Have you been afflicted with adult acne and irregular periods? The problem might be polycystic ovary syndrome (PCOS), an endocrine system disorder caused by off-kilter reproductive hormones; it affects 5 to 10 percent of women ages 15 to 44.
Experts believe there may be a genetic component. “There's a lot of evidence that says that it is multifactorial, that may be somewhat inherited, but there are certainly components of it that are not,” says Kathryn Born, MD, an OBGYN with Mercy Health Saint Mary’s in Grand Rapids, Michigan.
PCOS causes a myriad of changes to the body—in addition to altering a woman’s appearance, it affects menstrual cycles and reproductive health. And while the outward changes may be more immediately troubling, it’s important to understand what’s going on beneath the surface.
What happens to your body
Women with PCOS have elevated levels of androgen, usually considered a male hormone. When androgen levels in a woman’s body are higher than normal, she may develop traits characteristic of men. These can include male-pattern baldness or excess hair growth on the face, chin and more.
That’s not all—women with PCOS may also experience weight gain, acne and irregular menstrual periods. During a normal menstrual cycle, says Born, “You spend about half of the time building up the lining of the uterus to get ready for a pregnancy. Then, the second half of the cycle, after ovulation, the lining is stabilized and just waiting for pregnancy."
If you aren’t pregnant, the uterine lining sloughs off, leading to a regular period. Since women with PCOS don’t ovulate regularly, the lining continues to thicken, which can lead to heavy bleeding after ovulation or when you haven’t ovulated, and can increase the risk of endometrial cancer.
PCOS may also make it difficult for a woman to get pregnant. “Fertility in a perfectly normal cyclic woman is only about 15 to 20 percent per cycle,” Born says. “If you drastically reduce the number of cycles that a woman has, and then decrease her ability to predict when she's ovulating, then there's going to be a decrease in fertility,” she adds.
Experts believe PCOS is strongly linked to conditions like diabetes, obesity, high cholesterol and high blood pressure—all risk factors for heart disease, the leading cause of death in the United States.
An April 2018 study published in The Journal of Clinical Endocrinology and Metabolism suggests PCOS may also be linked to an increased risk of mental health disorders. Researchers compared data from nearly 17,000 women with PCOS to a similarly sized group of women without PCOS and found women with the condition had slightly higher rates of depression, anxiety and bipolar disorder. Screening for mental health issues among those with this hormone disorder may be a good idea, according to study authors.
The road to diagnosis
There is no single test that leads to a PCOS diagnosis. Instead, healthcare providers (HCPs) must rely on physicals, pelvic exams and blood tests to eliminate the possibility of other conditions. After they're ruled out, a woman must present with at least two of the following to be diagnosed with PCOS:
- Irregular periods
- High levels of androgen in the blood, which may cause excess hair growth, baldness or acne
- Cysts on one or both ovaries
“Diagnosis can happen anywhere from teenage years to 20s and 30s,” Born says. It's most common in teens, when their periods fail to become regular, or later on, when women are trying to conceive.
Let’s talk treatment
PCOS treatments vary based on the goals of the woman—if she isn't trying to conceive, birth control is usually prescribed to regulate periods and counter the effects of excess androgen, like acne and hair growth. If birth control fails to do the trick, medications like spironolactone may be used to reduce the appearance of these symptoms.
If a woman is looking to conceive, weight loss will likely be important. “At least 50 percent of women with PCOS are overweight and there's a lot of data that suggests that the fertility is improved by even just a 5 to 10 percent weight loss,” Born says. After slimming down, a woman wanting to get pregnant may be prescribed medication to induce ovulation.
At least there's some good news: Even though women will have PCOS for the rest of their lives, symptoms typically go away after menopause.
If you think you’re experiencing signs of polycystic ovarian syndrome, it’s best to speak with your HCP about PCOS diagnosis and treatment options.
