So what is PCOS, exactly?

Polycystic ovarian syndrome, or PCOS, is a common hormonal disorder. It’s the most common hormone abnormality of reproductive-aged women, occurring in up to 10% of such individuals. It is characterized by overproduction of the androgen testosterone, menstrual abnormalities when ovulation does not occur, and enlarged ovaries containing multiple small follicles (polycystic ovaries). It is the most common reason that people will have irregular periods during their reproductive years.

Here are some of the typical symptoms to look out for if you think you have PCOS

Typical symptoms of PCOS include irregular or absent menstrual cycles, hair growth along the jawline, upper lip, or chest, acne, and sometimes weight gain. If you have any of the above symptoms, it is best to see your physician for evaluation.

How can PCOS be diagnosed?

PCOS can be diagnosed by your doctor through a medical history evaluation, physical exam, pelvic ultrasound and blood work. The most commonly used criteria to diagnose PCOS are called the Rotterdam criteria. Through this criteria, you need to have at least two of the three following symptoms to be diagnosed with PCOS:

  • Irregular or absent menstrual cycles
  • Evidence of higher male hormone levels such as testosterone (this is determined via bloodwork or if you have evidence of hair growth in a male pattern)
  • Polycystic appearance of the ovaries on ultrasound inspection. 

Keep in mind: it’s extremely important to rule out any other hormonal problems that might be the root of your irregular periods. Hormonal issues like thyroid disease or a high prolactin level could also contribute to irregular cycles. In short? It’s not a good idea to self-diagnose PCOS just because you might experience two or more of the above symptoms. We recommend you schedule time with your doctor to receive a proper diagnosis.

What does having PCOS mean for my health?  

People with PCOS may have trouble getting pregnant due to their irregular cycles causing the body to release eggs inconsistently each month. Check out our post on PCOS and pregnancy [LINK], but first let’s explore some other medical concerns besides fertility issues that can occur from having PCOS. 

Diabetes

One of the hormone abnormalities associated with PCOS is insulin resistance. Sometimes, if the resistance reaches a severe form this can lead to Type 2 diabetes. Interestingly, people with PCOS are more likely to develop Type 2 diabetes in their lifetime compared to people without PCOS. Even if they are not diabetic, individuals with PCOS are often prone to insulin resistance. This can make it hard to lose weight. 

For people with PCOS, maintaining a normal weight and engaging in regular exercise can help combat the risk of developing Type 2 diabetes. Our clinical team recommends that patients with PCOS follow a healthy diet rich in fruits and vegetables, fiber, proteins and complex carbohydrates. Avoiding sugar, simple carbohydrates like white bread and rice, and processed foods will help minimize insulin resistance. For people who are insulin resistant or pre-diabetes, medications can be recommended to decrease the risk of developing diabetes. 

Endometrial Cancer

Additionally, people with PCOS are at a higher risk of developing endometrial cancer compared to those without PCOS. This is because individuals with PCOS generally ovulate less frequently (and sometimes not at all).

For those with normal monthly menstrual cycles, the endometrial lining inside the uterus is controlled by two hormones. These hormones are estrogen and progesterone.  In the first half of a menstrual cycle, a follicle containing an egg grows, while the ovaries produce primarily estrogen. Once the designated egg is released during ovulation, the resulting cyst on the ovary— known as the corpus luteum— produces both estrogen and progesterone. Estrogen promotes the uterine lining to grow. And progesterone halts the lining growth and leads to the changes necessary to allow for embryo implantation. And if you aren’t trying to get pregnant? An embryo won’t be created during that cycle, and the corpus luteum will stop making estrogen and progesterone after 14 days. This ultimately leads to the shedding of the uterine lining— cue your period.

Since people with PCOS have irregular or absent menstrual cycles, ovulation doesn’t happen regularly and the ovaries don’t produce progesterone. So the uterine lining never has a chance to grow and shed on a cyclical basis. But all this time, estrogen is still being produced by the ovaries. This can cause the uterine lining to grow continuously without regular shedding cycles. Over time, this unregulated growth can increase the risk of endometrial cancer.

What can I do to help regulate my period if I have PCOS?

For people with PCOS and irregular or absent periods, it’s important to prevent this overgrowth of the uterine lining. You can do this a few different ways. One way is by taking birth control pills. The pill has a synthetic progestin hormone that causes the lining of the uterus not to grow. Another way is by using an IUD with progestin. You can also take courses of progestin medication on a regular basis that will allow the uterine lining to shed.

If you think you may have PCOS based on the symptoms described above, it’s important to see your doctor for an evaluation. 

Dr. Serena Dovey
Dr. Serena Dovey
Dr. Serena Dovey is a board certified obstetrician and gynecologist and reproductive endocrinologist. She graduated from the University of Virginia in Charlottesville for medical school and completed her residency in OB/GYN at Beth Israel Deaconess Medical Center and Harvard Medical School in Boston, and her fellowship in REI at the University of Pittsburgh Medical Center. Before joining Kindbody, she worked in the Reproductive Endocrinology division at the University of Colorado and served as the director of the Fertility Preservation Program. Dr. Dovey was born in Auckland, New Zealand and grew up primarily in Denver, Colorado. In her free time, she enjoys traveling, hiking, yoga and cooking.