Polycystic ovary syndrome (PCOS) is a chronic hormonal condition that usually affects women within their reproductive years. The World Health Organisation (WHO) states that PCOS is one of the leading causes of infertility in females as it affects 8 – 13% of females within their reproductive years.
PCOS is characterised by high levels of androgens and a large number of cysts on one or both of the ovaries, commonly causing infertility, the absence of ovulation, and an irregular menstrual cycle. PCOS is commonly associated with other endocrine disorders such as hirsutism, acne, obesity, and insulin resistance, which can lead to diabetes.
PCOS is also a condition that can present without any symptoms and often goes undiagnosed globally.
Hormones and PCOS
Before looking into PCOS, it is necessary to understand the hormonal implications and how a disturbance in the hormone balance can cause PCOS. Sexual hormones are regulated by an axis. This axis starts in the brain at the hypothalamus, which is the control centre of the axis and is responsible for the secretion of gonadotropin-releasing hormone (GnRH), which stimulates the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinising hormone (LH). These hormones regulate the secretion and levels of the two female sex hormones known as oestrogen and progesterone.
In a normal menstrual cycle, FSH will be secreted during the first 14 days, stimulating the production of oestrogen. Oestrogen has proliferative effects, which will stimulate the growth of follicles in the ovaries while enriching the uterus lining with more blood flow and building up this lining, known as the endometrium. As these follicles mature, they develop an egg inside.
On day 14, when ovulation takes place, LH will be released at a peak, along with FSH reaching a peak, resulting in the follicle breaking open and releasing the egg into the fallopian tube. This is where fertilisation of the egg takes place. The rise in LH secretion stimulates the growth of the corpus luteum within the ovary, which usually secretes progesterone.
This progesterone prepares the lining of the uterus for the implantation of a fertilised egg. When the egg is not fertilised within 24 hours, it will disintegrate. If no implantation takes place, the lining will break down as oestrogen and progesterone levels decrease, resulting in menstruation.
With PCOS, the most remarkable hormonal change that occurs is the high levels of androgens that the ovaries produce. Androgens include progesterone and testosterone. This causes the follicle to grow but never burst open, becoming a sac filled with fluid. As it does not burst open, ovulation does not take place, and thus no fertilisation can occur, causing infertility.
There are also changes in the pituitary secretion, causing decreased levels of FSH and increased levels of LH, suppressing the normal growth of the follicle. It is the high levels of androgens that cause most of the severe side effects of PCOS, including facial hair growth, acne, and obesity.
Contributing Factors To PCOS
There are various elements that can play a role in contributing to the hormone imbalance that can lead to PCOS.
- Environmental Toxins: These toxins can lead to a hormonal imbalance, which changes the ratio of LH to FSH, resulting in lower FSH levels and more LH. This often presents with hirsutism and acne.
- Genetics: In some cases, PCOS can be caused by genetic predispositions leading to hyperandrogenism, or the increased secretion of androgens. This often leads to anovulation and sub-fertility.
- Lifestyle: Certain lifestyle choices, such as a poor diet and lack of exercise, can lead to obesity. This is often related to insulin resistance and diabetes. Insulin resistance causes insulin levels to rise, while the body becomes intolerant to glucose, which can lead to PCOS. This can often lead to other metabolic conditions.
How PCOS Is Diagnosed?
PCOS must be diagnosed by a medical doctor. This is usually done by starting with a range of questions regarding symptoms and signs. Some of these questions may include how long one’s period is, whether it is regular, and if someone experiences acne or facial hair. It is important to go prepared with a list of signs and symptoms experienced, along with any medication you are currently taking, as well as a family history of medical conditions.
A physical examination can then be performed, where the doctor usually looks for signs of excess androgens, such as facial hair and acne. A pelvic exam can be requested, where the doctor looks at the female’s ovaries via a sonographic imaging test, which can detect cysts on the ovaries. Blood samples can also be collected for analysis in a laboratory, where hormonal levels can be tested.
Hormones that can be tested include levels of testosterone (which is usually elevated), oestrogen, LH, as well as insulin. PCOS also has a genetic component and can run in families, so it is recommended that if a mother or sibling has PCOS, you go for a screening test early on to confirm the diagnosis.
Treatment For PCOS
Although PCOS is not curable, it is treatable. The first line of treatment is to make lifestyle changes to reduce the risk of diabetes. Insulin-sensitising medication can be prescribed to reduce insulin levels. Combination hormonal contraception can also be used to regulate the hormones and keep them in balance, while other medications that block the effects of androgens can also be prescribed.
