Atlantic Endocrinology New York City

General PCOS Symptoms: From Irregular Cycles to Hair Loss

Polycystic Ovary Syndrome (PCOS) can manifest in a variety of symptoms, from irregular menstrual cycles to unexpected weight gain. Recognizing these signs early is key to managing the condition and improving your quality of life.

It is important to consult a PCOS doctor in New York who can provide you with the right diagnosis and treatment plan tailored to your needs. Take the first step! 🌸

What Are the Common Symptoms of PCOS in Women?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects women of childbearing age, impacting the ovaries and sometimes the rest of the body. Understanding the common symptoms is crucial for early diagnosis and management.

Common Symptoms of PCOS

1. Irregular Periods or Missed Periods

One of the most common symptoms of PCOS is menstrual irregularities. Women with PCOS may experience missed periods, irregular cycles, or very light menstrual flow. These irregularities occur because of hormonal imbalances that affect ovulation.

2. Ovarian Cysts

Many women with PCOS have ovaries that are larger than normal and may contain multiple cysts. These cysts are small, fluid-filled sacs that develop on the ovaries, which can contribute to menstrual irregularities and infertility.

3. Excess Body Hair (Hirsutism)

PCOS often leads to an increase in male hormones (androgens), resulting in excessive hair growth. Women with PCOS may notice extra body hair on areas such as the chest, stomach, and back.

4. Weight Gain

Unexplained weight gain, particularly around the abdomen, is another common symptom of PCOS. Hormonal imbalances can make it harder for women to lose weight, and insulin resistance may also play a role in this weight gain.

5. Acne and Oily Skin

Women with PCOS often struggle with acne and excessively oily skin. These symptoms occur due to the overproduction of androgens, which can lead to an increase in skin oil production.

6. Thinning Hair or Male-Pattern Baldness

PCOS can cause hair thinning or male-pattern baldness. Hair loss in women with PCOS typically occurs at the scalp, and this is again linked to elevated levels of male hormones.

7. Infertility

PCOS is a leading cause of infertility in women. Due to irregular or absent ovulation, many women with PCOS may have difficulty conceiving.

8. Skin Tags

Small pieces of excess skin, known as skin tags, may develop in areas such as the neck or armpits in women with PCOS. These benign growths are harmless but are a common symptom associated with the condition.

9. Dark Skin Patches

PCOS can lead to dark, thick patches of skin, particularly in areas such as the back of the neck, armpits, and under the breasts. This condition is called acanthosis nigricans and is associated with insulin resistance, a frequent issue for women with PCOS.

How Hormonal Imbalances Cause PCOS Symptoms

PCOS is a hormonal disorder that affects the reproductive system, often resulting in a range of symptoms due to an imbalance in key hormones. This condition primarily impacts the ovaries, but its effects can extend throughout the body. 

What Causes PCOS?

The exact cause of PCOS remains unclear, but there is evidence suggesting that genetics, obesity, and insulin resistance all play significant roles. The hormonal imbalances associated with PCOS primarily involve higher levels of male hormones, or androgens, and issues with insulin regulation.

Androgen Imbalance and PCOS Symptoms

One of the hallmark features of PCOS is the overproduction of androgens, often referred to as “male hormones,” though they are naturally present in small amounts in women. When androgens are produced in excess, they disrupt the normal functioning of the ovaries, leading to several key symptoms:

1. Irregular Menstrual Cycles: Elevated androgen levels interfere with the ovaries’ ability to release eggs (ovulation), which causes irregular or absent menstrual cycles. Without regular ovulation, small fluid-filled sacs, called cysts, can form on the ovaries, which is why PCOS is named “polycystic.”
2. Acne: High androgen levels stimulate the sebaceous (oil) glands in the skin, leading to increased oil production, which can clog pores and cause acne. This symptom is common in individuals with PCOS and is typically seen in areas such as the face, chest, and back.
3. Excess Hair Growth (Hirsutism): The presence of excess androgens also leads to the growth of thicker, darker hair in areas where men typically grow hair, such as the face, chest, and back. This condition is known as hirsutism and is another common symptom of PCOS.
4. Male-Pattern Baldness: In some women with PCOS, elevated androgen levels can cause thinning of the hair on the scalp, often in a pattern similar to male baldness.

Insulin Resistance and PCOS

Another significant factor in PCOS is insulin resistance, where the body’s cells become less responsive to insulin, a hormone responsible for regulating blood sugar. This resistance leads to higher levels of insulin in the blood, which in turn causes the ovaries to produce more androgens. As a result, insulin resistance is directly linked to many of the symptoms of PCOS.

1. Weight Gain: Insulin resistance often contributes to weight gain, especially around the abdominal area. This weight gain can worsen PCOS symptoms, as excess body fat further increases insulin resistance and promotes higher androgen levels.
2. Suppressed Ovulation: Elevated insulin levels impair ovulation by increasing androgen production, which prevents the ovaries from releasing eggs regularly. This contributes to the irregular or absent periods commonly seen in PCOS.
3. Risk of Diabetes: Insulin resistance also raises the risk of developing type 2 diabetes. Though not all individuals with insulin resistance will develop diabetes, having PCOS significantly increases the likelihood of high blood sugar levels over time.

Inflammation and PCOS

Women with PCOS often exhibit chronic low-grade inflammation, which can contribute to the development and worsening of the condition. Although the relationship between inflammation and PCOS is still being studied, it is believed that this inflammation promotes insulin resistance and increases androgen levels.

1. C-Reactive Protein (CRP): Low-grade inflammation is often measured by elevated levels of C-reactive protein (CRP) in the blood. Individuals with PCOS may show higher levels of CRP, indicating that inflammation plays a role in the hormonal imbalances they experience.
2. Impact on Weight and Metabolism: Chronic inflammation can exacerbate weight gain and metabolic issues, both of which are commonly seen in women with PCOS. As inflammation increases insulin resistance, it creates a cycle that further aggravates PCOS symptoms.

Diagnosing PCOS: How is it diagnosed?

Diagnosing PCOS involves a combination of reviewing symptoms, conducting physical examinations, and performing specific tests. Here’s a guide to understanding how PCOS is diagnosed.

Step 1: Discussion of Symptoms and Medical History

The first step in diagnosing PCOS is a thorough discussion between you and your healthcare provider about your symptoms and medical background. They will ask about:

• Your symptoms: This includes irregular periods, acne, excess hair growth, weight changes, or difficulty getting pregnant.
• Your family history: PCOS can sometimes run in families, so your healthcare provider may ask about any history of PCOS, diabetes, or other related conditions in your biological family.

Step 2: Physical Examination

A physical exam is often conducted to check for physical signs of PCOS. During this exam, the healthcare provider will:

• Check your weight and blood pressure: Weight gain, particularly around the abdomen, and high blood pressure are common in women with PCOS.
• Examine for excess facial hair, hair loss, and acne: These are signs of higher androgen levels, one of the key markers of PCOS.
• Look for discolored skin and skin tags: Skin conditions such as darkened patches around the neck or armpits and skin tags are frequently associated with PCOS.
• Perform a pelvic exam: This helps to rule out other causes of irregular periods or abnormal bleeding.

Step 3: Ultrasound Examination

An ultrasound is a common tool used in diagnosing PCOS. This test uses sound waves to create images of the ovaries and other internal structures, such as the uterus.

• Ovarian cysts: An ultrasound can reveal if your ovaries are enlarged or if there are small cysts on the ovaries (a common characteristic of PCOS). However, not everyone with PCOS will have cysts.
• Endometrial thickness: The test can also assess the thickness of the lining of the uterus, which may be abnormal in women with PCOS due to irregular or missed periods.

Step 4: Blood Tests

Blood tests are crucial in confirming the diagnosis of PCOS by checking hormone levels and metabolic health.

• Androgen levels: High levels of androgens (male hormones) such as testosterone are a key indicator of PCOS. Your healthcare provider will look for elevated androgen levels in your blood.
• Blood glucose levels: PCOS is closely linked to insulin resistance, so your healthcare provider may also check your blood glucose levels to rule out prediabetes or diabetes.
• Cholesterol and triglycerides: These tests measure your lipid profile, as PCOS can often lead to abnormal cholesterol levels.

Diagnostic Criteria: The Three Key Symptoms

Healthcare providers typically diagnose PCOS based on the presence of at least two of the following three symptoms:

1. Irregular or missed periods: This can include infrequent periods or very heavy bleeding when menstruation does occur.
2. Signs of excess androgens: This can be physical signs such as acne, excess hair growth (hirsutism), or blood tests that reveal high androgen levels.
3. Enlarged or polycystic ovaries: Ultrasound may reveal enlarged ovaries or ovaries with multiple small cysts. However, not everyone with PCOS develops ovarian cysts.

Managing PCOS Symptoms: Treatment Options and Lifestyle Changes

Managing the symptoms of PCOS typically involves a combination of medical treatments and lifestyle modifications. The approach depends on whether the individual wants to become pregnant or not, as well as the severity of symptoms. 

Lifestyle Changes for Managing PCOS

Diet and Exercise

Lifestyle modification is one of the most important aspects of managing PCOS. A calorie-restrictive diet combined with regular exercise can significantly improve many symptoms of PCOS, including irregular periods and excess hair growth. Some key recommendations include:

• Low carbohydrate diet: Reducing carbs helps manage insulin levels, which can be beneficial since many women with PCOS experience insulin resistance.
• Caloric restriction: Cutting calories and managing weight can improve hormone levels, restore menstrual regularity, and reduce symptoms like acne and hirsutism (excess hair growth).
• Exercise: Engaging in regular physical activity helps regulate insulin levels, promotes weight loss, and may improve ovulation.

Losing even 5-10% of body weight can lead to significant improvements in PCOS symptoms, including menstrual regularity and reduction of hirsutism.

Smoking Cessation

Smoking cessation is another lifestyle change that can improve the overall health of individuals with PCOS. Smoking can worsen insulin resistance and other metabolic issues associated with PCOS.

Medical Treatment Options for PCOS

Treatment for Women Who Do Not Want to Get Pregnant

1. Birth Control Pills (Combined Oral Contraceptives)

Birth control pills are considered first-line treatment for women with PCOS who do not want to become pregnant. These pills help regulate menstrual cycles, reduce acne, and manage excessive hair growth. They also lower the risk of endometrial hyperplasia (a thickening of the uterine lining), which can lead to endometrial cancer.

2. Treatments for Hyperandrogenism

Hyperandrogenism refers to elevated levels of male hormones, which lead to symptoms like acne and excess hair growth. If birth control pills do not fully manage these symptoms, additional treatments may be recommended, including:

• Spironolactone: A medication that helps block the effects of androgens and reduce excessive hair growth and acne.
• Finasteride: A 5-alpha reductase inhibitor that lowers the production of androgens in the body.
• Eflornithine Cream: A topical cream specifically used to reduce facial hair growth in women.

These medications should not be used during pregnancy, as they can negatively affect fetal development.

3. Metformin

Metformin is a medication commonly used to improve insulin sensitivity in women with PCOS, especially those with type 2 diabetes or insulin resistance. Metformin can also help regulate menstrual cycles and aid in weight loss. In some cases, it is used in combination with other treatments.

Treatment for Women Who Want to Get Pregnant

1. Ovulation Induction

For women with PCOS who want to become pregnant, medications to stimulate ovulation are often prescribed:

• Clomiphene (Clomid): A commonly used medication to induce ovulation.
• Letrozole: Another option for ovulation induction that has been shown to be effective in women with PCOS.

2. Metformin

Metformin can also be used in combination with ovulation-inducing medications to help regulate insulin levels and reduce the risk of ovarian hyperstimulation syndrome (OHSS), a condition where the ovaries become swollen and painful.

3. Surgery

In cases where medications are ineffective, a surgical procedure may be recommended to remove androgen-producing tissue in the ovaries, although this is less common with the availability of newer medications.

4. In Vitro Fertilization (IVF)

If medication and lifestyle changes do not result in pregnancy, IVF may be considered as a treatment option. IVF involves fertilizing an egg with sperm in a lab setting before transferring it to the uterus.

Frequently Asked Questions

What are the early symptoms of PCOS?
Early symptoms of PCOS include irregular periods, mild weight gain, acne, and excess hair growth (hirsutism) on the face or body.

Can mild symptoms of PCOS still affect fertility?
Yes, even mild symptoms of PCOS can affect fertility by causing irregular ovulation or preventing the release of eggs.

How are common PCOS symptoms like hirsutism treated?
Hirsutism is treated with medications like birth control pills, anti-androgens such as spironolactone, and topical creams like eflornithine.

What are the hormonal causes of PCOS symptoms?
PCOS symptoms are caused by elevated levels of androgens (male hormones) and insulin resistance, which disrupt normal ovulation and hormone balance.

Can lifestyle changes help manage PCOS symptoms?
Yes, lifestyle changes such as a healthy, low-carb diet, regular exercise, and weight loss can help manage PCOS symptoms, improve menstrual regularity, and reduce insulin resistance.