PCOS 101
I have suffered from PCOS since I was thirteen. Right after I got my first period and understood that blood and pain will be a monthly ritual, I did not get another one for 10 months. I was elated but my mother was not. Over the next decade or so, I got 15–20 normal cycles, with the help of birth control pills. Apparently, there was no “cure” but symptoms could be managed. At 25, I started to develop hirsutism — thick hair in unwanted places like the face.
I was depressed. When I realized that this was also connected to my PCOS, it was a wake-up call. I started to read more and realized that I may not be able to conceive and might also end up with diabetes at some point. I started to ready up and realized I was not alone — 1 in 12 women in the US have it and as many as 6–12% in the reproductive age have it but many go undiagnosed. I have started to try out things to manage my condition and am happy to report that some of them are working. This blog series is an attempt to help others do the same. But, first, let’s talk about the basics…
- What does PCOS mean?
Polycystic Ovarian Syndrome
(Also called PCOD — Polycystic Ovarian Disease )
It is a disorder where hormones are out of balance and the body’s signaling mechanism is not working normally, resulting in most notably, irregular periods, and infertility. - What are the clinically qualifying symptoms of PCOS?
2 out of these 3 symptoms are required to qualify for PCOS
- Cysts in the ovaries — simply put, they’re follicles that have accumulated over many cycles. In a healthy female, eggs are released from the follicle and the follicle dies and vanishes.
- Hormonal imbalance — high testosterone (male hormone)
- Irregular periods
3. What are the other symptoms?
- Male pattern baldness (patches of hair loss in the smack middle of your head)
- Hirsutism — hair in unwanted places like the face, chest, tummy, toes
- Mood swings and depression
- Oily skin and acne
4. So, what if I have PCOS… how does it really impact me?
- Infertility — irregular periods or lack of “ovulation” eventually makes getting pregnant challenging
- Risk of Type 2 diabetes (initial sign — insulin resistance)
- Ovarian cancer
5. What causes PCOS?
- Good question — no one knows for sure but it does run in the genes and can be exacerbated by our environment and diet.
Now, that we have answered some basics, let’s dive deeper into the inner working of our beautiful bodies. The female reproductive system is indeed a wonder machine and I hope you appreciate the intricacies of it as you read more.
What does a normal menstrual cycle look like?
The menstrual cycle involves the maturation and release of eggs from the ovaries into the uterus, prompted by signals from hormones ( estrogen, progesterone, LH — Luteinizing hormone and FSH — Follicle Stimulating hormone). LH is associated with estrogen and FSH is associated with progesterone. The right balance of hormones enables a timely orchestration of a predictable cycle.
- Follicular phase — This phase coincides with the menstrual phase. As the uterine lining is shedding, the hypothalamus signals the pituitary gland to release FSH. FSH makes the ovaries release 5- 20 follicles — filled sacs containing the immature egg. While all the eggs are maturing, they are at different stages, and eventually, only one egg matures (sometimes two or more may too!). FSH is higher than LH during this time. But as the egg is maturing, estrogen gets released and signals the uterine lining to thicken. Finally, estrogen spikes and causes the PG to release LH.
- Ovulation phase — The increase in LH causes the fertilized egg to be released and travels down the fallopian tube to the uterus. The fertilized egg can live up to 24 hours which is your “ovulating” time. It can be fertilized by an existing sperm (they can last 3 -5 days) or by an incoming sperm. Meanwhile, in the ovaries, the follicle becomes what is called “corpus luteum”.
- Luteal phase — Corpus luteum signals the release of estrogen and progesterone which stop the thickening of the uterus. If the egg is fertilized, it releases hcG which keeps the corpus luteum alive. If not, the corpus luteum starts dying and progesterone levels start to fall. The fall in progesterone levels causes the endometrium to release prostaglandins which cause cramps. These cramps, along with the drop in hormones trigger the period.
What happens in the cycle of a PCOS person?
In a person with PCOS, dues to higher testosterone, LH is always higher than FSH. So, the follicle does not get the trigger to release the mature egg, i.e., NO ovulation.
The follicle remains in the ovary and over time, with failed periods, follicles collect and appear as abnormal structures or cysts on ovarian ultrasounds. Hence, the name “Poly Cystic ovaries.” The absence of the mature eggs disturbs the following steps and so, the uterus does not get the signal to shed and the menstrual cycle remains incomplete. The lack of ovulation also makes it impossible to conceive.
In the next article, I will explore the workings of the hormones, insulin, and get into more details about how they all tie in together.
