Polycystic ovary syndrome (PCOS) is the perfect example of how interconnected reproductive health is to overall health and quality of life.
Sasha Ottey, MHA, MT
Founder and Executive Director, PCOS Challenge: The National Polycystic Ovary Syndrome Association
PCOS used to be considered a condition that affects reproduction in women — which it does — but we now know that it affects much more. PCOS is an endocrine disorder that affects the whole body and person throughout their lifespan.
What is PCOS?
PCOS is one of the most common human disorders. It affects up to 1 in 5 women, girls, and people who menstruate. It is the most common hormone disorder in women and the most common cause of infertility due to absent or irregular ovulation. PCOS can also affect a person’s entire body and life experience outside of reproduction. It can impact metabolic, cardiovascular, and mental health as well as overall quality of life. Despite its prevalence, PCOS has been underrecognized, with 50-70 percent of people with the disorder going undiagnosed.
PCOS is a syndrome, which means it is a constellation of symptoms that may present in various combinations in different people. PCOS is diagnosed after ruling out other disorders with similar symptoms and if the person has two or three of the following:
1. Irregular or absent periods
2. Bloodwork showing high androgens or symptoms of high androgens such as excessive hair growth, severe acne, or hair loss
3. Polycystic ovaries on ultrasound (multiple immature follicles seen in the ovaries).
What are the symptoms?
Some of the earliest signs of PCOS show up right around puberty. Symptoms such as severe acne, irregular periods, and weight gain may overlap with regular signs of puberty; however, growing visible hair in areas such as the chin, upper lip, chest, upper thighs, and buttocks in girls, is a reason to see a doctor.
Even though most people start experiencing PCOS symptoms during puberty, many are not diagnosed until much later — for example, when having trouble conceiving a child or after being diagnosed with prediabetes or diabetes.
PCOS and reproductive health
One of the most commonly known features of PCOS is its connection to infertility. The hormone imbalance in PCOS disrupts the menstrual cycle and causes irregular or absent ovulation. Cycles are considered irregular if they come less than 25 days or greater than 35 days apart. High testosterone and other hormones in PCOS alter reproductive function. Many people with PCOS experience absent or infrequent periods and others experience heavy, painful bleeding for weeks at a time. It is impossible to get pregnant naturally if ovulation does not take place, and having infrequent and irregular ovulation makes it difficult to find the right time to get pregnant. Some women with PCOS go years trying to conceive without success. It is best to see an OB-GYN or a reproductive endocrinologist if you have PCOS and have been trying to conceive for 3-6 months or more without success, especially if over 35 years of age. When it comes to infertility, also remember that the male partner or donor should also be seen by a doctor to rule out male factor infertility.
Ovulation is not the only issue. The complexity of the hormone imbalance and metabolic features of PCOS not only makes it difficult to conceive but also for some people to sustain a healthy pregnancy.
The good news is that there are some women with PCOS who have no trouble conceiving at all, and for those who do, having access to competent healthcare professionals who understand PCOS can help with lifestyle and medical management and protect the health and outcomes for moms and babies.
PCOS and metabolic health
PCOS increases the risk for prediabetes, type 2 diabetes, metabolic syndrome, weight gain, hypertension, insulin resistance, cardiovascular risk factors, gestational diabetes, preeclampsia, liver disease, and more. According to the CDC, 50 percent of PCOS patients will become diabetic or pre-diabetic before age 40.
The underlying elevated testosterone, insulin, and other hormone imbalances play a major role in disrupting metabolic, psychological, and reproductive function. According to the latest PCOS guidelines, insulin resistance affects 75 percent of lean women and 95 percent of women with larger bodies. Having excess weight increases your risk, but lean people with PCOS are also at elevated risk for developing metabolic health issues.
Having PCOS increases the risk at a much younger age, even in adolescence, for developing metabolic and cardiovascular health issues.
PCOS and mental health
Compared to women without PCOS, there are higher rates of anxiety, depression, eating disorders, and body image issues. Most PCOS patients experience issues with psychosocial and psychosexual health which often affect relationship-building, education, and career pursuits, as well as overall quality of life.
Though each person’s experience with PCOS may be slightly different, the glaring fact is that one cannot separate reproductive health from other concurrent physical and mental health issues that compound the lived experiences of people with PCOS. For those with PCOS, it is important to seek out a good healthcare team including physicians, dietitians, therapists, and others. Early detection, intervention, and support will be helpful for improving and maintaining overall health and improving quality of life.