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Raise Your Awareness of PCOS

September is PCOS Awareness Month, and today the syndrome is understood to be a complex disorder that is characterized by an elevated level of male hormones (androgens) and anovulation. Not all women who are diagnosed witih PCOS have the polycystic ovaries — ovaries with small, immature egg-containing follicles that are called "cysts."

"In the United States, polycystic ovarian syndrome is one of the most common endocrine disorders of women in the reproductive age group, with a prevalence of 4 to 12 percent," says John Payne, M.D., a fertility doctor with Piedmont Reproductive Endocrinology Group (PREG) in South Carolina. "In various European studies, the prevalence of PCOS was 6.5 to 8 percent."

Criteria for PCOS

At least two out of three criteria are required for PCOS to be diagnosed:

  • Oligo-ovulation (infrequent ovulation) or anovulation (absent ovulation) manifested as oligomenorrhea (infrequent menstrual periods) or amenorrhea (absence of menstrual periods).
  • Hyperandrogenism (clinical evidence of androgen excess) or hyperandrogenemia (biochemical evidence of androgen excess)
  • Polycystic ovaries, as defined with ultrasound

In women with PCOS, the ovaries are not making all of the hormones needed for an egg to fully mature; instead they are making male hormones. The woman's egg follicles may start to grow and build up fluid, but ovulation does not occur, and the hormone progesterone is not made. Without progesterone, a woman's menstrual cycle becomes irregular or stops altogether.

Weight, Insulin Resistance Play a Role in PCOS

When discussing PCOS and weight, it's kind of like the chicken and the egg: Does being overweight cause PCOS or does PCOS cause you to gain weight?

"Between 40 percent and 85 percent of women with PCOS are overweight or obese, and obesity is closely linked to the development of PCOS," Dr. Payne says. "Although it is well established that obesity increases the severity of the clinical features of PCOS, data regarding the prevalence of PCOS in obese women and the change in body weight in women with PCOS over time are scarce."

He cites one study that investigated whether obesity increases the risk of PCOS in the general population. "They demonstrated that the prevalence rate of PCOS in underweight, normal-weight, overweight and obese women were 8.2 percent, 9.8 percent, 9.9 percent, and 9.0 percent, respectively, similar to that observed in the general population," he says "These results suggest that the risk of PCOS is only minimally increased with obesity."

However, a Spanish study had different results. "In a Spanish prevalence study among overweight and obese subjects, they demonstrated a 28.3 percent prevalence of PCOS, which is markedly higher compared with the 5.5% prevalence of PCOS in lean women in Spain."

PCOS also makes it more difficult for the body to use the hormone insulin, a condition called insulin resistance, which can cause insulin and glucose to build up in the bloodstream. These high insulin levels can also increase productive of male hormones, leading to symptoms such as body hair growth (hirsutism), acne and weigh gain. "Approximately 40 percent of patients with PCOS have insulin resistance that is independent of body weight," Dr. Payne says. "These women are at increased risk for type 2 diabetes mellitus and consequent cardiovascular complications compared with healthy women.
The American Association of Clinical Endocrinologists and the American College of Endocrinology recommend screening for diabetes by age 30 years in all patients with PCOS, including obese and nonobese women."

Be Aware pf Symptoms of PCOS

Symptoms of PCOS can show up at an early age, but may be confused with signs of puberty. "The age of onset is most often perimenarchal, before bone age reaches 16 years; however, clinical recognition of the syndrome may be delayed by failure of the patient to become concerned by irregular menses, hirsutism or other symptoms — or by the overlap of PCOS findings with normal physiologic maturation during the two years after menarche," Dr. Payne says.

Often, women are not diagnosed until they start trying to conceive and experience infertility. So be aware of PCOS and get treatment early to get the condition under control. While signs and symptoms of PCOS vary from woman to woman, here are some of the most common :

  • Infertility
  • Infrequent, absent or irregular menstrual periods
  • Hirsutism, which is increased hair growth on the face chest, stomach, back, thumbs or toes
  • Many immature follices/cysts on the ovaries
  • Acne, oily skin and dandruff
  • Weight gain or obesity, usually with extra weight around the waist
  • Thinning hair or male pattern baldness
  • Thick, dark brown or black patches of skin
  • Skin tags
  • Pelvic pain
  • Anxiety or depression
  • Sleep apnea

For more information, visit FertilityAuthority's section on PCOS.