What You Need to Know about Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is thought to be one of the most common hormone imbalances in women. This imbalance of the reproductive hormones can affect a woman’s ovaries, leading to possible infertility, irregular periods, weight gain and challenges with weight loss. Here’s what you should know about this condition:

What is PCOS?

PCOS affects between 5 and 10 percent of women. The syndrome is characterized by infrequent periods and excess levels of male sex hormones (such as testosterone) in the female body. It is frequently associated with increased risk factors for cardiovascular disease, including obesity, glucose intolerance, elevated cholesterol, fatty liver and obstructive sleep apnea.  Historically, 70 percent of women with PCOS are overweight or obese.

What causes PCOS?

PCOS is caused by a combination of several factors. Genetics are one of the main causes of the condition. If a woman has a first-degree relative with PCOS, she has a higher chance of developing PCOS — 20 to 40 percent compared to a much lower rate in the general population.

Another cause is a hormonal imbalance of the female hormones, called the luteinizing hormone (LH), which can lead to increased secretion of male sex hormones from the ovary (androgens).

Poor diet also appears to be a risk factor for PCOS, as it can lead to obesity, increased insulin resistance and worsening menstrual cycle changes.

How can PCOS affect women?

Women who have PCOS do not ovulate appropriately, which leads to irregular menstrual cycles and frequent infertility. However, PCOS is thought to be one of the most treatable causes of infertility. Treatment to help women with PCOS ovulate can increase the chances of fertility.

How does PCOS affect weight?

Although the majority of patients with PCOS are obese, the connection between weight and PCOS is not as strong as it once was. PCOS is now seen more frequently in all weight classes of women. However, in the obese population, there is a higher degree of insulin resistance, ovulatory and menstrual dysfunction, poorer pregnancy outcomes and increased risk of diabetes, cardiovascular disease and sleep apnea.

It’s also believed that PCOS can lead to weight gain or make it more difficult to lose weight. However, weight gain associated with PCOS is most likely related more to genetic and lifestyle factors rather than due to a direct link to PCOS. However, it can be more difficult for women with PCOS to lose weight due to those same factors.

PCOS also has been linked to insulin resistance. Fifty to 70 percent of women with PCOS have measurable insulin resistance, a condition where the body doesn’t respond to circulating insulin, which leads to increased glucose or blood sugar levels. Insulin resistance puts patients at increased risk for development of prediabetes and diabetes. Elevated insulin levels also affect the hormones produced by the ovaries and cause higher androgen levels. The exact cause of elevated insulin levels in women with PCOS isn’t known, but genetic and lifestyle factors may play a role.

How can women with PCOS sustain lasting weight loss? 

There are no quick fixes for weight loss. It takes hard work, dedication and, more importantly, a commitment to lifestyle changes. To achieve lasting weight loss, women must commit to an overall healthy lifestyle.

Dietary and behavioral changes account for the majority of weight loss. Exercise works along with these changes to increase weight rel="noopener noreferrer" loss and metabolism (the CDC recommends 30 minutes of cardiovascular exercise — walking, running, elliptical and aerobics — five to seven days per week to facilitate weight loss). Overall, lower caloric intake usually works well for most people. However, because of the increased insulin resistance associated with PCOS, women with this condition may benefit from restricting carbohydrate intake, as well.

Whether or not you have PCOS, consulting with a nutritionist could be really beneficial and help you make the right food choices.

What treatments are available for PCOS?

Although PCOS is often a lifelong and frustrating disease, it is manageable and there are several options to control symptoms and improve lifestyle and fertility. 

The first line treatment for PCOS is weight loss through diet and exercise. This directly affects circulating insulin and androgen levels, which improves overall health and ovulatory and menstrual cycles. Oral contraceptive pills (OCPs) are frequently prescribed with weight loss. While working on weight loss, OCPs can help decrease circulating androgen levels, improve menstrual cycle irregularities and provide contraception. 

Metformin, a medication that improves the body's sensitivity to insulin, can help to lower circulating insulin levels in women with PCOS, and in turn, improve menstrual cycle regularity and fertility. Other medications also can stimulate ovulation in women with PCOS who want to get pregnant. 

PCOS affects millions of American women. If you have symptoms like irregular periods, excessive hair growth on the chin, face and other parts of the body, or unexplained weight gain or difficulty losing weight, then it’s likely time to see a doctor. PCOS is one of the most common causes of infertility, so if you want to get pregnant, getting a proper diagnosis and timely treatment can improve PCOS symptoms and your reproductive health.