The ultimate guide to PCOS symptoms and management methods

Polycystic ovary syndrome (PCOS) can affect each patient differently, meaning that the methods and approaches to managing it can differ too. In this article, consultant endocrinologist Dr Shemitha Rafique describes the possible symptoms of PCOS, and what options patients can explore to manage it.

What is PCOS?

PCOS is a gynaecological condition where the ovaries – which are the female gonads and the producers of the sexual reproductive hormones called oestrogen, progesterone, and androgens – begin to overproduce androgens and may underproduce progesterone and oestrogen. This puts the sexual hormones out of balance and disrupts the menstrual cycle, causing small cysts to grow on the ovaries and the fallopian tubes. PCOS is not a condition that can be contracted later in life; rather, patients are born with it but will not have symptoms until puberty or even later in life around the early twenties, when the ovaries start actively maturing eggs and producing hormones.

What are the signs of PCOS?

There are many symptoms associated with PCOS, and not all of them will manifest in every patient – in fact, not even every patient will have symptoms at all. Symptoms, ranging from menstrual, dermatologic, and metabolic, can be triggered or exacerbated by obesity, insulin and thyroid dysfunction, stress, and inflammation.

Menstrual and fertility aspects of PCOS

The growth of cysts can obstruct the release of eggs from the ovaries, thus affecting the menstrual cycle and fertility. Patients with PCOS often have abnormal menstrual cycles, with inconsistency in their flow (oligomenorrhea). Their period can be notably heavy with pain in the pelvic area, or very light, even non-existent (amenorrhea).

The disruption to the normal cycle means that patients with these symptoms are likely to have decreased fertility or be infertile.

Dermatological aspects of PCOS

The excess of androgens (hyperandrogenism) will have an effect on the physical appearance on the patient in several possible ways, such as:

Hair loss or thinning (alopecia) on the scalp
Hair growth (hirsutism) on other areas of the body, such as the jaw, cheeks, chest, and legs
Acne and outbreaks of blemishes that are difficult to manage on the face, chest, and back

Metabolic aspects of PCOS

When reviewing the relationship between the metabolism and PCOS, there are some reoccurring attributes, although it cannot be said definitively if the PCOS causes these metabolic problems, or if these metabolic problems intensify PCOS. These include:

Insulin resistance, where the body is unable to utilise insulin effectively to process sugar (glucose), which is closely linked to the development of type 2 diabetes.
Being overweight, as many patients with PCOS are overweight or have obesity. Is thought that the androgens can cause weight gain.
High cholesterol (atherosclerosis), as cholesterol can build up in the blood without sufficient oestrogen, which is used to regulate cholesterol levels and protect the heart.
High blood pressure (hypertension), which can occur with atherosclerosis as well due to plaque build-up in the blood vessels restricting space for blood to flow through.

Psychological aspects of PCOS

The biological symptoms of PCOS can cause severe distress to patients, as they struggle with pain, abnormal periods, possible infertility, fluctuating weight and unwanted hair loss and growth. Not knowing what and why this is happening to them can compound their stress, leading to depression and anxiety, and patients may face stigma and may retreat from social and public environments due to this.

How is PCOS managed?

Because of this wide variety of possible symptoms, it is important that each patient has an individualised management plan for their PCOS. PCOS is not curable at this point in time, so treatment focuses more on alleviating pain and discomfort and improving the patient’s quality of life. If a patient is prioritising family planning, then there are also ways of improving fertility or exploring alternative options such as surrogacy and adoption. Natural conception is still possible with PCOS, but there is a higher risk of miscarriage, premature birth, or other birthing difficulties.

Approaches to the management of PCOS range from contraception and hormonal medications, lifestyle and diet, to surgery.

Contraceptive and hormonal management

Medications can be prescribed like clomiphene, which helps stimulate egg production and induce ovulation to regularise menstruation, and metformin, which is typically used for diabetes management but can lower insulin levels to also regulate menstruation and manage weight.

Combined contraceptive pill prescriptions can be particularly effective for reducing acne and hair loss due to the supplementation of progesterone and oestrogen, as well as reducing heavy blood flow.

There are further medications and treatments for hair growth and eliminating acne, which will depend on person-to-person based on their hair and skin type – a dermatologist will be able to provide the best advice regarding this.

Lifestyle and diet management

Those who have PCOS can minimise symptoms by making lifestyle and dietary adjustments. Exercise and hobbies have the additional advantage of helping manage any comorbidities in the form of high cholesterol, hypertension, or obesity, and assist with reducing stress while promoting weight loss.

This can be done through increasing weekly aerobic and strengthening activities:

Walking more
Cycling and running
Swimming
Dancing
Pilates
Yoga
Calisthenics

It is recommended to do around three hours of physical activity a week.

It can also be done by drinking more water and improving the diet by eating more:

Fibre
Fruits and vegetables
Nuts and seeds
Oily fish
Lean proteins

And eating less:

Meat, especially fatty cuts and red meat
Sugary foods and drinks
Dairy products like butter, cream, and hard cheese
Foods that are excessively salty
Foods that are deep-fried or processed
Carbohydrates

Surgical management and fertility preservation

Surgery for PCOS is more intent on improving fertility. A surgical procedure called laparoscopic ovarian drilling, which involves a laser or heat source excising sections of the ovarian tissue that is producing the androgens, can stimulate the ovaries to release more eggs and can be beneficial for those trying to conceive, but the results only last up to a year, so it may need to be repeated for multiple pregnancies or attempts at conception.

Another fertility treatment, that isn’t surgical, is in vitro fertilisation, where eggs are extracted straight from the ovaries after a cycle of drugs to forcibly mature them, and then they are fertilised in a laboratory setting. Once an egg has been successfully fertilised and is viable as an embryo, it can be implanted back into the patient’s uterus for the rest of the pregnancy.