Polycystic Ovary Syndrome (PCOS): What is it and what are the signs?

Carla Bozzolo

May 2013

Monthly changes in hormones affect nearly all women. Some of the symptoms are more bothersome or noticeable than others, and sometimes they signal health problems. Studies show that 4% to 18% of women of reproductive age have a condition called polycystic ovary syndrome (PCOS). It can be difficult to diagnose because it is similar to so many other conditions. What is PCOS, and what are the signs?

Also known as “Stein-Levanthal Syndrome,” PCOS is caused by hormone problems.[1] It is hard to identify in some women, particularly adolescents, because the symptoms vary widely and are not unique to PCOS. A woman can experience any combination of the following:[1],[2],[3]:

  • Obesity
  • Weight gain/Difficulty losing weight
  • Male pattern hair growth (e.g., stomach, nipples, and face) called Hirsutism
  • Irregular periods
  • No period after puberty
  • Acne
  • Chronic high blood sugar
  • High bad cholesterol (LDL)
  • High testosterone levels (male hormone)
  • Ovarian “cysts”
  • Infrequent ovulation/difficulty getting pregnant

PCOS is not a disease, and there is no cure; there are just different ways to lessen the impact of the various symptoms.

What are women with PCOS at high risk for?

It is important to know if you have PCOS, because it increases the chances of you developing the following health problems:

Research suggests that PCOS may also slightly increase the risk of breast cancer, but more research is needed before any conclusions are possible.[5],[6]

Women with PCOS who are pregnant, women who needed hormone treatments to help them get pregnant, and pregnant women with PCOS who are obese (Body Mass Index over 30) are at higher risk for gestational diabetes, a kind of diabetes that occurs only during pregnancy but can have lasting effects on the mother and the baby. [1]

What tests are needed to diagnose PCOS?

Unfortunately, there is no one reliable test to tell you if you have PCOS or not. [3]

Instead, there are a variety of tests you will need to take. Some of the tests are to rule out conditions that cause the same symptoms.

Fasting Glucose

The fasting glucose (blood sugar) test can help determine if you have the warning signs for developing type 2 diabetes. Not all women with high fasting blood sugar have PCOS, but many women with PCOS have high fasting blood sugar.

Testosterone Levels

A high level of testosterone in the blood is the major sign of PCOS. Testosterone is a hormone that all men and women have, but levels are higher in men, and it is responsible for PCOS symptoms such as acne, excess body hair, and irregular periods. Your doctor will also test the levels of other hormones at the same time.

Cholesterol Test

A high level of bad cholesterol (LDL) in the blood is a common sign of PCOS, especially in younger women.

Thyroid Function Test

Many symptoms related to thyroid disorders are similar to PCOS symptoms, so a thyroid function test is helpful to eliminate that condition as a reason for the symptoms.

Vaginal Ultrasound

The name “polycystic ovary syndrome” is misleading because it implies that all women with the condition have cystic ovaries.  Not all women do, and even those who seem to have cysts actually have immature follicles in the ovary.  A vaginal ultrasound can identify if there are any immature ovary follicles, which look like cysts and can cause irregular menstruation and irregular ovulation.

What are the treatments for PCOS symptoms?

While there is no cure, there are different ways to reduce the impact of PCOS on your everyday life. Studies have found that being overweight or obese worsens all of the symptoms, except the presence of ovarian “cysts”. The most successful way to treat PCOS is a healthy lifestyle. Eating a healthy diet, regularly exercising, and achieving and maintaining a healthy weight are the most effective ways of eliminating or at least reducing symptoms. [1],[3]

Other ways of coping with and minimizing symptoms include:

  • Excess body hair: Electrolysis (permanent and semi-permanent laser hair removal); or the prescription drug, Spironolactone. Spironolactone can cause serious side effects, although they are relatively rare.  More common side effects include frequent urination, dehydration, and fatigue, among others.
  • High cholesterol: Change in diet or cholesterol-reducing drugs.
  • Ovarian “cysts”: Laparoscopy is an operation involving small cuts in the abdomen or pelvis and a camera to guide the surgeon.
  • Birth Control Pills: Birth control pills contain female hormones that may reduce abnormal hair growth and improve acne. However, birth control pills increase the risk of blood clots, so they should be taken only if contraception is needed.  Different types of birth control pills have different risks and benefits for women with PCOS. Some women find that birth control pills help them control symptoms; while others say that the pills make their symptoms worse!

What is still unknown about PCOS?

PCOS seems to run in families, but the exact gene has not been found. Also, the way a woman experiences PCOS varies even within a family—your mother’s PCOS may have had very different symptoms from yours.

PCOS is also difficult to diagnose in adolescents because many of the symptoms, like irregular periods, are ones that can occur in any adolescent girl.

Bottom Line

If it is not diagnosed and no efforts are made to treat it, PCOS can be emotionally challenging and lead to health problems.  The more overweight a woman with PCOS is, the worse those health problems are likely to be.  Women with PCOS may feel uncomfortable with their looks if they have a lot of body or facial hair, and being unable to get pregnant can result in depression. Getting a diagnosis and getting help for symptoms reassures women that these are not “personal failings,” but rather symptoms of a health condition that can be controlled. As with so many health problems, eating nutritious food, exercising, and maintaining a healthy weight go a long way to combat the most serious health risks and noticeable symptoms.

References


[1] Moran LJ, Hutchison SK, Norman RJ, Teede HJ. Lifestyle changes in women with polycystic ovary syndrome. Cochrane Database of Systematic Reviews 2011, Issue 7.

[2] Lim SS, Norman RJ, Davies MJ, Moran LJ. The effect of obesity on polycystic ovary syndrome: a systematic review and meta-analysis. Obesity Reviews 2013; 14 (2), 95-109.

[3] Hakim EAE, and Wardle E. Polycystic ovary syndrome—what the GP can do. General Practice Update 2009; 2(2).

[4] Rajkhowa M, Glass MR, Rutherford AJ et al. Polycystic ovary syndrome: a risk factor for cardiovascular disease? British Journal of Obstetrics and Gynaecology 2000;107, 11-18.

[5] Anderson KE, Sellers TA, Chen PL et al. Association of Stein-Leventhal syndrome with the incidence of postmenopausal breast carcinoma in a large prospective study of women in Iowa. Cancer 1997; 79, 494-9.

[6] Vollenhoven B, Clark S, Kovacs G et al. Prevalence of gestational diabetes mellitus in polycystic ovarian syndrome (PCOS) patients pregnant after ovulation induction with gonadotrophins. Australian and New Zealand Journal of Obstetrics and Gynaecology 2000; 40, 54-8.