PCOS stands for Polycystic Ovarian Syndrome. It is sometimes also referred to as Stein-Leventhal Syndrome. Drs. Stein and Leventhal are the gynecologists who first described the syndrome (this occured in the 1930s).
PCOS is an endocrine disorder. Your endocrine system produces and regulates hormones. It is in charge of the “slow” body processes such as growth, digestion, sleep, and reproduction. Women with PCOS have an endocrine system that is out of whack, and that results in some or all of the following signs and syptoms:
- Absent or irregular menstrual periods
- Infertility, often due to absent or irregular ovulation (with or without menstrual bleeding)
- Obesity, often with weight centered around the waist
- Acne and oily skin
- Dark patches of skin (images: acanthosis nigricans) , particularly in the groin, on the neck, on the elbows and knees, or in skin folds
- Increased hair growth (images: hirsutism), particularly on the face, back, and chest
- Thin scalp hair, male-patterned baldness (images: androgenic alopecia in women)
- Skin tags (images: skin tags), often on the neck or in the armpits
- Cysts on the ovaries (images: polycystic ovary)
- Deep voice
- Sleep apnea
- High cholesterol levels
- Decreased insulin sensitivity, type II diabetes
PCOS is a syndrome. A syndrome is a collection of signs and symptoms that frequently appear together but do not have a known cause. This means that each woman with PCOS has her own individual cocktail of symptoms and hormone variations. There are morbidly obese women with PCOS and there are stick-thin women with PCOS. There are women with full-on beards that could rival that of my Armenian uncle, and there are women with nothing more than a few stray chin hairs.
Women with PCOS often have low levels of follicle stimulating hormone (FSH) and high levels of lutenizing hormone (LH). The high levels of lutenizing hormone cause the body to produce too much estrogen, testosterone, and DHEA-S. Testosterone and DHEA-S are androgens. Androgens are a group of compounds that stimulate or control male sex characteristics. Even though they are associated with male sex characteristics, androgens are found in all women. Women with PCOS have more androgens than women without PCOS. The high androgen levels are responsible for many of the signs and symptoms listed above.
The cause of PCOS is unknown; but, it is believed to be a combination of genetic and environmental factors. Women with PCOS often have female relatives with the disease as well. PCOS is one of the most common female endocrine disorders. Estimates of the number of women affected by PCOS vary; but, they tend to show that 2-10% of women worldwide are affected by the syndrome.
PCOS is typically diagnosed through a review of health history, physical examination by a medical professional, and blood tests. Sometimes a pelvic exam or pelvic ultrasound is used as well. There is not a definitive test for PCOS. Rather, it is usually diagnosed by exclusion. Women with PCOS are diagnosed when other explanations of their signs and symptoms are ruled out.
There is no cure for PCOS. The severity of symptoms can be lessened through regular exercise and weight loss. Weight loss is often very difficult for women with PCOS, but it is also the single most effective way to reduce the negative impacts of the syndrome. Medications to stimulate ovulation are used if pregnancy is desired. Oral contraceptives (aka “birth control”) and anti-androgenic medications are sometimes used to help restore regular menstrual cycles and to decrease acne and hair growth. Metformin is often prescribed to increase insulin sensitivity. A combination of medication, dietary changes, and lifestyle changes is required to make significant alterations.
The previous paragraphs have all discussed the physical characteristics and the underlying endocine causes, but not the emotional aspects of the syndrome. There are very real emotional consequences of PCOS. It’s discouraging to be overweight when thin-ness is highly valued in your society. It’s disheartening when people look at you like a freak because you have more facial hair than they find acceptable. It’s frustrating when people assume you have poor hygiene because you’re far older than a teenager and still have severe acne. It’s distressing to think that you will never get pregnant, and that you have a higher chance of miscarriage if you do get pregnant.
To borrow a phrase from the cancer folks, PCOS sucks. There is hope though. Your story doesn’t have to end this way.
If you have a question about PCOS, feel free to ask me using the Ask Ra page. I’d love to help you! You can do this!