Everything you need to know about PCOS

Your hormones are the messengers that send signals from one part of your body to another to tell it to complete different actions. They’re responsible for your menstrual cycle, physical growth, metabolism and development, and mood, among so many other things. These little chemicals are pretty amazing, and your body knows which ones to produce to trigger important processes. If your reproductive hormones are imbalanced, this can lead to a number of complications, including polycystic ovary syndrome (or PCOS).

You might have heard the name PCOS before but weren’t sure what it is. That’s normal; you may not have been taught about it in health class, after all. It’s thought to be one of the most common hormone disorders. So to help you get the lowdown on PCOS, two Flo experts outline everything you need to know. 

What is PCOS?

PCOS is a common hormonal condition that is thought to impact between 8% and 13% of women of reproductive age in the United States alone. That’s around 5 million people.

However, you might be curious as to what we mean by a hormonal condition. So, let's break PCOS down. 

PCOS is a condition that affects your hormone levels and usually causes an imbalance in your androgen levels, sometimes called male hormones. This imbalance can impact how often you ovulate (when your ovaries release an egg for fertilization) and how frequent your periods are. Sometimes people who have PCOS have multiple small cysts that form on their ovaries. However, surprisingly, this isn’t always the case. You could be diagnosed with PCOS and never have cysts on your ovaries. 

Keep reading to find out more about the three key symptoms that your doctor will look out for when diagnosing you with PCOS.

PCOS symptoms 

Symptoms of PCOS can vary from person to person, and they will often start around the time of your first period. However, you might notice some of the signs later on in your teens or early twenties. The three main symptoms of PCOS are: 

• Irregular periods: An irregular period could be classed as missing multiple periods in a row, your period stopping, or having a very long cycle (the average cycle is between 21 and 35 days). You can use an app like Flo to learn more about your cycle. As PCOS is a hormonal imbalance, it can lead to changes in the hormones that are needed for ovulation.
• High androgen levels: As mentioned above, some people who have PCOS also have noticeably higher levels of the hormones androgens which can result in acne and hair growth on your face, arms, and chest. 
• Polycystic ovaries: PCOS gets its name from this symptom, but as mentioned above, not everyone who has PCOS will have polycystic ovaries (ovaries that are larger than they normally would be and contain fluid-filled sacs called follicles that surround your eggs). 

If you have two out of three of these symptoms, then your doctor may diagnose you with PCOS. 

How PCOS affects your body

Understanding these three key symptoms may help you better understand PCOS. However, while you can track your cycle using an app like Flo, it’s very difficult to know if you have high androgen levels or polycystic ovaries without seeing your doctor. Dr. Ruth Arumala, obstetrician and gynecologist in Texas, US, explains that this hormone imbalance can affect your body in other ways. 

They include:

• Acne and oily skin: If you have higher androgen levels, then it may mean that more oil is produced on your skin leading to pimples and acne. 
• Excess hair growth on your face, back, arms, and chest (this is called hirsutism): This is caused by elevated androgen levels. It’s estimated that around 70% of people with PCOS experience hirsutism. 
• Hair thinning on your head
• Difficulties getting pregnant: If you have an irregular cycle, you may not ovulate every month. This can make getting pregnant more difficult. 
• Weight gain: PCOS is often associated with insulin resistance. Keep reading to learn more about this. 
• Darkening of the skin around your neck, armpits, between your legs, and under your breasts.

If you’re experiencing these symptoms, it can be tricky to know if they’re a sign of PCOS or something else, so if you’re concerned, the best thing to do is speak to your doctor. You shouldn’t have to manage your symptoms by yourself, and they’ll be able to help you decide what to do next. You can learn more about the symptoms of PCOS using an app like Flo. 

What causes PCOS?

It might surprise you that currently, the exact cause of PCOS isn’t known. “I always explain it to my patients to look at it as a complex genetic trait,” says Dr. Sameena Rahman, obstetrician, and gynecologist, clinical assistant professor, Northwestern Feinberg School of Medicine, Illinois, US. Doctors have found a range of medical and lifestyle factors that may be linked to PCOS, but there is no concrete reason as to why some people develop it and others don’t. 

Are some people more at risk of developing PCOS?

As mentioned above, while there’s no known cause for PCOS, doctors have found certain links between the condition and different factors. They include: 

Insulin resistance

You might have heard of insulin but weren’t sure what it is. Insulin is a hormone that your body produces to help you regulate your blood sugar levels. If you are insulin resistant, your body doesn’t process sugars in the way that it should, and you create more of the hormone to compensate. High levels of insulin can lead to weight gain. 

Hormone imbalance

Doctors have highlighted that many people who have PCOS also have higher levels of androgens than normal. Similarly, if you have PCOS, you may also have higher luteinizing hormone (LH) levels. LH is the hormone produced in your ovaries that triggers them to release an egg during ovulation. However, if your LH levels are abnormally high, then it may interfere with ovulation. You’ll be a hormone whiz by the end of this. 

Genes

When you speak to your doctor about your PCOS symptoms, they may ask you if anyone in your family has the condition. This is because it sometimes runs in families. If your mom, aunt, or grandma has PCOS, you may have an increased risk of developing it. This suggests there’s a genetic factor in the causes of PCOS. 

How is PCOS diagnosed?

You may already know that some of the symptoms associated with PCOS can be confused with other conditions. While irregular periods and acne are signs of PCOS, they are also symptoms associated with many other hormonal conditions. So, to diagnose you, your doctor will take your health history and will ask you about your cycle. While advocating for yourself and talking about your symptoms in a doctor’s office can be tough, rest assured that PCOS is very common and your doctor should be able to help you.

“PCOS is usually diagnosed with a thorough history and physical, blood work to rule out other conditions, [and a] pregnancy test to rule that out,” says Dr. Rahman. She explains that during your physical exam, your doctor may look for acne or hair growth on your body. A blood test will check your androgen levels, and an ultrasound scan can examine if you have polycystic ovaries. You can think of your PCOS diagnosis as a process of exclusion. Your doctor is ruling out other conditions and genetic disorders in order to determine if you have PCOS. As mentioned above, if you have two of the three symptoms (elevated androgen levels, polycystic ovaries, and irregular periods), then your doctor may diagnose you with PCOS. 

How to treat PCOS

Once you’ve been diagnosed with PCOS, your doctor should present the different treatment options to you. You might want to try a few different ways to manage your symptoms, and your medical options may be slightly different depending on whether you would like to be pregnant in the near future. 

PCOS treatment if you don’t plan on becoming pregnant

If you don’t plan on having a baby in the near future, then your doctor may suggest: 

• Looking into taking hormonal birth control — such as the pill, patch, injection, ring, or intrauterine device. This may help to make your cycle more regular and may treat the acne or increased body hair growth you’re experiencing. 
• Taking medications that block the effects of androgens. This may help if you experience acne or hair growth on your face and body because of your PCOS. 
• Taking medication traditionally used to treat diabetes. This may help you to balance your insulin levels. 
• Adapting your diet to help to balance your insulin levels and blood sugar. It’s recommended that you follow a balanced and healthy diet. 

PCOS treatment if you do plan on becoming pregnant

PCOS can make getting pregnant trickier because if you have an irregular cycle, you might not ovulate every month, which is vital if you want to conceive. However, don’t be disheartened — most people who have PCOS go on to get pregnant. 

Your treatment options may be slightly different if you want to become pregnant with PCOS because it would be counterintuitive to start taking hormonal contraception (like the pill, patch, IUD, and injection). Instead, your doctor may suggest:

• Medication that encourages ovulation: Some medications have been proven to aid in ovulation if you have a hormonal imbalance. 
• Assisted reproductive technology: These are treatments that may help you become pregnant if you’re struggling to conceive. They include in vitro fertilization. 
• Other fertility treatments, such as medication to help you ovulate and intrauterine insemination. 

Can you prevent PCOS? 

While there are lots of different ways you can manage and reduce the symptoms associated with PCOS, there’s no surefire way of ensuring you don’t get it. Since doctors don’t currently know what causes the condition, it’s impossible to prevent it altogether. 

Health complications linked to PCOS

Since PCOS is a hormone imbalance, it can lead to other health complications if it’s left untreated. This might sound scary, but you’re not the only one, and your doctor should be able to give you some different options to manage the symptoms of PCOS. 

It’s important to be mindful that if you have PCOS, you’re at an increased risk of developing Type 2 diabetes. This is because your body produces insulin but may not be able to use it in the way that it needs to. This excess insulin can mean that you gain weight more easily, which could lead to higher cholesterol, putting you at an increased risk of developing heart disease. All this might sound daunting, but it doesn’t happen to everyone — it’s just about increased risk. 

PCOS FAQs 

If you’ve still got questions about PCOS, then you’re not the only one. There’s still so much research going into the condition, and doctors have yet to establish what causes it. So here are some quick answers to some of the most common questions about PCOS. 

What happens if PCOS is left untreated?

As mentioned above, if PCOS is left untreated, then you may be at a greater risk of developing other health complications such as Type 2 diabetes, heart disease, and uterine cancer. 

Does PCOS get worse over time?

PCOS can impact people in different ways, and you might notice that as you enter different life stages (such as menopause), your symptoms may change. However, generally speaking, with treatment, your symptoms may become more manageable. 

Can PCOS be cured completely?

PCOS can’t be cured completely, but there are different lifestyle changes and medications that may help you manage your symptoms.  

Can I get pregnant if I have PCOS?

Yes! Most women who are treated for PCOS can get pregnant and have children. 

Can you have transitioned into menopause and have PCOS?

Yes. Menopause doesn’t cure PCOS, and studies have suggested that having PCOS may mean you reach menopause a few years later.

What’s the difference between PCOS and endometriosis?

PCOS and endometriosis are often linked as they’re both chronic conditions, but they’re actually very different. Put simply, PCOS is a hormonal condition, whereas endometriosis is a condition where the tissue similar to the lining of your uterus grows elsewhere in your body. This tissue is sensitive to your hormones and, just like during your menstrual cycle, it builds up and breaks down. However, the blood has nowhere to leave the body, and this can cause lesions, inflammation, and be very painful. 

PCOS: The takeaway 

Although doctors don’t currently know the cause of PCOS, it’s an incredibly common and manageable condition. Logging your symptoms and tracking your cycle using an app like Flo may help you understand it a little better and might assist your doctor when they’re diagnosing you. 

Once you have a diagnosis, your doctor will work closely with you to work out what the best next step is. If you don’t want to become pregnant in the near future, then they may recommend hormonal birth control as a way to regulate your cycle. If you would like to have a baby, then the good news is many people who have PCOS go on to have healthy pregnancies.  

Living with the symptoms associated with PCOS can be tough, but they shouldn’t impact your quality of life, and you don’t have to manage them alone. Your doctor may be able to help you to work out the best treatment option for you. Remember, a problem shared is a problem halved.