Understanding PCOS & PCOD–A Comprehensive Guide to Symptoms, Causes, Diagnosis, and Treatment

What is PCOS?

PCOS or Polycystic Ovary Syndrome is an endocrine disorder that affects women of the reproductive age group, which ranges from 15-49 years on average. As per various studies conducted on the prevalence of PCOS/PCOD, it is estimated that 1 in 5 women in India is diagnosed with PCOS.

PCOS affects the ovaries, the pair of oval-shaped glands on either side of the uterus. Their primary function is to produce eggs and release the female hormones estrogen and progesterone that regulate the menstrual cycle and pregnancy. Ovaries also produce a small number of androgens, the male hormones responsible for the development of female sexual characteristics, libido, sexual function, and bone health.

Generally, ovulation occurs every month when the ovary releases a mature egg for fertilization with the sperm. This process is controlled by two hormones in the pituitary gland—follicle-stimulating hormone (FSH) and luteinizing hormone (LH). FSH stimulates an ovary follicle (containing an egg cell) to mature and prepare for release. LH triggers the egg to release from the ovary. If the sperm fertilizes the egg, it will result in a pregnancy. However, if that does not happen, the egg and uterine lining will shed during periods.

High levels of LH and insulin can increase the androgens in the body. It can in turn disrupt the natural ovulation process, which can cause irregular or missed periods, ovarian cysts, and many other symptoms associated with PCOS. If left untreated, it can lead to health complications such as sleep apnea, depression, infertility, and endometrial cancer. While there is no cure for PCOS, treatments are available to manage the symptoms and prevent complications. It may include a combination of medications, lifestyle, and diet changes.

Also Read: What is PCOS/PCOD in Hindi?

Are PCOS and PCOD the Same?

PCOD means Polycystic Ovary Disease. The terms PCOD and PCOS are often used interchangeably to describe the same condition. While both conditions produce similar symptoms, they are fundamentally not the same. In PCOD, the ovaries make many immature or partially mature eggs at the same time, which go on to become cysts later on.

It can cause the ovaries to become enlarged and swollen and even cause hormonal imbalances, such as excess androgen production. Various factors such as obesity, stress, poor lifestyle, and diet choices can lead to PCOD.

What are the Common Symptoms of PCOS/PCOD?

The symptoms of PCOS will vary for everyone. You may experience all or a few of the following PCOS symptoms:

• Irregular or Missed Periods: Higher androgen levels can disrupt monthly ovulation. When there is no egg release, there will be no shedding of the uterine lining, leading to irregular periods. Women with PCOS have fewer than eight periods annually, while some may not menstruate at all.
• Heavy Periods: PCOS causes low levels of progesterone and excess estrogen. These hormonal imbalances can cause the uterine lining to become thicker than usual, leading to more severe bleeding during menstruation. Sometimes, blood clots may also occur.
• Ovarian cysts: When androgen levels are high, it can interfere with the proper maturation of the follicles and stop the egg from releasing. A lack of ovulation can lead to many immature follicles in the ovary, known as ovarian cysts. However, not all women with PCOS will develop these cysts.
• Hirsutism: It is a condition that causes thicker, darker, and excessive male-pattern hair growth on the face, chest, back, and other parts of the body where women usually do not have hair. It is associated with high levels of androgen hormones, such as testosterone.
• Hair Loss: Excessive androgens can also cause hair loss in a male pattern, known as androgenic alopecia. It can lead to hair thinning on the top and front of the head. Sometimes, it can also cause hair follicles to stop growing entirely, leading to hair loss.
• Acne or Oily Skin: Another common problem related to the raised androgen levels in the body is increased oil or sebum production, which can clog the pores and lead to acne. You may develop different types of acne, including pimples, blackheads, whiteheads, and cystic acne.
• Darkening of Skin: Insulin resistance, which is common in women with PCOS, can contribute to this condition, which is also known as acanthosis nigricans or hyperpigmentation. It is characterized by dark and velvety skin patches that may occur in the armpits, groin, neck, vulva, elbows, knees, knuckles, or lips.
• Skin Tags: The increased insulin levels can also lead to skin tags, which are small, soft, benign growths that can appear on the skin in areas such as the neck, armpits, and groin.
• Weight Gain: When the body is resistant to insulin, it raises blood sugar levels, which can promote fat storage and cause you to become overweight or obese. Furthermore, women with PCOS may have difficulty losing weight due to slower metabolism, reduced calorie burning, and increased hunger and cravings.
• Sleep Problems: Women with PCOS may also experience sleep problems such as obstructive sleep apnea, insomnia, sleep disturbances, and other sleep problems. The possible reasons for this may be insulin resistance, hormonal imbalances, and mental health conditions such as anxiety and depression.
• Fatigue: Various PCOS-associated factors, such as insulin resistance, hormonal imbalances, stress, heavy periods, and sleep problems, can cause tiredness and fatigue.
• Headaches: The hormonal fluctuations can cause frequent headaches in some women.

What are the Causes and Risk Factors of PCOS?

Even though PCOS is a common condition, its causes are not yet well understood by experts. However, the following factors seem to play a role in the development of PCOS:

Genetics

Genetics is believed to play a role in the development of PCOS, although the exact genetic mechanisms are not fully understood. PCOS has been shown to run in families, with some studies estimating that up to 40% of women with PCOS have a mother or sister with the condition.

Researchers have identified several genes that may contribute to the development of PCOS. These genes are involved in processes such as insulin signaling, hormone regulation, and ovarian function.

Insulin Resistance

Insulin is a hormone released by the pancreas. It helps your body’s cells absorb glucose from your blood for energy. Glucose, also called blood sugar, comes from the food you eat. If your body does not respond to insulin, the blood sugar levels in the body will increase. As a result, the pancreas will create more insulin to lower blood sugar. The high insulin levels may in turn cause the ovaries to produce more androgens. These hormonal imbalances can cause PCOS symptoms discussed earlier.

Chronic Low-Grade Inflammation

Inflammation is the body's response to injury or infection. Your body releases white blood cells and other chemicals to protect the body and promote healing. But when the inflammation becomes chronic and starts affecting the whole body, it can contribute to the development of various health conditions, including PCOS. Low-grade inflammation can be triggered by several factors, including insulin resistance, obesity, and hormonal imbalances.

Hormonal Imbalances

Women with PCOS often have imbalances in the levels of various hormones in their bodies, which affects ovarian function and causes menstrual irregularities, infertility, and other complications:

• High levels of androgens, a group of male hormones that are usually present in small amounts in females
• Low levels of follicle-stimulating hormone (FSH), a hormone that stimulates the growth of ovarian follicles, which contain eggs
• High levels of luteinizing hormone (LH), a hormone that triggers ovulation
• Low levels of sex hormone-binding globulin (SHBG), a protein in the blood that binds to testosterone and reduces its effect
• High levels of prolactin, a hormone that stimulates the breast glands to produce milk in pregnancy

Lifestyle Factors

Several lifestyle factors can contribute to insulin resistance, hormonal imbalances, and chronic inflammation, which have been linked to the development of PCOS. These include:

• Being overweight or obese, especially having excess fat around the waistline
• Living a sedentary lifestyle with not enough physical activity
• Consuming an unhealthy diet high in processed foods, carbohydrates, and saturated fats
• Having chronic stress
• Smoking and drinking excessive alcohol

Also Read: How to Get Pregnant With Polycystic Ovary Syndrome (PCOS)?

What are the Complications of PCOS?

If PCOS is not managed well, it can lead to several complications, such as:

Infertility

PCOS is one of the leading causes of infertility in women. The hormonal imbalances associated with PCOS can interfere with ovulation, making it difficult for women to conceive.

Type 2 Diabetes

Insulin resistance is commonly observed in women with PCOS. It means their bodies do not respond to insulin well enough for regulating blood sugar levels. It can lead to high blood sugar levels and over time, cause type 2 diabetes. Furthermore, they usually have other risk factors associated with insulin resistance and diabetes such as obesity, abnormal lipid levels, and chronic inflammation. Women with a family history of diabetes may be more likely to develop it too.

Metabolic Syndrome

Conditions associated with PCOS such as insulin resistance and obesity can increase your risk of developing metabolic syndrome. It is a cluster of conditions that raises your risk of heart disease, stroke, and diabetes. It includes:

• Increased abdominal weight
• High blood sugar
• High blood pressure
• High blood triglycerides
• Low HDL or good cholesterol
• High LDL or bad cholesterol

Endometrial Cancer

Every month, during a normal menstrual cycle, the endometrium or the uterine lining thickens in response to the hormone estrogen. Its function is to prepare the uterus for pregnancy. If pregnancy does not occur, the hormone progesterone rises and helps the uterus shed its lining during periods. However, many women with PCOS have insufficient levels of this hormone. Additionally, they also do not experience regular ovulation, thus interrupting monthly menstruation.

The endometrium keeps getting thicker due to the rise in estrogen levels every month. It can lead to the development of endometrial hyperplasia, a condition in which the lining of the uterus becomes thicker than normal. Endometrial hyperplasia is a known precursor to endometrial cancer. If left untreated, the abnormal growth of the endometrial tissue can progress to cancer.

Sleep Apnea

Sleep apnea is a serious sleep disorder in which breathing stops and restarts several times. It most commonly affects those who are overweight or obese, which is also a common symptom of PCOS. Excess weight can cause fat to accumulate around the neck and obstruct the airway during sleep. Common symptoms of sleep apnea include snoring loudly, daytime fatigue and sleepiness, insomnia, and nightmares.

Depression and Anxiety

Depression and anxiety are common complications of PCOS. It is not clear why these conditions occur together. However, research suggests that the following factors related to PCOS can increase the risk of depression and anxiety:

• Hormonal imbalances can cause frequent mood changes.
• Insulin resistance can contribute to inflammation and oxidative stress in the body.
• Chronic inflammation can increase cortisol levels and cause stress.
• Physical symptoms of PCOS such as hirsutism, acne, hair loss, weight gain, or infertility can cause chronic stress, self-esteem, and body image issues.  

How is PCOS Diagnosed?

Since PCOS is a syndrome, which means a set of correlated symptoms occur together in this condition, no single test can diagnose it. PCOS diagnosis involves a combination of medical history, physical examination, and diagnostic tests. To be diagnosed with PCOD/PCOS, you will typically need to meet at least two of the following criteria:

• Irregular or missed periods
• Excessive androgens
• Cysts in the ovaries

Medical History

Much similar to other medical appointments, your healthcare provider will begin by taking a detailed medical history. They will talk to you about your menstrual cycle patterns and unusual signs and symptoms you may be experiencing. You can expect questions about your family history as PCOS tends to be a genetic problem. It will also be helpful to keep a record of past and existing medical conditions, medications, and supplements you take.

Physical Examination

Your doctor will check for physical signs of PCOS such as acne, excessive hair growth, skin pigmentation, skin tags, or hair loss. They may check your weight by using your waist size, body mass index (BMI), or using other weight assessment tools. They will also measure your blood pressure.

Pelvic Examination

For a pelvic exam, your doctor will insert one or two fingers inside your vagina and press your lower abdomen with the other hand. It allows them to check your reproductive organs including the vagina, cervix, uterus, fallopian tubes, and ovaries for any growths, masses, or other unusual changes.

Ultrasound

During an ultrasound, your doctor will ask you to lie down on your back and then they will place an ultrasound device in your vagina. It will create sound waves to produce images of your internal organs such as the ovaries and uterus. They can check for the presence of cysts and measure the size of the ovaries. In PCOS, the ovaries are 1-3 times larger than normal. They will also see how thick your uterine lining is. Irregular or missed periods can lead to a thicker than normal uterine lining.

Blood Tests

Your doctor may order blood tests to assess the levels of a few hormones.

If you have PCOS, the levels of the following hormones may be higher than normal:

• Luteinizing hormone (LH)
• Testosterone
• Estrogen
• Androstenedione
• Anti-Mullerian hormone (AMH)

If you have PCOS, the levels of the following hormones may be lower than normal:

• Follicle-stimulating hormone (FSH)
• Progesterone
• Sex hormone-binding globulin (SHBG)

Other Tests

After the complete diagnosis, if you have PCOS, your doctor may order additional tests to check if you have any other associated conditions. Some of them include:

• Lipid profiles to check if you have abnormalities in cholesterol and triglycerides.
• Blood glucose test to check if you have diabetes.
• Insulin test to check if you have insulin resistance.

What are the Goals of PCOS Management?

The PCOS symptoms and their severity will vary for every individual. It is important to remember that PCOS cannot be completely cured but it is possible to effectively manage it. Your doctor will prepare an individualized PCOS management plan for you to meet the following goals:

• Reduce your symptoms
• Lower your risk for related future health problems
• Improve your mental health
• Address fertility problems and help you conceive, if required
• Help you meet individual goals related to your weight, skincare, and more

Which Doctors are Involved in PCOS Management?

Research suggests that when PCOS management involves a multidisciplinary team of healthcare professionals, it leads to better health outcomes. Various specialists that may coordinate your care include:

• Gynecologist
• Endocrinologist
• Primary care physician
• Nutritionist/ dietitian
• Reproductive endocrinologist/ fertility specialist
• Mental health professional
• Dermatologist

What are the Medical Treatments for PCOS?

The medical treatments for PCOS are aimed at managing the various symptoms associated with the condition, including irregular menstrual cycles, excess hair growth, hair loss, acne, skin darkening, weight gain, and infertility. Some of the common medications and procedures for PCOS include:

Menstrual problems

• Hormonal Birth Control: Birth control pills, patches, or vaginal rings can help regulate menstrual cycles and lower the risk of endometrial cancer. They are often recommended for women who do not want to get pregnant.
• Progestin Therapy: Progestin is a hormone that can be given as a pill, injection or intrauterine device (IUD) to help regulate periods and prevent endometrial cancer.
• Endometrial Ablation: In cases where heavy bleeding is a problem, endometrial ablation, a minimally invasive surgical procedure can be performed to remove the lining of the uterus and reduce menstrual bleeding.

Hirsutism

• Oral contraceptives: Hormonal birth control pills can reduce androgen production, thus helping reduce excessive hair growth.
• Anti-Androgens: Spironolactone is a type of anti-androgen medication that blocks the effects of androgens on the skin, reducing hair growth and improving hirsutism. It is often used in combination with birth control pills.
• Topical Applications: Eflornithine cream and topical retinoids can help slow hair growth when applied in the affected area. However, it cannot get rid of the existing hair. Hence, it is often used in combination with laser therapy.
• Laser Therapy: It uses focused light energy to destroy hair follicles and reduce hair growth. You may need multiple sessions for effective results.
• Electrolysis: It is a permanent hair removal method that uses a small electric current to destroy individual hair follicles over multiple sessions.

Hair Loss

• Oral Contraceptives: Since birth control pills decrease androgen levels in the body, they help slow down hair loss that is triggered by increased androgens.
• Anti-Androgens: Spironolactone and flutamide are medications that block androgens and their effects on the hair follicles to reduce hair loss.
• Finasteride and Dutasteride: These are hair-regrowth oral medications that are effective in treating male pattern hair loss.
• Topical Applications: Minoxidil (Rogaine) is a topical solution that can be applied directly on the scalp every day to promote hair growth.
• Platelet-rich Plasma (PRP): It is a three-step process that involves drawing blood from your arm, processing it to separate the platelet-rich plasma, and then injecting it into the areas of the scalp that need hair regrowth.
• Hair Transplants: In severe cases of hair loss, hair transplantation may be an option. It involves removing hair follicles from an area with healthy hair growth and transplanting them to the balding areas of the scalp.

Acne

• Oral Medications: The medications that treat hirsutism and hair loss can be effective for acne as well. It includes certain combination birth control pills and anti-androgen drugs such as spironolactone and flutamide.
• Topical Applications: These include benzoyl peroxide, salicylic acid, and retinoids that can be applied to the affected skin to see results.
• Laser and Light Therapy: Laser therapy targets the bacteria that cause acne, reduces inflammation in the skin, and promotes healing.

Skin Darkening

• Topical Applications: Some topical solutions containing ingredients like urea, alpha hydroxy acid, salicylic acid, and Retin-A can help lighten the affected skin.
• Dermabrasion: It is a skin-resurfacing procedure in which a rapidly rotating device is used to remove the outer layers of the skin. The new skin that grows back will be lighter in appearance.
• Laser Therapy: It uses high-energy light to remove the top layer of the skin which is darkened, thus revealing the lower layer of the lighter-colored and undamaged skin.

Weight Gain

• Medications: Certain medications can be used to manage PCOS-related weight gain, including metformin (to improve insulin sensitivity), orlistat (to prevent absorption of fat from the food), oral contraceptives (to regulate hormones), and spironolactone (to block androgens).
• Bariatric Surgery: In cases with severe obesity related to PCOS, bariatric surgery may be recommended. It involves making changes to your digestive system that can help you lose weight eventually.

Infertility

• Clomiphene (Clomid) and letrozole (Femara): These are fertility drugs that help in stimulating ovulation.
• Metformin: This medication is commonly used to treat insulin resistance in women with PCOS, but it can also help regulate menstrual cycles and improve ovulation.
• Gonadotropins: These are injectable hormones composed of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH), and are commonly used when Clomid or Femara is not successful in triggering ovulation.
• In vitro fertilization (IVF): IVF treatment involves retrieving mature eggs from the ovaries, fertilizing them with sperm in a laboratory, and then transferring them to the uterus.

What are Some Helpful Home Remedies for PCOS?

While home remedies do not guarantee permanent results, they are generally safe to try and may help in improving certain PCOS symptoms. In any case, it is best to consult your doctor before trying out any new home remedy. A few examples include:

For hirsutism, self-care methods that can temporarily remove or reduce the visibility of unwanted hair include plucking, shaving, waxing, depilation, and bleaching.

For hair loss, some hair growth techniques include scalp massages, taking supplements such as biotin, zinc, and iron, and applying essential oils like rosemary, lavender, or peppermint on the scalp. Avoid harsh chemicals like bleach, peroxide, or chemical relaxers.

For acne, some remedies such as tea tree oil, apple cider vinegar, green tea, honey, and aloe vera may help reduce inflammation, kill bacteria, and heal the skin.

For skin darkening, a combination of skin exfoliation scrubs and coconut oil can help.

What Lifestyle and Diet Changes are Helpful for PCOS/PCOD?

Apart from prescribing medications, your doctor will guide you on helpful lifestyle and diet changes. Some of them may include:

Well-Balanced Diet

A healthy diet is an important part of managing PCOS and can help improve symptoms such as insulin resistance, inflammation, weight gain, and hormonal imbalances. As far as possible, aim to eat home-cooked, well-balanced meals that incorporate macro and micronutrients including complex carbohydrates, fiber, lean proteins, healthy fats, vitamins, and minerals. Also, drink plenty of water to help reduce bloating, boost energy, and aid healthy digestion.

Foods to Eat:

• High-fiber vegetables such as green leafy vegetables, broccoli, beans, carrots, cauliflower
• Fruits such as apples, bananas, berries, oranges, guava, pomegranate, papaya, pineapple
• Nuts and seeds such as almonds, walnuts, flaxseeds, sunflower seeds, sesame seeds, pumpkin seeds
• Lean proteins such as chicken, egg, fatty fish, skimmed milk, tofu, curd
• Pulses such as chana dal, moong dal, chickpeas, dried beans, soybean
• Whole grains and millets such as daliya, jowar, bajra, ragi, brown rice, oats, barley
• Spices and herbs such as clove, cinnamon, fenugreek, ginger, turmeric, mint
• Healthy fats such as olive oil, coconuts, avocados

Foods to Avoid:

• Refined and processed foods such as cakes, jams, white bread
• Deep-fried foods, such as french fries, donuts
• Sugary foods and beverages, such as chocolates, sweets, sodas, energy drinks, packaged fruit juices
• Starchy vegetables, such as potatoes, corn, turnips
• Red meat, such as mutton, pork, beef
• Processed meat, such as hot dogs, sausages

Supplements and Herbs

Certain supplements and herbs may help manage PCOS symptoms, but it is important to talk to a healthcare professional before taking them to ensure they are safe and appropriate for your individual needs.

These supplements are known to improve PCOS symptoms such as insulin resistance, menstrual cycles, fertility, inflammation, hormone levels, BMI, and more.

• Inositol
• Vitamin D and calcium
• Omega-3 fatty acids
• N-acetyl cysteine (NAC)
• Chromium
• Zinc
• Evening primrose oil
• Ashwagandha
• Holy basil
• Cod liver oil
• Shatavari

Exercise

Regular exercise can have various benefits for individuals with PCOS. Apart from helping with weight loss and achieving a healthy BMI, it can improve insulin sensitivity, reduce inflammation, regulate menstrual cycles, and decrease testosterone levels and their effects. Additionally, it can drastically boost mood, sleep quality, and energy levels. A healthcare professional or a certified fitness trainer can help develop a safe and effective exercise plan that is tailored to individual needs and goals. The exercise plan of at least 120 minutes per week can be a combination of the following types of workouts:

• Cardiovascular Exercise: It includes brisk walking, jogging, running, cycling or swimming
• Strength Training: It includes bodyweight exercises such as squats, pushups, lunges, weightlifting, and resistance band exercises.
• Interval Training: It includes alternating between short bursts of high-intensity exercise and periods of rest or low-intensity exercise. It can be done using a variety of exercises, such as running, cycling, swimming, or bodyweight exercises.

Relaxation Techniques

Stress increases the cortisol levels in the body, which can lead to adverse effects such as weight gain, chronic inflammation, and mood disturbances. Thus, chronic stress can significantly worsen your PCOS symptoms. You can manage your stress levels using various relaxation techniques, such as:

• Meditation
• Yoga
• Deep breathing exercises

Sleep

Getting enough, good-quality sleep every night can reduce stress, regulate hormones, and improve insulin sensitivity. You can focus on good sleep habits to help you sleep better. Some of them include:

• Avoid caffeine and alcoholic drinks in the evening
• Eat light dinners
• Have a bedtime routine such as reading a book, taking a relaxing shower, or drinking warm milk before sleeping
• Switch off all electronic devices
• Sleeping in a good environment—clean bed and dark room

What are the Surgical Treatments for PCOS?

Surgery is generally not the first-line treatment for PCOS, but your doctor may recommend it if all other treatment methods have failed or are not suitable for your condition. Here are some surgical options for PCOS:

• Ovarian Drilling: It is a minimally invasive surgical procedure that can be used to treat infertility in women with PCOS. The procedure involves using a laparoscope to make small punctures in the ovaries, which can reduce androgen production and restore ovulation.
• Oophorectomy: In rare cases, if the cysts on the ovaries are very large and causing significant pain or other complications, surgical removal of one or both ovaries may be necessary.
• Hysterectomy: It is the surgical removal of the uterus, which may be recommended for women with PCOS who have very heavy, prolonged, or painful menstrual periods that do not respond to other treatments.

When Should You See a Doctor?

If you suspect you have PCOS, it is important to see a doctor, preferably an endocrinologist or a gynecologist who specializes in reproductive health. Here are some signs you must report to a doctor immediately:

• Prolonged irregular or missed periods
• Excessive acne, unwanted hair growth, or hair thinning
• Difficulty getting pregnant (not been able to conceive for over a year)
• Conditions such as high blood pressure, high cholesterol, and insulin resistance
• Sudden weight gain, weight loss, or any other unusual symptoms

FAQs on PCOS/PCOD

1. Can you Cure PCOS/PCOD Permanently?

Ans. Currently, there is no permanent cure for PCOS/PCOD, but it can be managed effectively with a combination of medications, lifestyle changes, and sometimes surgical interventions.

2. Can you Get Pregnant if You Have PCOS/PCOD?

Ans. While it may be challenging to get pregnant with PCOS/PCOD, it is not impossible. Certain medications and lifestyle changes can help boost fertility and help you conceive. In some cases, assisted reproductive technologies such as in vitro fertilization (IVF) may be recommended to increase the chances of conception.

3. Can Women Have PCOS/PCOD After Marriage?

Ans. Yes, women can develop PCOS/PCOD at any point in their reproductive years, including after marriage.

4. Does PCOS/PCOD Occur in Sexually Active Women? Ans. Yes, PCOS/PCOD can affect women regardless of their sexual activity status, including those who are sexually active, celibate or have never been sexually active.