Understanding PCOS and Its Symptoms

PUBLISHED BY Herbode on February 28, 2025

Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects women of reproductive age. It usually starts during adolescence, but symptoms may fluctuate over time. It causes hormonal imbalances, irregular periods, excess androgen levels and cysts in the ovaries. Irregular periods, usually with a lack of ovulation, can make it difficult to become pregnant. PCOS is a leading cause of infertility. It is a chronic condition and cannot be cured. However, some symptoms can be improved through lifestyle changes, medications and fertility treatments. The cause of PCOS is unknown but women with a family history or type 2 diabetes are at higher risk.

PCOS is a significant public health problem and is one of the most commonhormonal disturbances affecting women of reproductive age. The condition affects an estimated 8–13% of women of reproductive age, and up to 70% of cases are undiagnosed. The prevalence of PCOS is higher among some ethnicities and these groups often experience more complications (particularly related to metabolic problems). The biological and psychological effects of PCOS; particularly those related to obesity, body image and infertility, can lead to mental health challenges and social stigma.

Symptoms of Polycystic Ovary Syndrome (PCOS)

The symptoms of polycystic ovary syndrome can differ from person to person. These symptoms may change over time and often occur without a clear trigger. Possible symptoms include:

Heavy, long, intermittent, unpredictable or absent periods
Infertility
Acne or oily skin
Excessive hair on the face or body
Male-pattern baldness or hair thinning
Weight gain, especially around the belly.

Women with PCOS are more likely to have other health conditions such as;

Type 2 diabetes
Hypertension (high blood pressure)
High cholesterol
Heart disease
Endometrial cancer (cancer of the inner lining of the uterus).

PCOS can also cause anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other life areas such as family, relationships, work and involvement in the community.

Causes of PCOS

The exact cause of PCOS is unknown but the following factors contribute greatly:

Insulin Resistance: Insulin, the hormone that the pancreas secretes; when the body cells resist the actions of the insulin, the pancreas secrete more which causes excessive androgen in the body.
Heredity: Researches suggest certain genes are associated with PCOS.
Excess Androgens: Ovaries producing excess androgens which interferes with ovulation as the eggs don’t develop on a regular basis and aren’t released from the follicles where they develop.
Low grade inflammation: When white blood cells make substances in response to infection or injury; the response is referred to as low grade inflammation. Research shows people with PCOS have a long term type of low grade inflammation.

Key facts about PCOS

Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women.
Up to 70% of affected women remain undiagnosed worldwide.
PCOS is the most common cause of anovulation and a leading cause of infertility in women.
PCOS is associated with a variety of long-term health problems that affect physical and emotional wellbeing.
PCOS runs in families, but there are ethnic variations in how PCOS manifests itself and how it affects people.

TREATMENT OPTIONS FOR PCOS

PCOS treatment typically varies based on individual health and symptoms, however the goal of treatment focuses on managing symptoms and preventing long-term complications.

Some common approaches include lifestyle modifications, the use of drugs and management of symptoms.

Medical Treatments available for PCOS

Drugs used in the treatment of PCOS (Polycystic Ovary Syndrome) include:

Hormonal Birth Control Pills: These are often the first line of treatment to regulate menstrual cycles and reduce symptoms like acne and excessive hair growth.

Benefits of Hormonal Birth Control (HBC) for PCOS

Regulates menstrual cycles: HBC helps establish a regular menstrual cycle, reducing the risk of irregular periods and anovulation.
Reduces androgen levels: HBC decreases androgen production, which helps alleviate symptoms like acne, excess hair growth, and male pattern baldness.
Improves acne: By reducing androgen levels, HBC can help improve acne and reduce the risk of scarring.
Decreases hirsutism: HBC can help reduce excess hair growth on the face, chest, and back.
Provides contraception: HBC offers effective birth control, which is essential for women with PCOS who may have irregular ovulation.

Types of Hormonal Birth Control Pills for PCOS

Combination pills: Containing estrogen and progesterone, these pills are effective in regulating menstrual cycles and reducing androgen levels.
Progesterone-only pills: These pills can help regulate menstrual cycles, but may not be as effective in reducing androgen levels.
Hormonal patches: Transdermal patches that release estrogen and progesterone can provide similar benefits to combination pills.

Potential Side Effects of Hormonal Birth Control

These includes weight gain, hyperglycaemia and the risk of thrombosis

Metformin: This medication helps improve insulin sensitivity and can assist with weight management and restoring regular menstrual cycles in PCOS.

Benefits of Metformin for PCOS

Improves insulin sensitivity: Metformin helps the body use insulin more efficiently, reducing insulin resistance.
Regulates menstrual cycles: By improving insulin sensitivity, metformin can help regulate menstrual cycles and improve ovulation.
Reduces androgen levels: Metformin can decrease androgen production, which helps alleviate symptoms like acne, excess hair growth, and male pattern baldness.
Promotes weight loss: Metformin can help with weight loss, which is often a challenge for women with PCOS.
Improves fertility: By regulating menstrual cycles and improving ovulation, metformin can increase the chances of getting pregnant.

Potential Side Effects of Metformin

These includes; Gastrointestinal issues ( Nausea, vomiting, diarrhoea, and stomach cramps), Headaches, Fatigues and Vitamin B12 deficiency.

Anti-androgens: Medications such as spironolactone can help manage symptoms like hirsutism (excessive hair growth) and acne by blocking the effects of androgens.

Here are some common anti-androgens used to treat PCOS:

Spironolactone (Aldactone): A potassium-sparing diuretic that blocks androgen receptors.
Flutamide (Eulexin): A non-steroidal anti-androgen that blocks androgen receptors.
Finasteride (Propecia): A 5-alpha-reductase inhibitor that blocks the conversion of testosterone to dihydrotestosterone (DHT).
Cyproterone acetate: A steroidal anti-androgen that blocks androgen receptors.

Potential Side Effects of Anti-androgens

These include Breast tenderness, Mood changes, Fatigue, Nausea and Headache.

Clomiphene Citrate: This is commonly used to induce ovulation in women with PCOS who are trying to conceive.

Benefits of Clomiphene Citrate for PCOS

Induces ovulation: Clomiphene Citrate helps stimulate ovulation in women with PCOS who do not ovulate regularly.
Improves fertility: By inducing ovulation, Clomiphene Citrate can improve fertility in women with PCOS.
Reduces androgen levels: Clomiphene Citrate can help reduce androgen levels, which can help alleviate symptoms like acne and excess hair growth.

Potential Side Effects of Clomiphene Citrate

Hot flashes, Mood changes, Nausea and vomiting, Headaches and Visual disturbance.

Letrozole: Another medication that can be used to stimulate ovulation, particularly in women who do not respond to clomiphene.

Benefits of Letrozole for PCOS

Induces ovulation: Letrozole helps stimulate ovulation in women with PCOS who do not ovulate regularly.
Improves fertility: By inducing ovulation, letrozole can improve fertility in women with PCOS.
Reduces risk of multiple pregnancies: Letrozole is less likely to cause multiple pregnancies compared to other fertility medications.
Shorter treatment duration: Letrozole is typically taken for days compared to other fertility medications.

Potential Side Effects of Letrozole

These includes: Hot flashes, Headaches, Fatigues, Mood changes, Nausea and vomiting.

Gonadotropins: In some cases, injectable hormones may be used to stimulate the ovaries for ovulation.

Always consult a healthcare provider for personalized treatment options based on individual needs and symptoms.

Lifestyle Modifications for Polycystic Ovary Syndrome (PCOS)

While there’s no cure for Polycystic Ovary Syndrome (PCOS), lifestyle changes can help manage symptoms, improve fertility, and reduce the risk of related health problems. Here are some effective lifestyle changes for PCOS:

Diet and Nutrition

Balanced diet: Focus on whole, unprocessed foods like vegetables, fruits, whole grains, lean proteins, and healthy fats.
Low-carb diet: Reducing carbohydrate intake can help regulate blood sugar and insulin levels.
Omega-3 rich foods: Include foods high in omega-3 fatty acids, such as salmon, flaxseeds, and walnuts, to reduce inflammation.
Probiotics: Incorporate probiotic-rich foods like yogurt, kefir, and kimchi to support gut health.

Exercise and Physical Activity

Regular exercise: Aim for at least 150 minutes of moderate-intensity aerobic exercise, or 75 minutes of vigorous-intensity aerobic exercise, or a combination of both, per week.
Resistance training: Incorporate strength-training exercises to build muscle and improve insulin sensitivity.
High-intensity interval training (HIIT): HIIT can help improve insulin sensitivity and cardiovascular health.

Stress Management

Yoga: Practice yoga to reduce stress, improve mood, and enhance fertility.
Meditation: Regular meditation can help reduce stress, anxiety, and depression.
Deep breathing exercises: Practice deep breathing exercises to reduce stress and promote relaxation.

Sleep and Relaxation

Aim for 7-8 hours of sleep: Prioritize getting enough sleep to help regulate hormones and metabolism.
Establish a bedtime routine: Develop a calming pre-sleep routine to improve sleep quality.
Avoid screens before bedtime: Limit screen time before bed to promote better sleep.

Weight Management

Maintain a healthy weight: Aim for a healthy weight through a combination of diet and exercise.
Lose weight gradually: Aim to lose 0.5-1 kg per week for a sustainable weight loss.

Cessation of Smoking and Alcohol intake

Quit smoking: Smoking can exacerbate PCOS symptoms and reduce fertility.
Limit alcohol intake: Excessive alcohol consumption can disrupt hormone balance and worsen PCOS symptoms.

Get enough vitamin D: Maintain adequate vitamin D levels through sun exposure, supplements, or fortified foods.

By incorporating these lifestyle changes, women with PCOS can better manage their symptoms, improve their overall health, and increase their chances of getting pregnant.

Importance of Regular Monitoring with a Gynecologist or Endocrinologist

Regular check-ups with a gynecologist or endocrinologist are crucial for women with Polycystic Ovary Syndrome (PCOS). Here’s why:

Early Detection of Complications: Regular check-ups can help identify potential complications, such as insulin resistance, type 2 diabetes, or cardiovascular disease, early on.
Monitoring Hormone Levels: Regular blood tests can help monitor hormone levels, ensuring that treatment plans are effective and adjusting them as needed.
Tracking Menstrual Cycles: Regular check-ups can help track menstrual cycles, identifying any changes or irregularities that may indicate a need for treatment adjustments.
Fertility Planning: For women with PCOS who want to conceive, regular check-ups can help monitor ovulation, identify potential fertility issues, and develop a personalized fertility plan.
Mental Health Support: Regular check-ups provide an opportunity to discuss mental health concerns, such as anxiety or depression, which are common among women with PCOS.

What to Expect During Regular Check-Ups?

Medical History Update: Share any changes in medical history, including new medications or symptoms.
Physical Exam: A physical exam to monitor weight, blood pressure, and other vital signs.
Blood Tests: Regular blood tests to monitor hormone levels, blood sugar, and lipid profiles.
Pelvic Exam: A pelvic exam to monitor reproductive health and detect any potential issues.
Discussion of Treatment Options: A discussion of treatment options, including medications, lifestyle changes, and alternative therapies.

By prioritizing regular monitoring with a gynecologist or endocrinologist, women with PCOS can receive personalized care, manage symptoms effectively, and reduce the risk of long-term complications.

Managing PCOS with Lifestyle Changes and Emotional Well-being

Polycystic Ovary Syndrome (PCOS) is a complex condition that affects many aspects of life, from physical health to emotional well-being. While medical treatment plays a role, lifestyle changes and emotional support are equally important in managing PCOS effectively.

Diet and Exercise for PCOS Management

One of the biggest challenges with PCOS is weight management, which directly impacts insulin resistance and hormonal balance. A diet rich in whole, unprocessed foods can help stabilize blood sugar levels and support overall health. Reducing processed foods, increasing fiber intake, and including healthy fats can improve symptoms and promote better metabolic function.

Exercise is another powerful tool. Strength training and moderate-intensity aerobic exercise improve insulin sensitivity and support weight management. Finding a form of movement that feels enjoyable whether it’s yoga, dancing, or walking can make consistency easier.

The Emotional Impact of PCOS

PCOS affects more than just the body; it also has a profound emotional impact. Many individuals struggle with body image, stress, and anxiety, particularly due to symptoms like weight gain, acne, or excess hair growth. Fertility concerns can add an additional layer of distress, impacting relationships and self-esteem.

Hormonal fluctuations in PCOS can contribute to mood swings, anxiety, and depression. Irregular menstrual cycles and other symptoms are linked to increased mental health challenges, making emotional support essential. Addressing these concerns through mindfulness, therapy, and connecting with support groups is important.

Coping Strategies for Mental and Emotional Well-being.

Mindfulness and Stress Management: Practices like meditation, deep breathing, and journaling can help manage anxiety.
Therapy and Counseling: Speaking with a mental health professional can provide coping tools tailored to individual experiences.
Building a Support System: Connecting with others who understand the struggles of PCOS whether through online forums, local support groups, or social media can reduce feelings of isolation.
Focusing on Overall Well-being: Shifting the mindset from achieving “perfection” to prioritizing health and self-care can make lifestyle changes more sustainable.

Say No to Stigma: Strategies for Awareness and Education.

PCOS remains widely misunderstood, often dismissed as a mere reproductive issue rather than a condition with significant metabolic and mental health implications. Raising awareness is key to reducing stigma and promoting better support.

Public Awareness Campaigns: Using social media, television, and community events to share accurate information and debunk myths about PCOS.
Healthcare Education: Training healthcare professionals to recognize the psychosocial aspects of PCOS ensures more compassionate and effective care.
Advocacy for Media Representation: Encouraging accurate portrayals of PCOS in the media can help challenge stereotypes and encourage inclusivity.
Empowering Individuals Through Knowledge: Providing accessible, evidence-based information can help individuals advocate for themselves and navigate their health journey with confidence.

Integrating Psychosocial Support into PCOS Care

An approach to PCOS care should combine medical treatment with emotional and psychological support. Key strategies include:

Multidisciplinary Healthcare Teams: Collaboration between gynecologists, endocrinologists, nutritionists, and mental health professionals ensures comprehensive care.
Counseling and Mental Health Services: Regular mental health check-ins can help individuals manage stress, anxiety, and depression.
Patient-Centered Care Models: Prioritizing individualized treatment plans that address both physical and emotional well-being fosters a sense of empowerment.

While progress has been made in understanding PCOS, gaps remain. More research is needed to explore the long-term psychological effects, improve treatment strategies, and tailor interventions to the diverse experiences of those affected.