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.
We’ve spoken a lot about PCOS at Pollie, and you can check out more specific articles like how our co-founder’s PCOS diagnosis led to Pollie’s creation, what the longer-term health risks of PCOS are, and guidelines for managing PCOS through diet.
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
- Thinning of hair and hair loss from the head (alopecia)
- Oily skin, acne, psoriasis, eczema, or hives
- 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
- Obstructive sleep apnea
- Fatty liver disease
- Unexplained fatigue or insomnia
- Low sex drive
- Joint pain
- Abnormal skin discoloration
- Gut problems such as IBS or SIBO
*Because PCOS is often accompanied by other conditions, many symptoms are also related to insulin resistance and obesity.
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).
INSULIN-RESISTANT PCOS
- 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.
ADRENAL PCOS
- 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.
POST-PILL PCOS
- 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:
- Anovulation
- Hyperandrogensim
- Polycystic ovaries
New to the world of hormonal health and need a bit more context on this? Check out the graphic below:
Other conditions to look out for
PCOS is often not a stand-alone diagnosis; other non-communicable health risks tend to occur alongside PCOS. Below are some general recommendations for other conditions to monitor:
- Thyroid / adrenal function
- High inflammation
- Insulin resistance, obesity and diabetes
- High blood pressure, high cholesterol, and heart disease
- Estrogen dominance
- Depression and anxiety
These associated conditions can be confusing if not completely overwhelming to monitor and fully understand alone. That’s where Pollie steps in to help! You can learn more about associated PCOS conditions and how to take back control of PCOS health risks with the help of specialists at Pollie.
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 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. Thus, it is ideal to find pills with a non-androgenic progesterone. 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.
Lifestyle Interventions
- 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.
- Some reports have noted certain foods or herbal supplements have medicinal-like properties that can help them manage their symptoms.
- For Post-Pill PCOS, certain nutrients can help manage the transition
- 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.
Lifestyle Interventions
- 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: Changes to the hair are impacted by testosterone. However, 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.
Acne-Prone Skin
- 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.
- Cycle syncing: Cycle syncing is aligning your daily activities with the pattern of your cycle. While the research is still out on this, anecdotal evidence suggests this is a beneficial way to improve acne through understanding how your skin changes with your cycle. This method is most relevant for people with PCOS that have (at least somewhat) regulated their ovulation and periods.
Mental Health Counseling
- 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.
Your care team is here to help you navigate your PCOS journey. Be sure to reach out to your care coordinator or coach with any specific questions prior to your first appointment with our functional nutritionist.
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