For something that affects around one in ten UK women and AFAB people, Polycystic Ovary Syndrome (PCOS) often goes undiscussed.
Even if you are someone that considers themselves to be generally healthy, it's important to be in the know about your body. To help shed some light on PCOS, from the symptoms, causes and various ways to manage the effects, we tapped into the expertise of Dr Andrew Thompson to put together a jargon-free guide to understanding PCOS.
What is Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome (also known as Polycystic Ovarian Syndrome) is a hormone condition that affects people with ovaries during their child-bearing years.
With PCOS, small, fluid-filled sacs grow inside the ovaries that are actually follicles. It ultimately affects the reproductive organs that produce estrogen and progesterone — hormones that regulate the menstrual cycle. While people with PCOS can conceive children, they may be at risk of experiencing fertility struggles.
The word ‘polycystic’ refers to having multiple cysts. While people with PCOS can live healthy and regular lives, diagnosis is key for managing risks further down the track.
As Dr Andrew Thompson says, "While common, PCOS largely goes undiagnosed, and while women with PCOS don’t necessarily have a higher mortality rate, they are at an increased risk of developing more serious conditions later in life, such as Type 2 diabetes, cardiovascular disease and endometrial cancer."
What are the symptoms of Polycystic Ovary Syndrome (PCOS)?
Symptoms can vary from person to person, but they are, of course, linked to your hormones.
The most common symptoms can include irregular periods, abnormal weight gain or fluctuation, heavy bleeding, hirsutism (excess hair growth, typically on the face and also on the chest, buttocks and back), or hair loss, pigmentation and headaches.
The issue with these symptoms is that they can so often be mistaken for symptoms with other conditions, or dismissed as nothing or simply a phase, which is why Dr Thompson insists on keeping in tune with any changes. “I urge women experiencing two or more of the common symptoms of PCOS, such as irregular periods, thinning hair or excess hair, weight gain or acne, to seek a test for the condition," he says.
The hormonal imbalance can not only impact fertility but can also lead to metabolic syndrome (causing weight fluctuations), sleep apnea, endometrial cancer, and depression. So it's vital that we stay alert for the symptoms.
What causes Polycystic Ovary Syndrome (PCOS)?
Though there is no universally agreed-upon answer as far as causes go, genes, insulin resistance, and inflammation have all been linked to excess androgen production that triggers PCOS.
As Dr Thompson says, "PCOS can occur when women produce higher levels of male hormones in their ovaries. This can impact their menstrual cycle, fertility, and result in enlarged ovaries and cysts on the ovaries. While most women are diagnosed in their 20s and 30s, or when they find they have issues getting pregnant, PCOS can develop at any age after puberty."
Part of the confusion around PCOS comes from the name. Professor Wiebke Arlt, director of the Institute of Metabolism and Systems Research at the University of Birmingham, explained to Refinery29 in a previous interview that the name "wrongly reflects that it would be a disease of the ovaries and has something to do just with ovaries." It is actually a metabolic disorder. "The ovaries are just reacting to the insulin resistance and to the high androgens in the blood. This is the reason they become irregular."
This can lead to confusion in how PCOS is treated. Dr Arlt adds that "It's also due to the name, the majority of people who look after patients with PCOS are often gynaecologists, and not routinely endocrinologists or metabolic health consultants".
To get a diagnosis, you can always go to your GP, who may refer you to a specialist.
How do you treat Polycystic Ovary Syndrome (PCOS)?
Treatment for PCOS can include birth control as a way to regulate periods but mostly focuses on lifestyle changes to manage symptoms. Dr Thompson urges the importance of keeping frequent appointments with your doctor.
"For those already living with PCOS, it is important to have regular health checks with a doctor. Due to an increased risk of developing serious health conditions, and to manage the condition more effectively, women should seek tests for cholesterol levels and diabetes annually, along with a blood pressure check.”
While they're not exactly a surefire cure, below, Dr Thompson outlines just what changes might help to curb symptoms.
1. Implement a management plan with your doctor
Dr Thompson says an important first step after a PCOS diagnosis is a visit to a doctor to implement a management plan. “This could include medical therapies to manage certain symptoms, such as the contraceptive pill to combat problems with menstruation, acne and excess hair.
PCOS can also take a mental toll as much as a physical one, and sometimes antidepressants, therapies or anti-anxiety medications may also be prescribed.”
And you can always get a second opinion when it comes to managing the various symptoms, encourages Thompson."Seeking additional support from a range of health professionals, who may be better equipped to manage certain symptoms, is also important. This could include a dermatologist to combat acne or excess hair, a fertility specialist or gynaecologist, a psychologist for mental health support, an exercise specialist, or an endocrinologist."
2. Establish a healthy lifestyle
Maintaining a healthy diet is important, particularly because PCOS increases one’s risk of developing Type 2 diabetes and heart disease. Dr Thompson says, "Maintaining a balanced, nutrient-rich diet can help reduce the severity of symptoms. It is important to be particularly mindful of cholesterol levels and reduce processed foods, alcohol intake and avoid smoking, while increasing intake of foods rich in iron and protein." Dr Thompson says a consistent sleep routine is also necessary. Those struggling to maintain a healthy diet or sleep well can seek advice from a sleep specialist or dietitian for additional support.
3. Consider natural therapies
There are a few natural remedies that can be impactful in not only managing symptoms but that can also help to improve general wellbeing. Herbal medicines, teas and supplements can reduce symptoms and address vitamin deficiencies. "Vitamin D, calcium, omega-3 supplements and magnesium can be helpful. Low magnesium levels can be linked to diabetes, along with chromium, a mineral that regulates insulin and blood sugar levels in the body."
However, Dr Thompson warns that natural therapies won’t work for everyone and advises PCOS sufferers to speak to a doctor first. "Just as consultation is important before starting medical therapies, the same can be said for natural therapies. It is important to be aware of possible side effects and ensure natural remedies are used safely to help avoid potentially exacerbating symptoms or compromising one’s health."
4. Maintain a regular exercise routine
According to Dr Thompson, maintaining a consistent exercise routine is important, even for those not experiencing weight gain as a PCOS symptom. "Regular physical activity can vastly improve our physical and mental health. Whether it’s losing weight or maintaining a consistent weight, exercise can help regulate menstrual cycles and even reduce the risk of diabetes and heart disease associated with PCOS," he explains.
5. Aim to keep stress and anxiety at bay
Dr Thompson says it is important for women to combat stress and anxiety to maintain good mental health and warns that, as with many chronic illnesses, stress and anxiety can exacerbate symptoms and make them more difficult to manage.
"While maintaining a healthy diet and exercise routine can improve one’s emotional wellbeing, women can also introduce relaxing activities to their routine, such as mindfulness and meditation. Breathing exercises can also help keep anxiety symptoms at bay, such as panic attacks. Reducing caffeine intake is also important, as it can increase anxiety and interfere with sleep patterns." Dr Thompson advises women to visit their doctor or a psychologist who can start talking therapies and also provide strategies to better cope with stress and anxiety.
For more information on polycystic ovary syndrome, talk to your doctor.