In this article:
- High androgen levels, obesity, and genetics play defining roles in the occurrence of PCOS.
- Women with PCOS are generally overweight or obese, but lean and underweight women can also develop this condition.
- PCOS is a long-term condition that usually begins at puberty and continues even after menopause.
- Ceratin dietary interventions and treatment strategies can help reduce the intensity and frequency of PCOS symptoms.
- PCOS can give rise to fertility issues and several pregnancy-related complications if left untreated.
- Despite its name, PCOS need not lead to the development of multiple cysts on either or both the ovaries in all the patients.
- PCOS can put you at an increased risk of other chronic ailments if left unchecked.
Polycystic ovary syndrome (PCOS) is one of the most common endocrine disorders observed among women of reproductive age, but it is essentially a lifelong condition whose symptoms may persist well beyond menopause.
In the United States alone, 6%-12% of females are diagnosed with PCOS during their childbearing years, which translates to approximately 5 million women. (1)
This endocrinopathy is characterized by an excess of androgens, which are male sex hormones that are found in both genders.
Thus, women with PCOS tend to have abnormally high levels of androgens, which hamper the functioning of their ovaries and thwart the ovulation process. The ovary releases a mature egg into the fallopian tube every month, which if fertilized by a sperm leads to a pregnancy.
Given that ovulation is an essential prerequisite for pregnancy, PCOS can make it very difficult for a woman to conceive by causing anovulation (lack of ovulation in a menstrual cycle).
In fact, PCOS is regarded as one of the leading causes of both anovulation and female infertility. A lot of women with PCOS become aware of their condition only after getting tested for infertility issues.
There are other symptoms too that can indicate a possible PCOS diagnosis, including:
- An erratic menstrual cycle characterized by irregular periods
- Hirsutism, or the growth of excess unwanted hair on the face and body
- Hair thinning on the scalp (2)
PCOS gets its name from the fact that it often leads to the formation of multiple small fluid-filled cysts in and on the ovaries. That said, it is not entirely uncommon for women to have this disorder without the appearance of ovarian cysts.
Conversely, some women tend to develop ovarian cysts that have nothing to do with PCOS. Thus, the presence of ovarian cysts alone is not proof enough for a PCOS diagnosis.
PCOS also goes by some other lesser-known names such as Stein-Leventhal syndrome, functional ovarian hyperandrogenism, and ovarian androgen excess.
Why Does One Develop PCOS?
While the exact cause of PCOS remains unidentified, it is typically related to a hormonal imbalance in the woman’s body.
1. High levels of androgens
All women secrete a minimal quantity of male hormones, but in women with PCOS, the ovaries produce abnormally high levels of androgens.
Androgens play a central role in regulating the menstrual cycle and ovulation. The ovarian function is negatively affected when there is an excess of these hormones in the female body.
This type of hormonal imbalance can prevent your ovaries from releasing a mature egg during each menstrual cycle. This can cause irregularities in your menstrual cycle and fertility issues.
Because androgens are responsible for the development of masculine traits, women with PCOS often display features that are characteristic of men. These include extra hair growth on the face and body and male-pattern baldness.
2. High levels of insulin and obesity
Insulin is a peptide hormone that plays a critical role in the regulation of your blood sugar level and the conversion of food into energy.
It is a chemical messenger that triggers your body’s cells to draw out the dietary glucose from the bloodstream and use it as energy or store it in the cells for later use.
If your body’s cells fail to respond normally to the signals sent by insulin, this hormone will accumulate in the blood. The inability of the body to utilize insulin effectively is known as insulin resistance, which is a precursor to type 2 diabetes.
Researchers have also observed a link between increased levels of insulin and the corresponding increase in the secretion of male hormones in some women. (3)
Thus, in effect, it can be said that high levels of insulin stimulate the ovaries to produce more male hormones. (3)
This is probably why a lot of women with PCOS are found to be insulin resistant, particularly if they are struggling with obesity or are overweight, lead an inactive lifestyle, have unhealthy dietary habits, and have a family history of diabetes (usually type 2 diabetes).
3. Low-grade inflammation
Another common characteristic found in many women with PCOS is they suffer from a type of low-grade inflammation that triggers their ovaries to secrete high levels of the male hormones. (4)
Over time, this excess of androgens can pave the way for heart and blood vessel problems. (4)
Genetics is also considered an important factor as PCOS tends to run in families. If your mother or sister has PCOS, you have a 50% chance of having it as well.
Moreover, people with a family history of type 2 diabetes are also more likely to be diagnosed with PCOS as opposed to those who do not.
This inherited predisposition to PCOS cannot be traced back to any single gene. It is probably the result of a complex mix of several genealogical factors.
How Can You Tell That You Have PCOS?
Women with PCOS usually have at least two of the following three conditions: (2)
- The ovaries fail to release an egg regularly, leading to an unstable menstrual cycle. The absence of ovulation is characterized by irregular or prolonged periods (abnormal mensuration) and, in some cases, cessation of periods altogether (amenorrhea).
- In the majority of PCOS cases, one or both the ovaries sprout benign fluid-filled sacs or cysts.
- The excessive androgen secretion can lead to male-like features such as hirsutism or the growth of extra unwanted hair on the face, chin, and other parts of the body where women typically do not have hair.
The signs and symptoms of PCOS vary from patient to patient, but here are some of the most commonly reported ones:
- Hair loss from the scalp or male-pattern baldness
- Excessive cramping and bloating during menstruation
- Skin that is greasier than normal, causing acne breakouts on the face, chest, and upper back
- Dark skin patches on the body, especially in areas with skin folds such as the neck, groin, and under the breasts
- Appearance of skin tags, or small flaps of excess skin, in the armpits or around the neck
- Difficulty conceiving due to irregular ovulation or no ovulation at all
- Psychological stress and depression
- Fatigue and low energy for no discernible reason (other PCOS-related issues such as poor sleep may further aggravate the feeling of fatigue)
- Pelvic pain
- Rapid weight gain and difficulty shedding the extra kilos, making women with PCOS prone to obesity
- Increased susceptibility to mood swings, depression, and anxiety
PCOS can also lead to the onset of other chronic ailments over time. Women with this condition are at an increased risk of developing insulin resistance, type 2 diabetes, high blood pressure, high cholesterol, and heart disease. (5)
Early treatment and regular follow-ups can help safeguard you from these negative outcomes.
How Is PCOS Diagnosed?
If your physician suspects that you have PCOS, he or she will most likely refer you to a gynecologist or an endocrinologist for a more thorough analysis.
To get a clear understanding of your condition, the specialist will inquire about:
- Your symptoms, with a special focus on the regularity of your periods
- Your medical history
- The medicines you are currently on
- Allergies that you may have
- Health issues that run in your family
This preliminary investigation is followed by a physical exam, which typically includes:
- Measuring your weight and height to check if your body mass index (BMI) is within the healthy range
- Looking for physical symptoms that are commonly associated with PCOS, such as acne, excess facial or body hair, dark skin patches, and skin tags
Other health conditions can give rise to symptoms that are similar to PCOS, so your doctor may conduct extra tests to avoid misdiagnosis:
- Gynecologic exam: Expect your health care provider to conduct a physical examination inclusive of a pelvic exam. The pelvic exam helps eliminate other possible causes of your symptoms.
- Ultrasound: Your doctor may order an ultrasound to get a closer look at your ovaries. This imaging test measures the size of your ovaries, confirms the presence of ovarian cysts, and gauges the thickness of the endometrium (the lining of the uterus).
All of these are important factors for PCOS diagnosis.
- Blood tests: As PCOS is a hormonal disorder, your doctor may conduct blood tests to check if your androgen levels are above normal as well as other hormonal imbalances.
The blood work helps determine if your symptoms are caused by PCOS or problems with other glands such as the thyroid.
The doctor will also order tests to evaluate other health markers that are relevant to PCOS, such as blood glucose, insulin, cholesterol, and triglyceride levels.
There is no absolute cure for PCOS. Hence, the primary aim of treatment is to manage the condition.
Several medical interventions can address the main symptomatic concerns associated with PCOS, which include hirsutism, acne, weight issues, menstrual irregularities, and infertility.
Managing Hirsutism (Excessive Hair Growth)
One of the most conspicuous ill effects of PCOS is hirsutism or excessive hair growth on the face and the body. Here are a couple of treatment techniques to address this problem:
- Removing hair: Facial hair removal creams, laser hair removal, and electrolysis help remove excess hair.
While hair removal creams and products are readily available at drugstores, procedures such as laser hair removal or electrolysis require the expertise of a doctor and can only be performed clinically.
- Slowing hair growth: Your doctor may prescribe a skin treatment using eflornithine HCl cream to reduce the growth rate of unwanted facial or body hair.
Doctors routinely recommend the following medicines to manage PCOS symptoms:
Hormonal birth control: Women who are not planning on conceiving and are willing to use contraception can take hormonal birth control in the form of a pill, patch, shot, vaginal ring, and hormonal intrauterine device (IUD) to manage their PCOS condition.
It is essential that you speak with your doctor about the most preferable option for your particular case.
Birth control should ideally include both estrogen and progesterone, which will help you:
- Regularize your menstrual cycle
- Lower your risk of endometrial cancer
- Improve acne
- Reduce the excessive hair growth on your face and body
Anti-androgen medicines: These drugs are not approved by the Food and Drug Administration (FDA) to treat PCOS symptoms and come with their own set of precautions.
For instance, anti-androgen meds are strictly prohibited for pregnant women as they can trigger various complications. Thus, let your doctor decide if this treatment option is suitable for you or not, instead of self-medicating.
Anti-androgen medicines work by countering the unfavorable activity of excessive androgen levels in the body. They have been found helpful in reducing scalp hair loss, facial and body hair growth, and acne.
Metformin: Metformin is traditionally used in the treatment of type 2 diabetes and has been shown to help mitigate PCOS symptoms in some women. However, this drug is not approved by the FDA to treat PCOS symptoms.
Metformin enhances your body’s ability to utilize insulin. Such action may help bring down your blood sugar levels while simultaneously decreasing your insulin and androgen levels.
Continued use of metformin for a few months may even help restart ovulation. It may also help lower your body mass and improve your cholesterol level.
However, the drug is of little use when it comes to addressing the physical manifestations of PCOS such as acne and extra hair on the face or body.
Statins: Statins are a group of lipid-lowering drugs that may help reduce your cardiovascular risk.
Women with PCOS tend to have high cholesterol levels, which may jeopardize their heart health in the long run. Thus, they are more prone to having a heart attack or stroke than those without PCOS.
Statins inhibit the production of hepatic cholesterol and improve low-density lipoprotein (LDL) clearance from the blood. These actions help lower the levels of LDL cholesterol, also known as “bad cholesterol.”
Moreover, these drugs are attributed with anti-inflammatory properties that can help diminish certain inflammatory markers that are typically elevated in PCOS. (6)
Many PCOS symptoms improve with positive lifestyle choices. Here are things you can do to help manage your condition.
1. Maintain a healthy weight
PCOS symptoms tend to be more pronounced in women who are on the heavier side. Strict weight management is the only way to ensure that your ovaries function normally and produce an optimal level of hormones in the body.
Besides helping you attain a healthy hormonal balance, losing the excess weight may lower your blood glucose levels and improve the utilization of insulin by your body.
By addressing all these contributing factors, weight reduction may significantly reduce the intensity of various PCOS symptoms, such as hirsutism, acne, and hair loss from the scalp.
Additionally, healthy weight management can help reduce the risk of other long-term health issues that usually develop in association with PCOS.
2. Have regular health checks
PCOS can pave the way for other chronic medical conditions. Thus, you have to work closely with your doctor to monitor your overall health.
Once you are diagnosed with PCOS, it is important to visit your doctor for regular follow-ups to make sure that you are not developing any new health problems.
Regular health checkups can help your doctor detect the early signs of other PCOS-related conditions so that they can be treated right at its onset before it becomes serious. These conditions include the following:
- Diabetes: Women with PCOS who are over the age of 40 should get their blood sugar tested at least once a year to check for signs of diabetes.
The need for such tests is even more urgent if the BMI is 30 or over or if diabetes runs in the family. Women with such risk factors will most likely be tested for diabetes even before they turn 40.
- Cancer of the womb: Women with PCOS are advised to seek medical consultation if their periods are extremely irregular or if they haven’t had a period for over 4 months.
In such cases, the doctor usually conducts additional tests that may include an ultrasound scan of the womb (uterus) to check for signs of uterine cancer.
Moreover, the doctor will prescribe the appropriate treatment to regularize the erratic menstrual cycles.
- High blood pressure: Women with PCOS need to keep a close watch on their blood pressure and cholesterol levels. It is best to ask your doctor about how frequently you should get tested for these important health markers.
- Depression and psychological problems: PCOS can negatively impact your mental health and can trigger depression as well as other psychological problems.
If your doctor deems it necessary, he or she may refer you to a counselor or mental health specialist.
3. Keep your stress in check with yoga and meditation
The therapeutic effects of yoga are not limited to your physical body alone but encompass the mind and soul as well.
Certain yoga exercises relieve abdominal compression, restore gastrointestinal balance, and improve digestive functioning by gently massaging the internal organs. These asanas facilitate improved blood flow in the body, help open up the pelvic area, and make you feel relaxed. (9)
Additionally, doing a bit of yoga on a regular basis can also help you lose weight and keep your metabolism rate high.
Meditation is another fundamental aspect of yoga that helps you center your mind and tune out the stress of the world by focusing your energies inward. (10)
Kapalabhati is perhaps the most well-known rapid breathing technique, wherein air is inhaled normally, but expiration is forced with the help of the abdominal muscles. (11)
For any of the yoga techniques to work, it is essential that you take long and deep breaths while performing each pose.
Coordinating your exercises with your breathing helps align your mind and body in complete harmony and promotes a deep sense of relaxation.
Some of the most beneficial yoga asanas for PCOS management include:
- Baddha Konasana (Butterfly Pose)
- Savasana (Corpse Pose)
- Supta Baddha Konasana (Reclining Bound Angle Pose)
- Padma Sadhana (Lotus Meditation)
- Surya Namaskar (Sun Salutation)
4. Exercise to re-energize (for cramps)
Most of the discomforting complications associated with PCOS can be adequately managed by improving insulin resistance in the body.
Regular exercise is extremely effective in this regard, even if it does not result in any noticeable change in weight or body fat measurement.
A systematic review and meta-analysis of 14 studies conducted on 617 women with PCOS found exercise interventions to be useful in reducing the waist circumference, systolic blood pressure, and fasting insulin levels of the subjects while improving their lipid profiles. (12)
According to another 2017 review, structured physical exercise should be a mandatory part of PCOS treatment particularly for overweight patients, but it may also benefit lean women with PCOS by improving their insulin sensitivity, hyperandrogenemia, and menstrual frequency. (13)
Women with PCOS are usually recommended to take up a multipronged exercise routine that focuses on building both cardiac health and muscle strength.
Keeping yourself active regularly helps:
- Lower your androgen levels
- Improve your insulin resistance
- Regulate your menstrual cycles
- Increase your energy levels
- Improve your self-esteem
- Induce ovulation
- Enhance your fertility
- Reduce anxiety and depression
5. Quit smoking
A lot has been said about the damaging consequences of smoking on both cardiovascular and respiratory health, but not a lot of people know that smoking can also spike the level of male hormones in the body.
In fact, smoking during ovulation induction can greatly reduce the odds of live birth, especially if you have PCOS.
PCOS is associated with an increased risk of metabolic syndrome and cardiovascular ailments, and the risk is only made worse by smoking. This was corroborated by a 2014 study published in Gynecological Endocrinology.
The study found that women with PCOS who smoke are more likely to develop diabetes, metabolic syndrome, and other cardiovascular problems than PCOS patients who do not smoke. (14)
If you wish to bring your PCOS under control and ensure your overall well-being, do yourself a favor and quit this unhealthy habit for good.
Diet plays a critical role in the management of PCOS symptoms. Your diet should include at least 5 portions of fruits and vegetables daily, lean meats particularly fish and chicken as well as whole foods like brown rice, wholegrain cereals and wholemeal bread. (15)
Your GP may be able to refer you to a dietitian if you need specific dietary advice.
Word of Caution: You must speak with your ob-gyn before trying or adopting any new dietary interventions for PCOS to avoid any complications.
1. Add these kitchen ingredients to your diet
Note: Check with your doctor about the appropriate dosage, but you are generally advised to limit your daily cinnamon intake to 2 teaspoons. Excessive consumption of this spice can reduce your blood sugar to dangerously low levels.
Fenugreek is known to promote glucose metabolism in the body by reducing insulin resistance. This is an important pre-requisite for the correction of the hormonal imbalance in women with PCOS.
A 2013 study published in the Iranian Journal of Pharmaceutical Research found that adjuvant therapy using fenugreek seeds extract (with metformin) to treat PCOS led to an improvement in the sonographic results and menstrual cyclicity of the patient. (19)
Another 2015 study suggested that fenugreek supplementation may help shrink or dissolve ovarian cysts in women with PCOS and thereby improve their symptoms and regularize their menstrual cycle without causing any adverse side effects. (20)
Turmeric owes much of its medicinal potency to curcumin, which acts as a natural estrogen source. This yellow-colored compound is known to mimic the activity of estrogen. Thus, it can be beneficial for menstrual regulation and fertility.
Animal studies have highlighted the anti-inflammatory and antioxidant effects of curcumin, which may help in managing PCOS symptoms. However, there is still a need for direct human trials to conclusively establish these claims. (21)(22)
Chasteberry, also called vitex, is another popular medicinal herb for redressing the symptoms of PCOS and treating infertility due to hormonal imbalance. It is a great hormone-balancing herb and is also used as a remedy for menstrual problems. (23)
2. Make your meals nutrient-rich
Foods that are rich in omega-3 are particularly suitable for women with PCOS as they figure low on the glycemic index.
This essentially means that including such foods in your diet will help manage your PCOS symptoms without negatively impacting your insulin and sugar levels.
A 2017 double-blind, randomized clinical trial found omega-3 fatty acids to be helpful in decreasing bad cholesterol levels while increasing good cholesterol levels, reducing waist circumference, and decreasing the interval between menstrual periods. (25)(26)
Loaded with omega-3 fatty acids, fish oil helps enhance insulin sensitivity and thereby reduce androgen secretion.
A randomized controlled trial published in the American Journal of Clinical Nutrition supported the claim that fish oil intake can improve PCOS symptoms by balancing the androgen levels. (24)
To avoid complications, it is best to confer with your doctor about the appropriate dosage of omega-3 that will help your condition.
Caution: Consuming large amounts of fish oil is not recommended due to its mercury content, which is detrimental to human health.
Flaxseeds are also replete with omega-3 fatty acids and may help with PCOS management when consumed as part of an overall healthy and well-balanced diet.
You can take flaxseed supplements to relieve PCOS symptoms, but ask your doctor about the correct dosage instead of self-medicating.
While there is some scientific support for the use of flaxseeds for PCOS management, further research is needed to establish its efficacy. (27)
Caution: Flaxseeds should never be used unripe or raw as it is thought to be poisonous. It should be avoided by individuals suffering from gastrointestinal obstruction, bleeding disorders, and hormone-sensitive cancers and should be used with caution in pregnancy, hypotension, and hypertension.
Also, you may ask your doctor about taking omega-3 supplements, as it may improve the quality of eggs produced from the ovaries and, thereby, your fertility.
Some other sought-after dietary sources of omega-3 include tuna, salmon, walnuts, and soybeans.
Vitamin D and calcium
Women with PCOS generally run low on vitamin D which is evident from the fact that 6% to 85% of the patients showed serum concentrations of less than 20 ng/ml of vitamin D, approximately 25-hydroxy vitamin D (25 OHD). (42)
The primary role of vitamin D is to help your body effectively absorb calcium from food. Additionally, this vital nutrient plays a key physiologic role in reproduction, including ovarian follicular development. (28)
A vitamin D deficiency not only causes poor bone mineralization, but it is also known to worsen PCOS symptoms. (29)
Women with PCOS who are deficient in these nutrients can benefit from taking vitamin D and calcium supplements upon their doctor’s recommendation. Doing so can help alleviate PCOS symptoms and regulate any menstrual abnormalities. (30)
Insulin resistance and/or type 2 diabetes is associated with increased excretion of higher-than-normal amounts of magnesium in the urine.
The continued loss of heavy amounts of magnesium can render one deficient. This is why experts believe there may be an association between magnesium deficiency and the development of insulin resistance. (31)
It is, therefore, imperative for women with PCOS to up their intake of dietary magnesium. Some of the best food sources to meet your daily magnesium needs include:
- Green leafy vegetables (e.g., spinach)
- Whole grains
- Fortified foods (e.g., breakfast cereals)
- Dairy foods
Foods that contain B vitamins alleviate PCOS symptoms by promoting the healthy functioning of the hormonal system while reducing androgen levels in the body. (32)
One of the predominant symptoms reported among women with PCOS is an overwhelming sense of fatigue.
Several factors can contribute to low energy levels, such as an underactive thyroid, low vitamin B12 or vitamin D levels, sleep issues, and anemia (low blood count).
Moreover, certain medications such as metformin may also play a role in lowering vitamin B12 levels, which can further plummet your energy levels.
Consume more of whole grains, nuts, and skim milk, all of which are brimming with B vitamins and can help you deal with symptomatic fatigue. (33)
3. Try a ketogenic diet
PCOS makes you prone to rapid and drastic weight gain. It also makes it extremely difficult for you to lose the extra pounds.
This can be quite an ordeal as the excess body weight further exacerbates the symptoms of PCOS. Thus, an important aspect of PCOS management is to watch what you eat, besides getting your regular dose of exercise.
Some diets work better than others for PCOS patients, with ketogenic diet figuring as one of the most successful ones.
This dietary intervention helps in stimulating the release of ketones in the body, which serve as a healthier alternative to the normal source of energy, which is carbohydrates or sugar.
When your body lacks enough insulin to turn glucose into energy, the liver starts burning the fat for fuel. Ketones are by-products of fat metabolism in the liver.
Thus, a ketogenic diet aims to supplement your body’s energy needs through foods that are low in carbs and high in fat.
Sticking to this diet may help trigger faster weight loss as your carb intake is greatly reduced while your body uses up the fat reserves for energy.
Reducing your carbohydrate intake may help also lower your insulin levels, which are typically elevated in PCOS.
According to a small-sized study performed on 5 women with PCOS, 24 weeks of ketogenic diet helped the subjects lose an average of 12% of their total body weight, which was accompanied by nearly a 54% reduction in their fasting insulin levels and considerable improvements in the levels of PCOS hormones. (34)(35)
4. Limit junk food and added sugars
Women with PCOS are advised to minimize their intake of calorie-laden junk foods.
These foods usually contain a lot of added sugars that can increase the insulin levels and further disrupt the hormonal imbalance, both of which can aggravate PCOS symptoms.
Besides, regular consumption of unhealthy foods that are loaded with calories and added sugars is an easy shortcut for speedy weight gain.
Maintaining healthy body weight is an absolute must for women PCOS if they wish to avoid ovulation problems and loss of fertility.
Some common foods to avoid include: (36)
- Muesli bars
- Milk chocolate
- Potato chips
- Ice cream
- Fruit juice
- Soft drinks
PCOS in Teens
At the onset of puberty, the body is still adjusting to the drastic hormonal changes. Thus, most girls experience irregular menstrual cycles in the first few years after the beginning of menstruation (menarche).
Therefore, such early-stage menstrual aberrations cannot be taken as signs of PCOS.
It can take about 2 years for the menstrual cycles to effectively regularize after having your first period. However, if you continue to have irregular periods longer than that, it may indicate PCOS-related ovulation problems.
Menstrual irregularities are part and parcel of normal puberty, particularly during the first 2 years. But the likelihood of PCOS increases if a teenage girl exhibits the following symptoms 2 years after menarche:
Moreover, it is common for teenage girls to develop large ovaries with many follicles during puberty, which can easily be mistaken as a sign of PCOS.
Therefore, an ultrasound is useless for determining whether an adolescent has PCOS or not.
Will My Symptoms Go at Menopause?
Even though PCOS is generally associated with reproductive function, it has a bearing on the working of several other body systems.
This condition is brought on by an overproduction of androgens in the female body, and this hormonal imbalance does not resolve with age or menopause.
It is common for women with PCOS to experience a sudden regularization of their menstrual cycles as they near the menopausal age. However, this does not mean that their PCOS has been cured.
Once you are diagnosed with PCOS, the symptoms will persist as long as your androgen levels remain abnormally high.
Thus, PCOS is basically a long-term health condition without a permanent cure. You can only hope to manage or reduce the symptomatic discomfort caused by PCOS.
Although the hormonal imbalance does not worsen with age, you become more vulnerable to other PCOS-related health problems as you get older.
For instance, PCOS can predispose you to diabetes, stroke, and heart attack. The risk only increases with advancing age.
Hence, women with PCOS are more likely to develop these conditions at a later stage in their life, possibly after menopause.
PCOS in Lean Women
There is a general misconception that PCOS only affects women who are overweight or obese. While PCOS is commonly associated with excess body weight, it is not limited to women who are on the heavier side.
Women with a normal weight and a healthy BMI can also develop PCOS, but less commonly than those who are overweight.
In fact, some underweight women have also been diagnosed with this condition, although the odds of that happening are pretty rare.
Moreover, the condition often goes undiagnosed in lean women because of the widely circulated myth that they have to be obese or overweight to get PCOS.
Nearly 5% of lean women are diagnosed with PCOS, which accounts for 20%-30% of all PCOS cases.
Women of average weight are less prone to insulin resistance, which is recognized as an underlying cause of PCOS. Although lean women may have a lower risk of developing insulin resistance, they are not immune to it.
Medical experts debate the possibility that thin women with PCOS may not suffer from the same level of insulin resistance as the heavier patients. (37)
The treatment options for PCOS also vary depending upon the weight of the patient.
Can One Conceive with PCOS?
PCOS is recognized as a prime culprit behind fertility problems, which may make it difficult for the patient to get pregnant naturally – that is, without any medical assistance.
However, a lot of people are under the misguided impression that women with PCOS are infertile, which is anything but true.
Some women with PCOS may face no trouble at all in getting pregnant, whereas others may require special fertility treatments to help the process along. These treatments are usually multifaceted and may include one or a combination of the following:
Moreover, women with PCOS have to be extra careful even after they conceive a baby since they are usually at a higher risk for negative pregnancy outcomes as opposed to women without PCOS.
On account of all these complications, childbearing women with PCOS may have to give birth before the baby is due, often through a C-section delivery.
PCOS vs. Ovarian Cyst: Know the Difference
Having ovarian cysts does not necessarily mean that you have PCOS. Ovarian cysts are fluid-filled sacs that develop on one or both the ovaries, usually as a result of a normal menstrual cycle.
Most women get these harmless cysts at some point in their lives, which often disappear on their own without any medical intervention.
Unlike normal ovarian cysts which are functional in nature, PCOS is brought on by a substantial hormonal imbalance in the female body.
Women with PCOS have an unusually large number of follicles on their ovaries, which are responsible for the secretion of excess androgens. Therefore, it is very common for women to have several cysts in or on their ovaries without suffering from PCOS.
Conversely, a woman with PCOS may or may not have multiple ovarian cysts, but her ovaries will have an abnormally high number of follicles on them.
PCOS vs. Fibroids vs. Endometriosis
PCOS, fibroids, and endometriosis are all gynecological complaints that affect the reproductive functioning of women, mostly during their childbearing years.
While these conditions may share some common symptoms, their genesis and prognosis are markedly different.
PCOS can be traced back to an overproduction of androgens by the ovaries. It is often characterized by the development of numerous tiny fluid-filled sacs in the ovaries.
Uterine fibroids, on the other hand, are benign tumors that can form in or on the uterus. These noncancerous uterine growths affect a majority of women, but they do not always present symptoms.
Fibroids are made up of smooth muscle cells and fibrous connective tissue, and they can greatly vary in size.
Fibroids can grow inside the womb, within the uterine wall, or on the outer surface of the uterus. What leads to their development is still unclear.
Endometriosis is a painful disorder characterized by the abnormal growth of endometrial tissue that forms the internal lining of the uterus in other adjoining areas like the ovaries, fallopian tubes, bowel, and sometimes even extending as far as the rectum, bladder, and pelvic area.
Women with PCOS are increasingly prone to the following complications:
- Loss of fertility
- Insulin resistance
- Elevated cholesterol levels
- High triglyceride levels
- Heart disease
- Endometrial cancer (cancer of the inner lining of the uterus)
- Sleep apnea
When to See a Doctor
It is well-advised to consult your healthcare provider for proper diagnosis and treatment if you are:
- Regularly missing your periods without being pregnant
- Concerned about symptoms such as hirsutism, acne, and male pattern baldness
- Unable to conceive despite repeated attempts
- Experiencing symptoms related to diabetes such as increased thirst, hunger, blurred vision, and sudden weight loss
Questions to ask your doctor:
- Is there any probable cause for my PCOS?
- Am I at risk for other health problems?
- How does PCOS affect my chances of getting pregnant?
- What lifestyle changes should I adopt to relieve my PCOS symptoms?
- How can I regulate my blood sugar levels through my diet?
- What treatment options do you recommend for me?
Questions your doctor may ask you:
- What are your signs and symptoms?
- Does PCOS run in your family?
- Do you have other period problems, including irregular periods?
- Do you suffer from other medical conditions such as diabetes or thyroid disorder?
Expert Answers (Q&A)
Answered by Dr. Harshal Deshmukh, MBBS, PhD (Endocrinology)
In the short term, the answer is no. However, in the long term, women with PCOS have a significantly high risk of having obesity, diabetes and other cardiovascular diseases such as coronary artery disease and stroke. (38)(39)(40)
Hence, PCOS can be life-threatening, and it is important to get the diagnosis as soon as possible and have a thorough long-term follow-up with an endocrinologist.
For the diagnosis of PCOS, two of the following three are required:
1) Irregular periods
2) Excess body and facial hairs, acne, or blood tests indicating high levels of testosterone
3) Ultrasound scan showing cysts on the ovaries.
Based on these criteria, PCOS can be classified as mild, moderate, or severe. While there are no specific tests to predict which women with PCOS can become pregnant, usually those with mild and moderate PCOS are more likely to have a successful pregnancy. (41)
A new test, the anti-mullerian hormone (AMH) test, can tell the number of functioning ovarian follicles in the ovaries of women with PCOS. Normal levels of this hormone mean a high chance of a successful pregnancy. (41)
Many women living with PCOS can also have a successful pregnancy using assisted reproductive technologies (ART) such as in vitro fertilization.
Polycystic ovarian syndrome (PCOS) and polycystic ovarian disease (PCOD) are terms that are generally used interchangeably.
PCOS is now the more accepted term as it reflects the complete spectrum of clinical and biochemical features of women living with PCOS.
Weight loss with dietary changes is the mainstay of PCOS management. A majority of women with PCOS have insulin resistance. Thus they need higher levels of insulin to keep their blood sugar level in a normal range. Insulin resistance also leads to obesity.
Hence, women suffering from PCOS should limit their intake of refined sugar and eat a low-carbohydrate diet.
This means avoiding fizzy drinks and foods that have a high glycemic index, such as potatoes, rice, and white bread. It is important to work with a dietician to have a dietary plan with a low-carbohydrate diet.
There is no cure for PCOS. However, a majority of PCOS symptoms can be reduced through weight loss. Once the diagnosis is made, weight loss is the mainstay of treatment.
Weight loss can be achieved by dietary changes mentioned above or with certain medications.
Metformin is the most commonly used medication in women with PCOS. It helps by reducing insulin resistance and weight loss. Some women with PCOS benefit from taking fat binders such as Orlistat.
There is a suggestion that if women with PCOS lose a sizeable amount of weight in the short term using a very low-calorie diet, some of the clinical and biochemical features of PCOS can be reversed. This is being tested in a PCOS study being conducted at the University of Hull, UK.
PCOS is usually diagnosed when women recognize that their periods are irregular, they have excess body and facial hair, and they are unable to become pregnant.
These features tend to stay constant during the lifetime of women with PCOS. However, the metabolic features of PCOS, such as excess weight gain, high cholesterol levels, high blood sugars, and diabetes worsen with old age.
Women with PCOS are also at an increased risk of cardiovascular diseases such as heart attack and stroke. Hence, they need regular follow-ups with their general physicians or endocrinologist to monitor these conditions.
Women with PCOS can have very heavy and painful periods. If this happens, it is important to consult your general physician or gynecologist. Some women with PCOS have no or only very few periods.
It is important that they have at least three to four periods in the year so that the endometrial lining is shed off. Generally, in women with PCOS, hormonal contraceptive pills are used to regulate periods and balance the hormones.
Make an effort to lose the excess weight. Follow a low-carbohydrate diet and exercise regularly.
– Avoid fizzy drinks such as Coke and Pepsi, and carbohydrate-heavy fast foods such as chips, crisps, and white bread.
– If you are planning to have a baby, see your endocrinologist as soon as possible. He/she will treat your PCOS and will rule out other conditions that mimic PCOS.
– Avoid smoking, excess alcohol, and things that increase your risk for cardiovascular disease as women with PCOS are already at a higher risk.
– Women living with PCOS are more likely to be depressed than women in the general population. Hence, it is important that you address your mental health. Yoga, meditation, and Pilates are very useful tools.
About Dr. Harshal Deshmukh, MBBS, PhD: Dr. Deshmukh is a Clinical Lecturer of Endocrinology and Diabetes at the University of Hull. He was trained in Medicine in India. He has a Master’s in Epidemiology and Biostatistics from the University of Massachusetts Amherst, USA, and a PhD from the University of Dundee, Scotland.
He is currently working on the genetics of beta-cell function in type 2 diabetes, risk prediction in PCOS, and genetic overlap between osteoporosis and other autoimmune diseases.