PCOS Explained: Symptoms, Causes, & Management by Dr. Neha Mehta

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder affecting millions of women worldwide, often silently. It's a complex condition that can impact your reproductive health, metabolism, and overall well-being. As a gynecologist, I often see women grappling with PCOS symptoms, feeling confused or alone. My goal with this post is to shed light on PCOS, empower you with accurate information, and guide you towards effective management strategies.

What Exactly is PCOS?

PCOS is an endocrine disorder characterized by a hormonal imbalance. While the name 'polycystic' suggests many cysts on the ovaries, it's not the primary diagnostic factor, nor are these cysts typically harmful in themselves. Instead, PCOS often involves:

• Irregular or absent menstrual periods: Due to infrequent or absent ovulation.
• Excess androgen (male hormone) levels: Leading to symptoms like excess hair growth, acne, and hair thinning.
• Polycystic ovaries: Ovaries that may appear enlarged and contain numerous small follicles (fluid-filled sacs) when viewed on ultrasound.

It's a spectrum, and not every woman will experience all these signs.

Recognizing the Signs: Common PCOS Symptoms

PCOS can manifest in various ways, and symptoms often begin around puberty or later. Here are some of the most common signs:

• Irregular or Absent Periods: This is one of the hallmarks of PCOS. Cycles can be longer than 35 days (oligomenorrhea), or periods may stop altogether (amenorrhea). This occurs because ovulation is irregular or doesn't happen.
• Excess Androgen (Male Hormone) Levels: High levels of androgens (like testosterone) can lead to:
  • Hirsutism: Excess body and facial hair growth in areas typically associated with men (e.g., upper lip, chin, chest, back).
  • Acne: Persistent, often severe acne, especially on the face, chest, and upper back.
  • Androgenic Alopecia: Thinning hair on the scalp or male-pattern baldness.
• Polycystic Ovaries: On ultrasound, ovaries may appear enlarged and contain numerous small, fluid-filled sacs (follicles) surrounding the eggs.
• Weight Gain and Difficulty Losing Weight: Many women with PCOS struggle with weight, often around the abdomen, making weight loss challenging.
• Insulin Resistance: A significant factor in PCOS, where the body's cells don't respond effectively to insulin. This can lead to higher blood sugar levels and increased insulin production, contributing to weight gain and androgen production.
• Fertility Challenges: Irregular ovulation can make it difficult to conceive.
• Other potential symptoms: Skin tags, dark patches of skin (acanthosis nigricans), fatigue, mood changes, and sleep apnea.

What Causes PCOS? Unraveling the Complexity

The exact cause of PCOS isn't fully understood, but it's believed to be a multifactorial condition involving a combination of genetic and environmental factors:

• Genetics: PCOS often runs in families, suggesting a genetic predisposition.
• Insulin Resistance: Many women with PCOS have insulin resistance, meaning their bodies don't use insulin efficiently. To compensate, the pancreas produces more insulin, which can then stimulate the ovaries to produce more androgens.
• Excess Androgen Production: High levels of androgens are a key feature of PCOS, disrupting normal ovarian function and leading to many of the common symptoms.
• Inflammation: Some research suggests that chronic low-grade inflammation may play a role in PCOS.

Diagnosing PCOS: A Comprehensive Approach

Diagnosing PCOS involves a thorough evaluation by your gynecologist to rule out other conditions. There isn't a single test for PCOS. Diagnosis typically relies on a combination of:

• Medical History and Physical Examination: Discussing your symptoms, menstrual history, family history, and a physical exam to check for signs like excess hair growth, acne, or weight distribution.
• Blood Tests: To measure hormone levels (androgens, LH, FSH, thyroid hormones, prolactin), blood sugar, insulin, and cholesterol. These help confirm hormonal imbalances and rule out other causes of your symptoms.
• Pelvic Ultrasound: To examine the appearance of your ovaries and uterus, looking for the characteristic 'polycystic' morphology (though this alone isn't sufficient for diagnosis).

Diagnosis usually requires meeting at least two of the three Rotterdam criteria: irregular periods, signs of excess androgens, and polycystic ovaries on ultrasound.

Managing PCOS: Empowering You Towards Better Health

While there's no 'cure' for PCOS, it is absolutely manageable. The goal of treatment is to alleviate symptoms, reduce the risk of long-term complications, and improve your overall well-being. A personalized approach is key.

Lifestyle Modifications: Your Foundation for Health

Lifestyle changes are often the first line of treatment and can significantly improve PCOS symptoms:

• Healthy Diet: Focus on a balanced diet rich in whole grains, lean proteins, fruits, and vegetables. Limiting refined carbohydrates and sugars can help manage insulin resistance.
• Regular Exercise: Aim for at least 30 minutes of moderate-intensity exercise most days of the week. This helps improve insulin sensitivity and weight management.
• Weight Management: Even a modest weight loss (5-10% of body weight) can significantly improve symptoms like irregular periods, insulin resistance, and androgen levels.
• Stress Management: Chronic stress can worsen hormonal imbalances. Incorporate stress-reducing activities like yoga, meditation, or hobbies into your routine.

Medical Interventions (As Needed)

Depending on your specific symptoms and goals, your doctor may recommend medications:

• Oral Contraceptives (Birth Control Pills): These can help regulate menstrual cycles, reduce androgen levels, and improve acne and hirsutism.
• Anti-Androgen Medications: Such as spironolactone, can help reduce excess hair growth and acne by blocking the effects of androgens.
• Insulin-Sensitizing Medications: Metformin, for example, can improve insulin resistance, which may help regulate periods, improve ovulation, and aid in weight management.
• Fertility Treatments: For women trying to conceive, medications like clomiphene citrate or letrozole can stimulate ovulation. In some cases, assisted reproductive technologies may be considered.
• Treatments for specific symptoms: Topical creams for acne, hair removal methods for hirsutism.

Dr. Neha Mehta's Advice for Women with PCOS

"Understanding PCOS is the first step towards managing it effectively. As your gynecologist, my priority is to provide you with compassionate, individualized care. Remember these key points:

• Don't Self-Diagnose or Self-Treat: PCOS symptoms can overlap with other conditions. A proper diagnosis from a healthcare professional is crucial.
• Consistency is Key: Lifestyle changes require dedication. Be patient with yourself, and celebrate small victories. Sustainable changes yield the best long-term results.
• Regular Follow-ups: PCOS management evolves. Regular consultations help us adjust your plan as needed and monitor for any associated health risks.
• Focus on Long-Term Health: PCOS isn't just about periods or acne; it impacts metabolic and cardiovascular health. Proactive management helps prevent future complications like type 2 diabetes and heart disease.
• Seek Support: Connect with support groups or trusted friends and family. You are not alone on this journey.

My team and I are here to guide you through every step of your PCOS journey. We'll work together to find the most effective strategies tailored to your unique needs."

Conclusion: Embracing Your Health Journey

PCOS is a common endocrine disorder, but with the right knowledge, a proactive approach, and a strong partnership with your healthcare provider, you can manage its symptoms and live a healthy, fulfilling life. It's about understanding your body, making informed choices, and committing to your well-being.

Ready to take control of your PCOS journey? If you suspect you have PCOS, have been diagnosed and need a fresh perspective, or are looking for personalized management strategies, schedule a consultation with Dr. Neha Mehta today. Let's work together for your optimal health and well-being.