PCOS Is a Mystery Without a Solution

Polycystic ovary syndrome (PCOS) can cause a wide-ranging spectrum of effects, from irregular or infrequent menstruation, development of cysts on the ovaries, excess body or facial hair, weight gain, skin tags, acne, male pattern baldness or thinning hair, and infertility.

Experts refer to PCOS as a syndrome, not a disease, because it does not have a known, direct cause. Syndromes are typically clusters of symptoms, like the traits of PCOS.

"[PCOS is a condition] that happens in women, based on a hormonal imbalance in androgens—male hormones—that can have metabolic, reproductive, psychiatric and cosmetic consequences if left untreated," said Ana Maria Kausel, M.D., an endocrinologist in Miami and the co-founder of Anzara Health.

Essentially, PCOS occurs when there is an interaction between a hormone imbalance and the ovaries. The ovaries are glands located on either side of the uterus that have two primary responsibilities: They produce and store eggs until menstruation, and they produce the hormones estrogen and progesterone. People with PCOS may ovulate less because of higher androgen levels, making it challenging to have regular menstrual cycles.

Ovulation occurs when the ovaries release an egg. Sometimes, when a woman doesn't make enough of the hormones needed to ovulate, the ovaries can develop small, fluid-filled sacs or cysts. The cysts contain immature eggs called follicles, which fail to release the eggs. People with PCOS may have enlarged ovaries. According to Johns Hopkins Medicine, cysts make androgens, a group of hormones. Females typically produce a small number of androgens, though they are usually associated with male characteristics.

Androgens influence reproduction. People who present with PCOS typically have a higher level of androgens, and higher levels of androgens may produce outcomes such as menstrual irregularities, acne and facial hair. It's crucial to understand that PCOS impacts the reproductive system, metabolism and mental health.

The Centers for Disease Control and Prevention (CDC) states that women with PCOS are often insulin resistant, and though they can produce the hormone, they can't effectively use it. People with PCOS may be at risk for diabetes and other health conditions, such as high blood pressure, uterine cancer, or issues with the heart and blood vessels. Research found 50 percent of people with a PCOS diagnosis went on to develop prediabetes or diabetes. While PCOS itself is not life-threatening, the risk-associated conditions can be.

How common is PCOS?

According to Kausel, 5 percent to 10 percent of women have PCOS. In the United States, an estimated 5 million to 6 million women of reproductive age have it. For women of reproductive age in America, PCOS is the most common endocrine abnormality.

It's also one of the most common causes of infertility. Though PCOS may cause infertility, it is still possible to get pregnant while living with PCOS. The syndrome can create complications for pregnancy and may increase the risk of miscarriage or preterm birth.

Some women first learn they have PCOS when they struggle to become pregnant, but Kausel said symptoms could begin during puberty or the teenage years.

"It can start as soon as women start getting menstrual cycles," Kausel explained, adding that it's more common in younger women in their early reproductive years.

PCOS doesn't naturally go away. But do symptoms decrease during menopause? Hormone changes caused by menopause may alleviate symptoms for some people, but this is not always the case.

Criteria for PCOS

Specific symptoms that accompany PCOS may cause misunderstandings, mainly that if you have one symptom present, it equates to a diagnosis. The wide-ranging symptoms, from acne to infertility, may also cause people to think they are unrelated to PCOS, potentially causing a delay in diagnosis. With PCOS, some symptoms may be experienced more strongly than others, and it's also possible to have some but not all signs.

With the irregular or infrequent menstruation that may be present with PCOS, while the syndrome may cause no periods, it's common for people with PCOS to have fewer than nine periods per year.

Though polycystic means many cysts, not all women with PCOS have cysts, though some may go on to develop them. The ovaries may contain many small follicles, up to 8 millimeters in size. Cysts may occur on one or both ovaries. Polycystic ovaries appear on a pelvic ultrasound in more than 70 percent of patients.

Kausel explained that physicians may suspect PCOS when at least two out of these three criteria are present: irregular menses, usually skipping periods; positive clinical signs or positive blood tests; and a positive ultrasound.

You don't necessarily need an ultrasound for a provider to make the diagnosis. Blood tests measure hormone glucose and lipid levels.

It's common to assume you may have PCOS if you have ovarian cysts, but the most telling differentiating symptom of the syndrome is a hormonal imbalance. It is possible to have multiple ovarian cysts without having a hormonal imbalance or PCOS.

Preexisting conditions that can impact PCOS

A growing field of research is examining the causes of PCOS, though researchers have yet to discover one specific correlation. While there is no one direct cause, varying risk factors can play a role in the chances of developing it. A combination of environmental and hereditary factors may influence whether or not someone develops the condition.

Kausel said the following preexisting conditions could impact PCOS:

• Obesity or insulin resistance
• The presence of any type of diabetes
• History of early onset of pubic or axillary (armpit) hair
• Family history of PCOS
• Certain ethnicities; Hispanic patients are at higher risk
• Use of anti-seizure medications, specially valproic acid

There is no known way to prevent PCOS from developing, and different treatments exist depending on which symptoms present. While there is currently no cure for PCOS, early diagnosis and treatment can help mitigate symptoms and prevent further diseases such as diabetes from developing.