Polycystic ovary syndrome (PCOS) is a complex endocrine disorder that primarily affects women of reproductive age. This condition has far-reaching consequences, including infertility, insulin resistance, obesity, and various cardiovascular issues, among other health challenges. In fact, PCOS is a polygenic, multifactorial, systemic, and inflammatory disorder, marked by a dysregulated steroid state and exhibiting autoimmune characteristics (Patel, 2018).
Statistics reveal the significance of PCOS in women’s health. According to the Office on Women’s Health (OASH), approximately 1 in 10 women of childbearing age grapple with PCOS. The 2012 NIH workshop report estimates that around 5 million reproductive-aged females in the United States alone are affected by this condition (Rasquin Leon et al., 2022). Interestingly, PCOS prevalence appears consistent across different countries, including the United States, the United Kingdom, Spain, Greece, Australia, Asia, and Mexico (Wolf et al., 2018). However, research suggests that Hispanic women may experience a more severe PCOS phenotype characterized by heightened hyperandrogenism and dysmetabolism (Engmann et al., 2017).
PCOS not only disrupts hormonal balance and metabolic functions but also poses significant challenges to fertility. Hormonal imbalances lead to the formation of immature follicles around the ovaries and increase the risk of miscarriage, gestational diabetes, and preeclampsia (Basile, 2020). Many women discover they have PCOS only when they encounter difficulties conceiving, although the condition can develop at any point after puberty.
Pathogenesis of PCOS
While the exact path to PCOS remains elusive, it is evident that this condition is multifaceted, stemming from complex interactions between genetics and various environmental risk factors (Mohammad & Seghinsara, 2017). PCOS presents with a wide array of symptoms, including hormonal imbalances, reproductive dysfunction, and metabolic disturbances (Engmann et al., 2017).
The diagram below provides a summary of the genes implicated in PCOS, highlighting the intricate genetic factors at play. It’s worth noting that while no single genetic marker can diagnose or prevent PCOS, a family history of the condition does increase a woman’s risk significantly, with an estimated 20–40% of first-degree female relatives of PCOS-afflicted women developing the condition themselves (Osibogun et al., 2019).
However, genetics alone do not exclusively dictate the onset or progression of PCOS. The condition’s genesis is believed to start in utero, involving Central Nervous System programming and genetic/epigenetic factors. It continues into adulthood, influenced by factors such as diet, lifestyle, and environmental exposures, as depicted in the following image.
Although the precise cause of PCOS remains elusive, elevated levels of androgens and insulin are key contributing factors. Androgens, typically associated with male traits, can hinder ovulation when present in excess. Furthermore, excess insulin can sensitize the ovaries to luteinizing hormone (LH), disrupting ovulation. Insulin resistance is also linked to dyslipidemia, hypertension, glucose intolerance, diabetes, and metabolic syndrome, increasing the risk of cardiovascular disease (Osibogun et al., 2019). These complications can have implications during pregnancy as well.
Typical Symptoms of PCOS Include
- Irregular menstrual cycle. This can manifest in fewer periods in a year, more frequent periods, or the complete loss of a period all together.
Hirsutism. This is when a woman will have too much hair on their face, chin, or parts of the body where men usually have hair. “Hirsutism affects up to 70% of women with PCOS” (Plowden & Pal, n.d.).
Acne on the face, chest, and upper back
Thinning hair. This can also include hair loss on the scalp; male-pattern baldness. This is due to excess androgen levels.
Weight gain or difficulty losing weight. Obesity is associated with PCOS.
Darkening of skin. This is especially evident along neck creases, in the groin, and underneath breasts.
Small excess flaps of skin in the armpits or neck area (skin tags).
Darkening of the skin and skin tags are also signs of insulin resistance which is associated with PCOS.
Other Health Problems Linked to PCOS Include
- Diabetes
- High Blood Pressure
- Unhealthy Cholesterol Levels
- Sleep Apnea
- Depression and Anxiety
- Endometrial Cancer
(Plowden & Pal, n.d.)
You Do Not Have to Navigate PCOS Alone
PCOS is a complex condition that profoundly impacts women’s health and fertility. While genetics play a role, an integrative approach that considers environmental factors, lifestyle, and personalized care is essential for managing and addressing this challenging condition. If you suspect you might have a hormonal imbalance, please know that you are not alone. There are knowledgeable professionals who can provide you with effective guidance to overcome these challenges and achieve your reproductive goals.
In my practice, I run the DUTCH Hormone test to get a clear picture of hormones levels including estrogen, progesterone, testosterone, cortisol, melatonin, DHEA, and more.
To find out more, go to our services page. Or book a discovery call, by clicking the link below!
References
Engmann, L., Jin, S., Sun, F., Legro, R. S., Polotsky, A. J., Hansen, K. R., Coutifaris, C., Diamond, M. P., Eisenberg, E., Zhang, H., & Santoro, N. (2017). Racial and Ethnic Differences in the Polycystic Ovary Syndrome (PCOS) Metabolic Phenotype. American Journal of Obstetrics and Gynecology, 216(5), 493.e1-493.e13. https://doi.org/10.1016/j.ajog.2017.01.003
Mohammad, M. B., & Seghinsara, A. M. (2017). Polycystic Ovary Syndrome (PCOS), Diagnostic Criteria, and AMH. Asian Pacific Journal of Cancer Prevention : APJCP, 18(1), 17–21. https://doi.org/10.22034/APJCP.2017.18.1.17
Osibogun, O., Ogunmoroti, O., & Michos, E. D. (2019). Polycystic ovary syndrome and cardiometabolic risk: Opportunities for cardiovascular disease prevention. Trends in Cardiovascular Medicine. https://doi.org/10.1016/j.tcm.2019.08.010
Patel, S. (2018). Polycystic ovary syndrome (PCOS), an inflammatory, systemic, lifestyle endocrinopathy. The Journal of Steroid Biochemistry and Molecular Biology, 182, 27–36. https://doi.org/10.1016/j.jsbmb.2018.04.008
Plowden, T. C., & Pal, L. (n.d.). Polycystic Ovary Syndrome (PCOS). 2.
Rasquin Leon, L. I., Anastasopoulou, C., & Mayrin, J. V. (2022). Polycystic Ovarian Disease. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK459251/
