Polycystic ovary syndrome (PCOS) is one of the common hormonal conditions that affects reproductive-aged women globally. The World Health Organization (WHO) reported that it has been among the leading causes of anovulation (the lack of ovulation) and female infertility.
It occurs when a woman’s ovary produces unusually high levels of androgen, a sex hormone that contributes to reproduction and growth in both men and women. These excess hormones then result in a hormonal imbalance.
The Centers for Disease Control and Prevention (CDC) in the United States explained that the condition is often discovered if women have difficulties conceiving a baby. However, it can already develop as early as age 11 or 12, right after their first menstrual period.
Causes of PCOS
Unfortunately, the exact cause of PCOS isn’t yet fully understood and determined by medical professionals until now. However, several studies claim some factors are associated with the said condition, as follows:
- High androgen levels: This prevents ovaries from releasing eggs. As a result, women suffer from irregular menstrual cycles, develop polycystic ovaries, and have acne and excess hair growth.
- High insulin levels: This causes ovaries to make and release more androgens, which, as mentioned, can suppress ovulation. An increase in insulin levels can also lead to insulin resistance, which can lead to diabetes.
- Obesity: One research explains that PCOS is often associated with high glucose intolerance levels due to defects from β-cell function and insulin action. These concerns are substantially worsened by obesity, resulting in very high levels of glucose intolerance in obese reproductive-age women with PCOS.
- Family History: According to the CDC, women who have a family member with PCOS or type 2 diabetes are susceptible to developing PCOS. In the US, for example, around 30% of women diagnosed with PCOS have a mom, sister, or another family relative with PCOS.
- Ethnicity: Research shows that a woman’s race can lead to the development of PCOS. This is mainly due to the prevalence of certain conditions in a race that can lead to PCOS. For example, Black, Hispanic, and Asian women may have an increased risk of insulin resistance, which, as mentioned, has been linked to PCOS.
- Low-grade inflammation: This is a chronic response to foreign bodies, injuries, or diseases that continuously inflame our entire body. It’s diagnosed through blood tests measuring the levels of white blood cells and C-reactive protein (CRP). Research shows an excess of this inflammation can lead to higher androgen levels.
As noticed, most of the aforementioned factors are related to excess androgen production. However, note that high levels of androgen don’t always lead to PCOS. Research shows that this may also lead to Cushing’s disease (a condition where the body produces too much cortisol or stress hormone) and severe insulin resistance syndromes, among others.
Can Stress Cause PCOS?
Many studies claim that stress may cause PCOS. For example, the US National Institute of Health (NIH) stated that menstrual dysfunctions and infertility, two of the most common PCOS symptoms, can be caused by increased psychosocial stress.
Another NIH study reported that stress plays a major role in the pathogenesis (the process when a disorder or disease develops) of several diseases. These include metabolic syndrome (MBS), obesity, insulin resistance, and type 2 diabetes, which are also found in many women with PCOS.
Even worse, NIH added that women with PCOS are typically neurotic. This means having a mental disorder that causes someone to have a tendency toward negative emotions (e.g., anxiety, depression, or self-doubt), emotional instability, and difficulty coping with stress. This doesn’t only increase the risk of developing PCOS but also worsens its symptoms.
PCOS Treatment
Since the exact cause of PCOS remains unclear, there’s also no definitive cure for PCOS yet. On a positive note, several treatments and services are available to help women manage their symptoms.
Lifestyle changes are the typical initial step for PCOS treatment. These may include weight loss, a well-balanced, healthy diet, and regular exercise, which all should vary depending on a woman’s symptoms, pregnancy plans, and other health problems. In this case, professional advice is highly advised.
Research shows that just shedding 5-10% of body weight may already improve several PCOS symptoms. Typically, this weight loss helps regulate women’s menstrual cycle and reduce the risks of diabetes and MBS (e.g., cholesterol and high blood pressure).
For medical treatments, Metformin is often prescribed. While it’s widely used to treat type 2 diabetes, it may also treat PCOS symptoms by regulating insulin levels. This drug can be provided by the government for free through programs like patient assistance programs (PAPs), covered by insurance, or discounted by companies like BuzzRx.
Birth control drugs are also prescribed to treat PCOS. For example, taking a progestin-only pill (POP), also called a “mini-pill,” may help regulate ovulation and hormones, relieve excess hair growth and other symptoms, and protect against endometrial cancer.
Symptoms of PCOS
As mentioned, the most common symptom of PCOS is irregular ovulation (i.e., irregular or no menstrual cycles). It’s often accompanied by increased androgen levels, which can be confirmed through blood tests or monitoring physical symptoms, as follows:
- skin conditions such as oily skin, pimples, and skin tags
- acanthosis nigricans or darkening of the skin in intertriginous or fold areas, such as the neck, axilla or armpits, groin, and under your breasts
- hirsutism or excessive hair on the face or body
- alopecia or hair loss, particularly male-pattern baldness or hair thinning
- weight gain, especially around the belly
- infertility
Follicular cysts are another sign of PCOS. They’re in the ovaries, so they’re only visible through an ultrasound. To be clear, despite being called “cysts,” they aren’t really cysts but rather just follicles that don’t mature.
Specifically, they’re fluid-filled sacs with eggs that haven’t developed properly, mainly due to anovulation. These follicles are called polycystic ovaries, which are neither dangerous nor painful.
Additionally, despite being called “polycystic” or having many cysts, a woman doesn’t need to have follicles on their ovaries to have PCOS. Note that this condition isn’t a disease but rather a syndrome, which means it has a lot of symptoms.
Besides the aforementioned symptoms, women with PCOS are also at risk of developing the following:
- cardiovascular diseases, such as obesity, high cholesterol, high blood pressure, and heart disease
- insulin resistance, which may lead to diabetes
- preeclampsia or high blood pressure during pregnancy
- gestational diabetes or diabetes during pregnancy
- endometrial hyperplasia or increased thickness of the uterine lining
- endometrial or uterine cancer
- miscarriage
PCOS affects not only women’s physical health but also their optimal well-being. It can also lead to a negative body image, anxiety, and depression. These mental disorders, alongside other physical symptoms like unwanted hair growth, obesity, and infertility, can lead to social stigma, which affects their other life areas, including family, relationships, work, and community involvement.
Final Thoughts
A woman may have PCOS if she has irregular ovulation, signs of increased androgen levels, and polycystic ovaries, which are all better confirmed with medical guidance. While stress isn’t a definitive cause of the condition, all of these symptoms may be aggravated by it, so effective stress management is also advised.