What are the symptoms of PCOS - how can you obtain a diagnosis?
If you're reading this, it's most likely because you've recently been diagnosed with PCOS or have heard about the condition. Understandably, your mind is probably racing, and you probably have a million and one questions going around in your head.
PCOS : Behind these four letters hides a global physiological dysfunction, known as Polycystic Ovary Syndrome. This condition affects approximately 1 in 7 women, although this number is probably greatly underestimated. It’s also the leading cause of infertility worldwide.
In this article, we’ll provide you with insights into the different causes and consequences of this condition, as well as details of how it can be managed.
PCOS : An overview
PCOS is a relatively common hormonal imbalance that affects women. It’s a condition that encompasses multiple factors: these include a disruption of hormones produced by the ovaries and the pituitary gland*, as well as changes in how the body functions.
This condition was discovered in 1935 by Stein-Leventhal, hence the name "Stein-Leventhal Syndrome", which it is also sometimes referred to as.
*The pituitary gland is a small gland located in the brain. Its main function is to produce hormones.
Symptoms of PCOS
Here are the most common symptoms experienced :
● Irregular menstrual cycles or no periods
● Acne
● Excessive hair growth in unusual places (chin, abdomen, etc.)
● Weight gain or difficulty losing weight
● Insulin resistance (which is also a contributing factor in PCOS)
● Chronic fatigue
● Hair loss
● Ovaries with a multifollicular appearance
● Difficulty conceiving
● Depression, stress, anxiety
● Low sex drive
In terms of the symptoms mentioned by women afflicted with PCOS, this list is by no means exhaustive.
Diagnostic Criteria for PCOS
The diagnosis of PCOS is usually the result of an ultrasound scan of the ovaries (either transvaginally or by an MRI scan) and comprehensive blood testing prescribed by a doctor (a general practitioner, gynaecologist, and sometimes even an endocrinologist).
In France and Europe, health authorities have agreed on a set of criteria to effectively diagnose PCOS. These are known as the Rotterdam criteria, and are detailed below:
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Clinical hyperandrogenism (observable with the naked eye: for example, hirsutism (excessive hair growth), acne, abnormal hair loss) or biological hyperandrogenism (which would show up in the blood tests prescribed to you).
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Irregular ovulation or anovulation (usually irregular menstrual cycles. In some cases, women may not have menstrual cycles at all).
- Increased ovarian volume and/or a "polycystic" appearance on an ultrasound scan (meaning the presence of more than 12 follicles per ovary or an ovarian volume greater than 10ml).
In France, being diagnosed with PCOS means meeting at least 2 of these 3 criteria.
To help you gain a better understanding, here are just a few examples of situations where a diagnosis might be made :
● Marie, 26 years old, suffers from acne (clinical hyperandrogenism) and hasn't had a period for 2 years (anovulation). However, her ovaries have a normal appearance during an ultrasound scan.
● Jade has irregular cycles (irregular ovulation) and on the ultrasound scan there are 20 visible follicles (ovaries with a polycystic appearance). She does not have acne or any other visible signs of hyperandrogenism.
● Zoé has not had an ultrasound scan, but she has 60-day cycles (irregular ovulation) and excessive hair growth (clinical hyperandrogenism).
Please note that these are the diagnostic criteria used in France. Other countries may have different diagnostic criteria. In the United States, for example, hyperandrogenism is a symptom that must be present for a confirmed diagnosis of PCOS.
"Cysts" that are not really cysts
Vocabulary used to describe Polycystic Ovary Syndrome tends to revolve around the idea of "cysts," but we now know this is not the case.
When the condition was first discovered, doctors believed that the small masses visible on ovarian ultrasound scans were cysts. Today, we know they are actually follicles.
Follicles are small pockets where eggs mature. When an egg is ready to be released, the "dominant" follicle (the largest one) ruptures to let it pass: this is what is commonly known as ovulation.
For women afflicted with PCOS, eggs take much longer to mature than normal. This results in an accumulation of follicles in the ovaries. In simple terms: there is no dominant follicle; as a result, eggs remain in their small pockets and are not regularly released.
This creates what can best be described as a "traffic jam" scenario and gives the ovaries a "multifollicular" appearance on ultrasound scans. A more accurate term would be "ovaries with a multifollicular appearance."
*An egg cell is also known as a female gamete, as opposed to a sperm cell, which is the male gamete. If an egg cell is fertilised by a sperm cell, it becomes an "ovum." An egg cell is tiny, yet it is the largest cell in the human body !
The Different Types of PCOS
PCOS is often classified into four major categories. Please bear in mind that you may well fall into multiple categories.
It's not necessarily essential to fit into one of these boxes; the key is to actually identify the source of the imbalance for personalised management.
If you want to discover the four types of PCOS, this article will provide you with all the information you need !
Consequences for Women and Their Health
PCOS is an ailment that can have multiple repercussions on a woman's health. It's important to know that this condition will unfortunately be present throughout your life; to date, there is no cure. However, by no means do we want to scare you; rather we want to make you aware that PCOS is a common ailment that requires comprehensive management.
So please don't worry : certain dietary habits, a healthy lifestyle, as well as targeted supplements can greatly improve the day-to-day lives of women afflicted by PCOS.
Infertility
It is often while trying to get pregnant that women discover they have the syndrome : absent or irregular ovulation significantly reduces their chances of conceiving.
Affected women are also at a higher risk of miscarriage simply because their egg quality is impacted by hormonal dysfunctions.
Insulin resistance
This is a complex phenomenon which will soon be addressed in its own dedicated article. In summary, hyperinsulinism and insulin resistance have numerous negative effects on the body :
● Hypersecretion of androgens
● Weight gain or difficulty losing weight
● Weakening of the immune system
● Digestive disorders
● Predisposition to type II diabetes
● Risk of cardiovascular diseases
Excess weight and Eating Disorders
Although not all women with PCOS are overweight, it remains one of the main risks of this condition. When excess weight is combined with insulin resistance, it becomes challenging to lose those excess kilos.
On the one hand, metabolic dysfunction hinders weight loss, and on the other, affected women often opt for sugar-laden foods.
Unfortunately, these difficulties can lead to many women modifying their eating habits, sometimes to extreme levels. It is not uncommon to see the exclusion of certain food groups, constant and intensive diets, and even anorexia or bulimia.
These behaviours need to be actively monitored as they can endanger a woman's health and plunge her into an anxious or depressive state. If you recognise yourself in any of these symptoms, please don't hesitate to seek the help of a competent healthcare professional whom you can trust.
Other Pathologies
Other pathologies may develop as a result of PCOS, such as hypothyroidism (which can also be a cause of PCOS) or cardiovascular diseases.
A Vague Diagnosis
The Rotterdam criteria are currently the subject of many debates within the scientific community. Some doctors believe that a woman with PCOS should show signs of hyperandrogenism (e.g. clinical hyperandrogenism = visible to the naked eye, such as acne, or biological hyperandrogenism = visible in blood tests). Indeed, some women are diagnosed with PCOS when, in reality, the problem actually lies elsewhere. This can delay the effective management and improvement of their symptoms. Many women with irregular cycles or no periods do indeed have ovaries with a polycystic appearance on ultrasound scans. This phenomenon is logical since, if they do not have periods, ovulation does not take place. This will lead to an accumulation of follicles in the ovaries. However, while the absence of periods and ovulation can often be attributed to PCOS, other health conditions can also be at the root cause. Among them are hypothyroidism, hypothalamic amenorrhea, and even elevated prolactin levels. We urge you not to panic when reading these complex terms ; everything will be explained in our upcoming articles ! That's why, during your journey of discovery, it's essential to surround yourself with competent and attentive healthcare professionals. If you have any doubts about your situation, don't hesitate to discuss it with your gynaecologist or doctor.
