The Signs and Symptoms of PCOS

Acne
Everyone has acne at some point, right? This may be true, but in some cases the acne is more severe or lasts much longer than the teenage years. Acne is not welcome at any age, but can be much more frustrating when you are an adult. Many of us have tried every skin product known to man without success. In case of PCOS, the acne is caused by an excess of androgens and may need a different type of treatment.

Hirsutism
Hirsutism is defined as excessive, dark facial or body hair and can be caused by excessive androgens in your body. For women, this is a very common complaint, just look at commercials and all the products for bleaching or removing unwanted hair. Granted genetics does play a role in how hairy you may be, but sometimes this is may not be the only factor. If you find that suddenly you have more hair to deal with or that you are constantly struggling with unwanted hair, it is time to talk to your provider.

Alopecia
Alopecia, which is male pattern balding, is also a common complaint among women with PCOS. You may notice thinning on the top, front section of your hair as well in the rear. This can progress to a full head of thin hair or bald patches as well as a receding hair line.

Irregular or Absent Periods
Having irregular or absent periods is a telltale sign regarding ovulation and unbalanced hormones. If your level of androgens and insulin are too high, ovulation may not occur as expected. When ovulation does not occur, crucial steps in the rest of the menstrual cycle are disrupted. Normally, release of the egg from the ovary starts the rest of the menstrual cycle in motion, through the action of other hormones. Without this, the period will be delayed or may be skipped all together. In many cases, what appears to be your period can just be overflow shedding of the lining of the uterus. The necessary hormonal signals were never received to actually start the period or the complete shedding of the blood lining the uterus.

Abnormal Vaginal Bleeding
As is the case with irregular or absent periods, a woman may experience abnormal or heavy vaginal bleeding. This again is caused by the unbalanced hormones, leading to irregular shedding of the uterine lining. Bleeding may occur as the levels of unbalanced hormones fluctuate.

Inability to Get Pregnant
Infertility is a major concern in women with PCOS and it is often the first reason women seek care for what may indeed be PCOS. PCOS is now considered one of the foremost reasons for infertility. The cause of infertility in PCOS is anovulation which means lack of ovulation. The elevated levels of insulin and androgen interfere with the release of the eggs from the ovaries.

Polycystic Ovaries
Your provider may tell you that you have polycystic ovaries based upon an ultrasound. Multiple cysts may or may not be present in PCOS, despite the name. However, when multiple cysts are present, the cysts may block new eggs from being released. The multiple cysts are actually old egg follicles that were unable to mature and release the eggs, which usually indicates chronic anovulation. Some women have multiple cysts but do not have elevated androgen levels as seen in PCOS.

Abdominal Obesity
Abdominal obesity or central obesity is quite simply fat in your belly area. Some people tend to gather any extra weight in their stomach while others become bottom heavy with extra weight in their legs, hips and buttocks. This small difference has great influence over your health. Central obesity is associated with elevated insulin levels, abnormal cholesterol results, high blood pressure, diabetes and cardiovascular disease. It can also be a feature of PCOS, although not all women with PCOS are overweight. However, the more extra weight you carry, the worse the symptoms of PCOS tend to be.

Acanthosis Nigricans
Acanthosis Nigricans is a fancy name for thickened, dark skin folds and is usually due to high insulin levels. Skin folds are found any where on your body that skin folds or rubs against itself. The most common areas are under your arms, the groin, under the breasts and the neck area. Many people who have this feel as though these areas are dirty looking, but washing does not affect the appearance. The darker your skin color, the darker the skin folds may appear. People with more fair skin may note a yellowing of the skin. Increased obesity with higher insulin levels will cause the folds to darken even more.

Skin Tags
Skin tags are little pieces of normal colored skin that grow from your normal skin. They usually appear in the skin folds such as the neck and under the arms. Skin tags can be associated with elevated insulin levels and obesity and tend to worsen with increased weight or insulin levels.

Emotional Distress and Premenstrual Symptoms
In PCOS the normal cycles of hormones are interrupted and can cause a woman to feel more emotional with increased mood swings. Normally, premenstrual symptoms occur just before your period due a spike in the levels of estrogen. When the egg gets released from the ovary, your estrogen level falls back to a low level until it is time for you to ovulate again. Depending on the severity of the PCOS, the egg is not always able to release. If the egg does not release, the estrogen level does not fall back to a low level, but instead maintains a fairly moderate to high steady state. In other words, a woman with PCOS can feel premenstrual all the time!

Changes in Your Blood Sugar and Diabetes
If you have insulin resistance and hyperinsulinemia, your body will have difficulty dealing with sugar. In the earlier stages of PCOS, this may present as hypoglycemia, which is low blood sugar. At times, the level of insulin is higher that the amount of sugar in your system. The insulin takes up to much of the available glucose and you experience a low sugar reaction. You may feel light headed, dizzy, shaky, nausea, sweaty and may even pass out. This can happen much more frequently if you eat a lot of simple sugars, as the body gets confused and spits out too much insulin. Hypoglycemia is considered a precursor of diabetes. Because of insulin resistance, at some point the body is not able to generate enough insulin to manage the glucose. The result is extra glucose in your blood, also known as diabetes.

Dyslipidemia
Dyslipidemia is the collective term for abnormal cholesterol levels. It is a very common finding in women with PCOS due to hyperinsulinemia. Usually what happens is a decrease in your good cholesterol, (high density lipoprotein, HDL) along with an increase in your bad cholesterol, (low density lipoprotein, LDL). Most women will still have a normal total cholesterol level, but only because the HDL is lower than it should be. As your HDL level falls, your risk for heart disease increases. Your provider may also explain your cholesterol by using a ratio of your HDL to your LDL. A healthy ratio is 0.3 or above, less than that is associated with an increased risk of cardiovascular disease. Elevated triglycerides are also a common finding with PCOS.

Fatty Liver
A fatty liver (also known as nonalcoholic steatosis hepatitis or NASH) is excessive amounts of fat deposited in the liver. This is believed to be related to hyperinsulinemia and obesity. The diagnosis of fatty liver is usually made with blood work and diagnostic imaging such as an ultrasound.

High blood pressure
High blood pressure is a known consequence of hyperinsulinemia. Not all women with PCOS have high blood pressure, but are much more likely to develop it as their weight increases.

Cardiovascular Disease
Cardiovascular disease encompasses heart disease as well as strokes and other vascular disorders. Women with PCOS have increased risk of developing of cardiovascular disease due to negative health effects of hyperinsulinemia as well as other inflammatory changes. Often times, women present with advanced cardiovascular disease before PCOS has even been considered.

Vignesh, J. and V. Mohan "Polycystic ovary syndrome: A component of metabolic syndrome? Journal of Postgraduate Medicine 53.2 (April - June 2007): NA. 08 Sept 2007

Sharpless, Julie L. http://clinical.diabetesjournals.org/cgi/content/full/21/4/154 "Polycystic ovary syndrome and the metabolic syndrome" Clinical Diabetes Fall 2003 21.4: 154-161. 08 Sept 2007

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