PCOS Symptoms: A Comprehensive Guide

Introduction

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder that affects many women worldwide. It can have a significant impact on a woman’s reproductive health and overall well-being. Understanding the signs and symptoms of PCOS is crucial for early detection and timely management.

Signs and Symptoms of PCOS

PCOS manifests in a variety of ways, and its symptoms can differ from one woman to another. Here, we’ll explore the most common signs and symptoms associated with PCOS.

Irregular Menstrual Cycles

An irregular menstrual cycle is defined as a cycle that is shorter than 21 days or longer than 35 days

One of the primary indicators of PCOS is irregular menstrual cycles. Women with PCOS often experience infrequent periods or prolonged gaps between periods.

High levels of androgens (male-type hormones) and insulin can disrupt the monthly cycle of ovulation and periods, leading to irregular or no periods.

Long and irregular menstrual cycles are a hallmark of PCOS and have been associated with higher androgen and lower sex hormone-binding globulin levels (ref)

PCOS: Excessive Hair Growth

Hirsutism is a condition that causes excessive hair growth in women and people assigned female at birth (AFAB) (ref)

In Polycystic ovarian syndrome (PCOS) too many androgens, can lead to hirsutism. (ref)

Women with PCOS may notice hair growth on their face, chest, back, or abdomen, similar to male-pattern hair growth.

The severity of hirsutism can vary, and it is important to see a healthcare provider as soon as you notice unusual hair growth. Your healthcare provider will conduct a physical examination to determine the extent of the uncommon hair growth and note any other physical signs that may accompany the hair growth, such as acne. They may also ask you questions such as:

• How can you tell that I have hirsutism?
• If I don’t have hirsutism, what’s causing my hair growth?
• What medications or treatments do you recommend?
• What’s the cause of my hirsutism? 

Hirsutism may be caused by other conditions besides PCOS, such as Cushing’s syndrome. It is important to determine the underlying cause of hirsutism to determine the appropriate treatment. 

PCOS Acne

As we know that high levels of hormones called androgens is one of the key features of PCOS. This Androgens cause the glands in the skin to produce an excess of an oily substance called sebum, which can lead to the clogged pores and acne formation.

PCOS-related acne tends to flare in areas that are usually considered “hormonally sensitive,” especially the lower third of the face, including the cheeks, jawline, chin, and upper neck.

Weight Fluctuations

Weight gain is a common symptom of PCOS and can be caused by insulin resistance. While some may experience weight gain, others might find it challenging to lose weight due to the condition’s impact on metabolism.

Women with PCOS have higher levels of male hormones and are also less sensitive to insulin or are “insulin-resistant”. Many women with PCOS are overweight or obese, which can increase their risk of diabetes, heart disease, sleep apnea, and uterine cancer.

Insulin resistance makes it more difficult for the body to use insulin, which normally helps convert sugars and starches from foods into energy. As a result, insulin and sugar can build up in the bloodstream, leading to weight gain. Emotional issues like mood swings and depression can also contribute to weight gain in women with PCOS, as they may experience increased food cravings and emotional eating.

PCOS Hair Loss

PCOS is associated with higher than normal levels of testosterone, which can affect hair growth. Apart from excess hair growth, PCOS can also lead to hair thinning or male–pattern baldness in some women. (ref). This condition is known as androgenic alopecia. Here are some key points about hair loss in PCOS:

• Hair loss in PCOS is mostly due to the excess androgenic hormones that people with PCOS often have.
• Androgenic alopecia is a patterned loss of hair that is common in females with PCOS.
• The incidence of androgenic alopecia in PCOS is not clearly defined, but it is reported to have a prevalence of 40-70%.
• Hair loss in PCOS is usually accompanied by other symptoms such as hirsutism (increased hair growth).
• Adequate nutrition is important for healthy hair, and some individuals with PCOS may require dietary adjustments or supplements.

Ovarian Cysts

One of the main features of PCOS is the development of many small cysts on the ovaries. These cysts are fluid-filled sacs that contain immature eggs, called follicles. However, not all women with PCOS have cysts, and not all women with cysts have PCOS. (ref)

Ovarian cysts can also form during ovulation when the ovary releases an egg. Most ovarian cysts are small and harmless, and many women may not even know they have them.

Insulin Resistance

Insulin resistance is commonly associated with PCOS, affecting about 44% to 70% of people with the condition. 

Insulin resistance in PCOS is attributed to an inappropriate reaction to insulin in metabolically active marginal tissues, including adipose tissue and skeletal muscle. 

Obese females with PCOS are more susceptible to insulin resistance, which might lead to abnormal glucose and lipid catabolism. (ref) Women with PCOS are often insulin resistant, meaning their bodies can make insulin but can’t use it effectively, increasing their risk for type 2 diabetes.(ref) Insulin resistance is the most significant pathophysiological trait in people with PCOS

It occurs when the body’s cells become less responsive to insulin, leading to higher blood sugar levels and an increased risk of type 2 diabetes.

Mood Swings and Depression

PCOS can also impact a woman’s mental health. Mood swings, anxiety, and depression are frequently reported symptoms among women with this condition.

Women with PCOS often report signs of mood swings, which can feel like rapidly fluctuating emotions that can manifest as irritability, temper, sadness, and/or anxiety that results from hormonal imbalance.

People who have been diagnosed with PCOS are about three times more likely to be diagnosed with anxiety and depression than people without PCOS. Women with PCOS are also much more likely to report symptoms of anxiety and depression, and those symptoms are more likely to be severe. (ref)

The reasons for the increased risk of depression and anxiety in women with PCOS, as well as for PCOS women to develop psychiatric disorders, are still unclear, but we do know that stress is a contributing factor.

Sleep Disturbances

Some women with PCOS experience sleep disturbances. Here are some key points about sleep disturbances in PCOS:

1. Difficulty falling asleep: Women with PCOS are more likely to experience difficulty getting to sleep. This can manifest as trouble falling asleep or taking a longer time to fall asleep.
2. Excessive daytime tiredness: Women with PCOS may feel excessively tired during the day. This can be due to poor sleep quality or disrupted sleep patterns.
3. Obstructive Sleep Apnea (OSA): PCOS is associated with a higher risk of OSA, a condition where the airway becomes blocked multiple times during sleep. OSA can lead to snoring, pauses in breathing, and fragmented sleep.
4. Insomnia: Insomnia, characterized by difficulty falling asleep or staying asleep, is more common in women with PCOS. Hormonal imbalances, such as cortisol and melatonin, can contribute to sleep disorders like insomnia.
5. Impact on quality of life: Sleep disturbances can have a negative impact on the quality of life in women with PCOS. Poor sleep can affect mood, energy levels, and overall well-being. (ref)

Fertility Challenges

PCOS is one of the leading causes of infertility in women. (ref) Here are some key points about fertility challenges in PCOS:

1. Ovulation problems: Ovulation problems are usually the primary cause of infertility in women with PCOS. Due to hormonal imbalances, ovulation may not occur regularly or at all. This can be due to an increase in testosterone production or the failure of follicles on the ovaries to mature. Without ovulation, the release of eggs necessary for conception does not happen.
2. Irregular or no periods: Women with PCOS often experience irregular or no periods. This irregularity can make it difficult to predict when ovulation will occur, making it challenging to conceive.
3. Anovulation: Anovulation refers to the absence of ovulation. Many women with PCOS do not ovulate regularly or do not ovulate at all. This can significantly impact fertility as the release of a mature egg is necessary for conception.
4. Reduced fertility: Women with PCOS may take longer to conceive compared to women without PCOS. Irregular periods and anovulation contribute to reduced fertility rates in women with PCOS.
5. Other factors: PCOS can also increase the risk of other fertility-related issues, such as endometrial cancer and the presence of fibroids, which can interfere with implantation

Skin Discoloration

Skin discoloration, specifically acanthosis nigricans, can be a symptom of PCOS. Acanthosis nigricans, a skin condition characterized by dark, thickened patches, is another possible sign of PCOS. It commonly appears in body folds, such as the neck, armpits, and groin. (ref)

It is associated with insulin resistance, which is common in women with PCOS. While skin discoloration is not a direct symptom of PCOS, it can develop in women with PCOS who have insulin resistance.

Other skin changes in PCOS may include acne, hirsutism (excessive hair growth), androgenetic alopecia (hair thinning), and stria (stretch marks) .

Headaches

Frequent headaches or migraines may also occur in women with PCOS. (ref)

Here are some key points about headaches in PCOS:

• Surging hormones: The hormonal imbalances that cause PCOS can give you headaches
• Migraine: Insulin resistance is common in women with PCOS and may trigger migraine. In fact, some studies suggest that women with PCOS may be more likely to experience migraines than women without PCOS. (ref)
• Early sign of hormonal disturbance: Headaches in young girls/women may be an early sign of hormonal disturbance, including PCOS

PCOS Pelvic Pain

One of the lesser-known PCOS symptoms is pelvic pain, which can be caused by a variety of factors. However, it is important to note that PCOS itself does not cause pain in the pelvic area. (ref)

If you experience pelvic pain and have some of the symptoms of PCOS, you may have PCO and another condition causing the pain, such as endometriosis or muscle pain. Here are some possible causes of pelvic pain in PCOS:

• Ovarian cysts: Women with PCOS may have cysts on their ovaries, which can cause pelvic pain.
• Menstrual cramps: Some women with PCOS may experience painful periods and sharp pain with menstrual cramps.
• Endometriosis: Endometriosis is commonly found in infertile patients and is evidenced by finding endometrial tissue growing outside the uterus and implanting inside the pelvic area.
• Muscle pain: Muscle pain can also cause pelvic pain, and it is possible to have both muscle pain and PCOS at the same time

High Blood Pressure

PCOS has been linked to an increased risk of hypertension, which can lead to various cardiovascular complications if not managed effectively. (ref)

Here are some of the possible reasons why high blood pressure can be a symptom of PCOS:

• Insulin resistance: Insulin resistance is a common characteristic of PCOS, and it can lead to high blood pressure.
• Obesity: Women with PCOS are more likely to be overweight or obese, which can increase the risk of hypertension.
• Hormonal imbalances: PCOS is a hormonal disorder, and hormonal imbalances can contribute to high blood pressure.
• Inflammation: Inflammation is a common feature of PCOS, and it can also contribute to hypertension.
• Age: The incidence of hypertension increases with age, and women with PCOS are at a higher risk of developing hypertension at a younger age.

Abnormal Cholesterol Levels

Abnormal cholesterol levels are a common symptom of PCOS, and women with PCOS are at an increased risk of developing dyslipidemia, which is when you have unhealthy levels of one or more kinds of lipid – cholesterol and another type of fat called triglycerides – in your blood.

some of the possible reasons of abnormal cholesterol levels are insulin resistance, obesity, hormonal imbalances, inflammation & genetics.

Skin Tags

Skin tags are a common symptom of polycystic ovary syndrome (PCOS)

Skin tags are small, skin-colored tags that can appear on different areas of the body, such as under the arms and around the neck or bra line. They are thick lumps of skin that can grow in these areas. (ref)

Heavy Menstrual Bleeding

Women with PCOS may experience heavy, fast-flowing periods, and sometimes, they come with large blood clots. This is because the ovary is not reliably producing an egg, and the uterus receives very few messages to thicken its lining.

As there is no orderly ovulation, there is no drop in progesterone levels to trigger a period, so bleeding does not occur. Patients with PCOS, therefore, often have absent or sparse periods, but some may experience heavy bleeding. (ref)

Heavy periods or irregular frequent bleeding is more common in patients who are obese with PCOS.

Digestive Issues

PCOS can also contribute to digestive issues, such as bloating, constipation, diarrhea and abdominal pain. (ref)

The gut microbiome is closely linked to PCOS, and an imbalanced gut microbiome can affect hormone regulation and lead to digestive issues. Women with PCOS may also have a different balance of gut bacteria that can reduce the absorption of nutrients and lead to bloating and abdominal discomfort

Imbalanced gut bacteria in PCOS can reduce nutrient absorption and lead to bloating and discomfort.

Mental health issues like depression and anxiety, common in PCOS, can also affect digestion

Darkening of Skin

Hyperpigmentation or darkening of certain areas of the skin, especially on the neck and underarms, can be observed in women with PCOS.

The darkening of the skin in PCOS is often associated with insulin resistance, which is a common feature of the condition. High insulin levels associated with extra weight gain can lead to dark patches of skin. However, hormonal imbalances associated with PCOS can also lead to changes in the skin, including hyperpigmentation. (ref)

Vision Changes

Some women with PCOS may experience vision changes, including blurred vision or difficulty focusing. (ref)

Vision changes in PCOS can occur due to physiological and structural alterations in the eye. Some of the vision changes associated with PCOS include:

1. Dry eye syndrome: PCOS can lead to more severe dry eye symptoms. Dry eye occurs when the eyes do not produce enough tears or the tears evaporate too quickly, leading to discomfort, redness, and blurry vision.
2. Changes in central corneal thickness: PCOS may result in alterations in central corneal thickness. The cornea is the clear front surface of the eye, and changes in its thickness can affect vision.
3. Retinal changes: Studies have evaluated the presence of early retinal changes in women with PCOS. These changes may include alterations in macular thickness and retinal nerve fiber layers. The macula is responsible for central vision, and changes in its thickness can impact visual acuity.
4. Eye conditions: PCOS has been associated with various eye conditions, including glaucoma, retinal vein occlusion, and central serous chorioretinopathy4. These conditions can affect different parts of the eye and may cause vision changes or loss if left untreated

Increased Androgen Levels

Elevated androgen (male hormone) levels are a hallmark of PCOS. Blood tests can confirm these hormonal imbalances & high levels of androgens are detected in 75-90% of PCOS patients with oligomenorrhea. (ref)

Androgens are male hormones that are normally present in both males and females, but in PCOS, there is an excess of these hormones. This hormonal imbalance can disrupt the normal functioning of the ovaries and it is believed to be caused by a combination of genetic & environmental factors.

Elevated levels of adrenal DHEA-S, a precursor to androgens, are seen in 25-35% of women with PCOS. Additionally, free testosterone levels may be elevated in PCOS, and androstenedione levels may also be elevated.

Increased androgen levels in PCOS can lead to various symptoms, including irregular periods, hirsutism (excessive hair growth), acne, and hair loss.

Painful Intercourse

Women with PCOS may experience pain during intercourse or dyspareunia. (ref) This may be due to various reasons like:

• Decreased lubrication: PCOS can cause decreased lubrication, which can lead to painful intercourse. Symptoms of PCOS, such as being overweight, having acne, or facial hair, can contribute to decreased lubrication.
• Pelvic floor tension: PCOS can cause tension in the pelvic floor muscles, which can lead to pain during intercourse. Physical therapy can help manage pelvic floor tension and improve sexual function.
• Hormonal imbalances: Hormonal imbalances associated with PCOS can lead to changes in the vaginal tissues, which can cause pain during intercourse. Elevated androgen levels in PCOS can also lead to vaginal dryness and irritation.

Excessive Sweating

Excessive sweating or hyperhidrosis is a common symptom of polycystic ovary syndrome (PCOS). (ref)

Women with PCOS may sweat excessively and unpredictably, even when they are not particularly hot or involved in heavy physical activity. The most commonly affected areas are the palms, soles, and armpits.

PCOS can cause excessive sweating due to an overactive sympathetic nervous system, which regulates the body’s temperature and sweating response.

Thyroid Dysfunction

Thyroid disorders are more prevalent among women with PCOS, leading to additional symptoms and complications. (ref)

Women with PCOS may have a higher prevalence of subclinical hypothyroidism (SCH) and thyroid autoimmunity compared to women without PCOS. A study analyzed 600 women with PCOS and 200 healthy control women and found that high thyroid-stimulating hormone (TSH) levels were associated with hyperandrogenism in euthyroid women with PCOS. (ref)

PCOS has also been associated with autoimmune thyroid disease (AITD). (ref)

Research has found that women with PCOS have more hypoechogenic thyroids when compared to those without PCOS. Hypoechogenicity refers to the appearance of the thyroid gland on ultrasound, and it can be a sign of thyroid dysfunction. (ref)

Women with PCOS may also experience other symptoms related to thyroid dysfunction, such as weight gain, hair loss or thinning, and difficulty becoming pregnant.

It’s important to note that not all women with PCOS will experience thyroid dysfunction, and the severity of symptoms can vary among individuals. 

Mood Disorders

In recent years, the complex relationship between PCOS and psychosocial issues has come to the forefront, with a prominent link found between specific features of PCOS and mental well-being.

Women with PCOS may be at a higher risk of mood disorders such as anxiety and depression.

Studies have reported that psychiatric illnesses such as anxiety and depression in women with PCOS often go undetected, and experiencing these comorbidities can create a negative impact on their quality of life. 

Women with PCOS may also experience depressive features, poor body image issues, and negative self-esteem, which are associated comorbid conditions that make PCOS much more than just a physical disorder.

Studies have shown that women with PCOS are at an increased risk of diagnosis of depression, anxiety, bipolar disorder, and obsessive-compulsive disorder. (ref) 

Women with PCOS have higher depression scores and a higher risk of depression independent of body mass index (BMI). (ref)

The hormonal fluctuations that women with PCOS experience are also likely to bring about mood swings or emotional instability, which could be one of the symptoms of depression as well. 

FAQs (Frequently Asked Questions)

1. Q: Can PCOS be cured?
   A: PCOS is a chronic condition that can be managed effectively with lifestyle changes, medications, and hormonal therapies, but it doesn’t have a cure.
2. Q: How is PCOS diagnosed?
   A: PCOS is diagnosed through a combination of medical history, physical exams, blood tests, and imaging studies like ultrasound.
3. Q: Does PCOS only affect the reproductive system?
   A: No, PCOS can have broader impacts on a woman’s overall health, including metabolic and mental health issues.
4. Q: Can women with PCOS get pregnant?
   A: While PCOS can cause fertility challenges, many women with PCOS can still conceive with the help of medical interventions and fertility treatments.
5. Q: What are the best lifestyle changes for managing PCOS?
   A: Lifestyle changes such as adopting a balanced diet, regular exercise, stress management, and adequate sleep can significantly improve PCOS symptoms.
6. Q: Are all women with PCOS overweight?
   A: No, not all women with PCOS are overweight; the condition can affect women of all body types.

Conclusion

Understanding the signs and symptoms of PCOS is crucial for early detection and effective management of this condition. If you suspect you have PCOS or are experiencing any of the symptoms mentioned in this comprehensive guide, it’s essential to consult a healthcare professional for proper evaluation and personalized treatment. Remember, PCOS can be managed, and with the right approach, you can lead a fulfilling and healthy life.