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Everything You’ve Ever Wanted to Know About Polycystic Ovary Syndrome

The American Society for Clinical Pathology’s Sasha Ottey explains the symptoms, and dangers, of PCOS.


Sasha Ottey, MHA, MT (ASCP)

Executive Director, PCOS Challenge: The National Polycystic Ovary Syndrome Association

What is polycystic ovary syndrome?

It is the most common hormone disorder in women, affecting up to one in five women. That is 20% of people born biologically female. PCOS is a public health issue that is leading to some of the most serious and concerning burdens in healthcare such as infertility, diabetes, cardiovascular disease, nonalcoholic fatty liver disease, and mental health disorders. The latest International guideline on PCOS published in 2018 recommends that PCOS is diagnosed after excluding other disorders that have similar symptoms (such as a tumor or congenital adrenal hyperplasia), and if the person is experiencing two or three of the following:

  1. Irregular ovulation/periods;
  2. Signs of high androgens (male hormones) such as excessive hair growth called hirsutism, severe acne, or hair loss called androgenetic alopecia; and/or
  3. Polycystic ovarian morphology on ultrasound (multiple immature follicles seen in the ovaries).
  4. So, if a woman is having irregular periods or notices hair growing thicker or excessively in places such as the face, chest, abdomen, she should tell her doctor or healthcare provider as these may be signs of PCOS.

What are some symptoms to look out for?

Irregular periods and excessive body and facial hair are two of the most common symptoms that may signal PCOS. Other symptoms include weight gain – sometimes rapidly and unexpectedly, sleep disturbance, cystic acne, carbohydrate cravings, fatigue, and more. Mental health and PCOS are also closely intertwined. There is a high incidence of mental health disorders such as anxiety, depression, and eating disorders in PCOS.

How does this affect women’s ability to get pregnant?

Many women find out they have PCOS when they try to conceive and have trouble getting pregnant. PCOS causes irregular and infrequent ovulation and makes it difficult to find the right time to get pregnant if cycles are irregular. Cycles are considered irregular if they come less than 25 days or greater than 35 days apart. It is not uncommon for periods to skip months or to last for a few weeks when they do arrive. Other reproductive hormones that are needed for conception and a healthy pregnancy are also affected. One example is the hormone progesterone. Progesterone is an important hormone necessary for conceiving, implanting, and sustaining a pregnancy.

If trying to conceive for 3-6 months or more without success, see an OB/Gyn or a Reproductive Endocrinologist to help investigate further and provide you with appropriate medical care.

Are there treatment options?

PCOS is manageable. The first-line treatment for PCOS is to manage it with lifestyle interventions such as nutrition, exercise, and stress management – all of which should be tailored to the individual. There is lacking evidence to point to one type of diet or exercise program for PCOS, but many people find that paying attention to blood glucose management and incorporating muscle-building exercises have been beneficial.

There are currently no FDA-approved drugs for PCOS. However, oral contraceptives are frequently prescribed to address the high androgens and Metformin is frequently prescribed to address the insulin resistance in PCOS. Other PCOS treatments, supplements, and medications target specific symptoms.

Why is it so critical to spread awareness in 2021?

Awareness and advocacy are more important than ever for PCOS. 50-70% PCOS patients are going undiagnosed and legislators are making policy decisions that will directly impact the future of research, access to care, and quality of care. It is critical to have PCOS patients’ perspectives, lived experiences, and priorities included in these decisions. Before the advocacy work of PCOS Challenge, it had been over 80 years without any significant mention of PCOS in legislation. When it comes to health policy issues, it is out of sight, out of mind. We are either at the table or on the menu.

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