Do you suffer with weight gain, facial hair, acne, insulin resistance, dry skin, appetite fluctuations, edema, or any combination of these symptoms? It’s possible that you are suffering from polycystic ovarian syndrome, a condition that affects roughly 5-10% of child-rearing aged women in the United States.
Polycystic ovarian syndrome is defined as a disorder that affects women of childbearing age. It is among the leading causes of infertility in women. In this disease, you may find the development of many fluid-filled follicles or cysts on the ovaries. These follicles or cysts cause the failure of regular ovulation.
Along with developing cysts on the ovaries, there is also a hormonal imbalance in women suffering from this syndrome. This hormonal imbalance leads to menstrual problems in women. The menstrual problems include irregular menstrual periods, infrequent menstrual periods, and prolonged menstrual bleeding. There is also increased production of male hormones (androgens) in women suffering from this syndrome. The excess of the male hormones leads to excess development of hair on the body and face. This excess production of the male hormones also causes acne in females with PCOS. A detailed discussion about the causes, symptoms, diagnostic tests and treatment options for polycystic ovarian syndrome is in the following section.
Causes of Polycystic Ovarian Syndrome
PCOS has many causes. The most common causes of PCOS include genetic predisposition, insulin resistance, obesity, improper diet management, accumulation of toxic substances in the body, and dysregulation of the immune system. A detailed description of the causes of polycystic ovarian syndrome is in the following section.
1: Genetic Causes
PCOS has diverse genetic causes in different patients. However, all the genetic causes of PCOS are related to hormones, mainly androgens. There has been no identification of a single cause of PCOS, in any patient. So, polycystic ovarian syndrome is a polygenic disease.
The most common genetic cause of polycystic ovarian syndrome is a mutation in the genes responsible for enzymes of the steroidogenesis pathway. These genes include CYP11a, CYP21, CYP17, and CYP19.
All these genes are responsible for different enzymes involved in steroidogenesis. A mutation in these genes can lead to excess production of the androgens and subsequent PCOS. PCOS can also be caused by the over-activation of the genes involved in synthesising the androgens receptors. These overactive androgen receptors will amplify the effect of the androgens leading to PCOS. There are also some other minor genetic causes of PCOS, such as a mutation in the genes related to the production and action of gonadotropins.
2: Insulin Resistance
Insulin resistance is a vital driver of the metabolic disturbance that leads to PCOS. Insulin resistance and subsequent high blood glucose level disturb the regulation of androgen production. They also cause an imbalance in the hormones produced by the hypothalamus and pituitary gland. An Imbalance of gonadotropins is a significant contributor to PCOS pathogenesis. The cause of increased production of the androgens in insulin resistance amplifies the signalling pathways related to androgen production.
PCOS causes an increased risk of obesity, insulin resistance, and other reproductive disorders in women. There is an increased production of androgens and other hormones in obese women, such as testosterone. There are different ideas about the relationship between obesity and PCOS. However, the most common relation of obesity with PCOS is insulin resistance.
4: Inappropriate Diet
Diet can also be a contributing factor to the pathogenesis of PCOS. A diet rich in carbohydrates causes an increase in blood glucose levels. This increased blood glucose level leads to increased production of insulin by the pancreas. The high insulin level in the blood causes amplification of many metabolic pathways and increased glucose metabolism. This amplification can cause excess production of the androgens. The ultimate result is the development or progression of PCOS. In addition to a diet rich in carbohydrates, other highly processed diets affect the hormonal and metabolic balance. So, a highly processed calories rich diet puts you at risk of PCOS.
5: Chronic Inflammation
Chronic or recurrent inflammation can cause PCOS. There are different causes of inflammation. A weekend immune system allows the recurrence of infections of the urogenital tract. These infections can ascend to ovaries and cause inflammation there. A prolonged standing inflammation can cause the accumulation of fluid-filled cysts in the ovaries.
6: Autoimmune PCOS
An autoimmune disease is a disease in which the body starts to make antibodies that destroy self tissue. Autoimmune diseases often occur secondary to foreign infections or other diseases. The antibodies produced to destroy the foreign invader start to attack self tissue after removing the foreign agent. If such auto-antibodies are directed again to the ovaries, they lead to inflammation in the ovaries. This inflammation can later lead to PCOS.
Symptoms of Polycystic Ovarian Syndrome
The symptoms of PCOS depend on the severity of the disease. Usually, the cases of PCOS present with the following symptoms.
1: Irregular Menstruation
There is a lack of ovulation in PCOS. A lack of ovulation and a lower level of progesterone fails to cause regular shedding of the uterine wall—this failure of uterine shedding results in infrequent and irregular menstrual bleeding. There is an increase in the gap between uterine shedding, so there can be excessive bleeding after missed menstrual periods. The result of the loss of ovulation and irregular periods is infertility.
2: Inappropriate Hair Growth
There is an increase in the level of male hormones in PCOS. This increased level of male hormones causes growth of the hair on the women’s face, chest, and back. This excessive growth of the hair is called hirsutism.
Increased level of the androgens causes the skin to become more oily. Oily skin has an increased risk of acne. So, women with PCOS often have acne on the face and back.
4: Weight gain
PCOS is the cause as well as the effect of insulin resistance. So, PCOS causes an increase in insulin resistance and subsequent high blood glucose levels and obesity.
5: Pattern Baldness
Increased level of the male hormones causes increased growth of the hair on the whole body. But these hormones cause the hair of the head to shed. So, women with PCOS have thin hair on their scalp. There can be typical male pattern baldness in some cases.
Some other symptoms, such as lethargy and headache, are due to an imbalance of the hormones.
Blood tests for Polycystic Ovarian Syndrome
If you have PCOS symptoms, and physical examination and X-ray support the diagnosis of PCOS, your doctor may ask you for the following test.
1: Complete Hormonal Panel of the Blood
There is an imbalance of androgens and other reproductive hormones in PCOS, so a complete hormonal picture of the blood is necessary. The FSH level, LH, estrogen, progesterone, testosterone, anti-mullerian hormone and other hormones are checked. There will be a decrease in FSH level and a significant rise in androgen level in PCOS.
2: Blood Glucose level
A high blood glucose level also contributes to PCOS progression, so fasting, post-prandial, and OGTT are done to support the diagnosis.
3: Insulin Level
The insulin level is essential to measure in PCOS because insulin resistance and higher blood insulin contribute to the progression of the disease.
4: Lipid Profile
The doctor often suggests the evaluation of different types of lipids in the body in cases of PCOS. Patients with PCOS often have a raised cholesterol and triglycerides level.
Natural Ways to Minimize the Symptoms of PCOS
The genetic predisposition of PCOS is inevitable. But there are some natural ways that you can adopt to prevent PCOS or reduce PCOS symptoms.
1: Regular Exercise
Regular exercise can help prevent PCOS as well as in reversing the symptoms of the PCOS. By regular exercise, you can manage your weight. An appropriate weight will reduce the occurrence of insulin resistance. Hence, the chances of PCOS will reduce.
2: Diet Planning
Eating a plant-based diet is beneficial for patients with PCOS. A plant-based diet that is minimally processed is called a whole food diet.
Whole foods are helpful because it does not have too many carbohydrates, so it does not raise blood glucose levels. High blood glucose level is a risk factor for PCOS. Additionally, food with minimal processing has a more negligible effect on hormonal balance.
Myo-inositol is a beneficial supplement for women suffering from PCOS. It causes a reduction in insulin resistance. A reduction of insulin resistance lowers the risk of hormonal imbalance and PCOS. Some other supplements that have shown beneficial effects in PCOS cases include vitamin D, magnesium, and Omega-3 fatty acids.
4: Sleep and Stress Management
Your sleeping pattern and stress level are interconnected. An increase in mental stress causes hormonal imbalance. Hence, it increases the risk of PCOS. A proper sleep schedule and therapy for stress management can be helpful in the management of PCOS.
The Takeaway Message
PCOS is a severe disease related to hormonal imbalance and the development of fluid-filled cysts in the ovaries. It has various causes, such as genetic predisposition, insulin resistance, and inflammation. The disease usually manifests in the form of menstrual irregularities accompanied by symptoms such as hirsutism. If you have such symptoms, you should consult your doctor. A complete bloodwork panel may be needed to make an accurate diagnosis of PCOS.
Though the genetic causes of PCOS are inevitable, some lifestyle changes can help you reduce PCOS caused by other reasons. These lifestyle adaptations can also reverse the symptoms of PCOS. These lifestyle changes include regular exercise, a whole food diet plan, stress management, and some supplements.
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6: Sheehan M. T. (2004). Polycystic ovarian syndrome: diagnosis and management. Clinical medicine & research, 2(1), 13–27. https://doi.org/10.3121/cmr.2.1.13
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