21 early signs of PCOS
The early signs of PCOS are quite varied with many women having no symptoms at all. When present, symptoms are generally related to the high levels of the male hormones (androgens) or the insulin resistance in the body (inability of the body to respond to the insulin hormone).
Many times, the symptoms may be confused with other conditions, resulting in a consequent delay in the diagnosis.
Here are 21 early signs of PCOS:
- Oligomenorrhea (infrequent menstrual periods or periods occurring at an interval of over 35 days)
- Amenorrhea (cessation of menstrual periods)
- Heavy or scanty menstrual flow
- Infertility or trouble conceiving without medical help
- Being overweight or obese
- Hirsutism (excess body hair, seen on the face, chest, nipple, abdomen, and thighs)
- Thinning of hair or baldness
- Oily skin
- Pelvic pain
- Acanthosis nigricans (presence of dark, leathery lines on the skin, typically seen behind the neck, in armpits, groin area, or under the breast)
- Irregular menstrual periods
- Anxiety or mood swings
- Preterm birth (birth of the baby before 37 weeks of pregnancy)
- Risk of gestational diabetes
- Daytime sleepiness
- Reduced interest in sex
- Binge eating
How is PCOS diagnosed?
Polycystic ovarian syndrome (PCOS) is diagnosed based on medical history, examination, and some investigations.
- Medical history: The doctor may particularly ask about menstrual history (whether the cycles are regular if there is scanty or excessive bleeding, etc.), problems with getting pregnant, any noticeable weight changes, and other complaints, such as excess body hair or mood changes. They may ask whether the patient’s mother or sister has PCOS.
- Physical examination: The doctor will perform a thorough physical examination to look for any signs of high androgen or insulin levels. They will examine the pelvic area to look for any abnormalities including growths or lumps.
- Blood tests: The doctor may order certain blood tests to assist in the diagnosis. They may especially order tests for the levels of blood glucose, insulin hormone, cholesterol, and androgens.
- Other tests: The doctor may order an ultrasound, sleep studies, and glucose tolerance test (GTT). They may refer the person to a psychiatrist to screen for signs of anxiety or depression.
4 causes of PCOS
The exact cause of polycystic ovarian syndrome (PCOS) is not well-understood.
Certain factors have been found to play a role in PCOS, such as:
- Excess androgens: Usually, women contain very low levels of male sex hormones or androgens in their blood. In PCOS, the blood contains an excess of androgens giving rise to symptoms, such as acne, excess body hair, and menstrual irregularities. The excess of androgens is associated with imbalances in other hormones (such as follicle-stimulating hormone, luteinizing hormone, estrogen, and progesterone). This causes disturbances in the maturation and release of the egg or ovum from the ovaries. In the absence of ovulation, the ovaries develop various tiny fluid-filled sacs or cysts that produce androgens.
- Insulin resistance: Insulin resistance is a condition in which the tissues in the body do not respond to the hormone insulin. This results in greater insulin production in the body. The excess insulin in return stimulates more production of androgens. High androgen hormone levels further impair ovulation leading to infertility and irregular menstruation. The insulin resistance may lead to high blood glucose levels and eventually diabetes mellitus.
- Chronic inflammation: Women with PCOS have a state of chronic low-grade inflammation. It may be seen as increased blood levels of inflammatory markers, such as c-reactive protein. Chronic inflammation can contribute to various chronic diseases, including cardiovascular disorders, diabetes, and endometrial cancer.
- Genes: PCOS tends to run in families. Research suggests that genes may play a role to cause this condition. Females with mothers or sisters with PCOS or type II diabetes are more likely to have PCOS. Studies suggest that an unhealthy lifestyle along with excess body weight may increase the risk of PCOS in genetically predisposed individuals.
Can PCOS be cured?
Although PCOS cannot be cured, it can be managed well with medications and lifestyle modifications.
PCOS can lead to serious health conditions, such as heart diseases, high blood pressure, diabetes, liver diseases, and endometrial cancer (cancer of the lining of the uterus). Hence, if a person has PCOS, they must seek guidance from a qualified health professional to manage this condition and prevent its complications.
Studies suggest that a modest weight loss of even 5 to 10 percent may help correct menstrual irregularities. Weight management can help correct hormonal imbalances, including high androgen levels, and insulin resistance. This may help control acne and hirsutism, prevent diabetes, manage depression, and regularize the menstrual cycles.
Medications may be prescribed to correct hormonal imbalances and treat the symptoms of PCOS, and generally include:
- Oral contraceptive pills (OCPs): Also called birth control pills, these medications may help improve menstrual problems, treat acne, and control hirsutism. OCPs can lower the risk of endometrial cancer.
- Metformin: It may help lower insulin resistance, manage weight, and correct menstrual irregularities.
- Progestins: These hormonal medications help correct menstrual problems besides lowering the risk of endometrial cancer.
- Antiandrogens: These medications can block the action of the androgens, thereby reducing symptoms, such as acne and hirsutism.
- Fertility treatment: The doctor may prescribe medications (such as clomiphene or letrozole) to aid the maturation and release of the ovum (ovulation) from the ovaries. Some women may need assisted reproductive techniques (ART) to conceive.
- Topical medications: The doctor may prescribe creams or ointments containing antibiotics or retinoids to treat acne.
- Cosmetic treatment: The doctor may suggest cosmetic treatments, such as laser or electrolysis, to reduce unwanted hair. Laser treatment may help correct acne scars.
Barbieri RL, Ehrmann DA. Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics). UpToDate. https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics
National Institutes of Health. What are the symptoms of PCOS? https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/symptoms
Centers for Disease Control and Prevention. PCOS (Polycystic Ovary Syndrome) and Diabetes. https://www.cdc.gov/diabetes/basics/pcos.html
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