PCOS Symptoms

The symptoms of Polycystic Ovary Syndrome (PCOS) are numerous. PCOS is a common endocrine disorder affecting about 6% to 12% of women of reproductive age. This hormonal imbalance can disrupt normal ovarian function and impact various aspects of women's health. This article outlines the main symptoms of PCOS, categorized for a better understanding of this complex condition.

Diagnosing PCOS can be challenging since its symptoms are similar to other conditions. As a result, some women may receive a misdiagnosis. It's essential to understand the symptoms, available tests, and treatments to get an accurate diagnosis and appropriate care. Always consult your doctor, gynecologist, or endocrinologist for diagnosis.

What is PCOS?

PCOS is a common hormonal imbalance in women, characterized by dysfunction of the hormones produced by the ovaries and the pituitary gland (a small gland located in your brain), as well as a disruption of overall body functions. Discovered in 1935 by Stein and Leventhal, this condition is also known as "Stein-Leventhal Syndrome."

PCOS diagnosis typically relies on an ultrasound of the ovaries (transvaginal or MRI) and a complete blood test prescribed by a doctor (general practitioner, gynecologist, or sometimes endocrinologist).

Diagnosing PCOS via Ultrasound

Polycystic ovaries are marked by an excessive number of fluid-filled primordial follicles containing eggs. Normally, 4 to 12 follicles are present in each ovary during the reproductive period, but when more than 15 follicles are detected, the ovary is considered polycystic.

The exact cause of this disorder remains unknown, though it is likely related to hormonal dysfunction. It’s important to note that polycystic ovaries should not be confused with Polycystic Ovary Syndrome (PCOS). An ultrasound alone cannot diagnose PCOS.

Rotterdam Criteria

In France and Europe, health authorities have defined a set of criteria for diagnosing PCOS, known as the Rotterdam criteria:

1. Clinical hyperandrogenism (visible signs like hirsutism, acne, or abnormal hair loss) or biological hyperandrogenism (detected in blood tests).
2. Rare or absent ovulation (typically irregular cycles or no cycles at all).
3. Enlarged ovaries and/or polycystic appearance on ultrasound (presence of more than 15 follicles per ovary or ovarian volume greater than 10ml).

To be diagnosed with PCOS in France, at least two of these three criteria must be met.

The name "PCOS" can be misleading. Experts from the Androgen Excess and PCOS Society and the NIH have suggested a name change, as the current name emphasizes polycystic ovary morphology, which is neither necessary nor sufficient for diagnosis, hindering effective communication and education. The proposed name is "Reproductive Metabolic Syndrome," accurately describing the condition.

Menstrual Symptoms

Irregular Menstrual Cycles
One of the most common symptoms of PCOS is irregular menstrual cycles. In a normal cycle, an egg is released each month by the ovary. In PCOS, this process is often disrupted due to hormonal imbalances. Menstrual cycles may be irregular, very long (more than 40 days), or absent (amenorrhea). This irregularity can lead to complications such as endometrial hyperplasia, where the uterine lining thickens without ovulation.

PCOS and Infertility
PCOS is the leading cause of female infertility, making conception difficult. Ovulatory dysfunction often prevents the release of a mature egg for fertilization. Various treatments, such as Clomiphene Citrate, gonadotropin injections, and In Vitro Fertilization (IVF), can stimulate ovulation, improving the chances of conception for women with PCOS.

Metabolic Symptoms

Weight Gain
PCOS is often associated with weight gain and insulin resistance. Insulin is a hormone that regulates blood sugar levels. When the body becomes insulin-resistant, it produces more insulin, which encourages fat storage, particularly around the abdomen. A balanced diet, rich in fiber and low in sugars and processed foods, along with regular physical activity, can help manage weight and insulin levels.

Insulin Resistance and Diabetes
Around 60% of women with PCOS experience insulin resistance, which impairs their ability to metabolize carbohydrates and can eventually lead to type 2 diabetes. Reducing carbohydrate and sugar intake is often recommended. Managing this resistance involves dietary changes, exercise, and sometimes medication.

Skin and Hair Symptoms

Hyperandrogenism
Hyperandrogenism refers to the excessive production of male hormones (androgens), leading to symptoms like persistent acne, excessive body hair (hirsutism) in typically male areas (chin, upper lip, chest, back), and hair thinning (alopecia) on the scalp. Treatments include anti-androgens and oral contraceptives to regulate hormone levels and reduce these symptoms.

Skin Darkening
PCOS can cause thick, dark, velvety patches of skin, particularly under the arms, breasts, or on the back of the neck. Known as acanthosis nigricans, this is often related to insulin resistance. Proper skincare and insulin management can help reduce these skin changes.

Physical Symptoms

Pelvic Pain
Pelvic pain is common among women with PCOS, often due to the presence of numerous ovarian follicles. Menstrual irregularities can also cause painful periods and heavy bleeding. Sometimes ovulation itself can cause pain, a phenomenon known as "mittelschmerz." Pain management includes analgesics and anti-inflammatory treatments.

Breast Changes
Some women with PCOS may notice a reduction in breast size (breast hypoplasia). During pregnancy, breast volume may not increase as expected, and milk production may be low.

Voice Changes
High testosterone levels can also lead to a deeper voice. Though less common, this symptom is a sign of hyperandrogenism.

Polycystic Ovaries
Polycystic ovaries contain numerous small immature follicles resembling cysts. These follicles don't require specific treatment unless they cause significant symptoms. Their presence is a key indicator for diagnosing PCOS.

Psychological and Energy Symptoms

Mood Changes
Hormonal imbalances from PCOS can affect neurotransmitters in the brain, increasing the risk of mood swings, anxiety, and depression. Psychological support and behavioral therapies can help stabilize mood. Nutritional supplements may also help restore hormonal balance.

Chronic Fatigue
Women with PCOS often report chronic fatigue, despite getting enough sleep. This fatigue may be linked to sleep disturbances, insulin resistance, and hormonal imbalances. Proper sleep management, diet, and exercise are crucial to alleviate this symptom.

Sleep Problems
PCOS is associated with sleep issues like insomnia or poor-quality sleep. Sleep apnea, a condition in which a person stops breathing briefly during sleep, is also linked to PCOS, contributing to feelings of tiredness despite a full night's sleep.

PCOS and Thyroid Disorders

Thyroid disorders and PCOS are two of the most common endocrine disorders. Though their causes differ, they share many characteristics. For example, an increase in ovarian volume and a polycystic ovarian appearance have been reported in primary hypothyroidism. Conversely, thyroid disorders are more common in women with PCOS. Symptoms like irregular cycles, fatigue, weight gain, hair loss, and mood disorders are common to both conditions, complicating diagnosis.