Getting well on into your adult life, things haven’t always been perfect, but you’ve always dealt with adverse circumstances admirably and have come out on the other end a stronger person; lately, the occurrence of what appears to be polycystic ovarian syndrome symptoms have been standing in the way of a couple of big life goals.
You’ve always wanted to find your dream partner, and/or you wanted to start a family, but complications of what may be PCOS have stood in your way so far, preventing many potential partners from seeing you for who you really are, or they have prevented you from getting that elusive first pregnancy from taking root.
The first step towards getting treatment for what is likely PCOS is to see your doctor for an official diagnosis. They have the know-how to discern one disorder from another, allowing them to prescribe treatments, diets and drugs that will make a positive difference in your quest to achieve your relationship and family goals.
The following five polycystic ovarian syndrome symptoms are strong indicators that should lead you to seek the help of a medical professional so that you may get on with seeking the help that you need to get to where you want to go in life.
1) Your periods are irregular or are missing altogether
The length and regularity of one’s menstrual, or reproductive, cycle varies from one woman to another. They can be as long as 35 days; or as short as 24 days. However, the average menstrual cycle lasts for 28 days.
Every month, upon not having fertilized their ovulated egg, women shed a thin layer of the uterus that would have supported a successfully started embryo in a process called menstruation. More commonly known as a period, this is a normal, if messy, part of a woman’s reproductive cycle. Again, the length of each period differs. These variations may make it difficult to determine what is considered irregular, and what is not. It’s a good idea to keep a ‘period diary’, where you make a note of when each of your periods begin and end. This can help you identify what is irregular for you.
Don’t be immediately alarmed if you do have irregular periods. While irregular periods can be annoying and can catch you off guard, medical treatment isn’t necessarily required. Irregular periods are caused by a variety of factors; such as major changes in your reproductive cycle (for example, the menopause); thyroid problems; using oral contraceptives; high levels of exercise; stress; and sudden and large changes in your body weight. Irregular periods are also caused by an imbalance in hormones, which may be associated with PCOS. Women with PCOS may release a higher than average amount of testosterone; a hormone which men usually have higher level of, compared to women (1).
While the absence of one’s period usually means conception and the start of a pregnancy, in a significant portion of the female population, it is one of the more prominent polycystic ovarian syndrome symptoms out there. The origins of this occurrence have to do with the mass amounts of androgen and testosterone being released in conjunction with the machinations of this metabolic disorder. As a result of these abnormal hormonal levels, the discharge that normally occurs either takes much longer to proceed through to menstruation, or it doesn’t happen at all (2).
With PCOS, ovulation does not always occur. This means that the egg is not always released by the ovary each month, resulting in irregular periods. With PCOS, eggs are developed in sacs in polycystic ovaries – yet the sacs cannot release eggs. Hormones are required for your ovaries to ovulate, sent from your pituitary gland in your brain. Ovulation does not always occur in women with PCOS, because there is an insufficient production of LH (luteinizing hormone). A large amount of LH, around the 14th day of the average 28-day cycle, is the signal required for your ovaries to release an egg. However, LH levels in women with PCOS are already high throughout the cycle; which means there is no excess production of LH on day 14 (3).
With such many-varied and complex factors influencing the regularity of periods, you may want to consider the following symptoms of PCOS to help you identify if you may have it.
2) You have tried and tried to get pregnant, but to no avail
You’ve tried every fertility enhancing treatment there is, you and your partner had tried to give yourself every opportunity to achieve conception in and around the time of the month when you are usually ovulating, you’ve even opened your mind some pretty hippy dippy New Age stuff.
None of it has worked. It’s not your hubby’s fault, as your doctor has determined that his swimmers are viable enough to successfully participate in your quest to make your first baby, so it is likely have you have some disorder that is impairing your ability to get pregnant.
It goes without saying that having children is an important step for many people at some point in their lives. However, women with PCOS may find it difficult to conceive a child. It’s recommended that you see a doctor if you have been unsuccessfully trying to get pregnant for a year. It’s worth viewing fertility with PCOS on a spectrum. Having PCOS doesn’t necessarily mean you’re infertile; lots of women have PCOS and are able to conceive. However, it may take them longer to get pregnant, or they may require treatment to help them get pregnant.
There are many tried-and-tested methods of boosting your fertility, and it can be incredibly disheartening if they don’t seem to be having much, or any, effect. It takes two to tango; so if you are having trouble getting pregnant, you may want to consider for yourself and your partner to undergo fertility tests to identify any health issues which may be affecting your chances of having children.
Problems with getting pregnant with PCOS can be explained by different reasons. However, for many couples, the underlying cause of infertility remains unidentified. Ovulation-related issues are the most common cause of infertility. Other causes include damaged fallopian tubes (where the egg travels down to reach the uterus, before being implanted); pelvic inflammatory disease (where the womb and ovaries are infected, scarring the fallopian tubes); or endometriosis (a condition affecting the lining of the uterus) (4). If there are any irregularities in your period (some of which may have falsely led you to believe that you had succeeded in the past) as described above, it may be an indication that the processes of PCOS may be to blame for your impaired fertility.
Androgens are male hormones; and people with PCOS have excessive levels of androgens. In someone without PCOS, eggs have follicles – which are sacs containing fluid. The fluid builds up as the egg develops, and when the egg is released, the follicle breaks open. The main difference between polycystic ovaries and non-polycystic ovaries is that the follicles of polycystic ovaries cannot mature; preventing ovulation. In order for the follicles to develop properly, the hormone FHS (which simply stands for follicle stimulating hormone) is required, and is normally released by the pituitary gland. These follicles do not mature because of hormonal imbalances in PCOS. When one has Polycystic Ovarian Syndrome, the excessive quantities of insulin surging through your bodies send androgen production into overdrive, which can cause follicles to not reach maturity. As a result, cysts develop over them, inhibiting their ability to pop out an egg in the future (5). No egg, no babies. It’s as simple as that.
Despite the negative effect PCOS can have on conceiving, it’s important to know that there are treatments available to help boost your chances of getting pregnant. Medicines such as metformin aim to regulate the menstrual cycle (including ovulation), by balancing insulin levels in the body. Discuss your options for conceiving with PCOS with a medical professional.
3) You have excessive body and facial hair, along with thinning hair on your head
While the beauty media is often guilty of promoting body types that don’t accurately reflect the reality facing the majority of women, it’s well established when you put the average man next to the average woman, the former is far more likely to have more hair below the neck, and later in life, they might not have much left of it on their head. Females have much less to due to marked differences in hormone levels compared to the other sex, but when you throw a metabolic disorder like PCOS in the mix, some of these rules end up getting re-written.
Having excess body hair can be a knock to your confidence, but for many women with PCOS, it is a confronting part of having the condition. The most common reason for excess face or body hair on women is PCOS. This condition is also referred to as hirsutism. Excess hair can occur on the face – most notably on the chin, and above the lip; and the body – especially the stomach, arms, and chest areas. Different variables will affect the coarseness and density of facial and body hair. The amount of body and facial hair may also depend on your ethnicity, as certain ethnic groups tend to have a higher hair density than other ethnic groups (6). If you’ve had excess facial and body hair growth since puberty, the underlying cause could be PCOS. The development of hirsutism may be slowed down if you receive treatment for it earlier.
As discussed in the previous two points, androgen is secreted in high amounts due to the elevated levels of insulin which circulate in the bloodstreams of women with PCOS. With high levels of androgen – including testosterone – being produced by ovaries, hair growth is encouraged. As a result of this, the excessive levels of androgen that results from this stimulate hair follicles throughout the patient’s body to develop thicker, more coarse hair than what would otherwise grow (6).
Additionally, elevated levels of androgen have the opposite effect on scalp hair, inhibiting the growth of new hair follicles, and adversely affecting the quality of those that do succeed in producing new strands of hair (7).
To make things more complicated, people with PCOS may experience hair loss and hair growth – at the same time. This is because high levels of a certain type of testosterone can cause hair follicles to shrink. Eventually, the follicles cannot grow or maintain any more hair. Along with hair loss or growth, women with PCOS may also have a lower-pitch voice, which is caused by – you guessed it – the build-up of the male hormone testosterone (8).
Unwanted facial and body hair growth can be limited by medication, or physically removed through treatments such as plucking or laser removal.
4) You have had weight problems throughout much your life
While the North American diet and the sedentary nature of its lifestyle makes it very easy for any woman to gain unwanted pounds, some put it on far easier than others. These same folks have a heck of a time of ridding themselves of these excess weight, while others manage to shed it with weeks on concentrated effort.
If this sounds like you, have you considered the possibility that you might be playing the game of life with a hidden metabolic handicap? This parachute on your back is none other than PCOS (surprise!), as the mechanisms of this disorder involves a lack of insulin sensitivity.
Furthermore, women with PCOS tend to have a higher level of insulin, a hormone produced by the pancreas. Research suggests this is caused by beta cells – which produce insulin – not functioning as well in women with PCOS. The purpose of insulin is to help cells use up sugar – or glucose – for energy. Your body may be resistant to insulin if you have PCOS or are overweight; which means in order to stabilize blood sugar levels, more insulin is needed. This means glucose and insulin blood levels build up (9).
The increased levels of insulin in the body means that your body cannot use insulin as effectively – resulting in more insulin being produced, so that your cells can use up the glucose you get from food. This actually encourages the ovaries to produce more androgens. So, how does this link to weight gain? The androgens can cause weight gain – especially the storage of fat in the abdominal region, where men typically carry weight. Although fat is good in that it helps protect your organs, fat in this part of your body is particularly dangerous as it may increase your risk of heart disease (10).
The link between PCOS and being overweight isn’t as clear-cut as you might think. Some women develop PCOS after gaining a significant amount of weight, suggesting being overweight increases the likelihood of PCOS. On the other hand, women with PCOS have an increased risk of obesity, because of the excess insulin production. Either way, it’s important to ensure your weight is at a healthy level – it’s good to take plenty of exercise and eat a balanced diet. Losing weight may help balance your hormones; regulate your periods with PCOS; and reduce the severity of other polycystic ovarian syndrome symptoms.
Because your body cannot use glucose effectively, the glucose is stored as fat; rather than being used up as energy. As a result, more food ends up getting stored as fat per meal compared to someone with a normal level of insulin responsiveness, making it that much harder to diet in the traditional sense (11).
Along with insulin production and insulin resistance, a 2009 study of 91 women with PCOS showed that the metabolic rate was lower in women with PCOS, compared with women who did not have PCOS (12). This suggests that the rate at which women with PCOS burn energy, or food, is slower – which may encourage weight gain if there are more calories going in than being expended. Having a lower metabolic weight may there also make it harder for women who have excess weight to burn it off.
5) You’re well beyond your adolescence, yet you still struggle with acne
During your time in high school, you rationalized your struggles with a pepperoni pizza face by taking solace in the fact that once your hormones settled down, your complexion would clear up, after which people would stop judging you so much based on your appearance.
Flash forward several years, and you’re well into your twenties … and you still got a face filled with zits that cloak the awesome person that your family and your close friends know that you are. The fact that this is still occurring at this stage in your life despite your diligent facial hygiene and dietary efforts is one of the telltale polycystic ovarian syndrome symptoms that should lead you to contact your doctor. Once again, this is due to the hyperactive effects of androgen production run amok, which is a key manifestation of PCOS in women that have this disorder (13).
We’ve all been told different ways to ‘cure’ acne, or prevent spots from appearing in the first place; but hormonal acne is often thought to be a little harder to control. Putting toothpaste on a large spot in the hope it will dry up overnight can be disappointing when you wake up the next morning not with a clear complexion, but with a face smelling faintly of peppermint. These angry and resilient spots may be caused by hormone imbalances associated with PCOS. Not only do women who have PCOS often have acne as a symptom, but the acne tends to be persistent even through the adult years; more difficult to treat; takes a while to go down; and is severe in nature. You may also find that your skin is oilier – this excess sebum on the skin’s surface can become trapped in your pores, causing more spots.
Acne is may be particularly related to PCOS if it continues through to adulthood. The acne may be especially prominent along your jawline; chin; and cheeks, as acne in these areas are thought to be linked to hormones. Adult acne may also flare up at other parts of your body – such as your chest or back.
The cause of acne in women with PCOS lies in the androgens produced by the ovaries as a result of the condition. These male hormones encourage the production of oils, which may clog your pores. Bacteria and dead skin cells may also build up in your pores. These trapped substances become inflamed – causing a pimple to surface.
Having acne, especially if it continues through to your adult years, can be difficult to deal with, and it may lower your self-esteem. Remember that just like the other symptoms of PCOS, there are ways to treat acne. These range from oral contraceptives, antibiotics, or creams. Treatments aim to control the hormones which encourage acne. There’s mixed evidence to suggest whether making changes to your lifestyle can help with acne (14) – although you should be eating a healthy diet and drinking plenty of water anyway! A lot of these methods to treat acne may be trial-and-error, so it may be a case of trying different methods to see what works best for you and your skin.
Knowing you have PCOS
Every woman exhibits different symptoms of PCOS, to varying extents. If you think you may have PCOS, it’s best to seek medical advice so you know what the next steps are to manage PCOS. Even if you don’t feel as though these symptoms are having an adverse effect on your life, it’s important to get diagnosed, as having PCOS is associated with other health problems. This includes, but is not limited to, type 2 diabetes and high blood pressure. Leaving potential symptoms of PCOS undiagnosed is therefore damaging to your health in many other ways.
If you think you have any of these symptoms, discuss them with a physician. The treatments recommended to you may depend on your own preferences and goals; for example, women with PCOS who wish to conceive may be recommended a different treatment to those who wish to reduce facial or body hair. Finding out you have PCOS may be scary, but it’s a manageable condition, and a professional diagnosis can help reduce the risk of contracting other diseases. Can you really afford not to find out?
Sam, S. (2007) Obesity and Polycystic Ovary Syndrome. Obesity management. 3(2), 69-73.
Georgopoulos, N. A., Saltamavros, A. D., Vervita, V., Karkoulias, K., Adonakis, G., Decavalas, G. & Kyriazopoulou, V. (2009). Basal metabolic rate is decreased in women with polycystic ovary syndrome and biochemical hyperandrogenemia and is associated with insulin resistance. Fertility and Sterility, 92(1), 250-255.