Do You Have PCOS?
By Kirsten Petersen, DC
Do you have the suspicion that something is wrong with your hormones, but you’re not sure what? While there are many possible culprits, a common one that affects 1 in 10 women of reproductive age in the US is PCOS – Polycystic Ovarian Syndrome.
PCOS is unique in that it is often both underdiagnosed and overdiagnosed. It’s suspected when we see a constellation of reproductive and metabolic symptoms that surprisingly may or may not include ovarian cysts!
I’d like to share with you ten major signs that you might have PCOS. Most are related to the two major players in PCOS: an increase in androgens or insulin resistance.
10 Signs You May Have PCOS
Do you suspect PCOS? How many of these factors do you have?
1. Irregular periods
Most often this will include missed periods or long cycles, but it can show up as any type of irregularity. Women with PCOS have high levels of androgens like testosterone. Too many androgens slow our ovaries down, stalling ovulation. When ovulation is inhibited, the period will also arrive late and in some cases, not at all. Women with PCOS experience these irregularities more when they have gained weight or have been under a lot of stress. They often get put on birth control to regulate their cycle, but it may be worth digging deeper, as hormonal contraceptives come with other risks.
2. Hair issue
People often associate hair loss with thyroid issues, and this can be true, but loss of hair on the head (specifically in the front of the hairline or along the part) can be another unwanted effect of too many androgens. Testosterone is converted into a strong androgen known as DHT (Dihydrotestosterone) within the scalp. DHT is a killer for your hair follicles; it shrinks and damages them, causing hairs to enter the telogen phase where they soon fall out. Oily hair and dandruff can be present as well.
So you’re losing hair where you want it, and you also may be growing it where you don’t want it. Significant growth on the chin, upper lip, stomach or chest can tip you off to a hormonal issue. In fact, 90% of women with hirsutism (the name for this kind of growth) have PCOS! The hair will often be coarse, making removal difficult and frustrating.
3. Acne
Acne can be present in women of all ages, but moderate to severe acne that doesn’t respond to treatments may be a sign of PCOS. Other clues that it is PCOS-related include acne along the jawline and adult onset acne. Androgens cause excess sebum production, clogging the pores and causing bacterial overgrowth.
4. Weight gain, especially around the abdomen
Women with PCOS tend to gain weight easily and losing weight can be exceptionally challenging. This is due to insulin and leptin resistance, two of the central factors involved in PCOS.
The insulin resistance part may cause you to have food cravings, namely for carbohydrates. Insulin is a hormone that allows the glucose in your bloodstream to be taken into the cells and used as fuel. With insulin resistance, the glucose just stays in the bloodstream, and your cells continue to be starving for glucose, giving you the signal to eat more carbs. Then weight is gained around the abdomen. Insulin medications are often prescribed to women with PCOS.
Leptin resistance makes our brains think we are in starvation mode. Our hunger and fullness signals are disrupted and we eat more than we otherwise would.
5. Skin changes
There are two skin changes that sometimes accompany PCOS. One is called acanthosis nigricans, and it’s a darkening of the skin along the creases behind the neck, the armpits or the thighs. It’s caused by insulin resistance, but the good news is it can be reversed once the insulin resistance is addressed.
Skin tags are the other change you may see, and they also come in tandem with insulin resistance.
6. Depression and Anxiety
Women with PCOS experience anxiety and depression at a higher rate than the general population. This can be due to hormone changes directly, from inflammation that is present, or from the emotional turmoil that comes with dealing with the stressful symptoms of PCOS.
Of course, there are many factors at play when it comes to mental health, but if you’re not feeling like yourself and have other signs of PCOS, you may want to explore hormonal causes.
7. Ovarian cysts
While it seems like this should top the list, ovarian cysts are surprisingly not required for diagnosing polycystic ovarian syndrome. The focus on cysts can lead to under-diagnosis. When they are present, they will be seen on ultrasound and often referred to as “multiple small follicles”. It should be stressed that they aren’t typical ovarian cysts, but are partially developed follicles that have stalled in the process of preparing for ovulation.
8. Difficulty conceiving
Women with PCOS may have trouble conceiving for a variety of reasons. They ovulate less, which we covered in the irregular periods section. That means there are fewer chances to get pregnant. It also means that the ovulation kits many people use to track fertility won’t work. So if you are using them and see that they are always positive yet you aren’t getting pregnant, you should be suspicious. Lastly, the inflammation and hormonal shifts that go with PCOS impact fertility and egg quality. The good news is that it does not affect the number of eggs you have, so most people will get pregnant eventually, though it may take longer.
9. Fatty Liver
This is one you want to address early if you see signs of it. Also known as Non-alcoholic Fatty Liver Disease (NAFLD), the insulin resistance of PCOS can cause excess carbohydrates to be deposited as fat within our livers. Fatty liver is typically reversible but can be serious if not treated. It’s important to take steps right away to control insulin resistance if you have fatty liver.
10. Sleep apnea
Maybe you don’t even know you have apnea, but you struggle with insomnia or don’t feel rested, even after a long night’s sleep. You may want to do a sleep study and see if sleep apnea is the cause. Research shows that women with PCOS who are the most insulin resistant are more likely to suffer from obstructive sleep apnea.
Let’s be proactive
It’s been estimated that 50% of women with PCOS do not know that they have it. Since PCOS is a lifelong metabolic condition with links to diabetes and cardiovasular disease, early intervention could protect women’s health for years to come. I work with many women with PCOS in my clinic, and have seen the difference early intervention can make. There are diet and lifestyle modifications that can make a big difference, but women need to be informed and given these options early, before other diseases develop. Let’s help raise awareness of this often overlooked condition.