What is PCOS?

What the heck is PCOS?

Polycystic ovary syndrome or PCOS, is the most common endocrine disorder experienced by women, affecting between 4-20% of reproductive age women worldwide. While that is a broad range, it is likely that PCOS affects at least 1 in 10 women.

While often thought of as a reproductive disorder (because it often affects menstrual cycles), PCOS is a complex, lifelong hormonal condition that often has metabolic and psychological presentations.

What causes PCOS? 

The exact etiology, or cause, of PCOS remains unknown. It is likely a combination of genetic and environmental factors. So if one of your family members has PCOS, you might be at higher risk, as PCOS tends to run in families. For example, if your mother or sister has PCOS, you may be more likely to have PCOS. Some research suggests that PCOS could be caused by genetic or chemical changes in the womb. 

I like to think of genetic and environmental causes like a light switch. The genetic predisposition may be there, but there are certain factors (such as environmental factors) that can flip the switch, turning the light switch on and ultimately leading to PCOS. But even with genetic and environmental factors playing a role, remember, this doesn’t mean that PCOS is ever your fault. 

What are the symptoms? 

The common symptoms of PCOS include:

• Menstrual irregularities

• Anovulatory (no ovulation) menstrual cycles 

• Infertility or difficulty conceiving 

• Hirsutism, excessive hair growth in areas males tend to have hair

• Thinning hair

• Weight gain 

• Acne or oily skin

• Hyperandrogenism, or an excess of male hormones, such as testosterone

• Acanthosis nigricans, a thickening of dark patches on the skin 

• Polycystic ovaries

PCOS also has a psychological component that unfortunately, at times, gets overlooked (boo!).

Individuals with PCOS appear to have higher levels of 

• Anxiety

• Depression

• Disordered eating

• Eating disorders

And overall lower quality of life (but it doesn’t have to be that way…more on that below).

A common misconception is that PCOS only affects individuals at higher body weights and sizes. This is simply not the case.

PCOS affects individuals across body sizes. 

Thus, weight should not be the focus of a PCOS diagnosis or its management. 

How is it diagnosed?

The diagnosis of PCOS is usually based on meeting certain criteria. There are three common criteria that are discussed in the literature, the Rotterdam Criteria and the National Institutes of Health (NIH) Criteria, and the Androgen Excess Society Criteria. They are compared below:

Rotterdam Criteria (must have two of the three)

• Oligo- or anovulation*

• Clinical and/or biochemical hyperandrogenism

• Polycystic ovaries on ultrasound

National Institute of Health Criteria (NIH) (must demonstrate both)

• Oligo- or chronic anovulation

• Clinical and/or biochemical signs of hyperandrogenism

• Exclusion of other related disorders 

Androgen Excess Society (must demonstrate both)

• Ovary dysfunction (oligo-anovulation) and/or polycystic ovaries

• Clinical and/or biochemical hyperandrogenism

• Exclusion of related disorders 

*Oligo-ovulation = irregular or infrequent ovulation

*Anovulation = no ovulation 

The Rotterdam Criteria and the NIH criteria are the two most commonly used criteria, but if you notice the presence of polycystic ovaries is only a separate criteria on the Rotterdam criteria. This is because the presence of cysts on the ovaries on its own does not warrant a PCOS diagnosis. In fact, ovarian cysts can be quite normal! Ovarian cysts happen to be very common, occur naturally, and go away on their own without treatment. 

In fact, it is quite possible for someone with PCOS to not have ovarian cysts and someone without PCOS to have ovarian cysts.

PCOS presents a larger hormonal and metabolic condition and the fact that it is called polycystic ovary syndrome is in fact, somewhat of a misnomer. 

So to recap, just because you have ovarian cysts doesn’t mean you have PCOS. The presence of hyperandrogenism, of excess of male hormones, is needed, as PCOS is a hormonal and metabolic condition. 

Who can diagnose PCOS? 

If you suspect you have PCOS, speak to your primary care provider, gynecologist, or endocrinologist about your concerns. It is beneficial to get an appropriate and accurate diagnosis from a healthcare provider rather than diagnosing yourself. Many of these symptoms overlap with other health concerns, which will be ruled out as part of routine PCOS diagnostic workup. 

What should I do if I think I have PCOS?

The first step is getting an accurate diagnosis. Unfortunately, it is well documented that it can take several years to get an accurate PCOS diagnosis. But, if you suspect something is up, having a conversation with your doctor is the best first step. They will conduct lab work, a physical exam, and might require an ultrasound. As part of the work up, they will rule out other conditions that could cause many of the same symptoms as PCOS. But please, do not diagnose yourself!

What should I do if I have been diagnosed? 

If you have been diagnosed with PCOS, it can be both scary and a relief at the same time (especially if you have been trying to get a diagnosis for some time). Take a deep breath and remember you are not alone. About 1 in 10 women have PCOS. Remember that this is not your fault and not something you did to yourself. 

Talk to your provider about your options. They will likely recommend medication, such as hormonal birth control and/or metformin. These are options, but they are not your only options! It is always best to inform yourself of all the options, as well as all of the side effects of these treatments. 

Also, your provider may recommend weight loss, as if this is a magical answer for a complex hormonal condition. As tempted as you may be to trial a new restrictive diet, remember that dieting doesn’t work in the long term. There is so much evidence that demonstrates that long term caloric restriction and dieting is not sustainable, and can have harmful repercussions. Furthermore, folks with PCOS tend to have higher levels of disordered eating and eating disorders, so if you have struggled with your relationship with food in the past, I especially do not recommend dieting. 

Moving beyond the medical treatment options, which often aren’t long term solutions, there are also several natural and holistic ways in which you can manage your PCOS. There are many dietary and lifestyle strategies that can be implemented, as well as thoughtful supplementation, to improve PCOS symptoms and outcomes. 

If you haven’t already, be sure to check out the FREE 5 Non-Diet Steps to Kickstart PCOS Management, as a good starting point. 

At Nourish, we focus on not just the reproductive aspect of PCOS (although it is important!), but also take into consideration the metabolic and psychological presentations of the condition. Nourish approaches PCOS from a holistic standpoint, taking the entire picture into consideration. 

From there we work on healing relationships with food, ditching dieting once and for all, and incorporating gentle nutrition and lifestyle practices to manage PCOS symptoms from their root cause. 

Sign up for our newsletter below and check our our free resources page to support yourself through this journey. 

Here are Nourish, we are committed to helping you heal your relationship with food and thrive with PCOS through holistic and natural ways!

Learn more here and get in touch.

Be sure to check out my other blog post on the 4 types of PCOS, for targeted ways to manage PCOS, depending on your primary type.

Sources:

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