Polycystic Ovary Syndrome (PCOS): Causes, Symptoms, And Treatment

What is PCOS?

PCOS (polycystic ovary syndrome) is an endocrine condition affecting females. Follicles containing the developing eggs are normally found in the ovaries. However, in PCOS, they do not release the eggs and accumulate and overgrow. 

The exact cause is unknown. However, there are complex interactions between all endocrine systems. Insulin resistance leads to increased insulin secretion, which then leads to increased ovarian androgen production. 

Furthermore, increased frequency of GnRH pulses from the hypothalamus leads to increased LH levels, which then cause incomplete follicular development and thus the “polycystic” ovaries.

What is inflammatory PCOS?

Inflammatory PCOS is not a different type of PCOS but merely defines the chronic inflammation seen in the context of PCOS in many women. Patients with this polycystic ovary syndrome may experience excessive weight gain and acne. When a woman has polycystic ovary syndrome, her body may experience chronic low-grade inflammation while producing more androgen hormones and insulin resistance.

Symptoms of PCOS

PCOS symptoms frequently appear around the time of the first menstrual cycle. Symptoms may also appear later, after you’ve had your periods for a while, possibly around the time you’re trying to conceive.

The most common PCOS symptoms are:

• Irregular periods. Because they don't ovulate properly, women with PCOS frequently experience irregular or skipped periods.

• Weight gain. Most people suffering from PCOS have trouble managing their weight, leading to obesity.

• Excess hair growth. The face, back, arms, chest, thumbs, and toes are among the areas that may be affected by excessive hair growth. Hormonal alterations in androgens are the cause of hair growth related to PCOS.

• Hair loss. PCOS may also lead to alopecia, i.e., hair loss in a male pattern.

• PCOS is one of the leading causes of infertility in women and requires fertility treatments for a woman to conceive.

• The skin can become oilier on the face, upper back, and chest, leading to acne breakouts.

• Skin becoming darker (acanthosis nigricans). Black patches of skin develop on the back of the neck or under your arms.

• Polycystic ovaries. Most women develop cysts on their ovaries. Your ovaries may be enlarged and have numerous follicles.

Not all of these signs and symptoms are necessary for PCOS to exist.

What causes inflammation?

Your immune system is activated when the body is exposed to pathogens, such as bacteria, viruses, or toxic substances, or sustains an injury. The immune system sends out inflammatory cells and cytokines as first responders. These cells create an inflammatory reaction to kill pathogens and other harmful substances or to begin healing damaged tissue.

Pain, swelling, redness, and heat result from this process. However, inflammation also affects internal body systems. There are two types of inflammation, acute and chronic.

Acute inflammation

Injuries cause acute inflammation, where the body sends out inflammatory cells to start healing the damage. The process occurs quickly and happens when you fracture a bone, have a cut, or sprain an ankle, and the process is over after healing is complete.

Chronic inflammation

Chronic inflammation is typically low-grade, long-term inflammation secondary to metabolic alterations due to various conditions. As it is a short-term process that has gone long-term, it can cause many issues in various bodily systems in the long run, such as the increased risk of CAD or other metabolic mortality and morbidity.

Does chronic inflammation cause PCOS?

According to several studies, people with PCOS have increased CRP levels, implying that their body is experiencing some inflammation. When suffering from PCOS, the markers for inflammation, such as cytokines, white blood cells, and oxidative stress, are elevated. These elements are present during inflammation and play a role in the immunological response. However, chronic inflammation does not cause PCOS — rather, chronic inflammation may be seen in the context of PCOS.

Complications

Inflammation related to PCOS may lead to some health complications that include:

Heart disease

Over time, oxidative stress, linked to inflammation, can affect your heart. People with PCOS are at higher risk of coronary heart disease. However, this may be independent of markers of inflammation.

Type 2 diabetes

The CDC reports that type 2 diabetes strikes more than half of PCOS-affected women before they are 40. Chronic inflammation, weight gain, and insulin resistance influence type 2 diabetes and also are influenced by it.¹

Reducing inflammation

Chronic inflammation is a significant health issue that nobody would want. Here are some ways to reduce inflammation in your body:

Diet

By taking a vitamin and antioxidant-rich diet, you can reduce inflammation in the body. Try to stay away from dairy products, processed meats, beverages, sugary snacks, and alcohol. Also, avoid refined carbohydrates like pastries, white bread, cakes, and doughnuts.

Exercise

Exercise has the added benefit of lowering inflammation levels and assisting with weight loss. Get at least 150 minutes of moderate-intensity aerobic activity or 75 minutes of strenuous aerobic activity (or a mix of both), spaced out over the week, as recommended by the CDC/AHA.

Include at least twice a week of moderate- to high-intensity muscle-strengthening activities (such as resistance or weight training).

Other ways to possibly reduce inflammation include:

• Have an anti-inflammatory diet.

• Use anti-inflammatory compounds such as herbs and spices.

• Consume probiotic-rich foods like yogurt and sauerkraut to help improve gut microbiome.

• Get adequate sleep.

How is PCOS treated?

PCOS treatment depends on factors like age, symptom severity, and general health. Whether you intend to get pregnant in the future may also affect the type of treatment you receive. For a person planning to become pregnant, the treatment includes the following:

• Change in activity and diet - You can lose weight and lessen your symptoms by eating healthy and engaging in physical activity. These activities may help in ovulation since they decrease blood sugar levels and improve insulin use in your body.

• Ovulation medication - Medication will help the ovaries to produce eggs normally. However, these drugs come with certain risks. They may raise the possibility of multiple births, i.e., twins or more. They can also excessively stimulate the ovaries, causing them to overproduce hormones. It may result in symptoms that include pelvic pain or hot flashes. 

If you are not planning for pregnancy in the future, the treatment may include the following:

• Contraceptive tablets - They help regulate menstrual periods, bring down androgen levels, and clear up acne.

• Metformin - It is used to reduce the insulin resistance resulting from PCOS. Additionally, it might aid in lowering androgen levels, reducing hair growth, and promoting more frequent ovulation.

• Other medication - The treatment includes drugs for symptoms like acne or hair growth.

How do I know if I have PCOS?

When you notice some of the symptoms of PCOS, the first thing to do is visit a doctor. Your doctor will inquire about your medical history, evaluate your current symptoms, and give a physical examination. The doctor also does a pelvic exam to assess the condition of your internal and external reproductive organs. 

Some signs of PCOS are similar to those of other medical conditions. As a result, you might also undergo additional tests like:

• Ultrasound - The test visualizes blood vessels, organs, and tissues using sound waves and a computer. An ultrasound will examine the size of your ovaries, check for cysts, and measure the thickness of the uterine lining.

• Blood test - A blood test will determine the levels of androgens and other body hormones. Additionally, the doctor could check your blood glucose levels, triglyceride, and cholesterol levels.

What happens if PCOS goes untreated?

When PCOS is left untreated, it results in both short and long-term health complications. The side effects can range from minor to severe. Every woman, however, has a unique type of PCOS issue depending on their cardiometabolic implications. Every PCOS symptom has problems that are as diverse as the disorder itself. These include:

Gynecological diseases

Despite its many manifestations, gynecological symptoms are one of the major PCOS symptoms. Many significant gynecological difficulties arise from PCOS. They include irregular periods, oligomenorrhea, anovulation, and endometrial cancer risk.

With PCOS, intrinsic ovarian pathology and luteinizing hormone can cause ovulation failure and infertility. Treating these conditions requires medication and lifestyle changes in diet and weight reduction.

Pregnancy complications and infertility

Due to the reduced anovulation from the disorder, most women with PCOS are infertile or sub-fertile. Women with PCOS can increase their chances of getting pregnant with medication, but they run a higher risk of having difficulties during pregnancy, possibly from chronic inflammation. 

PCOS pregnancy problems consist of:

• Increased hypertension

• Preeclampsia²

• Pregnancy diabetes

• Pregnancy loss

• Premature birth

• Greater chance of miscarriage

Psychological conditions

PCOS has some psychological problems among its physical ones. Symptoms like weight gain and facial hair have a significant psychological impact. They can lead to depression and anxiety — hence women with PCOS may require counseling and management of their psychological issues.

PCOS can cause various issues that may necessitate hospitalization if undertreated or poorly managed. For optimal care, it is crucial to visit gynecologists or endocrinologists for consultation.

The lowdown

Chronic inflammation is typically present in most PCOS patients and can be associated with obesity and type 2 diabetes. The hormonal changes resulting from menopause may cause PCOS to go away. However, this is not always the case. Adjustments in your life that lessen the inflammation in your body are the best way to manage your PCOS symptoms and reduce your risk of complications.