Polycystic Ovarian Syndrome: Understanding your Symptoms and Knowing your Treatment Options 

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Polycystic Ovarian Syndrome: Understanding your Symptoms and Knowing your Treatment Options 

Chaimaa Riad
October 2024

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects around 5-10% of women of reproductive age.[4]While its prevalence is high, scientists are unsure of the cause of this disorder. Symptoms can often be overlooked, as PCOS can present in a variety of ways with very general symptoms. It is specifically challenging to diagnose PCOS in young girls because symptoms can often be seen as normal signs of puberty.[2] [4]It is important to recognize any signs and symptoms of hyperandrogenism and express concerns to your primary care provider to get the tests necessary to diagnose PCOS. 

Signs and Symptoms to Consider 

Family history is important to consider: 

  • Let your doctor know if there is a history of PCOS in the family, or a family history of acne, hirsutism, or obesity.[2] 

PCOS is strongly associated with metabolic dysfunction: 

  • Women should be aware of recent weight gain. While girls going through puberty are likely to gain weight, there should be a discussion of the progression of the weight gain. [2] 
  • Signs of insulin resistance are also associated with PCOS. The increase in fat associated with hyperandrogenism is likely to cause your body to not be able to respond properly to the insulin created in your body, leading to an increase in sugar levels, leading to type 2 diabetes.[2] 
Image by vwalakte on Freepik

Irregular menstrual cycles: 

  • Oligomenorrhea (infrequent menstrual periods)[1] 
  • Menorrhagia (heavy bleeding)[1] 
  • Primary amenorrhea (failure to get a first period by 15 years old)[1] 
  • Secondary amenorrhea (not having a period for at least three months)[1] ○ Infertility[1] 

Skin changes 

  • Hirsutism (excess hair growth on the face or body) [2] 
  • Abnormal acne or oily skin [1] [2] 
  • Acanthosis nigricans (hyperpigmentation usually in the axilla, groin, and neck secondary to diabetes).[2][3] 

Cardiovascular concerns

  • Although unclear, there have been concerns about atherosclerosis forming in young women who have PCOS. This can increase risk of stroke as well as heart attacks. More studies need to be done to properly assess this risk in women with PCOS.[1] 

Diagnosis 

According to the World Health Organization, diagnosis of PCOS includes at least two out of three of the following: 

  1. Symptoms that suggest high androgens (hirsutism, acne, high testosterone levels on lab testing) with no explanation of why there are high androgen levels [5] 
  2. Irregular menstrual cycles, as explained above in greater detail [5] 
  3. Ultrasound imaging showing polycystic ovaries [5] 

Laboratory studies are especially important to ensure that other endocrine disorders are ruled out, including: 

  • Hypothyroidism: TSH levels [3] 
  • Hyperprolactinemia: Prolactin levels [3] 
  • Congenital Adrenal Hyperplasia: 17-hydroxyprogesterone levels [3] 

Treatment Options 

After a diagnosis of PCOS is made, there are various methods of management:

  • Lifestyle modifications – a healthy diet and increased physical activity are ways that can help manage the comorbidities of PCOS including diabetes and obesity. In addition to this, women should follow up with their PCP to assess for any worsening of diabetes or any development of cardiovascular changes such as hypertension.[1] 
  • Medical management: As discussed, diabetic management can vary, and can be managed with medication, as well as hypertension.[1] Additionally, oral contraceptives can help with irregular menstrual cycles.[1] Specific types of medication vary based on the presentation and severity of the specific symptoms. 

There is no specific management for PCOS, but rather symptom-based intervention to help prevent serious complications. It is important to discuss with your PCP to know which specific intervention is right for you based on your symptoms. [1][4] 

References 

[1] Hoeger, K. M., Dokras, A., & Piltonen, T. (2020, November 19). Update on PCOS: Consequences, challenges, and guiding treatment. OUP Academic. 

https://academic.oup.com/jcem/article/106/3/e1071/5992309?login=false

[2] Screening and management of the hyperandrogenic adolescent. ACOG. (2024). https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2019/10/screening-an d-management-of-the-hyperandrogenic-adolescent 

[3] Teede, H. J., Piltonen, T., Costello, M. F., & Misso, M. L. (2018, August). Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. American Society for Reproductive Medicine. https://www.fertstert.org/article/S0015-0282(18)30400-X/fulltext 

[4] Why polycystic ovarian syndrome is often misdiagnosed. Why Polycystic Ovarian Syndrome Is Often Misdiagnosed: Women’s Healthcare of Princeton: Gynecologists. (n.d.). https://www.princetongyn.com/blog/why-polycystic-ovarian-syndrome-is-often-misdiagnosed [5] World Health Organization. (2023, June). Polycystic ovary syndrome. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome