PCOS: What You Need To Know
Myths, symptoms & treatment
Polycystic ovary syndrome (PCOS) is a syndrome—a group of symptoms—that affects the function of ovaries and ovulation, and impacts someone’s physical and mental health.
PCOS presents itself through 3 main features: irregular periods, a higher level of androgens, and polycystic ovaries. In order to be diagnosed with PCOS, you need to have at least 2 of these features, and not everyone with PCOS will have all 3.
A confusing name
Despite the name, you don’t actually have cysts on your ovaries if you have PCOS. The “cysts” in polycystic ovaries aren’t always present in women and AFAB individuals with PCOS, and when they are, they’re not like the cysts you’d get in other parts of your body. Rather, they’re follicles that never matured and contain an underdeveloped egg.
When your ovaries are getting ready to release an egg, they develop small fluid-filled sacs (follicles) that start to develop an egg for fertilisation. One of the follicles eventually releases the egg (ovulation). Often, in some people with PCOS, none of the follicles fully mature and release an egg, so these follicles—usually more than 10—remain on your ovaries.
It was originally thought that these follicular cysts were the cause of PCOS (rather than being a common symptom), and due to the confusion over the name of the condition, the healthcare community has been considering changing the name.
What causes PCOS?
Doctors still haven’t figured out the precise cause of PCOS, but the main theory is that PCOS is caused by a hormone imbalance.
Many people with PCOS have higher levels of testosterone (often referred to as the “male hormone”, but naturally produced by the ovaries as well), higher levels of luteinising hormone (LH), which stimulates ovulation but can have undesired effects if it’s too high, and lower levels of sex hormone-binding globulin (SHBG), a protein that binds to testosterone and reduces its effects.
The exact reason for this hormone imbalance is unknown, but it’s thought to either originate directly from the ovaries (which don’t function properly, due to their role in hormone production), or from insulin resistance.
You may be familiar with insulin’s role in diabetes, but it plays a role in PCOS as well. Insulin is a hormone produced in the pancreas that regulates blood sugar levels. It helps glucose (sugar) move from the blood to cells, where it’s broken down to produce energy. If someone has insulin resistance, their cells are less receptive to insulin so their body produces more of it to compensate. Insulin resistance and PCOS can be mutually exclusive, but the two conditions are related, and 70% of women with PCOS are insulin resistant.
Higher levels of insulin and/or LH cause your ovaries to produce more testosterone, which interferes with follicle development and stops normal ovulation.
PCOS also sometimes runs in families, which suggests that there may be a genetic component to PCOS, however specific genes associated with PCOS haven’t been discovered yet.
Symptoms of PCOS
PCOC is a common condition and it’s estimated that around 1 in 5 women and AFAB individuals in the UK have PCOS. Of those, half don’t show any symptoms, which means PCOS if often undiagnosed, and making it hard to know precisely how many people suffer from it.
If you do have symptoms of PCOS, they'll typically appear during your late teens or early 20s and include irregular periods or no periods at all (amenorrhea), difficulty getting pregnant, excessive body and facial hair, thinning hair or baldness, weight gain and acne.
Higher levels of testosterone are thought to be the main culprit of PCOS symptoms. Too much testosterone prevents normal ovulation, causing the formation of follicular cysts and irregular periods, as well as excess body and facial hair.
High levels of insulin, on the other hand, can cause weight gain, and excess body fat can in turn produce more insulin. It’s a very unfortunate vicious cycle, and PCOS is also associated with higher levels of cholesterol, and a higher risk of developing type 2 diabetes in the future.
Due to the emotional distress PCOS symptoms can cause, there is also a strong link between PCOS and mental health issues like depression and anxiety.
Since the exact cause of PCOS is unknown, currently there is no cure, nor is there one sole treatment. However, there are different treatments available to manage symptoms and prevent complications.
If you’ve been diagnosed with PCOS, the management usually involves a series of blood tests to check for high cholesterol or hormone imbalances, an ultrasound scan to check for polycystic ovaries.
The first course of action for PCOS is usually (albeit frustratingly) weight management. As weight gain and excess body fat are a symptom of PCOS that can make the condition worse, doctors often recommend good nutrition and exercise as a way to manage symptoms. The advice of losing weight is often a problematic one (and it can be triggering for anyone suffering or recovering from eating disorders), but there are other ways to treat PCOS.
Although there is no treatment specifically aimed at balancing hormone, several forms of hormonal contraception can offset PCOS symptoms. The combined oral contraceptive pill (COCP), contraceptive patch and vaginal ring have been shown to improve acne and excess hair growth, as well as make periods more regular.
For those trying to get pregnant, certain medications can increase your chances of conceiving. Guidelines are evolving for fertility treatment in PCOS sufferers, but the medication clomifene is often prescribed to stimulate ovulation, as is letrozole (which has just been added as first-line management for subfertility due to PCOS). The medication metformin, on the other hand, is prescribed to lower insulin and blood sugar levels in insulin-resistant PCOS sufferers, but recently the medical community has been debating its effectiveness.
A recently published study showed that although it takes longer for people with PCOS to conceive, the overall chances of having a baby is the same as people without PCOS (when the condition is diagnosed and treated).
Due to the mystery surrounding PCOS, treatment and management varies greatly from person to person and largely depends on symptoms, so there is currently no cure-all for PCOS.
- Polycystic ovary syndrome (PCOS) is a condition that affects normal ovarian function and ovulation. It’s characterised by higher levels of androgens, irregular periods and polycystic ovaries. You need to have 2 out of these 3 features in order to be diagnosed with PCOS.
- Despite what the name may suggest, polycystic ovaries aren’t a prerequisite for PCOS. Unlike cysts you’d find elsewhere on your body, they’re follicles that never matured and contain an undeveloped egg.
- PCOS causes irregular periods, excessive hair growth, difficulty getting pregnant, weight gain and acne. It’s also linked to depression and anxiety.
- Insulin resistance and genetics are both possible causes for excess testosterone, which stops ovaries from functioning properly and releasing an egg every month (ovulation).
- There is no cure for PCOS, nor is there one single treatment. However, there are several treatments aimed at managing individual symptoms. These include some forms of hormonal contraception, general lifestyle changes like good nutrition and exercise, and certain medications that increase your chances of getting pregnant.
Written by Liv Cassano. Liv is the Editor of Vitals, follow her at @liv_css.
This article was fact-checked by Daye's female health specialist Dr. Harry Baxter.
Be the first to know...
when the world’s first cramp-fighting tampons launch.
You’re in. Welcome to the future of women’s health.
Want exclusive access to the first limited run of our cramp-fighting tampons? We thought so. Every time you share your unique referral link, you move up on our waitlist.
Check your spam folder if you've missed our email.