I once read somewhere that a woman experiences more hormonal changes in one month than a man does in a lifetime. I took that as a joke, of course. But, I could not help thinking that a tiny fraction of truth exists in such a statement. At least when explaining the differences in healthcare needs between women and men.
As women, we are generally aware that many of the female-specific medical issues stem from the state of our reproductive health. With Polycystic Ovary Syndrome or PCOS, that connection is crystal clear.
Still, many live with PCOS without seeking help. It often remains unrecognized and misdiagnosed, leaving women to cope with multiple symptoms that profoundly affect many aspects of their life.
Changing this trend is imperative for all women. More so for those working in healthcare, like me. Recognizing the early symptoms and getting a proper diagnosis is the invaluable first step toward better physical and mental health and a higher quality of life.
What is PCOS?
Medical science classifies PCOS as a metabolic and endocrine disorder. Statistics show it affects up to one in five women worldwide. As such, it is the most common female reproductive health issue and a leading cause of infertility. However, its effects on general well-being reach even further.
An early diagnosis is essential for the quality management of PCOS symptoms. However, many women feel shy asking for professional help in the early stages of adolescence, when the first signs of PCOS usually appear.
Some of these symptoms do not show a clear link to reproductive health. For example, acne, weight gain, or excessive facial and body hair (hirsutism) may all look like separate issues in young woman’s eyes.
Having so many bodily issues simultaneously, without knowing the real cause, damages physical and mental health. It may lead to insecurity, low self-esteem, lack of physical and social activity, obesity, anxiety, depression, and so on.
All these factors together aggravate the problem and make looking for professional assistance much less probable.
How do you recognise the early signs of PCOS?
The top three pieces of advice I have for every woman are:
1. Listen to your body. – If something feels off, don't accept it as normality.
2. Don’t be shy or afraid to ask for help.
3. Seek a second opinion if you are not satisfied with the level of medical care you are receiving.
The early symptoms of PCOS may include:
· Proneness to weight gain
· Irregular periods
· Hirsutism ( facial and body hair growth in a male-like pattern)
· Hyperhidrosis (excessive sweating)
· Acne
The inability to conceive is usually an indication of late PCOS discovery. That does not mean it is too late to get a check-up and begin treatment.
So, if you are experiencing one or more of these symptoms, you should check your reproductive health. But, getting a proper diagnosis may not be as easy as you think.
Primary care doctors often lack the necessary knowledge about PCOS. It's not that they do not want to help. It's just that they don't do enough, and sometimes they don't do anything. So, some women start feeling like they’re stuck in an episode of “Mad Men.”
If your doctor tells you: "Don't worry, it's nothing" or "Wait until you are older." – You should seek a second opinion.
Diagnosing PCOS
There are three steps toward getting a PCOS diagnosis:
1. Discussing the symptoms with your doctor to rule out other potential causes.
2. Blood tests - to determine hormones, blood sugar, and cholesterol levels.
3. Ultrasound scan of the ovaries.
All three steps are necessary before a conclusive finding.
If the doctors rule out all other potential causes for your symptoms, they will use the following criteria to determine whether or not you have PCOS:
· The presence of infrequent or irregular periods.
· High levels of male hormones (testosterone).
· Ultrasound scan showing multiple follicles on your ovaries (polycystic ovaries).
Meeting two out of three criteria means that you have PCOS.
PCOS and Obesity
Obesity has a central role in PCOS. That is a scientific fact that leaves little room for doubt. However, the big question most researchers ask themselves is: What comes first? Is obesity the cause or the consequence of PCOS?
The data from some relevant studies show that up to eighty percent of women with PCOS may be overweight or obese. However, there are many lean women with PCOS too.
So, to try and answer the "What came first" question, scientists look at certain factors in obese and normal-weight women with PCOS.
The most important of these factors are:
· The presence of hyperandrogenemia (excess facial hair, acne, etc.),
· Insulin resistance, and
· Body fat distribution
The findings are intriguing. They show that both lean and overweight women with PCOS share the same reproductive function problems, such as menstrual irregularity, and metabolic issues like lower insulin sensitivity.
Therefore, we cannot conclusively say whether Polycystic Ovaries Syndrome causes obesity or if being overweight increases the risk of developing PCOS.
One thing is guaranteed, though. Managing the symptoms of PCOS on healthy body weight is simpler by far.
Also, losing weight lowers the risk of other health complications and chronic illnesses, such as type 2 diabetes or heart disease. It improves self-confidence and the overall quality of life.
Treatment and Outcomes
There is no cure for PCOS. After all, to cure something, we need to know the exact cause. Fortunately, we can do much to improve the symptoms.
Not all common symptoms of PCOS are present in every patient. They also often differ in intensity.
Making lifestyle changes, such as getting more exercise, eating healthy, and losing weight, is a great way to start managing your PCOS. However, that’s rarely enough.
Certain medications can help improve particular symptoms, such as:
· Irregular periods (contraceptive pills or progestogen tablets)
· Fertility issues (Clomiphene, Metformin, Letrozole)
· Unwanted hair growth (Combined contraceptive pills, Finasteride, Spironolactone)
· Low insulin sensitivity (Metformin)
· High cholesterol (statins)
Some devices and procedures can aid the treatment, such as Intrauterine System (IUS), laser hair removal, and Laparoscopic Ovarian Drilling (LOD). The latter is a type of minor infertility surgery that corrects the function of your ovaries.
Talk to your OB/GYN specialist about all treatment options, make a plan, and stick to it. With that approach, things can only get better.
References:
1. Deswal R, Narwal V, Dang A, Pundir CS. The Prevalence of Polycystic Ovary Syndrome: A Brief Systematic Review. J Hum Reprod Sci. 2020 Oct-Dec;13(4):261-271. doi: 10.4103/jhrs.JHRS_95_18. Epub 2020 Dec 28. PMID: 33627974; PMCID: PMC7879843.
2. Smet ME, McLennan A. Rotterdam criteria, the end. Australas J Ultrasound Med. 2018 May 17;21(2):59-60. doi: 10.1002/ajum.12096. PMID: 34760503; PMCID: PMC8409808.
3. Sam S. Obesity and Polycystic Ovary Syndrome. Obes Manag. 2007 Apr;3(2):69-73. DOI: 10.1089/obe.2007.0019. PMID: 20436797; PMCID: PMC2861983.
4. Woodward A, Klonizakis M, Broom D. Exercise and Polycystic Ovary Syndrome. Adv Exp Med Biol. 2020;1228:123-136. doi:10.1007/978-981-15-1792-1_8
5. Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics. 2015;136(6):1154-1165. doi:10.1542/peds.2015-1430