What are the symptoms of polycystic ovary syndrome (PCOS): is it dangerous?

Posted On March 23, 2022May 28, 2022

Introduction

Are you having signs and symptoms of polycystic ovary syndrome (PCOS)? If yes. Then, keep reading it.

One day my wife asked me, “Do you know PCOS?”

I said to her, “No, I don’t have much idea about this disease. But why are you asking?” 

She said, “I have a female colleague in my office, and she is facing this PCOS problem. She is currently having pimples, increased weight, improper menstrual periods, and hair problems. Is it curable?

Then I searched the PCOS on google. I found that PCOS is a polycystic ovary syndrome. According to the Indian Journal of Medical Research, 2019 revealed that around 3.7 to 22.5 % of females have PCOS in India.

It means nearly one out of every five females has polycystic ovary syndrome (PCOS).

It is not a problem in India. As per concern globally, PCOS affects 4 to 20% of females. 

PCOS prevalence is increasing year by year and becoming a significant health problem. Now, PCOS has become a leading cause of infertility in females. 

Then I thought, why should I not write something on this medical condition. So, I decided to write an article on PCOS. 

In this post, I will reveal the common signs and symptoms of polycystic ovary syndrome (PCOS). 

You need to recognize your PCOS symptoms early to avoid complications like endometrial cancer, virilization (female get male features), heart disease, and other medical conditions. 

Along with that, we will see the cause and pathology of PCOS.

I’ll help you to clarify all your doubts here. So, without further delay. Let’s get started right away.

What is polycystic ovary syndrome simple explanation?

The PCOS term was initially described in 1935. It is one of the most common medical conditions of females. Let’s understand the meaning of each word separately – 

“Poly = means multiple or many

Cyst = cluster of cells

Ovary = female reproductive part

Syndrome = collection of signs and symptoms.”

In PCOS, you get multiple small clusters of cells in your ovary due to metabolic and hormonal disturbances. As a result, you may experience a lot of signs and symptoms.

So, PCOS is not a disease. It is a syndrome that does not have a definite cause. It is a very complex hormonal and metabolic disorder.

PCOS = Hormonal syndrome + metabolic syndrome

In PCOS, you may have hormonal disturbances like – 

• Increase testosterone
• Decrease FSH 
• Increase LH
• Decrease progesterone
• Decease estrogen
• Increase Insulin level

Likewise, you may have metabolic disturbances too – 

• Obesity
• Insulin resistance 
• Impaired glucose metabolism 
• Hypertension 
• Dyslipidaemia

It is more prone in teenage or adolescent group females, but it may occur in adult females too.

This disease can negatively affect your reproduction, general health, sexual health, and quality of life.

What is the main cause of PCOS?

Despite the higher incidence of this syndrome, the cause of PCOS is still unclear. But PCOS is mainly seen in those females who have unhealthy lifestyles, unhealthy diets (like eating junk and processed foods), and lack of exercise.

Sometimes, PCOS may also run-in families. If your mother or sister has PCOS, you are more likely to have PCOS. 

These genetic and environmental factors disturb your normal functioning of the hypothalamus-pituitary-ovarian axis (HPO).

Due to this, it causes – 

• excess amount of testosterone, 
• imbalance of estrogen and progesterone, 
• imbalance of FSH and LH
• insulin resistance

Among these parameters, the excess production of androgen (testosterone hormone) is a primary culprit of PCOS. It is also a hallmark sign of your PCOS. 

What is the pathology of PCOS?

A review article published in Evidence-Based Complementary and Alternative Medicine, 2013 is, found that PCOS is a complex syndrome, and it is unclear when or where the pathology of PCOS actually begins. 

However, the excess androgen level and insulin resistance are two key players in developing PCOS.  

A small amount of androgen (testosterone) is usually secreted from the ovaries. But it gets exacerbated during PCOS. Let’s see how – 

Normal menstrual cycle (follicular phase)

Firstly, you need to understand HPO (Hypothalamus-pituitary-ovarian axis).

In HPO, the hypothalamus typically secretes gonadotropin-releasing hormone (GnRH). This GnRH stimulates the anterior pituitary gland, releasing two crucial hormones – LH and FSH.

These hormones go to the ovaries, where FSH help in the production of eggs, and LH has a significant role in ovulation and release of progesterone. 

In the menstrual cycle, ovulation is an essential phase in the release of the egg. Typically, your ovary makes a mature egg in the form of a Graafian follicle every month.

It releases on the 14th day, which is called ovulation. In the follicular phase, Graafian follicle is a mature follicle that contains – 

Ovum (center) + zona pellucida + granulosa cell (inside the fluid-filled cavity) + theca cell (outer layer)

Here, the Theca cell has a vital role in producing androgen (male sex hormone – testosterone). This androgen moves inside the granulosa cells under the influence of FSH (Follicle-stimulating hormone). It converts androgen into estrogen (female sex hormone) by the aromatase enzyme.

This estrogen goes to the uterus, which helps in the proliferation of the uterus wall. 

Excess androgen level in PCOS 

Let’s see how the story is changed here in PCOS. 

Since there is dysfunction of the hypothalamus-pituitary-ovarian axis (HPO). So, FSH does not release appropriately. As a result, follicles don’t get mature, and ovulation does not take place. 

Due to ovulation failure, the unmatured follicles get the club together and make multiple cysts (small cysts 4 to 9 mm in diameter) in the ovary.

You will also get the stronger influence of LH (Luteinizing Hormone). This increased level of LH stimulates theca cells and impairs the conversion of androgen to estrogen. As a result, you get a high surge of androgen during PCOS.  

Insulin resistance in PCOS

If you eat more junk or processed foods and do not do exercise. In response to that, your pancreas works rigorously. Eventually, it produces an excess amount of insulin. 

A massive amount of insulin goes to insulin receptors. Then it starts to stimulate. Due to continuous stimulation of inulin on insulin receptors, insulin receptors get down-regulated.

In down-regulation, you may have fewer insulin receptors and make the cells less sensitive. 

Eventually, this down-regulation of insulin receptors causes the excess insulin in your blood to lead to insulin resistance (or hyperinsulinemia). 

Now, this excess insulin goes to the ovaries and stimulates them. Due to this stimulation, ovaries start to make more testosterone. 

What are the main symptoms of polycystic ovary syndrome (PCOS)?

You’ll usually experience symptoms of polycystic ovary syndrome (PCOS) when you’re in your late adolescent’s age (18 to 21) or beyond teens (30s).  

The symptoms may vary from mild to severe, and not all women will experience all of them. 

Some females may experience just menstrual problems; others do not have any. These are the most common symptoms of polycystic ovary syndrome include:

1. Menstrual irregularity 

Menstrual irregularity is the first sign of PCOS. It is an early symptom of polycystic ovary syndrome. 

You may have delayed menstrual periods (less than 9 menstrual periods per year or menstruation intervals 35 days or greater) in menstrual irregularity. It is called oligomenorrhea.

According to a study, around 85-90% of females have oligomenorrhea among PCOS patients. 

It is mainly due to the failure of ovulation. 

The primary cause of ovulation failure is the imbalance of hormones like increased LH, decreased FSH, decreased estrogen, and progesterone. Instead of that, androgen levels get increase.  

If you are not ovulating, your uterus will not prepare for the next menstrual cycle. 

Due to this hormonal imbalance, you may also have secondary amenorrhea. 

You will not get menses in secondary amenorrhea due to medical conditions (like PCOS) or pregnancy. Whereas primary amenorrhea is a term where you never had a menstrual period. 

Sometimes, you may also experience heavy bleeding in the menstrual period because of a very low level of progesterone called menorrhagia. 

2. Infertility

PCOS is the leading cause of female infertility. Now, it is being a significant concern in public health.

As per a study, approximately 70 and 80% of women with PCOS are infertile. 

Although, not all patients with PCOS have infertility. But if you are not having a proper menstrual period and your ovary cannot release the egg. In that case, you can’t achieve pregnancy. 

Since the egg is the primary source for fertilization and then pregnancy occurs. However, it fails to release in PCOS.

Anyhow if you get pregnant, there may be a higher chance of miscarriage and increased pregnancy complications, including –

• gestational diabetes mellitus (diabetes developing during pregnancy)
• pre-eclampsia (high blood pressure during pregnancy)
• postpartum hemorrhage (heavy bleeding after giving birth) 
• infection 
• preterm delivery (if a baby is born too early before 37 weeks) 
• stillbirth (if baby die before delivery)

3. Pimples (Acne vulgaris) 

Pimples (acne) are a crucial clinical sign and symptom of polycystic ovary syndrome. 

There is a 9.8-34% prevalence of acne in PCOS patients. During PCOS, you may have acne beyond 30 years of age; it is called late-onset or hormonal acne. 

The excess production of testosterone is crucial to acne development in PCOS women. 

4. Hirsutism

Hirsutism is also an essential clinical feature in PCOS women. In Hirsutism, you will get unwanted hair growth on the face, neck, upper lip, chest, back, and abdomen. 

According to a study published in the Egyptian Journal of Medical Human Genetics, 60 to 80 % of women have complained of hirsutism problems in PCOS. 

The most common cause of Hirsutism is hypersecretion of male sex hormone (testosterone).

This excess testosterone production freely circulates in your body and stimulates the pilosebaceous gland, causing unwanted hair growth.

5. Alopecia (loss of hair)

PCOS is strongly associated with alopecia, with a prevalence of 3.2 to 34.8% depending on the population. 

It is one of the most common reported symptoms of polycystic ovary syndrome. 

You may experience thinning of scalp hair and male pattern baldness. It is because overproduction of androgen hormones in the blood cause hair loss. 

6. Acanthosis nigricans  

Acanthosis nigricans is highly associated with PCOS. According to a study, 56% of patients with PCOS reported that they had acanthosis nigricans. 

The most common cause of acanthosis nigricans is due to insulin resistance.

Acanthosis nigricans is seen chiefly in obese (BMI more than 30 kg/m2) and diabetic people. 

In PCOS, you may get too much insulin in your blood, and this excess insulin crosses the dermal-epidermal junction, which directly binds to the IGF-1 receptor (Insulin-like growth factor).

This insulin proliferates to outer skin cells (keratinocytes) and accumulates there. As time passes, it appears in dark skin folds, thick, velvety skin texture.

Acanthosis nigricans is mainly found in body folds like the neck, underarms, groins, elbow, knees, and sometimes in the fingers and forehead.

7. Obesity

Obesity is an important finding in PCOS women. The leading cause of obesity in PCOS is insulin resistance. 

Insulin is a crucial hormone for the uptake of glucose into cells. But it becomes less sensitive in PCOS, which causes hyperinsulinemia (excess inulin).

Due to this, you may have abdominal obesity and increased waist circumference (>88cm; >35 inches).

8. Diabetes and cardiovascular problems 

PCOS disturbs your metabolic function. As a result, you may have heart disease, hypertension (>130/85 mmHg), fatty liver disease, and type-2 diabetes mellitus. 

According to an article published in Oncotarget journal, 2016 shows that PCOS is significantly associated with increased coronary heart disease.

Apart from this, there is a higher risk of developing diabetes if you struggle with PCOS. Around 10% of people get diabetes in PCOS.

Even in a study, the risk of developing diabetes is four times greater in PCOS women.

In this condition, you may have increased urination, increased drinking, and increased eating.

There are a lot of contributing factors involved that cause comorbidities in PCOS – 

• Increase Cholesterol level (>150 mg/dl)
• Increased insulin levels 
• Glucose intolerance 
• Obesity
• Increase androgen level 

9. Obstructive sleep apnea 

Obstructive sleep apnea is another important clinical finding in PCOS women.

In this condition, you will have difficulty breathing during sleep. It reduces airflow in your lung by obstructing the upper airway.

Due to this, you may experience snoring, excessive daytime sleepiness, and feeling tired throughout the day.

It could be a dangerous sign because the risk of heart attack increases 20 times in obstructive sleep apnea.

Sleep apnea may be due to alteration in sex hormones (increase androgen and decrease estrogen) and obesity. 

Conclusion

For every female, it is always necessary to monitor PCOS symptoms so that they can get appropriate treatment. 

If you do not monitor early, it may lead to serious complications like endometrial cancer, diabetes, heart problems, and other health complications. 

In this post, we have seen how the imbalance hormones and metabolic disturbance cause changes in your entire body. Due to this, you get unwanted symptoms like menstrual irregularities, infertility, acne, etc. 

Excess androgen hormones and increased insulin levels are the main contributing factors causing PCOS. 

You need to be more aware. If you are experiencing symptoms of polycystic ovary syndrome, then you must consult your doctor. 

In the following article, I will explain the treatment options of PCOS. 

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