Irregular Periods and PCOS: Symptoms, Causes and Diagnosis

Elsa, in her mid-20s, began noticing troubling changes in her body. She started struggling with irregular periods, severe acne, sudden weight gain and an increase in facial hair. Despite healthy diet habits and regular exercise routines, the troubling changes continued. After consulting with a specialist, she found out that she was diagnosed with Polycystic Ovary Syndrome (PCOS). 

Like Elsa, millions of women around the globe have PCOS, in which they face troubling changes in their bodies and challenges in their lives.  PCOS is a common but misunderstood hormonal disorder.  

In this blog, we will look into what PCOS is, its symptoms, diagnostic criteria, causes, management options, impact on fertility, and associated health risks. 

What is Polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a problem with hormones that happens during the reproductive years. In PCOS, there is a hormonal imbalance that occurs when the ovaries (the organ that produces and releases eggs) create extra hormones. The ovaries produce unusually high levels of hormones called androgens. This causes the reproductive hormones to become imbalanced. As a result, PCOS leads to irregular menstrual cycles, missed periods and unpredictable ovulation.  

PCOS is one of the most common causes of infertility in women and people assigned female at birth (AFAB). It can also increase the risk of other health conditions. PCOS is a condition characterised by hormonal imbalances and metabolism problems, which can affect a woman’s overall health and appearance. 

According to WHO, polycystic ovary syndrome affects an estimated 8–13% of reproductive-aged women. 

Women with PCOS may experience a variety of symptoms, including:

Irregular periods: Abnormal menstruation involves missing periods or not having a period at all. One might also have heavy bleeding during periods. 

Acne: PCOS can cause acne on your back, chest and face. This acne may continue past your teenage years and may be difficult to treat. 

Abnormal hair growth: You may grow excess facial hair or experience heavy hair growth on your arms, chest and abdomen (hirsutism). This affects up to 70% of people with PCOS. 

Darkening of the skin: You may get dark skin patches, especially in the folds of your neck, armpits, groin (between the legs) and under your breasts. This is known as acanthosis nigricans. 

Skin tags: Skin tags are little flaps of extra skin and are often found in the armpits or on the neck. 

Thinning hair: People with PCOS might lose patches of hair on their head or might even start to bald. 

Obesity: People with PCOS might have obesity and have trouble maintaining a weight that’s healthy for them. 

Infertility: PCOS is the most common cause of infertility in people AFAB. Not ovulating regularly or frequently can result in not being able to conceive. 

How is it diagnosed?

The healthcare provider will: 

• Talk about the symptoms and medical history. 

• Will ask about the biological family’s medical history. 

• Take weight and blood pressure. 

• Perform a physical exam, looking specifically for excess facial hair, hair loss, acne, discoloured skin and skin tags. 

• Perform a pelvic exam to look for other causes of abnormal bleeding and order blood tests to check hormone land glucose levels. 

• Perform a pelvic ultrasound to look at ovaries, check the thickness of the uterine lining and look for other causes of abnormal bleeding.

The Rotterdam Criteria: Diagnosing PCOS:

To diagnose PCOS, healthcare professionals often use the Rotterdam criteria. According to these criteria, a diagnosis is made if a woman has at least two of the following three main symptoms: 

Irregular or absent ovulation: Indicated by irregular menstrual cycles or anovulation (lack of ovulation). 

Hyperandrogenism: Clinically or biochemically elevated levels of androgens, leading to symptoms like hirsutism, acne, or alopecia. 

Polycystic ovaries: Detected by ultrasound, showing 12 or more follicles in each ovary measuring 2–9 mm in diameter and increased ovarian volume (>10 ml). 

What is the main cause of PCOS?

The exact cause of PCOS is still unknown. But there’s evidence that genetics play a huge role. Several other factors, most importantly obesity, also play a role in causing PCOS: 

• Higher levels of male hormones called androgens: High androgen levels prevent your ovaries from releasing eggs, which causes irregular menstrual cycles. This causes acne and excess hair growth.
• Insulin resistance: An increase in insulin levels causes the ovaries to make and release male hormones (androgens). Increased male hormones suppress ovulation and can also contribute to other symptoms of PCOS. 
• Low-grade inflammation: People with PCOS likely have chronic low-grade inflammation. Healthcare professionals can perform blood tests that measure levels of C-reactive protein (CRP) and white blood cells, which can indicate the level of inflammation in the body.

How Can PCOS Be Treated?

• Lifestyle changes: Healthy eating habits and diets, regular physical activities and exercise, along with maintaining a healthy weight, can help manage symptoms and improve insulin sensitivity.
• Medication: Medications, as prescribed by the healthcare professional, can address irregular periods, manage acne, and regulate blood sugar levels depending on individual needs.
• Fertility treatments: For women struggling with infertility, there are various treatments that the healthcare professional might advise.

PCOS and Fertility: How a Healthcare Professional Can Help

PCOS is one of the most common causes of infertility in women. The hormonal imbalances and irregular ovulation associated with PCOS make it difficult to conceive. Yet, many women with PCOS can become pregnant with the help of healthcare professionals.  

Treatments such as ovulation induction medications, lifestyle modifications, and, in some cases, ART i.e. assisted reproductive technology used to treat infertility, can significantly improve the chances of pregnancy. Working closely with a fertility specialist can help tailor the most appropriate treatment plan. 

PCOS Might Put You At Risk For Other Health Conditions.

Women with PCOS are at an increased risk for several other health conditions, including: 

Type 2 diabetes: Due to insulin resistance. 

Heart disease: Elevated insulin levels can contribute to cardiovascular risk factors. 

Sleep apnea: Obesity, common in women with PCOS, increases the risk of sleep apnea. 

Endometrial cancer: Prolonged absence of menstruation increases the risk of endometrial cancer. 

Depression and anxiety: Hormonal imbalances and the symptoms of PCOS can contribute to mental health issues. 

Don’t hesitate to seek help 

Understanding PCOS is very important for managing and reducing its associated risks. If you suspect you might have PCOS, consult a healthcare professional, as it’s essential to get an accurate diagnosis and effective management. This will significantly improve the quality of life and help manage potential long-term health risks.  

By adopting healthy lifestyle habits and utilising medical treatments, women with PCOS can lead healthy, happy, fulfilling lives and improve their chances of conception. 

Disclaimer: Please note that the information is strictly for informative purposes. It is not intended to be used in lieu of professional medical advice, inclusive of diagnosis or treatment. It is strongly advised that you seek a doctor’s medical advice on any treatment or medical condition that you learn about.