PCOS Signs and Symptoms
PCOS Signs and Symptoms
• Amenorrhea (no menstrual cycles) or oligomenorrhea (irregular menstrual cycles)
Irregular Menstrual (Amenorrhea)
One of the most common symptoms of polycystic ovarian syndrome is infrequent or absent menses. Some women have oligomenorrhea, which is defined as less than 10 menses a year. Lack of ovulation leads to a decrease in the production of progesterone, which eventually leads to a lack of menses (also termed amenorrhea). Several months of no menses will lead to accumulation of the lining of the uterus and cause women to have prolonged irregular cycles. Long-standing absence of menses may increase the risk of endometrial hyperplasia, which can increase the risk of cancer of the lining of the uterus by three fold.
Women who do not ovulate regularly have a hormonal imbalance between estrogen and progesterone, which leads to irregular heavy bleeding or no bleeding at all.
It is important to note that having menses every month does not necessarily mean that ovulation is occurring regularly.
- Lack of ovulation will lead to amenorrhea and increase the risk of endometrial hyperplasia. (Link to PCOS Fertility Treatment Page)
- Hirsutism/thinning hair is seen in up to 70% of cases (Link to page)
Acne can occur at any age and it is often due to excess androgens. Oral contraceptives, in combination with antibiotics, can be effective at eliminating or minimizing acne. Accutane has been used with varying degrees of success.
Hair loss around the scalp is called androgenic alopecia and is due to an increase in androgens causing hair thinning. Several combination treatments must be utilized to minimize hair thinning, including a combination of oral contraceptives and spironolactone. Minoxidil or Rogaine have been moderately effective in growing hair and must be used continuously. Retin-A may also be effective alone or in combination with Rogaine.
Excess body hair (hirsutism)
Hirsutism is present in approximately 25% of women and in about 70-80 % in women with the diagnosis of Polycystic Ovarian Syndrome. Hirsutism may signal underlying endocrine or metabolic abnormalities, such as androgen excess and PCOS. Other signs of elevated androgens include hair loss, irregular menses, acne, acanthosis nigricans, and others. Approximately 5-15 % of women with hirsutism have no identifiable underlying cause.
Hirsutism is often due to elevated ovarian testosterone, which leads to thinning of the scalp hair while increasing facial and abdominal hair in women. High levels of testosterone can result in a lowering of the voice, classic “pear shaped” body appearance, irregular (or no) ovulation, and other symptoms.
Normalization of testosterone levels can often be achieved by using a combination of oral contraceptives and Aldactone (spironolactone), a diuretic that also decreases androgen production.
All patients with hirsutism should undergo a physical and laboratory examination, which includes menstrual history, evaluation of progression of hair growth, and review of current medications.
The laboratory evaluation should include thyroid hormones, prolactin levels, fasting insulin, glucose levels, free testosterone, DHEAS, 17-hydroxprogesterone, and sex hormone binding globulin. These laboratory fertility tests are typically performed in the morning before day 8 of the menstrual cycle.
Treatments for Hirsutism
- Oral contraceptives, alone or in combination with Aldactone (spironolactone), work well to decrease the growth of new hair.
- Vaniqa-A cream applied twice daily may decrease hair growth after only 8 weeks of therapy.
- Electrolysis is effective for permanent hair removal; this involves the insertion of sterile probes into the hair shaft followed by heat and/or chemical treatment. This necessitates frequent sessions and multiple treatments per follicle. Scarring, hypopigmentation, and skin puckering can result if not performed correctly.
- Laser hair removal uses treatment principals similar to electrolysis but with quicker and more effective long-term results. The laser utilizes light to heat melanin (the pigment in the hair) so the hair and the surrounding follicle structures are damaged and destroyed, sparing the skin.
- Shaving or clipping with scissors is the fastest temporary hair removal method and will not promote hair growth.
- Tweezing and waxing are the worst techniques producing thicker, darker, and denser follicles. Also, the skin may develop acne, ingrown hairs, folliculitis, and scarring.
- Acne can occur at any age and it is often due to excess androgens. Oral contraceptives in combination with antibiotics can be effective. Accutane has been used with varying degrees of success.
- Hyperandrogenism: elevated androgens (male hormones)
- Infertility seen in 55-75% (Link to PCOS Infertility Treatment page)
- Polycystic ovaries: enlarged ovaries with multiple small follicles (Link to page)
- Chronic pelvic pain
- Obesity or weight gain: 70% of PCOS patients are overweight and 30% are of normal weight (Link to page)
LINK PCOS Weight Loss & Nutrition
Many women with polycystic ovarian syndrome (PCOS) struggle with their weight. Women with PCOS often find it difficult to lose weight even with dramatic decreases in their food intake. They are at high risk for impaired insulin metabolism and diabetes. Studies have shown that lower carbohydrate (41% vs. 55%) diets resulted in lower fasting glucose, lower fasting insulin, and lower testosterone levels.
What is Body mass index (BMI)?
- BMI is a measure of body fat based on height and weight.
- BMI is a better predictor of disease risk than body weight alone. However, there are certain people who should not use BMI as the basis for estimating body fat content. Examples include: competitive athletes and body builders whose BMI is high due to a relatively larger amount of muscle and women who are pregnant or lactating. BMI is also not intended for use in growing children or in frail and sedentary elderly individuals.
If your BMI is high, you may have an increased risk of developing certain diseases, including:
- Cardiovascular disease
- Adult-onset diabetes (Type II)
- Sleep apnea
- Female infertility
Prevention of further weight gain is important and weight reduction is desirable.
• Insulin resistance is estimated to be present in 80% of patients and obesity increases the incidence of insulin resistance
Many studies have found insulin resistance in 60-80% of women with PCOS. In patients with PCOS, the cells in the ovary and muscles do not respond adequately to normal level of glucose and over-produce insulin to compensate. The cells in the pancreas have to work very hard to keep up with insulin secretion, and insulin resistance can eventually progress to diabetes mellitus. Insulin overproduction stimulates the production of ovarian testosterone, which contributes to irregular ovulation, irregular menstrual cycles, hirsutism, and weight gain.
Insulin resistance is diagnosed in cases where the glucose to insulin ratio is greater than 4.5, the 2-hour glucose levels are greater than 140 mg/dL, or if fasting insulin is greater than 10 µIU/mL.
Progressive insulin resistance will eventually lead to exhaustion of the cells of the pancreas and the development of diabetes mellitus ensues.
Insulin resistance and the risk of diabetes can be resolved through careful lifestyle modification with an appropriate diet and an exercise program. Along with lifestyle modifications, medications such as metformin (Glucophage) or DCI (Dichiro inositol) are used to decrease insulin production. Our individualized PCOS nutrition and wellness program offers ways to naturally decrease insulin levels, decrease inflammation, and consistently improve weight management. The individualized nutrition programs are supervised by qualified individuals who will guide our patients with scheduled consultations and continued support until they achieve their goal.
- Hypertension (high blood pressure): women with PCOS often suffer from high blood pressure
- Dyslipidemia: includes elevation of cholesterol/triglycerides (seen in 70% of women)
- Cardiovascular Disease: there is substantial evidence that increased lipids, insulin resistance, and hypertension can result in an increased risk of cardiovascular disease.
The following factors are found in patients with PCOS:
- Increased CRP (C-reactive protein is a marker of inflammation and correlates with the risk of cardiovascular disease)
- Increased coronary artery (vessels feeding the heart) calcium, which can increase the risk of heart disease
- Increased carotid intima-media thickness (vessels which supply the brain), which can increase the risk of stroke
- Acanthosis nigricans: thickening and dark areas around the neck, groin, underarms, and skin folds. The skin manifestations are due to excess insulin, and may be a sign of an underlying insulin abnormality.
- Reducing the levels of insulin may lighten the patches and Retin-A may also be effective in reducing the skin color and thickness.
- Depression/Anxiety/Mood Swings.
Depression, anxiety, and mood swings
It’s unclear whether depression and/or anxiety are due to the hormonal imbalances seen in PCOS or a natural response to the weight gain, excessive hair growth, acne, and infertility that come with the condition. It is vital to a healthy life to manage your PCOS symptoms.
May be caused by insulin resistance in the system or an increased body mass index. Fatigue is just as common and may be related to insulin resistance or low thyroid function (hypothyroidism), either of which can cause reduced energy levels.
Studies show a link between PCOS and an under-active thyroid, a condition known as hypothyroidism, Hashimoto’s Disease, or chronic lymphocytic thyroiditis. For this reason, women who have been diagnosed with PCOS should undergo routine thyroid function testing.
Metabolic Syndrome: a combination of various metabolic conditions. The syndrome is diagnosed when a patient meets three or more of the following criteria:
- Blood pressure: 130/85 mm Hg or higher
- Triglyceride levels: 150 mg/dL or higher
- HDL-cholesterol levels: less than 50 mg/dL
- Abdominal obesity: waist circumference greater than 35 inches
- Fasting glucose: 110 mg/dL or higher