOS have cysts on their ovaries, in fact, 20% of women without PCOS have cysts on their ovaries and conversely 30% of those with PCOS don’t have cysts. This is so counterintuitive that a number of panels and bodies have suggested changing it’s name to reduce some of the confusion into the condition.

In a nutshell, PCOS, is an excess of androgens this is known as hyperandrogenism. Androgens are often incorrectly referred to as ‘male hormones’. They are found in higher concentrations in men, but women have small doses of these hormones in their body and they still have a role to play in women.

Androgens are mainly produced by the ovaries, although the adrenal glands also play a significant role – these are the predominant cause of many of the symptoms of PCOS. Although, 2 other key hormones appear to be related to PCOS

  • Insulin – It appears that sufferers of PCOS aren’t as responsive to insulin as women without PCOS; this is known as insulin resistance. Insulin is vital in allowing the cells to absorb glucose and convert it to energy. This resistance can lead to a build up of sugar within the blood similar to Type 2 Diabetes which can further increase the creation of androgens.
  • Progesterone – Those with PCOS often have a deficiency of progesterone. This hormone is important in regulating your menstrual cycle and also supporting early pregnancy. As such many suffer with irregular or no periods and are also at a slightly greater risk of early miscarriage.

Diagnosis of PCOS

It is difficult to say for certain, but it is highly likely that PCOS is an under-diagnosed condition. This is likely due to the fact that women often just don’t report their symptoms or think of them as normal. We spoke to one woman diagnosed with PCOS and she had this to say

“I have been steadily putting on weight since my late teens. I had really painful period pains and my cycle could be anything from 15 day to 42 days – When I was 22 I spoke to my doctor and they just told me that this is completely normal for ladies, just take paracetamol and take the pill so I did. What helpful advice.

So, for another 7 years I struggled through the pain and a multitude of other symptoms, even whilst off the pill. I came off contraception when my husband and I wanted to try for children. That’s when things really went downhill, I put on 27kg in a year, started to grow hair in places I never used to have it and developed type 2 diabetes, or so I thought. Living with this whilst not managing to conceive also pushed me into depression. It was this that pushed me to seek help, not my ‘normal woman’s problems’.

Then my therapist referred me to a gynaecologist as she suspected that I had PCOS and sure enough, I had the tests and was diagnosed with PCOS after having an excess of androgens, cysts on my ovaries and problems with my ovulation. My questions were answered but it took 9 years total to get my answers! I don’t understand why doctors dismiss symptoms of women as normal, but I took this and listened to this terrible ‘advice’ most of my young adult life. Luckily once I knew what it was I was able to take steps to improve my condition, mainly through diet, exercise and some medications and I’m pleased to say my husband and I now have a healthy wonderful boy who is 4 years old”

For those of you living with PCOS this may sound like your own story. Many women don’t find out about their PCOS until later in life whilst TTC or for some they are asymptomatic (have no symptoms). Sadly, knowledge amongst general doctors and patients is pretty low and symptoms are often not linked soon enough, and doctors often treat each symptom individually. Furthermore, many of the symptoms, especially acne, weight, infertility, depression and sexual dysfunction are often put down to stress and lifestyle factors. Whilst it is true that all of these can be caused by lifestyle and stress, it’s a doctor’s job to look at all the symptoms, not cherry pick.

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Thus, importantly you may need to advocate for yourself and specifically ask to be tested for PCOS.

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PCOS used to be defined and in some countries is still defined by the NIH criteria, although most countries now use the Rotterdam Criteria, which is as follows:

In order to be diagnosed with PCOS you must have at least 2 out of 3 of the following

  • Anovulation – Meaning you don’t ovulate
  • Hyperandrogenism – This can be diagnosed clinically – through specific symptoms related to hyperandrogenism or biochemically i.e. through blood tests
  • Polycystic ovaries seen on ultrasound.

However even with these in place it can still be difficult to diagnose as we saw in the story above. Your point in life, weight genotype, diet can all impact PCOS characteristics and the contraceptive pill can cause false negatives because they reduce androgens.

But to make this easier for you to understand when you should seek medical advice and ask to be tested let’s take a look at the PCOS signs and symptoms.

What are the signs and symptoms of PCOS?

Generally speaking, women suffering with PCOS have 3 broad Key characteristics of PCOS:

  • Obesity
  • Irregular menstrual cycles/Fertility Problems
  • Hair/Skin problems

But PCOS doesn’t present the same in all patients; you can be slim, with excess hair growth and cysts. You can be over-weight and have no periods but have no cysts or any combination of the above.

To add another layer of complication to the diagnosis, symptoms can cause other symptoms, for example insulin resistance can cause cardiovascular problems and body image can cause depression and anxiety.

It is your specific combination of symptoms which are important and not any one in isolation and they define which type of PCOS you experience.

The infographic below shows the common signs and symptoms of PCOS, so if you have a combination of at least 2 of these and you think you may have PCOS then ask your doctor to test you.

Is there a cure for PCOS?

Unfortunately, there is no cure for PCOS. The good news is that many women manage their PCOS through a variety of medications and also with a holistic approach, focusing on healthy living and exercise many women have meant that their PCOS doesn’t impact them as much as it once did.

We are currently working on a selection of articles to guide you through how to manage your PCOS; but until they are polished and ready to show the world we advise you to take a look at Verity – A charity specialising in PCOS and living with the condition.

We hope that you have found this helpful. We think you might find these articles of interest next.

A complete guide to infertility diagnoses: A look at the key diagnose which cause infertility.

An overview of fertility testing: A look at what you can expect from your fertility testing from initial appointment all the way through to exploratory surgery.

12 Strategies to help you cope with infertility: Our tips to help you cope with your infertility.

How to improve egg quality: The best way to improve your fertility and chances of getting pregnant explored.

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