Navigating PCOS - The condition many don’t know they have

Introduction

We often hear of hormonal imbalances, but what exact impact can an imbalance have on our health? For people with ovaries, the most common condition linked to hormonal imbalance is called polycystic ovary syndrome, or PCOS. It is a condition affecting the ovaries, the organs responsible for producing eggs. 

According to the WHO, up to 70% of people with ovaries don’t know that they have PCOS. The condition is often misunderstood and it can take a long time to diagnose. That’s why it is helpful to learn about PCOS, its symptoms, and what to do if you think you might have it. 

In this article, we will explore what PCOS is, how it’s diagnosed, and what biomarkers are linked to it. 

What is PCOS?

In people with PCOS, the ovaries produce a higher than usual amount of hormones called androgens. These hormones are often referred to as "male hormones" but are also present in female bodies. They include testosterone and DHEAS, among others. 

Some people may develop cysts (small sacs filled with fluid) within their ovaries. But it doesn’t happen in every case.

PCOS is the most common condition linked to hormonal imbalance and impacts between 10-13% of people with ovaries in reproductive age. It is a common but treatable cause of infertility. 

The origins of PCOS remain unclear. New evidence indicates that this condition arises from a complex combination of lifestyle factors, genetics, epigenetics, and other environmental factors. The immune system might also play a role. PCOS may also be more common if there is a family history of the condition.

Research has suggested a link between PCOS and insulin resistance. If the body is resistant to insulin, it might cause an overproduction of androgens. This could lead to a hormonal imbalance over time. More research is needed to fully understand this link.

What are the symptoms of PCOS?

The symptoms of PCOS are varied and can differ from person to person. They might include:

• Irregular periods

• Increased hair growth

• Hair loss

• Persistent acne

• Underbelly/lower pelvic pain

• Weight gain (PCOS belly)

• Mood swings

Sometimes, PCOS doesn’t cause any noticeable symptoms.

Also, PCOS is linked to an increased risk for metabolic conditions such as:

• Elevated insulin resistance

• Type 2 diabetes

• High blood pressure

• High cholesterol or triglycerides

• Certain heart conditions

How do doctors diagnose PCOS

PCOS may develop after puberty, but often is not diagnosed for a long time. Most people discover they have PCOS if they visit the doctor due to trouble conceiving. The diagnosis of PCOS is based on a comprehensive medical examination that includes a physical examination, medical history, an ultrasound, and lab tests. Doctors will also rule out other conditions with similar symptoms before diagnosing someone with PCOS. 

If you have ovaries and are experiencing  PCOS symptoms, you should talk to your gynecologist or endocrinologist. They will carry out the necessary diagnostic tests.

What biomarkers are relevant to PCOS?

Testing for the following hormones is particularly relevant: 

• Follicle-stimulating hormone (FSH): Regulates the development of egg cells. It can be normal or lower with PCOS.

• Luteinizing hormone (LH): Plays a role in the ovulation process. Might be in range or  high with PCOS. Usually, the LH/FSH ratio will be high in people with PCOS. 

• Total testosterone: Usually high in case of PCOS.

• Free testosterone index: Might be high in people with PCOS.

• DHEAS: Can be high or in range with PCOS

• SHBG: Can be lowered in PCOS, indicating a higher circulation of free testosterone in your body. 

• Prolactin: Should be in range in PCOS. 

It is important to know that blood test values alone cannot be used to diagnose PCOS. Instead, your doctor will consider many other factors and make a comprehensive assessment.

What can I do to manage PCOS? 

Scientists haven’t yet found a cure for PCOS, but the condition can be well-managed with a combination of medication and lifestyle choices. 

Research has shown that lifestyle changes alone can improve fertility rates, even without medication. They may also help reduce the risk of developing metabolic conditions such as insulin resistance. Effective lifestyle changes include:

• Trying to maintain a healthy weight for you

• Regular exercise, including HIIT or interval training

• Eating low glycaemic foods such as vegetables 

• Increasing fiber intake

• Reducing high glycemic foods such as refined sugars

• Drinking 1 tablespoon of apple cider vinegar in water before meals
  

• Nuts and seeds 

• Quitting smoking