Signs, Symptoms and Health Risks

Signs and Symptoms of PCOS

• Irregular menstrual cycles
• Absent period
• Anovulatory cycles (no egg released)
• Abnormal mid-cycle bleeding
• Excessive or heavy menstrual bleeding
• Alopecia (balding)
• Hirsutism (excessive body hair)
• Acne
• Acanthosis nigricans – a darkening of the skin in the armpits, back of the neck, or groin
• Polycystic ovaries
• History of ovarian cysts
• Mood disorders
• Obesity
• Recurrent Miscarriage

Health and Fertility Risks Associated with PCOS

• Infertility
• Menstrual cycle irregularities
• Possible increased risk for endometrial and breast cancer due to unopposed estrogen
• Cardiovascular disease
• Diabetes
• Gestational diabetes

How PCOS is Diagnosed.

When PCOS was first discovered it was named Polycystic Ovarian Syndrome because of the presence of polycystic ovaries seen by ultrasound. Over time doctors began to realize that PCOS was a complex array of health issues. 

Pituitary and Ovarian Hormone serum levels:

• Luteinizing Hormone (LH)
• Follicle Stimulating Hormone (FSH)
• Estradiol
• Progesterone
• Prolactin

Circulating Androgens:

• Free testosterone
• Free androgen index (FAI): 17-hydroxyprogesterone
• Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
• Dehydroepiandrosterone sulfate (DHEA-S)
• Insulin-like Growth Factor (IGF)-1

Endometrial Biopsy (usually reserved for women 35 and older with menstrual irregularities or complete lack of menses for over 6 months)
Glucose Tolerance Test
Thyroid Panel
Blood Lipid Profile

 Please talk to your doctor in detail about what your test results mean for your fertility. Some doctors may tell you that you have mild PCOS. Women may have some or all of the symptoms of PCOS, and some may have normal menstrual cycles and some may not. Testing is the best way to find out if you have PCOS for sure or not.

How does PCOS Affects the Menstrual Cycle?

What happens in a normal menstrual cycle?

In very simple terms the hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH (luteinizing hormone) and FSH (follicle stimulating hormone). The release of GnRH is pulsatile in women with regular menstrual cycles. The normal pulsatile release of GnRH signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone. This estrogen/progesterone signal is recognized by the pituitary gland. As the follicles begin maturing they release and increase the hormone estrogen over time. The rising estrogen level signals the pituitary gland to curb the release of FSH. This communication allows for ovulation to occur. In women with PCOS the menstrual cycle follows a different pattern of endocrine function and communication.

What the menstrual cycle is typically like in a woman with PCOS…

In women with PCOS the menstrual cycle starts off irregular, with the hypothalamus releasing GnRH in a higher than normal pulsatile frequency. This allows for increased LH and decreased FSH, which in turn leads to excessive production of the androgens androstenedione and testosterone. This causes the follicle to only mature some, but not enough to achieve full maturity in order to be released for ovulation. This also allows for continued increase of estrogen, primarily estrone. During a woman’s reproductive years, estrone levels are relatively low. Typically we associate estrone with menopause, not the fertile years of a woman’s life. The higher levels of androgens and estrogen create a chronic state of low to very low progesterone and anovulatory cycles.

Classic polycystic ovaries are a result of chronic anovulation. Endocrine function is imbalanced from the very beginning of the menstrual cycle causing mild to severe hormonal imbalance, depending on the individual.

Excessive levels of estrogen may also cause uterine hypertrophy, also known as endometrial hyperplasia. Unopposed estrogen may cause excessive cell proliferation of the endometrium. The endometrium is the innermost layer of the uterus that is shed during menstruation. Endometrial hyperplasia may cause heavy menstrual bleeding or prolonged bleeding during menstruation. The uterus may become bulky and larger than normal. Endometrial hyperplasia can lead to uterine cancer.