PCOS Explained: Causes, Symptoms, And Treatments

Italian scientist Vallisneri is thought to be the first person to describe the symptoms that are now known as polycystic ovary syndrome (PCOS), including infertility and enlarged ovaries (via the National Library of Medicine). However, it wasn't until the 1990s that the condition finally had a name and diagnosis criteria that are still used and refined by the medical world today.

According to the CDC, PCOS currently affects as many as 5 million women of reproductive age in the United States. Although many women may not know they have PCOS for years after first developing symptoms, research shows that the condition could start in childhood or after puberty begins (per Metabolic Syndrome and Related Disorders).

PCOS is still somewhat of a mystery in medicine, as there's no clear-cut cause for most cases. That said, more is being uncovered about the condition. Several factors can play a role in PCOS development, including high levels of "male hormones" (androgens) and insulin (via the Office on Women's Health).

PCOS is characterized as a hormonal disorder, which is why women with the condition may experience hormonal changes like facial hair development and missed or irregular menstrual periods (per Mayo Clinic). While there's no one clear cause for PCOS, one of the key factors in the disorder is a higher-than-usual level of androgens. Because androgens are typically more dominant in males, women who have PCOS and elevated androgens may have symptoms that usually occur more commonly in males, like baldness and body hair.

According to Verywell Health, hyperandrogenism or having above-average androgen levels is one of the most tell-tale symptoms for diagnosing PCOS. While all women have some androgens in the body — some of them form into estrogen, a primary female hormone — some women have more than others. A physician may diagnose hyperandrogenism based off physical symptoms like excessive acne or facial hair, or use lab work to test androgen levels.

According to Clue, many people with PCOS have either high insulin levels or insulin resistance. Insulin resistance causes the pancreas to create more insulin to regulate blood sugars, which could lead to normal glucose levels but high insulin numbers. Insulin resistance occurs in as many as 95% of people with PCOS. Additionally, people with PCOS and obesity are more likely to have insulin resistance.

It's important to note that PCOS symptoms could be caused by insulin resistance. High insulin levels can lead to miscarriage and other infertility issues due to improper nutrition for an embryo and may affect hormone production, leading to excessive androgens in women (via Verywell Health). Endocrinologist Ula Abed-Alwahab explains this phenomenon further in a Cleveland Clinic article, stating: "Insulin is a fat-storage hormone that concentrates fat in your abdominal region. High insulin levels can tell the ovaries to make more testosterone. That's why some women with PCOS have symptoms of excess androgens, like dark hairs on the face and belly."

Inflammation is an important part of our immune system. Inflammation differs from swelling in that it can become chronic and affect large areas of the body. Sometimes, inflammation isn't as helpful to us, even though the body thinks it's doing something good by starting the process.

Inflammation responds to what the body thinks is an ailment or injury. However, PCOS can cause a number of altered bodily processes that may signal to the immune system that inflammation is necessary when it's not (via Verywell Health). People with PCOS usually have higher-than-normal C-reactive protein (CRP) levels, which often indicates an inflammatory response.

A 2020 research article examined inflammatory markers in women with PCOS (via BioMed Research International). One covered study included women with and without PCOS and found that CRP and white blood cells were significantly higher in women with PCOS. Additionally, BMI and insulin resistance seemed to play the biggest part in increased CRP levels.

Verywell Health notes that following an anti-inflammatory diet like the Mediterranean diet could help control inflammation and, therefore, related symptoms and conditions if you have PCOS.

When a woman's menstrual cycle gets thrown off, her ability to reproduce can be affected, too. According to The American College of Obstetricians and Gynecologists (ACOG), the excess androgens that women with PCOS produce can interfere with the menstrual cycle. These male hormones have the power to prevent ovulation by causing the ovaries not to release monthly eggs as usual. ACOG also names PCOS as a leading cause of infertility in women.

However, women who experience infertility issues because of PCOS may still be able to get pregnant. WebMD states that regulating a period with birth control medications sometimes helps women get back on track. For others, ovulation-friendly drugs like clomiphene and metformin can trigger regular ovulation cycles. Potential other treatments include making dietary and physical activity changes for an overall healthier lifestyle and lowering stress.

Most importantly, having a good relationship with your doctor and speaking openly about your PCOS symptoms and concerns is the best course of action to combat infertility.

There are currently three diagnostic criteria for a woman to receive a PCOS diagnosis (per the National University of Natural Medicine). These are polycystic ovaries, excess androgen hormones, and delayed ovulation, in no particular order of importance. Still, women with PCOS may experience just two of these symptoms along with a multitude of other symptoms, making diagnosis somewhat complicated. Currently, diagnostic rules state that women with two out of three of the primary symptoms are eligible for a diagnosis, but other conditions should get ruled out first.

Dr. Jessica Chan explains in a Q&A with Cedars-Sinai that blood work can detect the excess androgens that cause acne and excessive body or facial hair. "Your doctor will use an ultrasound to check for cysts," says Chan. She also states that "collections of 12 or more egg follicles or 'cysts' on your ovaries that may be larger than normal" can check the box for a polycystic ovary diagnosis.

While there's no magic medication to treat PCOS, there are a few medicinal treatments your doctor might suggest for your symptoms. Most commonly, your doctor may start you on birth control pills that contain estrogen and progestin, which help the body regulate female hormone production and combat the male hormones that might be currently taking over (via Mayo Clinic). Birth control may also regulate your menstrual cycle. Some women might start medication therapies to spark ovulation. These medications allow the ovaries to release eggs as they should, which may benefit women dealing with infertility.

According to Mayo Clinic, other common medications target acne and hair growth, like eflornithine to slow facial hair growth and spironolactone to inhibit the effects of androgens. Johns Hopkins Medicine also notes that some women begin medications for diabetes to lower insulin resistance, but a few of them are also helpful for ovulation and nixing the side effects of male hormones.

Physical symptoms may not be the only ones you have with PCOS. The condition can also take its toll on a woman's mental health. A review published in a 2018 edition of Endocrine covered 57 studies of women and mental health disorders like anxiety and depression. Women diagnosed with PCOS were likelier to also have a diagnosis of depression, anxiety, bipolar disorder, or obsessive-compulsive disorder. Additionally, the women ranked the severity of their symptoms higher than women without PCOS.

In another study led by researchers at the Columbia School of Nursing, menstrual abnormalities, infertility, and hair growth were among the top contributors to mental distress for women with PCOS.

It's crucial to focus on your mental health as well as your physical health if you've been diagnosed with PCOS. Clue suggests making changes to your exercise and diet habits to see what works for you, along with trying mindfulness and relaxation techniques. In some cases, medications and supplements might be worth discussing with your team.

If you or someone you know is struggling with mental health, please contact the Crisis Text Line by texting HOME to 741741, call the National Alliance on Mental Illness helpline at 1-800-950-NAMI (6264), or visit the National Institute of Mental Health website.