Polycystic Ovary Syndrome (P.C.O.S) - Causes, Symptoms, Treatment

Polycystic ovary syndrome is a problem in which a woman's hormones are out of balance. It can cause problems with your periods and make it difficult to get pregnant. PCOS also may cause unwanted changes in the way you look. If it isn't treated, over time it can lead to serious health problems, such as diabetes and heart disease.

Most women with PCOS grow many small cysts on their ovaries. That is why it is called polycystic ovary syndrome. The cysts are not harmful but lead to hormone imbalances. Early diagnosis and treatment can help control the symptoms and prevent long-term problems.

Hormones are chemical messengers that trigger many different processes, including growth and energy production. Often, the job of one hormone is to signal the release of another hormone. For reasons that are not well understood, in PCOS, the hormones get out of balance. One hormone change triggers another, which changes another. 

For example, the sex hormones get out of balance. Normally, the ovaries make a tiny amount of male sex hormones (androgens). In PCOS, they start making slightly more androgens. This may cause you to stop ovulating, get acne, and grow extra facial and body hair. The body may have a problem using insulin, called insulin resistance. When the body doesn't use insulin well, blood sugar levels go up. Over time, this increases your chance of getting diabetes.

Cause
The cause of PCOS is not fully understood, but genetics may be a factor. PCOS problems are caused by hormone changes. One hormone change triggers another, which changes another. PCOS seems to run in families, so your chance of having it is higher if other women in your family have it or have irregular periods or diabetes. PCOS can be passed down from either your mother's or father's side. Symptoms tend to be mild at first. You may have only a few symptoms or a lot of them. The most common symptoms are:

• Acne.
• Weight gain and trouble losing weight.
• Extra hair on the face and body. Often women get thicker and darker facial hair and more hair on the chest, belly, and back.
• Thinning hair on the scalp.
• Irregular periods. Often women with PCOS have fewer than nine periods a year. Some women have no periods. Others have very heavy bleeding.
• Fertility problems. Many women who have PCOS have trouble getting pregnant.
• Depression.

To diagnose PCOS, the doctor will:

• Ask questions about your past health, symptoms, and menstrual cycles.
• Do a physical exam to look for signs of PCOS, such as extra body hair and high blood pressure. The doctor will also check your height and weight to see if you have a healthy body mass index (BMI).
• Do a number of lab tests to check your blood sugar, insulin, and other hormone levels. Hormone tests can help rule out thyroid or other gland problems that could cause similar symptoms.
• You may also have a pelvic ultrasound to look for cysts on your ovaries. Your doctor may be able to tell you that you have PCOS without an ultrasound, but this test will help him or her rule out other problems.

Symptoms

Symptoms tend to start gradually. Hormone changes that lead to PCOS often start in the early teens, after the first menstrual period. Symptoms may be especially noticeable after a weight gain. These may include:

• Menstrual problems. These can include few or no menstrual periods or heavy, irregular bleeding.
• Hair loss from the scalp and hair growth (hirsutism) on the face, chest, back, stomach, thumbs, or toes.
• Acne and oily skin.
• Fertility problems, such as not releasing an egg (not ovulating) or repeat miscarriages.
• Insulin resistance and too much insulin (hyperinsulinemia), which can cause things like upper body obesity and skin tags.
• Depression or mood swings. 
• Breathing problems while sleeping (obstructive sleep apnea). This is linked to both obesity and insulin resistance.

Reproductive problems

Hormone imbalances can cause several types of pregnancy problems and related problems, including:

• Infertility. This happens when the ovaries aren't releasing an egg every month.
• Repeat miscarriages.
• Gestational diabetes during pregnancy.
• Increased blood pressure during pregnancy or delivery, having a larger than normal or smaller than normal baby, or having a premature baby.
• Precancer of the uterine lining (endometrial hyperplasia). This can happen when you don't have regular menstrual cycles, which normally build up and "clear off" the uterine lining every month.
• Uterine (endometrial) cancer. Risk during the reproductive years is 3 times greater in women who have PCOS than in women who ovulate monthly.
• Problems with blood sugar. Insulin is a hormone that helps your body's cells get the sugar they need for energy. Sometimes these cells don't fully respond to insulin. This is called insulin resistance. It can lead to diabetes.

Heart problems and stroke

High insulin levels from PCOS can lead to heart and blood vessel problems. These include:

• Hardening of the arteries (atherosclerosis).
• Coronary artery disease and heart attack.
• High blood pressure.
• High cholesterol.
• Stroke.

What Increases Your Risk

A family history of diabetes may increase your risk for PCOS because of the strong relationship between diabetes and PCOS. Long-term use of the seizure medicine valproate (such as Depakote) has been linked to an increased risk of PCOS.

When To Call a Doctor

Polycystic ovary syndrome causes a wide range of symptoms, so it may be hard to know when to see your doctor. But early diagnosis and treatment will help prevent serious health problems, such as diabetes and heart disease. See your doctor if you have symptoms that suggest PCOS.

Call your doctor right away or seek immediate medical care if:

- You have severe vaginal bleeding. You are passing clots of blood and soaking through your usual pads or tampons every hour for 2 or more hours.

- More vaginal bleeding, or bleeding is more irregular.

- Regular menstrual cycles but you have been trying unsuccessfully to become pregnant for more than 12 months.

- Any symptoms of diabetes, such as increased thirst and frequent urination (especially at night), unexplained increase in appetite, unexplained weight loss, fatigue, blurred vision, or tingling or numbness in your hands or feet.

- Depression or mood swings. Many women may have emotional problems related to the physical symptoms of PCOS, such as excess hair, obesity, or infertility.

Watchful waiting

Taking a wait-and-see approach (called watchful waiting) is not appropriate if you may have PCOS. Early diagnosis and treatment may help prevent future problems.

Treatment

Treatments depend on your symptoms and whether you are planning a pregnancy. Regular exercise, healthy foods, and weight control are the key treatments for PCOS. Treatment can reduce unpleasant symptoms and help prevent long-term health problems. Try to fit in moderate activity and/or vigorous activity often. Walking is a great exercise that most people can do.

Eat heart-healthy foods. This includes lots of vegetables, fruits, nuts, beans, and whole grains. It limits foods that are high in saturated fat, such as meats, cheeses, and fried foods. Most women who have PCOS can benefit from losing weight. Even losing 10 lb (4.5 kg) may help get your hormones in balance and regulate your menstrual cycle.

If you smoke, consider quitting. Women who smoke have higher androgen levels that may contribute to PCOS symptoms. Your doctor may also prescribe birth control pills to reduce symptoms, metformin to help you have regular menstrual cycles, or fertility medicines if you are having trouble getting pregnant. It is important to see your doctor for follow-up to make sure that treatment is working and to adjust it if needed. You may also need regular tests to check for diabetes, high blood pressure, and other possible problems.

It may take a while for treatments to help with symptoms such as facial hair or acne. You can use over-the-counter or prescription medicines for acne. It can be hard to deal with having PCOS. If you are feeling sad or depressed, it may help to talk to a counselor or to other women who have PCOS.

There is no cure for PCOS, but controlling it lowers your risks of infertility, miscarriages, diabetes, heart disease, and uterine cancer.

Healthy lifestyle

If you are overweight, weight loss may be all the treatment you need. A small amount of weight loss is likely to help balance your hormones and start up your menstrual cycle and ovulation.

Eat a balanced diet that includes lots of fruits, vegetables, whole grains, and low-fat dairy products.

Hormone therapy

If weight loss alone doesn't start ovulation (or if you don't need to lose weight), your doctor may have you try medicine(s) to help you start to ovulate. If you aren't planning a pregnancy, you can also use hormone therapy to help control your ovary hormones. To correct menstrual cycle problems, birth control hormones keep your endometrial lining from building up for too long. This can prevent uterine cancer.

Hormone therapy also can help with male-type hair growth and acne. Birth control pills, patches, or vaginal rings are prescribed for hormone therapy. Androgen-lowering spironolactone is often used with combined hormonal birth control. This helps with hair loss, acne, and male-pattern hair growth on the face and body (hirsutism). 

Taking hormones doesn't help with heart, blood pressure, cholesterol, and diabetes risks. This is why exercise and a healthy diet are key parts of your treatment. If weight loss and medicine don't restart ovulation, you may want to try other treatments. 

Regular checkups

Regular checkups are important for catching any PCOS complications, such as high blood pressure, high cholesterol, uterine cancer, heart disease, and diabetes.

Prevention

Polycystic ovary syndrome cannot be prevented. But early diagnosis and treatment helps prevent long-term complications, such as infertility, metabolic syndrome, obesity, diabetes, and heart disease.

Credits: WebMD, Google images