PCOS is a syndrome and is identified as a collection of symptoms. It can affect each woman differently, some of which some women may present with particular symptoms but not others. Each woman will develop a varied set of symptoms in a variety of different ways. There is no one size fits all approach. Failure to ovulate can cause a reduction in both oestrogen and progesterone (female hormones) and an increase in testosterone and other androgens (male hormones). The source of the androgens can be the ovaries themselves or the adrenal cortex. The sequential disturbance in follicular maturation is an important cause of unwanted fertility and absent menstruation and the underlying cause of the prominent symptoms.
Due to the disruption in ovulation periods may become infrequent or irregular. A woman may be suspected of having PCOS if she has fewer periods (fewer than eight in a year). Sometimes, periods come more frequently and may come every 21 days or more often. Some women with PCOS can stop having menstrual periods for long periods of time. Periods can also range from light to extremely heavy. It can also cause fertility and pregnancy complications.
Women with PCOS often experience excessive hair on the face, chin, or parts of the body where men more commonly have hair. This is called “hirsutism.” Hirsutism affects up to 70% of women with PCOS. Cystic acne most commonly under and around the chin area are also common due to the excess androgens. Rising androgen levels cause the oil glands under the skin to grow. The enlarged gland produces more sebum. Excessive sebum can break down cellular walls in the pores, causing bacteria to grow.
Due to Insulin resistance, PCOS is more common in women who struggle to lose weight. Women with PCOS are more susceptible to weight gain, and this can occur at any age. There are, however, some women with PCOS that do not experience weight gain or inability to lose weight. Weight gain can further intensify the severity of the signs and symptoms of PCOS, insulin resistance can create intense sugar cravings and weight gain and create a negative feedback that is hard to break. Obesity is an added aggravating factor in the already increased risk for impaired glucose tolerance, type 2 diabetes and cardiovascular disease.
The presentation of PCOS also varies depending on a woman’s age: for young women, the signs of high male-like hormones are more common, so excessive body hair or acne may be the main concern that prompts a visit to your doctor. For women in their 20’s and 30’s, fertility issues and difficulty in falling pregnant are reasons to seek help (fertility is not impaired in all women with PCOS and many women conceive without medical intervention). In later life, what is referred to as metabolic features, which includes the propensity for excess weight gain, an increase in prediabetes and type 2 diabetes, are more prominent. Hormone imbalances can also affect mood and sometimes include increase in anxiety and depression symptoms, sleep disturbances and low mood. High insulin causes ovaries to produce androgens instead of oestrogen. Insulin also decreases the production of sex hormone binding globin (SHBG). SHBG binds hormones and makes them inactive. Low SHBG means you have more free or active testosterone in circulation to act on hair follicles. Women who have polycystic ovarian syndrome (PCOS) may experience this kind of hair loss.
A summary of common symptoms below:
- Infrequent, absent, and/or irregular menstrual periods – 50 words
- Heavy periods/painful periods
- Increased hair growth on the face, chest, stomach, back, thumbs or toes
- Small cysts presenting in the ovaries. These fluid filled sacs are actually follicles, each one containing an immature egg. In PCOS, eggs that do not mature fully are not released during ovulation and therefore remain in the ovary as pearl-sized, fluid-filled sacs
- Sugar cravings
- Acne particularly under the chin
- Weight gain or trouble losing weight
- Sleep Apnoea
- Mood changes – Anxiety /depression
- Scalp hair loss
- Infertility or difficulty becoming pregnant