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Signs, symptoms, causes, and treatment of PCOS

Signs, symptoms, causes, and treatment of PCOS

Dr. Yolanda Kirkham
Dr. Yolanda Kirkham, OBGYN

Did you know that PCOS is not directly related to infertility? PCOS affects 6-12% of all women and those with ovaries who are of reproductive age (about 1 in 100), and often does not hinder most people’s ability to have a child. If you or a loved one frequently skips periods, it is a good idea to visit the doctor to have bloodwork and ultrasound done to find the cause.

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What is PCOS?

PCOS stands for Polycystic Ovarian Syndrome.  This is a metabolic condition involving not only reproductive hormones, but also insulin hormone which regulates your blood sugar. What does this mean for someone with PCOS?  This results in skipped periods or very long cycles (ie. periods that come very few months instead of monthly, or less than 9 periods per year), unwanted hair on the face or abdomen, acne, changes seen on hormonal bloodwork (increased androgens or male sex hormones). People with PCOS may also find it difficult to lose unwanted weight. The name polycystic ovarian syndrome actually describes the numerous small cysts (fluid-filled sacs) that form in the ovaries. While having physiological ovarian cysts is normal for reproductive-aged women because this is how eggs are released (ovulation) monthly, they may show up on ultrasound as plentiful (or polycystic) because they don’t get released in PCOS. In other words, people with PCOS don’t ovulate regularly, resulting in a late or missed period as ovulation is the trigger for bleeding 2 weeks later when there is no pregnancy.

person holding a pad

Signs and symptoms of PCOS

The are three main signs and symptoms which your doctor will look for when diagnosing PCOS. If you have any two of these three signs, you are likely to have PCOS:

  • Excess acne or hair growth on the face, chest, abdomen, or upper thighs.
  • Infrequent menstrual cycles: this can occur if you don’t have a period at least 9 times a year, or you have long cycles, or more than 35 days between each first days of your period.
  • Multiple small fluid-filled sacs in the ovaries: Your ovaries might be enlarged and contain many follicles (eggs) that haven’t ovulated.

As a result of these symptoms, it is hard to time having sex for trying to get pregnant. Or others do get pregnant and don’t know because they think are used to missed cycles.  Since your ovaries are not releasing or ovulating eggs monthly, it may become harder to become pregnant. Ovulation usually happens 2 weeks before the next period. However, it is very possible to get pregnant even with PCOS, and so you should take preventative measures if you don’t want to be pregnant.

person performing an insulin test

Causes of PCOS

The exact reason for PCOS is unknown, but there are some factors which can play a role. Some of these include insulin resistance, genetics, and lifestyle factors. Speak to your healthcare provider to learn more!

How is PCOS diagnosed?

There are two different methods to diagnose PCOS, either by an ultrasound or a blood test.

  • Ultrasound. This test uses sound waves to create images of blood vessels, tissues, and organs. This test is used to look at the size of the ovaries and see if they have excessive cysts. The test can also look at the thickness of the lining of the uterus (endometrium).
  • Blood tests. These look for high levels of androgens and other hormones to rule out other causes of skipped periods. Your health care provider may also check your blood glucose levels. And you may have your cholesterol and triglyceride levels checked.

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Treatment for PCOS

There are many options for treating and managing PCOS based on stage of life and current goals. Factors that impact treatment include your age, how severe your symptoms are, and your overall health. The type of treatment also depends on whether you want to become pregnant currently.

Lifestyle changes are the most important!  PCOS can be improved by exercising regularly (150 minutes per week) and enjoying nutritious foods with proteins, grains, healthy fats, fruits and vegetables.  Cutting out unnecessary sweets, pop, and juice is helpful. You may also choose medication (like period or birth control pills) to have regular periods to prevent a thick uterus lining that builds up between periods. This prevents uterus cancer in the long run. Short term medication (progestins) can also be prescribed to have a period at least every 2-3 months. If concerns are excess hair or acne, medications can also target these symptoms.  Additionally, diabetes medication to lower insulin resistance can also be explored.

For those trying to get pregnant, seeing a gynecologist, endocrinologist, or fertility doctor can help. Fertility doctors can monitor your ovaries and help trigger ovulation with 1 time injection medication.

Although PCOS may seem like a complicated group of symptoms, there are a lot of options available to minimize the impact on your daily life and help with pregnancy goals.

It is important to know that if you have PCOS, you are not alone. As many as 5 million women in the US who are of child-bearing age suffer from PCOS. This September, let’s raise awareness and educate ourselves about PCOS and how we can support those who have it.

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