Polycystic ovary syndrome (PCOS) is a hormonal condition commonly associated with irregular periods, infertility, and polycystic ovaries in people of reproductive age. Although the condition is frequently underdiagnosed, PCOS is reported to afflict 12-21% of people with ovaries.
This article is intended to be a crash course, and it’s perfect for you if you’re asking the following questions:
What is PCOS?
What are common symptoms of PCOS?
What is the main cause of PCOS?
What are the 4 “types” of PCOS?
How is PCOS diagnosed?
Can PCOS be cured? How do I manage my symptoms?
What are the symptoms of PCOS?
Some symptoms of PCOS are more common than others. For that reason, let’s break this down into common and less frequent symptoms.
COMMON SYMPTOMS OF PCOS
The symptoms that present PCOS will differ for every individual, and tend to vary with age. At younger ages, PCOS tends to manifest mainly through reproductive symptoms. Metabolic symptoms tend to increase with age or in younger individuals that are overweight.
Irregularity or absent periods
Hirsutism (excess growth of dark or coarse hair in a male-like pattern)
Male pattern balding found with high levels of androgens
Infertility or subfertility
Polycystic ovaries (scanned for by your doctor, see below)
Psychological symptoms such as depression, anxiety, psychosexual dysfunction or eating disorders
Metabolic changes such as excessive weight gain or loss, dyslipidemia, or diabetes
Including insulin resistance
LESS FREQUENT SYMPTOMS
Although these symptoms are less common, some people with PCOS experience the following symptoms as well.
Thinning of hair and hair loss from the head (alopecia)
Oily skin, acne, psoriasis, eczema, or hives
Unexplained fatigue or insomnia
Low sex drive
Abnormal skin discoloration
Gut problems such as IBS or SIBO
What are the likely causes behind this condition, and how does this relate to the 4 “types” of PCOS?
The exact genetic cause is unknown and varies depending on the type of PCOS. A major component of PCOS is often based on a high level of androgens (hormonal imbalance).
Consistently high levels of insulin, also known as metabolic syndrome, can be a symptom of pre-diabetes or diabetes. High insulin could be driving your androgen levels up and decreasing your estrogen levels.
Most people with PCOS will have an elevated level of androgens such as testosterone and androstenedione in their ovaries, and DHEA-S in their adrenal glands, yet those with only higher DHEA-S and normal testosterone and androstenedione have adrenal PCOS.
Adrenal PCOS is not triggered by inflammation or high insulin levels, but rather a physiological overreaction to stress.
If you’ve recently gone off of a birth control pill with drospirenone or cyproterone, such as Yasmin, Yaz, Brenda or Diane, it can be common to have withdrawal effects such as an androgen surge.
This surge in androgens is temporary and means that in many cases, your PCOS symptoms can diminish with time.
INFLAMMATORY (HIDDEN CAUSE) PCOS
Chronic inflammation can trigger our bodies to release too much testosterone, and when this inflammatory cascade is the primary agent, then it can be Inflammatory PCOS.
Oftentimes the bodily inflammation can come from other sources such as environmental or physiological reactions, and therefore Inflammatory PCOS can also be known as Hidden Cause PCOS, as the chronic inflammation can be caused by any number of factors. This includes (but is not limited to!) things like food sensitivities, environmental toxins, thyroid disease, and autoimmune disorders.
Common signs of inflammation include fatigue, headaches, skin conditions, joint pain, and digestive issues such as IBS.
How is PCOS diagnosed?
Diagnosing your PCOS is step one of the puzzle. From there, you may find that you have other health issues that are catalyzed by (or catalyzing!) your PCOS. To manage your symptoms effectively, having an understanding not just of your PCOS diagnosis but all related conditions is important.
Getting a PCOS diagnosis
According to the Rotterdam diagnostic criteria, there are three primary indications of PCOS. Two of the three criteria must be present in order to diagnose PCOS:
New to the world of hormonal health and need a bit more context on this? Check out the helpful graphic below:
What treatments are available for PCOS to help manage my symptoms?
Although listed below are common treatments for PCOS and associated conditions, Pollie recommends speaking to a licensed healthcare provider to create a personalized treatment plan for your specific case.
FERTILITY & OVULATORY TREATMENTS
One key aspect of managing PCOS is encouraging ovulation. For those of us trying to conceive (TTC), the reason behind this is obvious: we want to be pregnant, and pregnancy is not possible if our body won’t release an egg!
Still, encouraging regular cycles is important even for those of us who are not trying to have kids. Shedding our uterine lining monthly helps decrease risk of uterine and other estrogen-related cancers, and regular cycles also means more manageable periods when they come (i.e., for many cysters that go several months without a period, they may find they have an unmanageable flow when it does come since their lining has been building up for so long).
Regular ovulation - and regular periods - are also a strong indicator that our hormones are working themselves out. For that reason, ovulatory normalcy is often associated with improved other symptoms like acne, hair loss, and more.
Medications & Therapies
If you are trying to regulate your cycles: Hormonal contraceptives (e.g., Yasmin, Yaz, Diane, Brenda) can help some people regulate their periods and in some cases help minimize symptoms like acne and hair loss. You should be aware that some pills, particularly those that are lower in estrogen or progestin-only methods, have been shown to cause hyperandrogenism as a side effect. In these cases, hormonal contraceptives can make symptoms worse. All this said, you should always be aware that hormonal birth control does not cure your PCOS, but rather puts a bandaid on your symptoms. This is just fine for some of us, but make sure that you discuss all options with your OBGYN or primary care doctor.
If you are TTC: Clomiphene citrate (e.g., Clomid, Serophene) is a pill, generally administered orally for 5 days, that can help induce ovulation. This is prescribed to many people experiencing infertility that is due to a lack of ovulation. Some people experience side effects from clomiphene citrate while other bodies don’t; likewise, this drug is enough to help some families get pregnant while many still do not see success with it.
Exercise: Any form of physical activity, all in moderation. Be sure to partake in a type of movement that works for you. For some of us that may mean yoga or light walking while others thrive on short HIIT sessions or running routines. You do you!
Healthy nutrition:Whole, plant-based foods are key. In general, make sure you are adding loads of colorful vegetables and healthy fats to your plate. For many of us, high-quality protein sources and whole grains are also needed to optimize our fertility. Many sources may advocate specific meal plans like keto, paleo, or veganism. While we are not here to make recommendations, we cannot emphasize enough the power of personalization.
Stress management: Stress management is key, especially if you are experiencing Adrenal PCOS, which is often spurred by high cortisol levels. Meditation and mindfulness practices can help here, as can making sure you are getting enough sleep, not overdoing it at the gym or at work, and maintaining healthy relationships with boundaries. You can find some more helpful information on the different types of stressors to look out for here.
SYSTEMIC TREATMENTS OF ASSOCIATED CONDITIONS & SYMPTOMS
Since PCOS occurs in synchrony with other systemic conditions, treatments vary widely depending on your own clinical needs. Many of the symptom-specific treatments can also influence other associated conditions along with your PCOS; for further clarification we recommend you create an account with Pollie to get connected to a healthcare provider.
See above! Changes in lifestyle behaviors can also influence almost all other associated conditions besides PCOS.
Hair Growth Treatments
Direct treatments: Spironolactone and Minoxidil, both pharmaceuticals, and herbal supplements can all encourage hair growth. Make sure to work with a qualified provider before starting any new regimen, even if you are using over-the-counter medication or supplements: our bodies are all unique, and what may encourage hair growth in one person does not mean it will automatically work for you.
Diabetes or insulin-resistance treatment: Insulin-resistance can accelerate other imbalances that lead to hair loss. If you have Insulin-Resistant PCOS and are experiencing issues with your hair, you may see improvement from using Metformin, alpha-glucosidase inhibitors, DPP-4 inhibitors, dopamine agonists, GLP-1 receptor agonists, sulfonylureas, and more. Similar to hair loss treatment be sure to work with a qualified provider before beginning any treatment for insulin resistance.
Hormonal contraceptives: As mentioned above, hormonal birth control can help put a band-aid on high androgens like testosterone. Hyperandrogenism is a leading cause of acne in female bodies as it leads to more sebum creation.
Other targeted treatments: Pharmaceuticals like Accutane and Differin can help acne for many; that said, be aware that if PCOS is the root cause of your skin issues breakouts will likely pop up again if underlying imbalances are not confronted. Beyond conventional drugs, natural options include supplements and facial oils.
As mentioned, mental health issues like anxiety and depression are commonly seen with PCOS. If you are experiencing these issues, be sure to seek out help from a qualified counselor or therapist like one of the specialists in Pollie’s directory. If this is not realistic financially, there are dozens of lower-cost digital tools that you can use to help manage your mental health. Our concierge service can help you find one of these tools.
PCOS care at Pollie
PCOS is a very common, and also very complicated, condition. While there is no “cure” for PCOS, symptoms can be managed, and some people even find they can remove themselves from the PCOS spectrum with the proper lifestyle changes and in some cases, medication.
PCOS should not be something you have to deal with alone. Pollie is here to help you understand and manage your hormonal health. For more information on PCOS and how to find your “perfect provider”, read our blog and get started as a member today.
Jocelyn is a certified crisis counselor and health journalist passionate about integrative healthcare, plant-based nutrition, and socio-cultural determinants of health. She double majored in Human Health at Emory University and aspires to make biomedicine more digestible and explore cultural wellness phenomena.