Polycystic ovary syndrome (PCOS) is the most common hormonal disorder that affects 8-13% of women of reproductive age, making it a leading cause of infertility [1]. This disorder is defined by a series of symptoms and signs and can vary amongst individuals, while the exact cause remains unclear. There has been a rise in incidence of PCOS globally for the past two decades, with the World Health Organization estimating that up to 70% of affected women remain undiagnosed [1].
Although the root cause remains unknown, there is a substantial link to excess amounts of Androgen (a predominately male hormone) seen in 60-80% of women or children with PCOS. Other potential links attributed to PCOS include insulin resistance or elevated insulin levels, which can influence androgen levels, abnormal hormonal responses from the brain to the pituitary gland, excess hormone release from fat tissues, as well as hereditary genetics and ethnic variations.
The constellation of symptoms PCOS can manifest as include:
Irregular or absent menstrual periods
Infertility
Weight gain (particularly around the waist)
Acne
Obesity
Polycystic ovaries on ultra sonographs
Excess hair on face and/or body
Thinning scalp hair
Skin tags
Darkening of skin particulary around the neck, underarms, and groin
Depression and/or anxiety
Poor sleep or insomnia [2,3].
When to see a doctor? If you notice any combination of the forementioned symptoms, it is recommended to consult a primary care physician, so they can confirm if you have PCOS. The management of PCOS often targets symptoms and depending on the severity may need an interdisciplinary team of primary care providers, gynecologists, endocrinologists, dermatologists, and psychologists. A general first line strategy when managing PCOS is lifestyle changes, particularly focusing on exercise therapy and nutritional diets. Additionally oral contraceptives, anti-diabetic drugs, and insulin sensitizer drugs are often utilized to manage symptoms [3,4].
PCOS has ties to a variety of long-term health problems; co-morbidities such as Type 2 Diabetes, metabolic dysfunction associated with steatosis liver disease, cardiovascular disease (CVD), hormone dependent cancers, dementia, and eating disorders. As greater public awareness for PCOS has increased, so have incidence rates. In 2023, an international guideline for PCOS assessment offered the most recent diagnostic criteria for PCOS assessment and management. The 2023 guideline supports a PCOS diagnosis based on the presence of at least two of three indicators: (1) Clinical/biochemical hyperandrogenism, (2) ovulatory disfunction, and (3) polycystic ovaries as assessed by ultrasound or anti-Mullerian hormone blood test [3].
With PCOS, the ovaries develop several small sacs of fluid along the outer edge of the ovary called cysts which contain immature eggs. Due to the excess fluid, the ovarian volume increases to being greater than 10mL, compared to normal physiology, and cause impediments to releasing the egg from the follicle to the fallopian tube. Obesity is also considered to be one of the most important features, with 61-76% prevalence amongst women with PCOS, in increasing morbidities of developing insulin resistance and metabolic syndromes later in life. Unfortunately, women with PCOS also have a higher risk of obesity and increased visceral and subcutaneous body fat, which then increases androgen production, sustaining the metabolic features of PCOS.
The economic burden of PCOS is significant, with the US spending ~$4 billion annually in 2020 for screening and treating its various symptoms and endocrine morbidities. Additional healthcare burdens due to pregnancy related and long-term morbidities increase the overall costs of this under-resourced disease closer to ~$8 billion [5]. The recent rise in incidence rates has stressed the need for more research investments for evidence-based diagnostics and treatment strategies. The prevalence of PCOS has also emphasized the importance of recognizing PCOS as a public health priority and underscores the impact it may have on women’s health globally. Improving awareness and education of PCOS, filling gaps for the public and physicians, is the first step to understand, identify, treat and prevent PCOS.
References:
1. Polycystic ovary syndrome, World Health Organization 28 June 2023, © 2024 WHO. https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome
2. El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly Cystic Ovarian Syndrome: An Updated Overview. Front Physiol. 2016;7:124. Published 2016 Apr 5. doi:10.3389/fphys.2016.00124
3. Endocrine Society."Polycystic Ovary Syndrome | Endocrine Society." Endocrine.org, Endocrine Society, 21 November 2024. https://www.endocrine.org/patient-engagement/endocrine-library/pcos
4. Polycystic ovary syndrome, Mayo Clinic, 08 September 2022 © 1998-2024 Mayo Foundation for Medical Education and Research (MFMER). https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
5. Riestenberg C, Jagasia A, Markovic D, Buyalos RP, Azziz R. Health Care-Related Economic Burden of Polycystic Ovary Syndrome in the United States: Pregnancy-Related and Long-Term Health Consequences. J Clin Endocrinol Metab. 2022;107(2):575-585. doi:10.1210/clinem/dgab613 Assessed and Endorsed by the MedReport Medical Review Board