Women with PCOS often do not have regular periods because it is harder for their bodies to ovulate due to higher levels of androgens, or male hormones, as well as other endocrine imbalances. Since ovulation is needed for a period, lack of ovulating (or irregular ovulating) means that women with PCOS often have irregular menstrual cycles that fall outside of the 24 - 35 day “normal” length. Periods can be regulated with lifestyle changes that encourage more frequent and consistent ovulation. Some people may choose to use medication to regulate their cycles like birth control and Clomid, but these pharmaceuticals are a “band aid” treatment that does not address the root cause.
70 - 90% of women with PCOS also are insulin-resistant, meaning that their bodies do not efficiently convert food and blood sugar into energy. This is because insulin, a hormone produced by our pancreas, is responsible for turning blood glucose into energy for our muscles. If you are insulin resistant, your body does not respond as readily to insulin which can lead to overproduction of insulin (which can further inhibit ovulation through encouraging androgen production) as well as high blood sugar. Over time this can lead to stubborn weight gain, obesity, and eventually diabetes for women with PCOS. Insulin resistance can be managed with dietary modifications and in some cases medications like Metformin.
Even as adults, people with PCOS oftentimes struggle with hormonal acne. With PCOS, this is commonly seen as cystic acne along the chin and jawline. For most people with PCOS, acne is caused by high levels of androgens, or male hormones. Testosterone specifically catalyzes extra “sebum” production, or the oily, waxy substance produced by our bodies to keep our skin moist. The proper amount of sebum is a good thing for our skin, but too much can cause pores to clog and lead to breakouts. Inflammatory responses - which are often seen with PCOS - can be another reason behind acne. Hormonal acne caused by PCOS can be managed by both medication like (e.g., birth control, spironolactone) as well as lifestyle tactics like managing diet and stress management.
PCOS can cause male-pattern hair loss in females due to high levels of androgens (male hormones) like testosterone and DHEA. Thinning hair due to the effects of androgens is called androgenic alopecia.This hair loss is often seen around the temples and top of the head, similar to male hair loss patterns. While it is not always reversible, PCOS hair loss can be controlled by lowering androgen levels, which can be through lifestyle modifications or medication like birth control and spironolactone. Treatment depends on the person!
“Hirsutism” is male-pattern hair growth, seen most often on the face, neck, check, back, thighs, stomach, and butt. Like hair loss, this is also due to high androgen levels. While not all instances of hirsutism are reversible, like hair loss, it can be controlled (and kept from worsening) with lifestyle changes, pharmaceuticals, or a combination of both methods.
PCOS is the #1 cause of infertility. This lays largely in irregular ovulation seen with PCOS: our ovaries need to release an egg to get pregnant, and if this is only happening several times per year (or not happening at all!) it will be harder to conceive than it will be for a woman whose body releases an egg every month like clockwork. Low progesterone relative to estrogen, or estrogen dominance, is also seen with PCOS. This can make it difficult for an egg to implant in the womb once fertilized and also cause early miscarriage, as progesterone is responsible for building up the uterine lining to prepare for a healthy pregnancy. This said, many people with PCOS are able to conceive naturally or with the help of fertility treatments like an IUI or IVF. Working on re-balancing your body and regulating ovulation before you try to start a family is a great way to optimize your chances.
PCOS leaves you at a 3-times higher risk of developing anxiety or depression. Although the exact reason for this association between conditions is unknown, many symptoms of PCOS, such as hirsutism, infertility, body weight fluctuations, and a general lack of control over one’s health and body can be frustrating and anxiety-provoking. Some studies have suggested that insulin resistance or higher androgen levels could be a factor that predisposes people with PCOS to develop mental health conditions. Working with a therapist, finding a support group, learning mindfulness, and taking medication are techniques that have all been tactics demonstrated to help with PCOS mental health challenges.
