Better Me

PCOS: What is It and Why is It So Hard to Diagnose?

It’s one thing to feel like a hormonal teenager when you’re, well, a teenager, but you’ve been an adult now for a while—so what’s up with the irregular periods and acne? Perhaps you’ve even noticed a slight 5 o’clock shadow.

When your symptoms pile up and you can’t seem to figure them out, you might have a condition called polycystic ovary syndrome, or PCOS.

What is PCOS?

PCOS is a common metabolic/hormonal disorder that can disrupt your hormones and menstrual cycle and cause things like infertility, acne and facial hair. It can also lead to serious health problems. “Women with PCOS are also at higher risk for depression, diabetes, high blood pressure, heart disease and endometrial cancer,” said Rachel Darché, MD, an OBGYN at Banner – University Medical Center Tucson.

Although it’s common, affecting 5 to 10 percent of women, there’s still some mystery on what causes it. Thankfully, celebrities like Keke Palmer, Jillian Michaels and Harnaam Kaur are shining a light on this disorder and helping women identify their symptoms and seek medical treatment sooner.

So, what exactly causes PCOS and could it explain what’s going on with your body? We spoke with Dr. Darché for some answers.

What causes PCOS?

The cause of PCOS is unknown, although a combination of genetic and environmental factors may play a role. Having a first-degree relative with PCOS may also increase your risk.

Many women with PCOS have insulin resistance—meaning their body cannot regulate blood sugar effectively. “In the setting of insulin resistance, the body produces more and more insulin, which decreases levels of a protein that usually bind excess androgen (male-type) hormones,” Dr. Darché said. “This can result in elevated androgens circulating in the bloodstream, which is a central feature to PCOS.”

What symptoms should I look out for?

PCOS affects every woman differently. For some, their periods may be longer than normal, while for others, you may hardly get a period at all.

“Women who have infrequent periods, particularly those who go months or longer between menstrual periods, should discuss with their doctor whether PCOS should be considered,” Dr.  Darché said. “Because excess androgens are a common feature of the syndrome, women who have severe acne or those with excess or coarse hair growth on their face, chest or back should also be tipped off that something isn’t right.”

In addition to changes in your menstrual cycle, acne and excess hair growth, some women may also experience the following:

  • Obesity
  • Male pattern baldness
  • Infertility
  • Depression and/or mood swings

Why is PCOS so hard to diagnose?

There are a number of reasons why PCOS can be difficult to diagnose. One reason, according to Dr. Darché, is there is no universal definition of the condition. “There are multiple expert-derived criteria for the syndrome, which means there is no universal diagnostic test or algorithm that doctors use to assess patients,” she said. “The other reason is that some patients have all the signs and symptoms of the syndrome, while others only have some; in other words, it can present differently in different people, which can also make diagnosis difficult.”

In addition, symptoms might not necessarily point to PCOS but could be related to other issues, such as hypothyroidism and other endocrine issues, obesity, or it could just be natural variations in menstrual cycles and hormone levels between and within women.

“Because symptoms can have multiple causes, PCOS is best diagnosed based on the patient’s symptoms, a physical exam and the results of either laboratory testing, ultrasound exam of the ovaries, or both,” Dr. Darché said.

What treatments are available?

There is no cure for PCOS, but there are things you can do, such as lifestyle changes and use of medications, to help ease symptoms.

Lifestyle changes:

For obesity: A healthy diet and exercise can help you lose weight, help reduce your cardiovascular risk and help your body use insulin more efficiently. “For obese patients, even losing 5 to 10 percent of body weight can make a difference in their menstrual period and ovulation,” Dr. Darché said.

For excess hair growth: Facial hair can be embarrassing for some, but there are plenty of hair removal techniques available, including shaving, depilatory creams, waxing and laser hair removal.

Because your hormones fluctuate with PCOS, “it’s important to note that none of the above options prevent further hair growth, but that can be addressed with oral medications that decrease blood levels of androgens,” Dr. Darché said.

Medications:

For infrequent or absent periods: If you don’t plan on getting pregnant, birth control can help regulate your cycle. For those who do wish to get pregnant, cyclic hormones that don’t prevent pregnancy but cause bleeding to occur every few months may help.

“Endometrial hyperplasia (an overgrowth of the uterine lining) and endometrial cancer are increased in patients with PCOS who do not ovulate regularly,” Dr. Darché said. “For this reason, it is important for women with infrequent menstrual cycles to use some type of hormone to protect their endometrium and help prevent overgrowth and cancer.”

For acne: Topical and oral medications may help reduce and prevent breakouts.

For insulin resistance and androgen excess: Some medications, like Metformin, that are used to treat type 2 diabetes can also be used to treat PCOS. They can help improve ovulation rates, decrease androgens and improve insulin sensitivity.

For infertility: PCOS can interfere with becoming pregnant, but Dr.  Darché said women shouldn’t be discouraged. “The good news is that women with PCOS typically have excellent ovarian reserves and a great response to fertility medications and treatments to help with ovulation and pregnancy,” she said.

Next steps if you think you have PCOS

Don’t wait, question or suffer alone. If you’re experiencing symptoms, you should talk to your doctor as soon as possible. To find a Banner Health specialist near you, visit bannerhealth.com.

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Women's Health Wellness

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