Do you ever wonder if something isn’t quite right with your hormones? Maybe your periods
have been irregular for so long that you now just consider them to be your “norm”. That’s
fair, but what about those other strange symptoms that seem to have appeared out of the
blue? If you have a hunch that something is off, you are probably right. Could it be due to
Polycystic Ovarian Syndrome?
Polycystic Ovarian Syndrome (PCOS) is the most common hormonal condition among
women of reproductive age. It affects roughly 1 in every 10 women, yet approximately 50%
don’t even know that they have it. PCOS develops when two main areas of our physiology
go awry. The brain normally sends out a series of hormones that in turn tell our reproductive
organs what to do. Women with PCOS release more of a certain hormone relative to
another, resulting in a significant imbalance that causes a disconnect between the brain and
the ovary. The second process that often (but not always) occurs is the development of
insulin resistance, such that the body is unable to respond appropriately to the effects of
insulin as others would. Both of these factors lead to elevated levels of a group of hormones
called androgens. Androgens, in excess, can wreak havoc on the menstrual cycle by
causing the follicles that house your eggs to arrest in their development. When this occurs,
the ovaries develop a collection of small “cysts” that are essentially eggs that have not
matured properly. This can create problems with ovulation itself and may lead to further
imbalances in your levels of estrogen and progesterone.
Seeing that September is PCOS Awareness Month, there is no better time to familiarize
yourself with the symptoms so that you can seek care if you need it. Below are the top 5
symptoms that may suggest that you have PCOS.
If your cycles are of an unpredictable length or you can’t even remember the last time you
had a period, PCOS could be to blame. The reason for such change lies in the way that the
increased levels of circulating androgens prevent a mature egg from being ovulated. Often
women with PCOS have cycles that are very infrequent (longer than 35 days apart) or not at
all. When they do have a period it is usually a result of breakthrough bleeding, which occurs
when the endometrial lining has proliferated to the point where it can’t be sustained any
longer without adequate progesterone. Ovulation is one of the ways in which progesterone
is made, but if this process is not occurring then estrogen is free to work unopposed,
leading to heavy and painful bleeds that aren’t “true” cycles. This is most common
presentation, however, it can get far more complex than this when different hormones
(including thyroid hormones) interact in various ways.
Hormones are powerful chemicals! In the right balance they can do so much good, but
when slightly out of proportion your skin is often one of the first places to suffer. Patients
with PCOS commonly present with moderate to severe acne, particularly along the jawline.
The reason for this occurrence is due to the excess androgens that are produced.
Androgens overstimulate the oil glands in your skin by increasing the production of sebum.
When this occurs, pores get clogged more easily and bacteria are able to thrive, often
resulting in inflamed, painful, and cystic lesions on the skin. Patients may also present with
a dark, velvety-like discolouration of their skin in creases under the arms, neck, knees, and
thighs. It is referred to as acanthosis nigricans and is a marker of underlying insulin
Hair growth (or loss) in unwanted places.
The androgens have struck again… and this time they aren’t so pleasant. Androgens are
often referred to as the male sex hormones, with testosterone being the most common of
the group. While it is normal for these hormones to be naturally present in females, in
excessive amounts they can cause hair to grow or be lost in unwanted places. Under the
influence of androgens, excessive amounts of coarse terminal hairs can develop on places
where men typically grow them, such as on the upper lip, chin, chest, abdomen, and back.
In women, this symptom is called hirsutism and happens to be one of the most distressing
aspects of PCOS. Women can also experience hair loss and thinning that occurs in a malepattern
distribution on the scalp. This occurs because testosterone can get converted to a
more potent androgen called DHT within the area of the scalp, which actually causes the
hair follicles to shrink.
No matter what you do, you just can’t seem to lose any weight. Does this sound familiar?
Well, you are not alone! Weight gain, particularly around the abdomen, is one of the most
common symptoms of PCOS but is not always necessarily present. Many women struggle
to lose weight because their cells are resistant to insulin, causing their body to store more
fat. Because of this factor, women with PCOS are at an increased risk of developing type 2
diabetes, obesity, and cardiovascular disease. It is important to note that this can be true
even in lean women with PCOS, as studies have shown that insulin resistance can be
present in both types of patients.
Trouble getting pregnant.
Have you and your partner been trying to conceive for 12 months or longer without
success? It might be worth taking a closer look. PCOS is one of the leading causes of
infertility in women because of the effect it has on ovulation. Women with PCOS often have
cycles that are irregular, which makes it difficult to predict the timing of ovulation should it
occur. Standard ovulation tests are often not useful because the hormone that they detect is
present in constant amounts throughout the cycle. This hormone is released by the brain in
an excessive proportion, causing the body to produce more androgens and ultimately halt
the development of the follicles. Without adequate follicular growth, ovulation will not occur
and the chances of conception each month are very slim.
If you present with any of these symptoms, don’t hesitate to discuss them with your doctor
or request additional testing. PCOS is a condition that is widely under-diagnosed given its
complexity and variance in presentation. Early diagnosis and intervention are key because
of the impact it can have one’s health in both the short and long term. The good news is that
it is most definitely treatable – yes, hair symptoms and all!
Let’s support one another and raise awareness for PCOS by sharing these symptoms with
a family member, colleague, or friend.
Yours in health,
Dr. Jessica Geil, ND
Health Over All