What Actually Causes PCOS—and What to Do About It
Polycystic ovary syndrome is common but mysterious.
Irregular periods can be scary and inconvenient—especially if you're trying to conceive. But a wonky cycle could also signal more serious issues with your health, including a condition called polycystic ovary syndrome or PCOS. About 10% of women will be diagnosed with PCOS between ages 15 and 44.
Symptoms of PCOS range from irregular or infrequent periods to abnormally heavy ones, severe acne, and unwanted hair growth on the face and body (called hirsutism). Weight gain is another symptom of PCOS, however women of all body types are diagnosed.
PCOS can lead to difficulty getting pregnant, as well as insulin resistance, diabetes, and cardiovascular disease, and it also increases your risk of endometrial cancer. This is due to a common condition in women with polycystic ovary syndrome called endometrial hyperplasia, an abnormal thickening of the lining of the uterus.
What causes PCOS?
Most women with PCOS have high levels of androgens (male hormones like testosterone) and high insulin. Unfortunately, researchers have not been able to determine exactly why that happens. It’s thought that both genetic and environmental factors play a role in causing PCOS.
Excess levels of insulin may also fuel androgen production.
How do you get diagnosed with PCOS?
Women are diagnosed with PCOS when they have at least two of these major symptoms of the condition: irregular periods, high androgen levels, and cysts on the ovaries.
To make a PCOS diagnosis, your doctor may do an ultrasound to look at your ovaries for cysts (which can be very small or large enough to warrant surgical removal) and blood work to check hormone levels. They may also do a physical exam to look for symptoms like facial hair or acne.
How is PCOS treated?
For women with PCOS, weight loss and diet changes can be extremely beneficial for treating symptoms. "Weight loss for obese women can help improve hormonal levels and insulin resistance and help regulate cycles," Angela Chaudhari, MD, a gynecologist at Northwestern Medicine in Chicago, tells Health.
Some research suggests a low-sugar, low-dairy diet (or even the keto diet) may help women manage PCOS. Those diets may help “decrease inflammation and insulin resistance, which, in many cases, can be behind abnormal hormone levels seen in polycystic ovary syndrome," says Ula Abed Alwahab, MD, an endocrinologist at the Cleveland Clinic, where doctors use a version of the keto diet to treat people with PCOS. "Patients with PCOS who have issues with fertility may find that the diet helps restore regular periods and might help fertility by making the patient more responsive to fertility treatments," she says.
Birth control pills are another treatment option often prescribed to women with PCOS to help regulate hormones. "The pill may help prevent new cysts from growing and prevent you from ovulating, giving time for your current cyst to resolve and get your cycles back on track," Dr. Chaudhari says.
Other medication options for women with PCOS may include spironolactone, which lowers androgen levels in women and may help with acne or unwanted hair growth, and metformin, which lowers insulin levels and helps prevent diabetes.
A gynecologist or endocrinologist will be able to help you diagnose and treat your PCOS. "Women should see their gynecologists if their period remains irregular over more than two cycles," says Dr. Chaudhari. "Other abnormalities that should be evaluated are: spotting between regular cycles, soaking through a pad or tampon every hour, bleeding for more than 10 days in a row, or having symptoms of anemia during your cycle, such as dizziness or extreme fatigue."
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