It’s the most common hormonal disorder, affecting 1 in 10 women. You might well have it yourself - you certainly know someone who does. So why aren’t we talking about it more? Let’s chat about Polycystic Ovary Syndrome. 

Ok, so what is PCOS? 

PCOS is a chronic hormonal disorder that affects between 8-13% of women of reproductive age, that is, from when your period begins until menopause. 

Although it’s possible to have multiple cysts surrounding the follicles of your ovaries, PCOS comes down to a hormone imbalance so it doesn’t just affect the ovaries. When your hormones are unbalanced, sometimes the body just doesn’t ovulate. This is where infertility with PCOS comes into play, and why missing periods can occur. No ovulation? No period. But also... no conception. 

The symptoms of PCOS can vary, but the most common ones include: 

• Abnormal menstruation: irregular periods, not having a period at all, or bleeding heavily during periods. People with PCOS usually have fewer than six to eight periods per year.
• Excess hair growth: due to increases in androgen production, PCOS can cause male-pattern hair growth on the face, stomach, chest, back, upper arm and inner thigh.
• Acne: elevated androgen levels can also increase acne on the face, chest and back.
• Weight gain: PCOS is associated with gradual weight gain, particularly in the abdomen.
• Infertility: due to irregular ovulation, people with PCOS can struggle to get pregnant.
• Sleep apnea: a sleeping condition in which breathing repeatedly stops or starts. It may occur in up to 50 percent of people with PCOS. 

What causes it? 

In a lot of cases, PCOS is something of a cruel generational gift. It could be a combination of genetic and environmental factors, including family history, a higher level of insulin and/or higher levels of “male” androgen hormones. People with PCOS are often insulin resistant, requiring increased levels to maintain normal glucose levels. This results in higher levels of insulin in the blood, which can cause the ovaries to produce more androgens. 

How do I get diagnosed? 

Diagnosis will typically involve a combination of medical history assessment, physical exams, and blood tests to measure hormone levels. Ultrasounds may also be utilised to check the ovaries for cysts. To be diagnosed with PCOS, you must have two out of the three symptoms listed below: 

• Irregular menstrual periods resulting from irregular ovulation or anovulation (when an egg is not released from the ovary during your menstrual cycle). 
• Evidence of elevated androgen levels
• Polycystic ovaries on a pelvic ultrasound.

Treatment 

Unfortunately, in the context of medical conditions, it’s the four words we absolutely hate to read. There is no cure. BUT! There are a number of treatments available to manage the symptoms. Your doctor is the best person to talk to about the specifics of your treatment plan, but often their advice will look something like this: 

• Change your diet and avoid certain ingredients to help to reduce insulin resistance. Diet recommendations may be whole foods (fruits, vegetables, whole grains, and legumes), plant-based protein sources and anti-inflammatory foods (the Mediterranean diet has lots of anti-inflammatory options like olive oil, tomatoes, and fatty fish). 
• Exercise regularly 
• Try hormonal birth control pills. These can help to regulate menstrual cycles, excessive hair growth and acne. Insulin-sensitising medicine, such as metformin, can be used to treat diabetes and help the body process insulin. There are also medications to block androgens, which helps to control acne and hair growth. 
• If you want to become pregnant, there are certain drugs that induce ovulation. You can also try in vitro fertilisation (IVF) and surgeries that remove androgen-producing tissues in the ovaries. 

Just about categorically, PCOS sucks, and comes under the all-too-familiar category of afflictions that only affect ~50% of the population. The good news is that in talking about it more and sharing our experiences, research, development and treatment options are following suit. If you think you may be affected by PCOS, do see your GP. And know that you’re far, far from alone.