Polycystic Ovarian Syndrome (PCOS) can be caused by Insulin Resistance and may take the form of numerous
symptoms, which vary from woman to woman.
The following is a list of the more common symptoms. Some woman may experience two or more of these traits.
Most experts consider that a woman must have evidence of both lack of ovulation (anovulation or oligo-ovulation) manifested by irregular periods AND signs of excess male hormones (hyperandrogenism or hyperandrogenemia) to be diagnosed with PCOS. Some experts also require the presence of polycystic ovaries to diagnose PCOS. If you have some of these symptoms below, please discuss with your doctor the possibility that you might have PCOS.
It is important to rule out other diseases that can cause symptoms similar to PCOS such as Congenital Adrenal Hyperplasia (late onset), Cushing Syndrome, excess prolactin production (hyperprolactinemia), and low thyroid function (hypothyroidism). That's why you and your doctor may elect to do some testing to investigate your symptoms further. You will find a list of possible tests at the bottom of this page.
PCOS Symptoms:
 Weight Gain or Inability to Lose Weight. Many women with PCOS gain weight around their
abdomen, taking on an apple shape rather than a pear shape. Such
weight gain is linked with imbalances of glucose and insulin in
the body.
Other women may not necessarily gain weight but find that, no matter how hard they try, they cannot lose any weight. Not every woman with PCOS will have problems with excess weight. In fact, up to half of women with PCOS are lean. Even lean women with PCOS may struggle with high insulin levels or insulin resistance, however.
Absent or Irregular Periods (Amenorrhea or Oligomenorrhea). Nine or few menstrual cycles per year may be
a sign of PCOS. Bleeding may be heavier than normal. These
conditions are caused because the ovaries are not producing
hormones that keep the menstrual cycle regular. Irregular or absent menses indicate that a woman is probably not ovulating.
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 Infertility. The high levels of excess insulin seen with PCOS
can stimulate the ovaries to produce large amounts of the male
hormone (androgens), which can possibly prevent the ovaries
from releasing an egg each month, thus causing infertility.
Because women with PCOS don't have regular menstrual cycles,
many are unable to become pregnant. With help, however, many
PCOS sufferers conceive.
Excess Hair Growth (Hirsutism). This symptom causes excess hair, which can be
difficult for many women. For most PCOS sufferers, hair in the
mustache and beard areas becomes heavier and darker. Masculine-looking
hair on the arms and leg is also possible, as well as hair on
abdomen, chest or back, together with more growing in the pubic
area. High levels of male hormones cause this
condition.
 Thinning Hair. Just as heavier hair growth is possible, so is
the type of hair thinning that many men experience. This is
caused in women by higher levels of androgens.
Acne. Pimples and oily skin can also bother women with PCOS. The
acne is usually found around the face (especially along the jaw
line), chest and back.
Ovarian Cysts. The elevation in insulin levels contributes to the formation of cysts in the ovaries in part due to the hormonal imbalances and also because the ovaries are highly sensitive to the influence of insulin. These multiple, immature ovarian cysts, after which the condition was named, are associated with irregular menstruation and trouble conceiving.
Polycystic ovaries are defined as 12 or more follicles in at least one ovary as seen by ultrasound. Follicles are small, fluid-filled sacs containing eggs. In PCOS, the follicles bunch together to form cysts. Note that not every woman with PCOS has polycystic ovaries.
Fatigue. We hear from many women with PCOS who are tired all the time! Fatigue is a common symptom that may be related to PCOS in that insulin resistance can be one cause of reduced energy levels. Furthermore, many women with PCOS also have low thyroid function (hypothyroidism), a very common endocrine condition, which itself causes fatigue.
Other Skin Problems. Skin tags - thick lumps of skin sometimes
as large as raisins - can form as a result of PCOS. They are
usually found in the armpits, at the bra line or neck and can
easily be removed by a dermatologist. Darkening and thickening
of the skin can also occur around the neck, groin, underarms or
skin folds. This condition, called Acanthosis Nigricans, is a
sign of Insulin Resistance, the underlying cause of PCOS. Other women with PCOS note an increase in dandruff.
 Mood Swings. Many women with PCOS may find themselves more anxious or depressed by their appearance or their inability to become pregnant. Mood swings can also be caused by hormone problems. Managing your PCOS symptoms may help to relieve depression.
High cholesterol (Hyperlipidemia) and High Blood Pressure (Hypertension). Increased LDL cholesterol, the "bad" cholesterol, is known as a marker for risk of heart attack and stroke. Women with PCOS must pay special attention to their cholesterol levels and also their blood pressure, as both of these markers of heart disease are more prevalent in this community.
Sleep Apnea. Women with PCOS have a high risk for sleep apnea. This may be due to the increased BMI (Body Mass Index) in about half of women with PCOS. Another possible reason for the increased prevalence of sleep apnea in people with PCOS is the effects of testosterone on blood vessels.
 Diagnosing PCOS. To diagnose PCOS, doctors use a combination of clinical symptoms (what you experience as the patient, such as excess hair growth, irregular menses, acne, skin tags, weight gain, infertility, etc.) and lab tests. The blood tests to consider are:
- Free testosterone - elevated in PCOS.
- DHEA -S- elevated in PCOS.
- Sex hormone binding globulin (SHBG) - usually low in PCOS.
- Fasting insulin - elevated in PCOS. Results greater than 9 or 10 can indicate insulin resistance. Insulin resistance is usually the underlying cause of PCOS, as you will read elsewhere on our web site. Some doctors may also order a 2-hour post-prandial insulin test, along with a 2-hour post-prandial glucose test.
- Fasting glucose or 2-hour post-prandial glucose - elevated in PCOS. Using this information in combination with the insulin tests helps to diagnose insulin resistance. Also, women with PCOS have a higher risk of diabetes so it is important to screen for this early and often.
- LH: FSH- Some doctors may also look at the ratio between these two hormones. In PCOS, we would expect LH (Lutenizing Hormone) to be elevated in comparison to FSH (Follicle Stimulating Hormone).
- Ultrasound to check for the presence of ovarian cysts. Even if the ovaries do appear normal, the absence of ovarian cysts does not mean that a woman doesn't have PCOS. Not everyone with PCOS has ovarian cysts, and not everyone with ovarian cysts has PCOS.
- Some doctors will check cholesterol levels and liver function tests, as these can also be abnormal in PCOS (as well as in many other conditions).
Your health care practitioner should perform some or all of these tests to help identify PCOS. It can be helpful to have these baseline levels to compare to over time to assess the effectiveness of different treatments.
 "We believe that to reverse PCOS, a complete, non-pharmaceutical system is needed to address both insulin resistance and the symptoms of PCOS. This approach includes nutraceuticals (vitamins, minerals and herbs formulated to address specific conditions) as well as nutritional guidance, a realistic exercise program, addiction/cravings awareness and a support network that will help you change unhealthy lifestyle choices." |
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DR. SARI COHEN
CONSULTING & ADVISORY TEAM
INSULITE LABORATORIES |
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Click here to read Guidelines for PCOS
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