PCOS has been labelled a “syndrome,” or group of symptoms that affects the ovaries and ovulation. As a syndrome refers to a collection of symptoms, PCOS can look different on every woman!
To understand PCOS you need to understand the basics of a women’s menstrual cycle.
A woman’s menstrual cycle begins when the pituitary produces follicle-stimulating hormone (FSH). Follicles are where each egg resides in the ovaries. When FSH is produced, it stimulates about 20 follicles to start growing and maturing. These growing follicles then start to release oestrogen. Increasing oestrogen levels encourage thickening of the uterine lining as well as stimulate the pituitary to start producing luteinizing hormone (LH). A spike in LH causes one or two maturing follicles to release its egg – ovulation. Oestrogen will then drop because the follicles are no longer producing it, which allows progesterone to rise. This hormonal change encourages the uterine lining to be more nourished in anticipation of fertilisation. If the egg is not fertilised, progesterone and oestrogen levels drop resulting in menstruation. The dominant follicle then releases its egg each month
In a woman with PCOS, the mature follicle often never gets the signal to release its egg. If this happens, your body might fail to make enough progesterone, which is needed to keep the cycle regular. In PCOS normally the ovaries are stimulated to produce excessive amounts of male hormones, particularly testosterone. Though they are called “male hormones,” androgens are normal and necessary in small amounts in females but in PCOS they are being produced in excess. These extra male hormones disrupt the menstrual cycle, so that women with PCOS often can experience fewer or skipped periods and symptoms like facial hair and acne. Because of this, PCOS is best defined as androgen excess (high male hormones). Oestrogen excess can also occur in PCOS. The interplay of the reproductive hormones has basically been disrupted, which causes an imbalance in the natural process of the cycle.
PCOS three main features are:
- irregular menstrual cycles,
- a higher level of androgens (a type of hormone including testosterone) in the body, and
- 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. Over the course of time, many cysts may develop into what looks like a string of beads when viewed by ultrasound imaging.
As mentioned earlier to further complicate things, there are arguably now 4-7 different types of PCOS that have now been identified. Each one presenting with a slightly different pathophysiological pathway, although the below aren’t set either and will often cross over depending on each individual case. For example, one client may present with Insulin resistance, extreme stress and excess androgens but their DHEA levels (adrenal/stress hormone) are low. While another may present with excess androgens but normal insulin levels but be craving sugar and are still gaining weight. This is why it is so important when treating PCOS that we look at every person as an individual and this is why it is so important to treat PCOS person by person rather than simply putting women in one category or another.