Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome (PCOS) affects 1 in 10 women of childbearing age and is a complex disorder affecting much more than a woman’s ovaries. PCOS is an endocrine disorder that results in symptoms such as depression, anxiety, mood swings, weight gain, irregular menstrual cycles, acne and infertility. 

PCOS is becoming increasingly common, with estimates approaching 15 to 20% of women of childbearing age. This disorder affects a woman’s menstrual cycle, ability to have children, hormone levels, physical appearance, mental health and mood, and has been found as a risk factor for cancer, cardiovascular disease and metabolic syndrome. Recognizing and treating this disorder is an important part of overall physical and emotional health as it is the most common cause of infertility and significantly contributes to metabolic and mood disorders as well.

Symptoms of PCOS include:

  • Irregular or absent menstrual periods
  • Infertility
  • Weight gain (especially around the waist)
  • Acne
  • Excess hair on the face and body
  • Thinning scalp
  • Skin tags
  • Darkening skin
  • Depression
  • Anxiety
  • Mood swings
  • Poor sleep

PCOS Quiz

Women with PCOS usually have certain symptoms. The following quiz was created by the Center for Young Women's Health to help you figure out if you might have PCOS. This quiz is designed as an educational tool and is not a substitute for medical advice by your health care provider.

 Quiz: Do You Have PCOS? 


What causes PCOS?

The exact cause of PCOS is unknown, however, we do know that an imbalance of the endocrine system is responsible for many changes associated with the condition. Below is a list of circumstances that are highly related to PCOS:

Insulin Resistance

Some women are less sensitive to insulin than normal, which makes their ovaries produce too many male hormones.

Genetics

PCOS appears to run in families, so having a mother or sister with the condition makes you more likely to have it.

Obesity

Because women and girls with PCOS are more likely to gain excess weight and women and girls who are obese are more likely to have the condition, there is a tight, but not absolute, link between the two.

In addition, the following are more recent developments in the understanding of PCOS:

Autoimmunity

It was recently discovered that women with PCOS have a particular antibody in their blood, indicating that PCOS may be an autoimmune disease. 

Polycystic Ovary Syndrome May Be an Autoimmune Disorder 

Endocrine Disruption

The endocrine system is a network of glands and organs that produce, store, and secrete hormones. Normally, women make small amounts of “male” hormones (called androgens), but women with PCOS produce slightly higher amounts of androgens. This hormone imbalance causes an assortment of health problems, many of which are related to the reproductive system. Metabolism is closely linked to nutrition and makes energy from the food you eat. A metabolic disorder disrupts this process. Emerging evidence supports that two metabolic characteristics exist among women with PCOS: those who are considered metabolically healthy and those who are metabolically unhealthy.

Phenotype and Metabolic Disorders in PCOS

PCOS and Hormonal Contraception: A Tale of Two Syndromes?

How is PCOS diagnosed?

Balance Women's Health providers conduct a thorough review of contributing factors such as medical conditions and medications, vitamin deficiencies, endocrine disorders, exposure to endocrine disrupting chemicals, menstrual history, family history, current dietary habits and food cravings, fertility history, relationships and life stress as well as mood and anxiety disorders. A lab evaluation can help rule out other causes for your symptoms and target therapies to your individual needs. Additionally, as needed, a physical exam may be performed and sometimes an ultrasound of the ovaries. 

How is PCOS treated?

Treatment options for PCOS vary because some women experience a range of symptoms, or just one. Balance believes it is important for women to understand their diagnosis, the underlying dysfunction in the body and options for treatment.

Main treatment options for PCOS include: 

Regulating Hormones

Birth control medications such as an oral contraception pill or a hormonal intrauterine device are options that can help manage irregular periods associated with PCOS. You should discuss these options with your OB/GYN or women’s health care provider.

PCOS: The Oral Contraceptive Pill

Sex Hormone Binding Globulin (SHBG) and PCOS

Weight Loss, Insulin Levels, Diet, Supplements and Medication

For women with PCOS, maintaining a healthy weight can be a constant struggle. PCOS makes it more difficult for the body to use the hormone insulin, which can cause insulin and sugar (glucose) to build up in the bloodstream. This build up is called insulin resistance and is often linked to obesity. Many women with PCOS tend to make too much insulin which is responsible for some of the weight issues associated with this disorder. Dietary changes, primarily limiting carbohydrates, can be helpful as well as monitoring blood sugar levels, and getting regular exercise. In addition, medication such as metformin and supplements, such as inositol, can improve insulin resistance in PCOS patients. 

4 Things to Know About Taking Inositol for PCOS

New Metformin Warning: Mandatory Supplementation with Vitamin B12

Metformin: How it works, and what you need to know if you have PCOS

Ortho Molecular: N-Acetyl Cysteine

Drug Combination Promotes Weight Loss in Polycystic Ovary Syndrome

6 Ways NAC Supports Your Health With PCOS

More Magnesium, More Benefit in Prediabetes?

Depression, Anxiety, and Stress

In recent years, the complex relationship between PCOS and psychosocial issues has come to the forefront, with a prominent link found between specific features of PCOS and mental well-being. The scientific literature now shows clearly that anxiety levels, psychological distress, depressive feelings, and social fears are much higher in the women with PCOS. In one study of 300 women, nearly 30% had anxiety, and quality of life was lowest in those with a combination of stress and depression. The reasons for the increased risk of depression and anxiety in women with PCOS, as well as for PCOS women to develop psychiatric disorders, are still unclear, but we do know that stress is one of the common mechanisms that induce psychological disorders.

Significant stress changes the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis includes the hypothalamus, pituitary gland, and adrenal glands. Together they work to regulate your stress response, mood, motivation, metabolism, energy levels, sleep/wake cycles, and immune system. Women with PCOS tend to have adrenal glands that overproduce the hormones cortisol and adrenaline. An increase in these hormones cause mor inflammation and poorer sleep. The higher levels of cortisol and adrenaline make women with PCOS more prone to anxiety and sleep dysfunction, negatively affecting mood. Women with PCOS tend to have an abnormally increased cortisol response to physical and psychological stressors which cannot be explained by their BMI, increased percent of body fat, fasting insulin, or elevated androgen levels. Additionally, there is evidence of an increased incidence of eating disorders, social phobia, and suicidal behavior among PCOS women. 

Depression and Anxiety In Women With PCOS

PCOS Linked to Anxiety and Depression

When Not to Treat Depression in PCOS With Antidepressants

PCOS, Infertility, and Pregnancy

PCOS is the most common, but treatable, causes of infertility in women of reproductive age. Women with PCOS may miss periods or have fewer periods (fewer than eight in a year). Or their periods may come every 21 days or more often. Some women with with PCOS stop having menstrual periods. Having PCOS does not mean you can't get pregnant. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don't ovulate, you can't get pregnant. 

PCOS can cause problems during pregnancy for you and your baby. Women with PCO have higher rates of:

  • Miscarriage
  • Diabetes during pregnancy
  • Pregnancy-induced high blood pressure (preeclampsia)
  • Premature delivery
  • Endometrial cancer 
  • Children with mental health and neurodevelopmental issues, including autism

PCOS Is Associated With Adverse Mental Health and Neurodevelopmental Outcomes


Please remember this information is intended for educational purposes only and should not substitute medical advice from a healthcare provider.