What every woman should know about PCOS

Polycystic ovary syndrome (PCOS) affects around one in ten women in the UK [1]. And women can go years without a diagnosis due to a lack of awareness and knowledge.  

Whether you have been diagnosed with PCOS, or want to find out more, this blog aims to empower you with the information that every woman should know about PCOS, including: 

• What is PCOS?  
• What causes PCOS 
• PCOS and insulin resistance  
• How PCOS is diagnosed 
• Where to get support for PCOS 

What is PCOS?

PCOS is a common, long-term hormonal condition among women of childbearing age that affects how their ovaries work. 

The ovaries are the female reproductive organs that are responsible for: 

• Protecting eggs  
• Releasing eggs into the fallopian tubes for fertilisation 
• Producing oestrogen and progesterone (important for regulating the menstrual cycle) 

There are three main features of PCOS, these are [1]: 

1. Irregular periods – meaning your ovaries don’t regularly release eggs (also known as ovulation). 

2. Excess androgens (male hormones) – high levels of male hormones (such as testosterone) can cause physical symptoms like excess facial or body hair. 

3. Polycystic ovaries – your ovaries become enlarged and contain many fluid-filled sacs (follicles) that surround the eggs. 

If you have at least two of these features, you may be diagnosed with PCOS. If you think you have two or more of the above characteristics, ask your doctor to assess your likelihood of having PCOS. Guidelines recommend using the Rotterdam PCOS Diagnostic Criteria (the above three features). 

Despite the name. the cysts in polycystic ovary syndrome are actually follicles (these are the undeveloped sacs where eggs would usually develop). And in PCOS, these sacs are often unable to release an egg – halting ovulation.  

Due to higher levels of male hormones, and the lack of ovulation, PCOS is a common cause of infertility in women. However, having PCOS does not mean you will not ever be able to conceive – it just may take a little longer.  

What are the symptoms of PCOS?  

It’s hard to say exactly how many women have PCOS, but it is estimated that it affects one in every ten women in the UK. And more than half of them do not have any symptoms.  

Symptoms of PCOS include: 

• Irregular or absent periods 
• Difficulty getting pregnant  
• Weight gain  

You can read more about symptoms of PCOS in our main symptoms of PCOS blog.  

What causes PCOS?

The exact cause of PCOS is unknown, but it is related to abnormal hormone levels.  

Other factors that are thought to play a role in the cause of PCOS include: 

• Genetics - it is also now believed that PCOS may run in families, and there appears to be evidence of a genetic link [2]. 
• Inflammation – women with PCOS often have increased levels of inflammation in their bodies which has been linked to higher levels of androgens [3]. Being overweight can also affect a woman’s inflammation levels.  
• Insulin resistance – it has been shown that 70% of women with PCOS have insulin resistance, meaning their cells can’t use insulin properly [4]. You can read more about insulin resistance below.  

A common myth is that PCOS is caused by contraceptive pills, however, this is false. Some women may be diagnosed with PCOS when they stop taking the contraceptive pill and their periods have stopped. It is not the pill that has caused PCOS, but rather that the hormones in the pill have masked the symptoms and these become obvious once they've stopped taking it. 

PCOS and insulin resistance

What is insulin resistance? 

Insulin resistance is considered a key player in developing PCOS and exacerbating symptoms. It occurs in 30-75% of women who have PCOS and is more prevalent in women who are obese and have PCOS [5]. 

High insulin can impair ovulation and cause the ovaries to make excess testosterone, which leads to insulin resistance being a causing factor of PCOS [6]. 

Insulin resistance leads to elevated glucose levels that can increase your risk of developing gestational diabetes and type 2 diabetes.  Read through our blog on how to reverse pre-diabetes to see how you could improve your HbA1c result.

Testing your risk for diabetes with PCOS 

When diagnosed with PCOS, it is essential to assess your risk factors for diabetes.  

Factors that increase your risk of developing diabetes include: 

• Family history of diabetes 
• Ethnicity  
• Age 
• BMI (Body Mass Index) 

Your doctor may check your diabetes risk with a glucose and/or an HbA1c blood test, depending on your age. You can also do it from the comfort of your own home with our Diabetes (HbA1c) Blood Test. It is recommended that you repeat a blood glucose test every one to three years, depending on the severity of your insulin resistance.  

Treatment of Insulin Resistance 

Insulin resistance can be treated through both lifestyle and medication. If it is decided that the best treatment for you is to take medication, then you will most likely be prescribed metformin.  

What is metformin? Metformin makes the body’s cells more sensitive to insulin and helps to rebalance blood sugars. It can also cause weight loss, which further helps to reduce insulin resistance.   

How is PCOS diagnosed?

Many women express that getting a PCOS diagnosis can be a struggle as there is no single test to show whether you have it. PCOS is a complex condition which varies in presentation and can mimic other medical conditions, making it challenging to diagnose.  

In 2018, the international evidence-based guideline for the assessment and management of PCOS was published. These guidelines endorse the Rotterdam PCOS Diagnostic Criteria, which define the syndrome by the presence of at least two out of the three key features.  

If you have at least two out of the three, your doctor will investigate with further testing - starting with the assessment of your periods. If it is found that you either have an absence of periods or irregular periods (cycles that are shorter than 21 days or longer than 35, or fewer than eight cycles per year), you may then be referred for blood tests and an ultrasound.  

A blood test can check your level of androgens (male hormones) and rule out any other medical conditions that could be either mimicking or associated with PCOS, such as a thyroid disorder. 

Your doctor may perform these blood tests, but you can also check key biomarkers yourself with our simple, at-home Polycystic Ovary Syndrome Blood Test.  

If you are referred for an ultrasound, the sonographer will check your abdomen for cysts on your ovaries. However, if you already have two out of the three features, then an ultrasound scan may not be necessary. It is important to remember that cysts on your ovaries are not necessary for a diagnosis of PCOS. 

Can PCOS be cured? 

It’s not possible to cure PCOS. However, it can be very well controlled through lifestyle changes and medication.  

If you think you may have PCOS, speak about your concerns to your doctor and ask to be assessed for PCOS. 

Where can I get help and support with my PCOS?

In the case of PCOS, knowledge is power. The more knowledge you have about your condition, such as factors that worsen or better your condition, the more you can learn to control your condition. 

Every woman is individual and will, therefore, have different emotional and physical needs. Women will respond differently to their diagnosis. But whatever you feel, it is good to seek out as much knowledge as possible so that you feel that you are in control of your condition, rather than it being in control of you. 

Speaking with your doctor is the best place to start. If you are experiencing physical symptoms or suffering from depression, stress or anxiety, your doctor will be able to refer you for specialist help. 

Some great PCOS charities can help. Verity, a self-help group set up in 1997, aims to improve the lives of women living with PCOS. The charity supports thousands of women both in the UK and internationally. Their website offers awareness and knowledge of PCOS, as well as information on events and local support groups.

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References 

1. nhs.uk. 2022. Polycystic ovary syndrome. [online] Available at: <https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/> [Accessed 24 May 2022]. 
2. Khan, M., Ullah, A. and Basit, S., 2019. &lt;p&gt;Genetic Basis of Polycystic Ovary Syndrome (PCOS): Current Perspectives&lt;/p&gt;. The Application of Clinical Genetics, Volume 12, pp.249-260. 
3. González, F., 2012. Inflammation in Polycystic Ovary Syndrome: Underpinning of insulin resistance and ovarian dysfunction. Steroids, 77(4), pp.300-305. 
4. Traub, M., 2011. Assessing and treating insulin resistance in women with polycystic ovarian syndrome. World Journal of Diabetes, 2(3), p.33. 
5. Stepto, N., Cassar, S., Joham, A., Hutchison, S., Harrison, C., Goldstein, R. and Teede, H., 2013. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Human Reproduction, 28(3), pp.777-784. 
6. Corbould, A., Kim, Y., Youngren, J., Pender, C., Kahn, B., Lee, A. and Dunaif, A., 2005. Insulin resistance in the skeletal muscle of women with PCOS involves intrinsic and acquired defects in insulin signaling. American Journal of Physiology-Endocrinology and Metabolism, 288(5), pp.E1047-E1054.