PCOS

Polycystic Ovary Syndrome

Kaitlyn Acosta

Do you have periods lasting many days? Or are you not menstruating very often? Although there are numerous explanations for these questions, there is a possibility that your body has an abnormal amount of androgens. With an abnormal production of androgen, the female body can be affected by a condition known as the Polycystic Ovary Syndrome or PCOS. Polycystic Ovary Syndrome is a result of an imbalance of the androgen hormone, which affects the reproductive system of the female body (Cleveland Clinic, 2023).

Before we jump in-depth into the syndrome, we will first cover what it is and how it develops.

What is PCOS?

PCOS, or polycystic ovary syndrome is a condition of hormone imbalances of androgens in the female reproductive system. The abnormal amount of androgens causes several small cysts or sacs that form along the outer edge of the ovaries. These small cysts are previous follicles, containing an ovum or egg that were previously selected to mature and in preparation for being released through the oviducts (StayWell Company, 2022). This process is also known as the follicular phase of the menstrual cycle, just before ovulation occurs.

In the follicular phase, the ovaries become stimulated by the follicle-stimulating hormone (FSH) by the pituitary gland. The pituitary gland is located at the base of the brain and is responsible for stimulating or inhibiting the secretions of various hormones such as FSH. The hormone FSH is responsible for stimulating the growth of multiple follicles inside the ovaries, so one follicle to be selected and matured to be capable of ovulation (LeVay, Baldwin, & Baldwin, 2021). Those who experience PCOS undergo an abnormal hormone imbalance of FSH, that prevents the development of these follicles.

Ovulation is a phase seen in the menstruation cycle where the ovaries release an egg to oviducts as it awaits to be fertilized by sperm (LeVay, Baldwin, & Baldwin, 2021). If this egg fails to become fertilized, the lining of the thickened uterus will shed through the cycle known as menstruation (LeVay, Baldwin, & Baldwin, 2021). The hypothalamus, a part of the brain that is responsible for producing and managing hormones throughout the body, stimulates the process of ovulation (Cleveland Clinic, 2022). The hypothalamus is triggered by the protein stimulator kisspeptin to release gonadotropin-releasing hormone (GnRH) (LeVay, Baldwin, & Baldwin, 2021). The releasing hormone GnRH is used by the pituitary gland to stimulate the production of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) (Cleveland Clinic, 2022). As previously mentioned, the hormone FSH is responsible for stimulating the development of follicles in the ovaries. A surge of the luteinizing hormone (LH) promotes ovulation by stimulating the ovary to release an egg into the oviduct (Cleveland Clinic, 2022). Females that have PCOS fail to create enough FSH and LH hormones needed to stimulate ovulation. With the lack of ovulation, the oviducts will often develop small cysts within their structure. These small cysts contain immature eggs, and follicles failing to release these eggs (Mayo, 2022).

The image depicts the comparison of a healthy ovary versus a polycystic ovary. Those with PCOS can develop small follicle cysts along the walls of the ovary (Cleveland Clinic, 2023).

(Healthdirect, 2023)

https://www.healthdirect.gov.au/polycystic-ovarian-syndrome-pcos

What is the main cause of PCOS?

The main cause of PCOS is unknown, but some factors contribute. Firstly, high levels of androgens in the female body can prevent the release of eggs causing irregular menstrual cycles (Cleveland Clinic, 2023). Androgens are steroid hormones, such as testosterone in the body that are responsible for sex development and other functions in both sexes’ bodies (LeVay, Baldwin, & Baldwin, 2021). In females, androgens provide feedback inhibitions of the gonadotropins FSH and LH necessary for ovulation stimulation. When the ovary produces high levels of androgens, the hypothalamus is triggered to lower the production of GnRH. This low production of GnRH inhibits the pituitary gland from stimulating additional gonadotropins in the ovaries (LeVay, Baldwin, & Baldwin, 2021). With minimal production of FSH LH, the follicles in the ovaries fail to produce well-matured follicles capable of ovulation and stimulate ovulation. High levels of androgens preventing potential eggs from being released in ovulation cause a build-up of small fluid-filled sacs in the ovaries.

Another factor contributing to the condition is insulin resistance. Insulin is responsible for signaling the ovaries to secrete androgens. Higher androgens found in the female body can negatively affect the level of insulin produced. Insulin resistance can cause hormonal imbalances such as FSH and LH, which are necessary to promote ovulation. Insulin resistance can also create an imbalance of progesterone, a steroid hormone that is responsible for the establishment and maintenance of pregnancy by the ovary and placenta (LeVay, Baldwin, & Baldwin, 2021). Progesterone helps properly regulate the menstrual cycle by thickening the uterine lining for a fertilized egg to implant (Washington Fertility Center, 2023). As mentioned previously, an increase in androgen levels can prevent ovulation causing PCOS symptoms. Insulin resistance is also caused by elevated insulin levels, which could indicate diabetes or obesity, which are symptoms of PCOS (Cleveland Clinic, 2023).

Approximately 10% of females live their lives affected by PCOS at any time and age after puberty. Out of this 10%, females between the ages of 15 and 44 go about their lives undiagnosed with PCOS (OASH, 2021).

(Goff, 2019)

https://www.couricenter.com/articles/are-you-the-one-in-ten-by-dana-humes-goff-aprn-cnm-dnp/

Common Symptoms

PCOS symptoms may include:

Irregular periods, including missing or very light periods.

Failure to release an egg in ovulation prevents menstruation from occurring (Cleveland Clinic, 2023).

Infertility
Androgenetic alopecia (baldness or thinning of hair). in a male-like pattern. Bodily hair including the chest, stomach, or back.

The androgen hormone dihydrotestosterone (DHT) is responsible for adult male-like patterns and distribution of hair growth (LeVay, Baldwin, & Baldwin, 2021). In females, these hormone levels can drop and shrink hair follicles, causing hair growth loss (Cleveland Clinic, 2023).

Skin tags, excess pieces of skin typically found around the neck or armpit of the body
Patches of darkened skin, located in the folds of the neck, armpits, groin, and underneath breasts

Insulin resistance can cause a build-up of insulin causing darker spots around the body (Cleveland Clinic, 2021).

Abnormal enlargement of the ovaries (indication of follicle cysts presence) (Cleveland Clinic, 2023)
Acne around the face, back, or chest that continues after surpassing teenage years
Obesity

(Hopkins, 2024)

https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos#:~:text=Polycystic%20ovary%20syndrome%20(PCOS)%20is,that%20form%20in%20the%20ovaries.

(Academy, 2023)

https://medinaz.com/blog/2023/07/25/pcos-symptoms-a-comprehensive-guide/

Diagnosis

PCOS can be difficult to diagnose as there are a variety of symptoms that can be used to diagnose. Typically a healthcare provider will ask about previous medical history, the length of your last menstrual period, and any symptoms experienced. After the healthcare provider will conduct a physical exam to observe any acne or excess hair growth, then a pelvic exam to examine the reproductive organs for any abnormalities (Hopkins, 2024).

The healthcare provider could further examine the patient by:

Blood tests, to examine hormone levels such as androgens and glucose levels to measure the body’s response to sugar (Mayo, 2022).
Ultrasound or sound waves create imaging of the body’s blood vessels, tissues, and organs. It also allows for a more in-depth examination of the ovaries and any possible cysts present, as well as the thickening of the uterus (Hopkins, 2024).

Treatment

Although PCOS is not a curable condition, various treatments can be of aid such as medications and lifestyle changes. These treatments can vary depending on a female's intention of becoming pregnant or not.

If planning to become pregnant, treatments may include:

Medications inducing ovulation such as clomiphene, letrozole, and gonadotropins by injection (Cleveland Clinic, 2023). These medications help the ovaries produce and regulate egg release.

Lifestyle changes include proper dieting and an increase in activity. Achieving a healthy diet and exercising lifestyle can reduce symptoms as well as insulin resistance by lowering blood glucose levels to ovulate.
Surgery involves the removal of ovary tissues that produce androgen hormones (Cleveland Clinic, 2023).

If planning not to become pregnant, treatments may include:

Birth control, including birth control pills, shots, vaginal rings, etc. Birth control helps regulate menstruation, acne, and body hair growth. The combination birth control pill, containing progestin and estrogen hormones is highly recommended (LeDuc, 2019). The pill mimics ovulation and suppresses the body from releasing any eggs. This is caused by an increase of progestin and estrogen in the body that suppresses FSH and LH from stimulating ovulation (LeVay, Baldwin, & Baldwin, 2021).
Lifestyle changes include proper dieting and an increase in activity. Achieving a healthy diet and exercising lifestyle can reduce symptoms as well as use insulin effects, lowering blood glucose levels to ovulate.
Medications blocking the production of androgens help reduce acne and excessive hair growth.