First of all, the words sign and symptom have different meanings in medicine. A sign is something that a physician can directly observe, verify, or measure, like acne or hirsutism which is visible to the naked eye. A symptom is something that a patient reports, but which a physician cannot directly observe, like mood swings or pain. Also, not all women with PCOS will have the same collection of signs and symptoms or the same severity for each. Every woman is different and every instance of PCOS is different.
Common SIGNS of PCOS include:
These are two related terms. Hyperandrogenemia can be broken down into words parts which makes its meaning clear and easy to remember. Hyper is a prefix meaning “excessive”. Androgen is a root referring to male hormones — which comes from two other word parts: andro, which means “man” or “male”; and gen, which means “to make” or “cause”. Thus, an androgen is something that makes you masculine or causes male features. -Emia is a suffix that means “a condition of the blood”. So, we can see that hyperandrogenemia is a blood condition with an excess of hormones that cause male features. Hyperandrogenism is the collection of symptoms that result from hyperandrogenemia, and it comes from all the same word parts, except it uses the suffix -ism, which refers to a state of being. All of which can cause the following:
This comes from the word hirsute, meaning “hairy”, and the suffix -ism, which means “state of being”. So hirsutism is the state of being hairy, and it refers to the unwanted facial and body hair that comes from having excessive male hormones — androgens: testosterone or DHEA, for example.
- Androgenic alopecia
Here we have the familiar word part androgen with the suffix -ic that means “of something” or “relating to something”. Alopecia comes from a Greek word that means “fox-mange” (some of our word parts don’t make a lot of sense to modern people, but we’re stuck with them for historical reasons), and it means “bald”. So androgenic alopecia is baldness related to androgens, and any woman with PCOS who has thin head hair probably knows how unpleasant it can be.
This one doesn’t need much explanation, anyone who’s ever had a pimple knows what acne is. But the word does have an interesting origin. It comes from the Greek word akmas (meaning “point”). But, sometime around the 6th century, a scribe copied down aknas instead of akmas, and from that we get the word acne today. There are many different types of acne, but most adult women with severe acne have PCOS.
Again, the word parts are a great way to define these terms. Menorrhea comes from two roots: meno meaning month and rrhea meaning flow. So this part refers to your monthly flow, or menses (which actually just means “monthly”). The prefixes a- and ologo- mean “none/no/absent” and “few/insufficient”, respectively. Many women with PCOS go months at a time without a cycle or any menstrual flow, and some have never had a natural period in their entire lives. You’ll also sometimes hear the terms primary amenorrhea and secondary amenorrhea. This just refers to whether the condition began at puberty or later in life. Not all clinicians think that it is useful to distinguish between primary and secondary amenorrhea, but others do. It can be part of differential diagnosis in some cases.
Anyone who is trying to conceive knows what ovulation is: it is the point in a woman’s cycle when the egg fully matures and is released from the ovary and is ready to be fertilized by a sperm. This comes right after the follicular phase of egg maturation and requires a special hormonal signal that women with PCOS don’t produce. Thus, many women with PCOS do not ovulate (the prefix “an-” just means “none/no/absent”). Anovulation actually leads to another sign of PCOS, which is:
- Polycystic Ovaries
This sign actually puts the PCO in PCOS, but unfortunately it is a little misleading as a term. A cyst is pretty much any fluid-filled cavity in the body (it comes from the Greek word kystis which means “bladder” or “pouch”). However, the “cysts” on the ovaries of women with PCOS are actually eggs stuck in the follicular phase. This phase of egg maturation comes just before ovulation, and since many women with PCOS never ovulate, they wind up with lots of eggs trapped in this phase. Sometimes, these follicles can go on to form a true cyst, but much of the time the “cysts” observed during ultrasound of women with PCOS aren’t true cysts at all. They are follicles that never finished ripening and were never released.
This is too much (hyper) insulin in the blood (-emia). Insulin is a very powerful hormone that tells the body when to dispose of sugar in the blood. Many women with PCOS are insulin resistant, meaning their body’s cells don’t respond to insulin the way they should. Since the sugar doesn’t get disposed of, it builds up in the blood, which stimulates production of more insulin. This is a vicious cycle that can be very dangerous if it goes uncontrolled and can lead to type II diabetes in the long term and a life-threatening conditon called ketoacidosis if it goes untreated for long enough.
This is too much sugar (the root glyco means “sugar”) in the blood. It is caused by insulin resistance and it in turn can cause:
This comes from the roots poly, meaning “many/excessive” and dypsos, meaning “thirst”. The suffix -ia is a very common suffix in medicine that means “condition”. So, this is a condition of excessive thirst.
The root uro just means, you guessed it: “urine”. This is a condition of excessive urination. Not entirely unexpected if one is already experiencing polydypsia.
Many women with PCOS are obese or overweight, and a woman with PCOS is significantly more likely than a woman without PCOS to be obese or overweight. This is probably a result of insulin resistance, although other factors can play important roles. Moreover, women with PCOS, because they have hyperandrogenism, will frequently have a masculinized adipose distribution. This means that their excess weight will go to the midriff, typical of men, as opposed to the breasts, buttocks, and thighs, which is typical of women.
Common SYMPTOMS of PCOS include:
Depression is more common and more severe in women with PCOS than in those without PCOS. This has been shown in numerous studies over several decades. Some of this may be caused by the abnormal hormonal profile, and there also appears to be a link between body satisfaction (which is affected by many signs of PCOS) and depression.
Feelings of worry or uneasiness are slightly more common in women with PCOS than in those without PCOS. It is still unclear whether this is related primarily to the hormonal changes associated with PCOS or to coping with the social pressure of PCOS signs.
- Mood Swings
Women with PCOS often report mood swings, significant changes in mood without an obvious cause. This may be linked to dramatic changes in blood sugar and the many hormonal imbalances that often accompany PCOS.