Polycystic Ovarian Syndrome (PCOS) is a chronic metabolic condition affecting 10-20% of women globally. Characterized by hormonal imbalances, particularly excess androgens (male hormones like testosterone), PCOS presents with a variety of symptoms including unwanted hair growth, acne, scalp hair thinning, irregular menstrual cycles, infertility, mood swings, weight gain, and insulin resistance.
Insulin resistance is a key feature of PCOS, as elevated testosterone increases fat deposition and worsens insulin resistance, often leading to weight gain, particularly around the abdomen. Below we will dive deeper into PCOS symptoms, treatment, and understanding how it affects women.
Table of Contents
PCOS Symptoms
PCOS affects each individual differently, and the symptoms can range in severity. Common symptoms include:
- Hirsutism (excessive hair growth)
- Acne
- Weight gain, especially around the abdomen
- Scalp hair loss
- Irregular menstrual cycles
- Infertility
- Mood swings
- Insulin resistance
PCOS Treatment: How Specialists Help
The goal of PCOS treatment is to balance hormones by reducing androgens (6), helping to alleviate symptoms and improve quality of life.
- Insulin Sensitizers:
Medications such as Metformin and GLP-1 agonists (e.g., Semaglutide) have been included in the most recent PCOS treatment guidelines. These medications help lower insulin resistance, which also reduces androgens. - Birth Control:
Birth control pills are commonly used in PCOS treatment to help regulate menstrual cycles. Estrogen competes with testosterone at receptor sites, but not all birth control methods have the same androgenic effects, so working with a PCOS specialist is essential to select the right one for each individual. - Androgen Blockers:
Medications like Spironolactone act as direct androgen blockers, reducing symptoms like hirsutism and acne. - Fertility Medication:
Although fertility medications like Letrozole and Clomid do not directly treat PCOS, they address the infertility that often results from the hormonal imbalances associated with the condition.
At PCOS Sisters, our approach is individualized. We understand when to use and how to adjust these treatments for optimal results, ensuring that each patient receives the care they need.
PCOS Specialists: The Key to Effective Management
According to the PCOS treatment guidelines, OBGYN, Primary Care Providers (PCP) that are PCOS informed, and Endocrinology are all providers that are helpful to add to your PCOS management team. (6) However, finding a PCOS specialist can be challenging, making it crucial to interview potential providers. PCOS specialists, such as those at PCOS Sisters Telehealth Clinic & Wellness Centers, provide holistic diagnosis and treatment for long-term success in managing this lifelong condition.
Why Is Diagnosing PCOS So Difficult?
PCOS is often misdiagnosed, with studies showing that 50-70% of women experience delays in diagnosis (2). Many women see multiple healthcare providers before receiving the correct diagnosis, with an average wait time of more than two years. Here are some factors that make getting a PCOS diagnosis challenging:
- It is a syndrome meaning not every PCOS woman will experience all of the same symptoms making it particularly difficult to diagnose based on phenotype and symptoms.
- The name itself is a misnomer and is under consideration for change! Only 17-33% of women with PCOS have “polycystic ovaries.” In fact, cysts is not the proper term at all. They are follicles. Follicles house eggs and are a normal party of ovulation. If fertilization does not occur, these follicles should dissolve. When this doesn’t happen they aggregate into “grape-like clusters” of tiny follicles. It is not common for them to cause pain unless they were to further aggregate into a cyst. Cysts are not a defining feature of PCOS. There are often other co-morbid conditions such as endometriosis or a ruptured cyst if you are experiencing pain. However, PCOS can cause heavy cycles, which could be responsible for menstrual related cramping. (4,5)
- Misnomers such as this can prompt non specialized providers to refer for imaging or even cause a delayed or missed diagnosis, believing they must prove cysts are present to diagnose. Imaging is not required for a PCOS diagnosis. Blood work is required and often not included.
- PCOS treatment that is already started prior to diagnosis, such as birth control will mask the diagnostic results. In this case, a provider who is skilled in interpretation of endocrine panels and collection of a thorough patient history will be required to properly diagnose.
- PCOS is a diagnosis of exclusion. You must rule out tumors and other endocrine disorders to receive a diagnosis. Proving testosterone is high is not only not required, but difficult to catch high on any given day. We still attempt to catch it high, but chasing “proof” of high testosterone can also delay diagnosis or cause women to suffer with untreated PCOS.
PCOS Financial Burden
PCOS has a substantial economic impact. A 2021 study revealed that the cost of treating PCOS-related health issues in the U.S. is around $8 billion annually (1), accounting for both direct treatment costs and the long-term complications associated with the condition.
Long-Term Consequences of Untreated PCOS
PCOS is not just about managing symptoms; untreated PCOS can lead to significant long-term health risks, including:
- 50% of women with PCOS develop diabetes by age 40 if left untreated
- PCOS is the #1 cause of infertility
- Women with PCOS are 7x more likely to suffer a stroke
- 4x greater risk of heart attack and 19% greater risk for cardiovascular events
- 40% of women with PCOS have hypertension
- 80% have insulin resistance
- 70% have elevated cholesterol
- 35% have sleep apnea, which contributes to hypertension (3)
PCOS Screening & Diagnosis
If you’re unsure whether you have PCOS, you can take our PCOS Screening Questionnaire to assess your symptoms and determine whether you should seek an official diagnosis. Visit www.pcossisters.com to schedule your consultation today.
If you’re a healthcare provider interested in further education on PCOS, including access to free screening tool flyers, visit our provider partnership page.
FAQ: Understanding PCOS
What is Polycystic Ovarian Syndrome (PCOS)?
PCOS is a hormonal disorder that affects 10-20% of women and causes symptoms like irregular periods, acne, infertility, and insulin resistance.How is PCOS diagnosed?
PCOS is diagnosed through a combination of blood tests and a thorough patient history; imaging is not required for diagnosis.What treatments are available for PCOS?
PCOS treatment may include insulin sensitizers, birth control, androgen blockers, and fertility medications, tailored to the individual’s symptoms.Can PCOS be cured?
PCOS is a lifelong condition, but symptoms can be managed effectively with the right treatment plan from a PCOS specialist.How can PCOS affect my long-term health?
Untreated PCOS can lead to serious health risks such as diabetes, heart disease, and infertility. Early diagnosis and treatment can help prevent these complications.
References
- https://www.endocrine.org/news-and-advocacy/news-room/2021/treating-polycystic-ovary-syndrome-costs-8-billion-a-year-in-us-alone#:~:text=The%20most%20common%20hormone%20disorder%20affecting%20women,Society’s%20Journal%20of%20Clinical%20Endocrinology%20&%20Metabolism.&text=The%20economic%20burden%20of%20this%20care%20is,$4.3%20billion%20a%20year%20as%20of%202020.
- https://www.pennmedicine.org/news/news-releases/2017/january/two-years-and-multiple-doctors-often-needed-to-diagnose-polycystic-ovary-syndrome
- https://www.ahajournals.org/doi/10.1161/JAHA.123.033572
- https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/uog.13402
- https://pmc.ncbi.nlm.nih.gov/articles/PMC4341818/#:~:text=The%20presence%20of%20polycystic%20ovaries,decreased%20insulin%20resistance%20(38).
- https://www.monash.edu/medicine/mchri/pcos/guideline
