Understanding Polycystic Ovary Syndrome (PCOS)

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Overview of PCOS

Polycystic ovary syndrome (PCOS), a hormone imbalance that causes multiple physical problems in women, may also cause emotional problems certain emotional “burnout”. Reproductive consequences may occur. In particular, women with PCOS often experience irregular menstrual periods because they don’t ovulate each month. Not ovulating can cause a woman to miss her menstrual period and to develop immature follicles that foster the growth of many small cyst-like structures in the ovaries, which is why this condition is called “polycystic ovary syndrome”. A woman’s body functions optimally when hormones called gonadotropins, secreted by the brain, travel to the ovaries and signal the production of estrogen. The estrogen stimulates the growth of the follicle that holds the egg in the ovary. When the estrogen level reaches a certain point, the brain recognizes this and releases a surge of additional gonadotropin, which stimulates the egg to develop to the point of ovulation, where it is burst from the follicle and released from the ovary.

Polycystic ovary syndrome (PCOS) is a condition that causes irregular menstrual periods because monthly ovulation is not occurring and levels of androgens (male hormones) in women are elevated. The condition occurs in about two to ten percent of women of reproductive age. The elevated levels of male hormones may cause other symptoms, such as acne, male-pattern hair growth, and hair loss or male-pattern hair thinning. Insulin resistance and elevated levels of insulin may also be observed in some women with PCOS. These elevated insulin levels might increase the risk of overweight, obesity, and type 2 diabetes.

Definition and Symptoms

Researchers also believe that genetic variants might be linked to PCOS. The highest prevalence is observed in overweight women, especially those with type 2 diabetes. The hormonal imbalance in women suffering from PCOS leads to an increase in the levels of androgen hormones, such as testosterone, or to an increase in insulin levels produced by the ovaries, influencing the menstrual cycle and the production of ovarian cysts. When a woman has PCOS, the release of these two hormones goes out of control. Anovulatory infertility is due to elevated luteinizing hormone levels and increased ovarian androgen biosynthesis leading to arrested folliculogenesis in small ovarian follicles. It affects a woman’s menstrual cycle, fertility, hormones, insulin production, energy level, and weight. It can affect your appearance, including weight gain, acne, and excessive body hair, the so-called hirsutism. PCOS ranges from a mild condition to severe diagnosed, with a greater risk of developing other health issues.

Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome (PCOS), is a condition that affects a woman’s hormone levels and can lead to symptoms such as irregular menstrual cycle, infertility, and increased facial and body hair, along with symptoms such as acne and thick, dark skin patches. It is a heterogeneous disorder characterized by persistent anovulation, hyperandrogenism, and hyperinsulinemia. In PCOS, a lot of very small cysts (not more than one centimeter each) that contain eggs may be found by ultrasound in the ovaries. Polycystic ovary syndrome is a problem that few women would like, but few know what it really is. PCOS is a disorder that is affected by hormones.

Causes and Risk Factors

Increases in male hormones (androgens) disrupt the menstrual cycle and ovulation. It is not certain why or how these disruptions in hormonal levels happen, but the high levels of luteinizing hormone and progestin are thought to cause both the high androgen levels and the lack of ovulation. The high luteinizing hormone levels cause the ovaries to produce too much androgen, which disrupts follicle growth. This may prevent follicles from growing normally, which can build up in the ovaries and appear as cysts. In response, levels of sex hormone-binding globulin are usually low in women with PCOS, which means that sex hormones are not bound to those proteins as they would be in women without PCOS. Some reports have also demonstrated that estrogen and cortisol may also stimulate androgen production.

The exact cause of polycystic ovary syndrome (PCOS) is still unknown. A combination of genetic and environmental factors is thought to influence the condition’s development. The primary cause is generally thought to be related to abnormal hormone levels, which the body reacts to in various ways. There appear to be multiple factors that contribute to the condition, and in some women, PCOS is associated with an abnormal response to normal levels of insulin. This is often referred to as insulin resistance or hyperinsulinemia. It is unclear whether this disorder is the primary cause of PCOS or if it is caused by the condition.

Diagnosis and Treatment Options

Currently, diagnosis of PCOS is based on the knowledge that there are three major components: ovulatory dysfunction, evidence of high levels of androgen hormones, and polycystic-appearing ovaries based on an ultrasound exam. Of these three, lack of regular menstrual periods is the most important sign of PCOS. Due to the high association of elevated testosterone and insulin levels with PCOS, both your blood levels and levels of these hormones of their metabolic products can be useful for diagnosing PCOS. However, there is inconsistency in the diagnosis, depending on the particular criteria used. There are several possible therapeutic options for PCOS. An oral contraceptive can help reestablish regular menstrual cycles and decrease the levels of the male hormone, or androgen, responsible for hirsutism. An oral contraceptive that contains cyproterone acetate, a peripheral action blocker, may be more effective in decreasing the levels of testosterone.

Among the most common symptoms of PCOS are irregular menstrual cycles, hirsutism, and acne. Irregular menstrual cycles, also known as oligomenorrhea, can lead to infertility. Hirsutism, excess hair growth that is the result of higher levels of testosterone, can be one of the most distressing symptoms of PCOS. In addition, severe acne is related to increased levels of testosterone. Elevated levels of luteinizing hormone (LH) relative to follicle stimulating hormone (FSH) can lead to high levels of male hormones, suppress ovulation, and lead to acne. LH is the hormone produced by the pituitary that triggers the ovary to release an egg in preparation for ovulation. Polycystic ovaries, or ovaries that house an abnormally large number of immature follicles, can lead to anovulation and infertility.

Impact of PCOS on Women’s Health

Given the plethora of negative health outcomes in women with the syndrome, it is clear that they require careful medical surveillance. Moreover, emerging evidence suggests that daughters of women with PCOS have equivalent features to women with PCOS, even after controlling for obesity. Those included not only ovarian function but also symptoms of high blood pressure, which is not entirely surprising since women with the syndrome are more likely to have symptoms of high blood pressure than obese controls. Obesity and abdominal adiposity increase the likelihood that a woman will develop cardiovascular concerns, and early onset of PCOS predisposes to a further increase in cardiovascular risk, independent of obesity status. Increased insulin resistance and hyperinsulinemia also contribute to endothelial dysfunction, vasoconstriction, and vascular hypertrophy, each contributing to the progression of cardiovascular disease.

Although a clear prescription of which women with the syndrome are at the utmost risk is challenging, the presence of certain symptoms makes some women inclined to more closely emulate the pattern of presentation of those seen in women affected by diabetes or heart disease. Indeed, while lean women with the syndrome receiving hormonal contraceptives may not demonstrate the expected endometrial changes, particularly when taking oral contraceptives, overweight and obese women with the syndrome are at increased risk of endometrial carcinoma, not only because they are not using oral contraceptives, leading to an increased level of circulating androgens but also because of the additional metabolic and hormonal perturbations related to insulin resistance. Administer synthetic hormones that are acted upon by aromatase, which is abundant in adipose tissue. In addition to reducing the ovulatory burden in women with PCOS, some, but not all studies have suggested that oral contraceptives could have a health protective role against endometrial carcinoma in obese women with PCOS. These conjectural results were driven by small sample sizes, whereas research with larger sample sizes have not confirmed a beneficial effect of contraceptive use on endometrial health.

The metabolic, cardiovascular, and psychological symptoms of polycystic ovary syndrome can have a serious impact on a woman’s quality of life. While not all women with PCOS experience symptoms and signs to the same extent, and not all are at equal risk for complications, various health concerns have been associated with the syndrome. These include endometrial cancer, heart disease, diabetes, psychological disorders, and even early death in some cases. These possible and serious complications call for the recognition and proper management of the syndrome.

Menstrual Irregularities

The syndrome has been discussed and described in medical literature for more than 75 years—indeed, numerous other possible causes were excluded before Stein and Leventhal pointed to the presence of cysts and elevated serum testosterone as associated factors to define the syndrome. Menstrual irregularities affect the quality of life and self-esteem of all individuals affected by PCOS, although many strategies are currently available to manage this issue. Understanding the experiences of adolescents and young women with PCOS and the management strategies they commonly use has important implications for interventions to improve quality of life or their parents.

Polycystic ovary syndrome (PCOS) is an endocrine disorder, characterized primarily by the presence of androgen-excess, which is also the result of ovulatory dysfunction. However, this is a syndrome, and as such, varies from woman to woman. Women can have different combinations of signs and symptoms, ranging in type and severity. Diagnostic criteria include two out of three of: 1) high androgen levels clinically or by blood test; 2) irregular menstrual cycles; or 3) polycystic ovaries. Hormonal causes are known to influence the condition, but the way genetics and the environment influences these hormonal changes are unclear. It affects the quality of life of affected women and their families.

Infertility and Pregnancy Complications

Females with polycystic ovary syndrome (PCOS) have a number of characteristics relating to reproductive and other health parameters. 60% – 80% of women affected by PCOS have infertility issues. Attempts have been made to establish how the contributing factors for infertility translate into a mechanism. However, the variation in phenotypic expression of PCOS, age, and environmental factors has made research in the area difficult. By improving understanding on PCOS and how to overcome the effects that might contribute to infertility, it is clear that a multifaceted approach has to be taken. Pregnancy complications known to occur with PCOS include early pregnancy loss, gestational diabetes, gestational hypertensive disorders including preeclampsia, preterm delivery, pregnancy-induced hypertension, birth weight difference, iatrogenic prematurity, and delivery complications. Evidence suggests that spontaneous conception pregnancy won the rate of pregnancy complications compared to conceived pregnancies using either letrozole and gonadotropin-stimulating agents. To achieve a healthy pregnancy in women with PCOS, experts in the field have consensually agreed that lifestyle modifications and weight loss should be recommended for overweight and obese women and that caloric intake should not be lower than 1200–1500 kcal per day. Long-term preconception folic acid should be taken: 400–800 µg folic acid daily because the rate of neural tube defects is higher for women with PCOS even if they are not on metformin therapy. Researchers should investigate things like health care professional training, lifestyle factors associated with pregnancy, health behavior change, improvement of psychosocial health, information on gestational weight gain, weight management strategies, hormone use, and the psychosocial impact of fertility reservations. PCOS: polycystic ovary syndrome OCP: oral contraceptive pill developing chronic diabetes and cardiovascular disease are recommended for women who are overweight, pre-obese, or obese.

Metabolic Issues and Weight Gain

Many women with PCOS begin to develop metabolic issues that can lead to gestational diabetes. A diabetic diet should be initiated to prevent this complication, and weight should be monitored, particularly during the first trimester. After delivery, regular glucose testing should be performed because PCOS phenotypes frequently develop type 2 diabetes in early adulthood. A moderate and balanced low-protein diet in conjunction with oral hypoglycemic medications and exercise can delay diabetes onset and reduce the risk. PCOS women with a body mass index more than 30 kg/m² have an increased risk of developing gestational diabetes. Obstetric complications were reported in 5387 women with PCOS and 5762 without. Women with PCOS as diagnosed according to Rotterdam criteria had an increased risk of pregnancy-induced hypertension, pre-eclampsia, preterm delivery, gestational diabetes, and cesarean section. The presence of both PCOS and obesity further increased the risk of having gestational diabetes, pregnancy-induced hypertension, pre-eclampsia, and cesarean section. Women with PCOS should be monitored closely before and during pregnancy because they have a higher likelihood of complications. PCOS should be taken into account in risk evaluation.

Many women with PCOS have problems with their metabolism, or the way their bodies use up the energy from food. Although many women with PCOS are overweight, not all have a weight problem. Women with PCOS who have a higher amount of body fat around the waist and lower body (apple shape) are more likely to have problems with blood sugar, type 2 diabetes, and high cholesterol. They are also at increased risk for future heart disease. It is important not to gain excess weight around the middle. Women with PCOS should try to live a healthy lifestyle, including regular physical activity and a low-calorie diet, while losing weight or maintaining a healthy weight. If overweight, display insulin resistance, type 2 diabetes (e.g., elevated sugar or glycosylated hemoglobin), and dyslipidemia should be monitored yearly. Some thin women with PCOS can also have high cholesterol and triglyceride levels.

Managing PCOS through Lifestyle Changes

You can improve your general health and help to manage your symptoms by eating a healthy diet and keeping your weight within the normal range for your height. This is especially important if you are overweight or obese. Regular physical exercise effectively reduces insulin levels. It increases the effects of insulin, lowering blood glucose levels. It also increases weight loss, helping improve periods and general health. Eating at regular intervals is healthy. Eating an early breakfast, for example by 7am, is better than delaying it until 10am. This is because the increase in insulin after meals (postprandial insulin levels) plays a role in raising fasting insulin levels. Eating earlier in the day can help to lower fasting insulin levels, which is better for metabolic health.

Depending on your symptoms, regular exercise and a good diet can help to keep your weight healthy. This can help to lower high insulin levels and reduce high androgen levels. This then reduces symptoms and your risk of long-term health problems. People with PCOS can also face a range of psychosocial challenges, such as poorer quality of life, anxiety and depression. Managing PCOS through a healthy lifestyle is a safe and complimentary approach to other treatments. It can also help to prevent the long-term health problems associated with developing type 2 diabetes – an infographic explains the range of health problems, and how healthy living can help to avoid them.

Diet and Nutrition Recommendations

No two diets are the same for people, let alone for individuals with PCOS. Each person is different and has different needs due, in large part, to the unique nuances of the genetics and environmental factors they are exposed to daily. The following nutritional guidance was developed with a focus on helping individuals with PCOS to maintain the healthiest possible metabolism and appropriate weight, optimally use other treatments, prevent other diseases, and improve their overall sense of well-being. It is not meant to be static, but rather to allow a vibrant lifestyle while minimizing disease risk. For many individuals with PCOS, managing body weight with regular exercise, fatty acid and macronutrient balanced diets will improve metabolic health. There may be exceptions, therefore really small weight loss goals may be needed and the actual diet may need to be personalized based on individual metabolic, environmental and other differences. Profiles include the actual amount of physical activity, the effects of exercise, insulin resistance, hyperinsulinemia, dyslipidemia, and metabolic endotoxemia. Profiles can be mapped to part of the food pyramid to ensure that carbohydrates, fats, and proteins are tailored to the basic metabolic needs of an individual.

Polycystic ovary syndrome (PCOS) is associated with many health complications including insulin resistance, hyperinsulinemia, dyslipidemia, obesity, and cardiovascular disease. Women with PCOS may also experience reproductive abnormalities such as anovulation, menstrual irregularities, hirsutism, infertility, and polycystic ovaries. If you cannot discuss difficult topics because it causes you too much stress or anxiety, there are other actions you can take that may help you cope as a couple. Good nutrition, good health, and good food are the key to preventing and treating diseases whether the concern is early on or later in life. The issue of how to eat properly can be challenging: there is a wealth of conflicting “right” ways to eat and many media-savvy tactics in place to push us away from true nutrient-dense, disease-avoiding diets and toward the unhealthy and increasingly obese health profile of people in the U.S.

Exercise and Physical Activity

It has been shown that exercise can improve insulin function and action. Exercise influences cell signaling pathways, and a single exercise session can greatly affect insulin sensitivity and glucose regulation. Various studies have shown that resistance training can be as effective in improving glucose regulation as a combination of aerobic exercise and resistance training in women with PCOS. According to previous studies, exercise seems to have similar effects on androgen levels in women with PCOS, both in acute and chronic exercise, in both healthy and overweight and obese women. Another study reported that 12-week high-intensity aerobic interval training improved blood lipid profiles, hormonal changes, and menstrual cycle frequency in women with PCOS. The results of the resistance training studies showed that 12 weeks of resistance training could decrease testosterone in overweight and obese women with PCOS and could not regulate gonadotropin-releasing hormone. Overall, these results suggest a positive impact of supervised and regular exercise on overall health.

As with most chronic medical conditions, the limitations of physical activity have a negative impact on patients’ general health status in patients with PCOS. It is generally known that regular and habitual exercise has a positive effect on health, well-being, and quality of life. Moreover, it can control body weight, reduce fat mass, help in menstrual cycle regulation, improve ovulation, and reduce androgen levels by increasing the bioavailability of sex hormone-binding globulin. As a result, it can help reduce all symptoms associated with PCOS. Over the last few decades, research on the effect of exercise on patients with PCOS has become increasingly popular, as has the use of exercise as a treatment.

Support and Resources for Women with PCOS

The immersion of complementary and alternative medicine therapies with Western medical practices may be a useful resource for women with PCOS. Typically, when at the doctor’s office, we don’t discuss our cycles/periods and gush over obstetrics issues and pregnancy, often while overflowing with baby-themed pamphlets and expecting bellies. People with PCOS are not abundant in numbers – but, we exist. Navigating the journey of life with PCOS usually means looking beyond traditional Western Medical practices. A support group or person is also an invaluable resource. Complementary therapies can complement, as the name implies, the service provided by your GP. Empowering yourself with information is equally important, and the following references have been invaluable. Reading through some general women’s health books is amazing to find other tips and strategies that can potentially help people with PCOS. I have loved learning about other people’s experiences and how having PCOS shaped other women. Sometimes, information can be more powerful than drugs, and it comes at a rather low cost – the time it takes to enjoy a book.

The Polycystic Ovary Syndrome Support Group in South Australia (SA) has meetings once a month for women with PCOS to meet and share their experiences within a supportive environment. The meetings usually last a couple of hours and rotate between different locations. The Support Group was developed for women with PCOS by a woman with PCOS and operates solely by volunteers. The group aims to empower, nurture, and support women with PCOS to make positive lifestyle choices, thereby improving their health and quality of life. Participating in the group activities, you will learn the importance of managing your symptoms and make positive changes in your life with the support of like-minded women.

Online Communities and Support Groups

An online support group can be defined as “a group with members who communicate and interact with one another via electronic or non-electronic means, usually only on a single topic or topic area. Examples of inquiries in the PCOS forums are those about diet, menstrual cycle, pregnancy issues, and PCOS medications. Women might also seek social support and form relationships with others who share the common thread of having PCOS or infertility. Online support groups are a type of “self-help group” which shares the complementary goals of emotional support, the exchange of information, and experiential understanding and social solidarity. In fact, there is a wide variety of support groups meeting the needs of people experiencing PCOS, including structured groups in which there is a therapist that leads the group and unstructured groups that meet without any leader at all.

Online communities are groups of people who meet to communicate with one another and possibly form relationships and work toward common goals through the use of the internet. Online communities have become a source of support and an integral part of people’s social networks, particularly for communities such as breast cancer, endometriosis, and infertility. One of the main reasons for the use of online communities and support groups by infertile individuals is avoidance of emotions. These communities allow infertile individuals to address their emotional concerns from infertility while remaining anonymous. Online support services reduce feelings of stigma that some women associate with seeking support for infertility. When people are diagnosed with a chronic illness such as infertility in the case of women with PCOS, one conversation with a doctor is insufficient to address their concerns and questions. These forums provide them with the safe place and a group of individuals who also share the same problems from which to ask questions.

Counseling and Mental Health Services

In patients with PCOS, the potential presence of mood disorder symptoms is often overlooked, but they should be taken into account in outpatient care. Data on psychological symptoms in PCOS women requiring hospitalization are extremely limited, with the majority of studies assessing symptoms with self-reported and not standardized scales or diagnostic interviews. In a study, the somatization symptoms resulted as the most represented ones followed by obsessive-compulsive, depression, hostility, and interpersonal sensitivity. Data analyzing potential correlations between endocrine and metabolic dysfunctions and the levels of BFI, SF-36, and GHQ-12 scores in women with PCOS who were referred as inpatients are largely unknown. BFI, GHQ-12 scores, and SF-36 scores showed significant variations if associated with biohumors related to PCOS metabolic and endocrine dysfunction. Furthermore, BFI and GHQ-12 scores show more significant variations than SF-36 with increasing WC.

Counseling of adolescents and adult women with PCOS should be recommended beginning at an early age. Education of parents of adolescents with PCOS is also important. Counseling to promote physical activity and a healthy diet needs to be provided. It is important to provide clear information regarding chronic management and development of long-term care relationships. For adolescents, school-based counseling can be ideal. Stress levels are higher among PCOS patients and are associated with hyperandrogenism and thus should be quantified and emerged in pretreatment for individual care. Psychoeducation of lifestyle changes with healthy habits and, at the same time, equilibrated physical load and attempts to reduce stress may be important in the comprehensive psychotherapeutic management of these women. Increased psychopathology in the women with PCOS may be mediated by the psychological stress as it is known that significant costimuli to the hypothalamic–pituitary–adrenal axis cannot only generate an increase in adrenal and hyperadrenergic PCOS and high levels of chronic peripheral circulating catecholamines but also affects resiliency. The women with PCOS might be considered as a vulnerable population developing more negative thoughts and perceptions, a reduction in hope, cognitive distortions, and behavioral dysregulation in addition to decreased resilience. This confirms that a psychosocial approach to these women is necessary. Important potential psychological factors need to be discussed including decreased quality of life, low self-esteem, mood swings, difficulty in maintaining a social relationship, body dissatisfaction, and eating disorder features including binge eats and emotional eating.