PCOS, or polycystic ovary/ovarian syndrome, is a hormonal disturbance that leads to a host of clinical features in women. The three main features of PCOS is :
- Menstrual irregularity
- Androgen excess
- Ovarian cysts
While many signs and symptoms may be missed or ignored by a women who has not as yet been diagnosed with PCOS, the three key symptoms that often leads one to seek medical attention is :
- Pain – period pain, ovarian pain
- Periods – absent, irregular, heavy or very light (scant)
- Pregnancy – difficulty falling pregnant, infertility
It has to be noted that not every woman with PCOS will experience problems with period pain or issues relating to pregnancy. Similarly, ovarian cysts are not always present. Disturbances in the menstrual cycle, however, are present in almost every case of PCOS.
PCOS occurs when there are high levels of androgens in the body, often as a result of an excess of LH (luteinizing hormone). An associated decrease in FSH (follicle-simulating hormone) affects the way the body deals with these androgens. The estrogen levels are subsequently reduced while the androgen levels are elevated. This affects the menstrual cycle and ovulation.
These differences in the hormone levels will present with a host of features affecting multiple systems of the body.
Impaired glucose tolerance or diabetes mellitus (sugar diabetes) is often seen as a result of insulin resistance and these signs and symptoms may also be present.
In younger girls, menarche (the onset of menstruation) may be delayed. This is known as primary amenorrhea.
Girls or women who are menstruating may find that their menstruation ceases for 3 months or more. This is known as secondary amenorrhea. The periods may resume but the cycle is usually irregular and periods are infrequent (oligomenorrhea). It could be a very light bleed (scanty) or extremely heavy (menorrhagia). Excessive blood clots may also be present.
Period pain (dysmenorrhea) is often reported in PCOS. Ovarian pain, a term attributed to lower lateral abdominal pain (pain on the sides) even without menstruation, may be persistent and exacerbates during ovulation (ovulatory pain) or during menstruation (period/menstrual pain).
A common misconception is that severe pain during ovulation and/or periods is a normal occurrence. This often leads to young girls and women delaying in seeking medical treatment. While there may be discomfort, mild pain or slight cramping during menstruation, severe pain is not the norm and may be a sign of PCOS.
The pain may be severe to the extent that it triggers nausea, vomiting, and even fainting (vasovagal reflex).
Infertility is not present in every case of PCOS. However, persistent anovulation is frequently seen in PCOS despite menstruation. This is known as an anovulatory cycle. Ovulation does occur intermittently thereby allowing for pregnancy although it often takes longer to conceive. In a minority of cases, women with PCOS are infertile.
Difficulty conceiving is a common reason for many women to seek medical treatment only to be diagnosed with PCOS. The other signs or symptoms of PCOS may be absent, minor or ignored despite being blatantly obvious to the patient.
Other Signs and Symptoms of PCOS
- Oily skin
- Pigmentation – hyperpigmentation on nape of neck and skin folds (acanthosis nigricans)
- Hirsutism – growth of excessive hair on face, abdomen, chest, back in women
- Male-pattern hair loss – androgenic alopecia
- Abdominal obesity – abdominal circumference greater than 35 inches (88 centimeters)
- Weight gain
- Luteinizing hormone (LH) – high levels of luteinizing hormone in the blood
- Prolactin – high levels of prolactin in the blood (hyperprolactinemia)
- Androgens – high levels of free testosterone or free androgen index
- Glucose – high levels of blood glucose (hyperglycemia)
- Insulin – high levels of insulin (hyperinsulinemia due to insulin resistance)
- Cholesterol – high levels of blood cholesterol (hypercholesterolemia)
- Ovaries (transvaginal ultrasound)
- Multiple ovarian cysts (12 or more)
- Ovarian cyst size (2 to 9 millimters) but often cysts vary between 5mm and 15mm
- Enlarged ovaries (> 10 cubic centimeters) on both sides
- Hypertension (high blood pressure)