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Any woman with polycystic ovary syndrome (PCOS) knows that the symptoms of this complex disease involve much more than its name implies. Numerous small cysts on the ovaries, which can sometimes cause lower abdominal or pelvic pain, are only part of the picture. In fact, these cysts are rarely the direct cause of symptoms. Instead, the long list of PCOS symptoms includes everything from infertility to excessive facial and body hair.
What is PCOS?
PCOS is the most common hormone-related disease in reproductive-aged women, affecting between 6% and 20% of women during their childbearing years. As Dr. Naumes states, it is also the most common cause of infertility in the United States.
How is PCOS Diagnosed?
To be diagnosed with PCOS, a woman must have at least two of the following:
- Chronic lack of ovulation (failure of the ovaries to release an egg during a menstrual cycle)
- High levels of male sex hormones (particularly testosterone)
- Numerous small cysts on the ovaries.
PCOS Hormone and Metabolism Problems
In addition to these three problems, numerous additional hormonal and metabolic abnormalities characterize PCOS. For instance, Dr. Naumes discusses how lack of ovulation and infertility in women with PCOS are partly the result of high levels of luteinizing hormone (LH) relative to follicle stimulating hormone (FSH). Besides the high LH/FSH ratio, PCOS is also often characterized by low levels of progesterone relative to estrogen. All of these hormones are part of the feedback loop between the brain and the ovaries and they play a critical role in maintaining the normal function of the reproductive system.
Dr. Naumes also discusses the large role that insulin resistance plays in PCOS. Insulin resistance is a condition in which the body produces insulin but does not use it effectively. This causes glucose to build up in the blood instead of being absorbed by the cells, leading to type 2 diabetes or prediabetes, excessive inflammation, abdominal obesity, and heart disease. Insulin resistance also further disrupts reproductive hormone balance already present in PCOS.
The many hormonal and metabolic abnormalities associated with PCOS lead to a wide variety of symptoms. These symptoms may differ from one woman to the next and can vary in strength,
severity, and frequency. Which PCOS symptoms a woman experiences, and how severe they are, depends on many factors, including her age, ethnicity, genes, diet, exercise, and other lifestyle and environmental factors.
Some of the most classic symptoms associated with PCOS, according to Dr. Naumes, are abnormal body hair growth on the nipples and below the belly button, thinning of scalp hair, abnormal menstrual cycles, and obesity or difficulty losing weight.
A more extensive list of PCOS symptoms includes:
- Prolonged intervals between menstruation or cessation of periods
- Episodes of prolonged and/or heavy vaginal bleeding
- Thinning hair on the scalp
- Body hair growth on the upper lip, chin, chest, back, abdomen, arms, and legs
- Overweight or obesity, especially abdominal obesity
- Difficulty losing weight
- Oily skin and acne
- Darkening of the skin, typically on the neck and armpits
- Increased risk of miscarriage
- Pregnancy complications such as gestational diabetes
- Depression and anxiety
- Inflammation, which may cause joint pain, aches, and fatigue
PCOS Complications and Associated Medical Conditions
In addition to these symptoms, PCOS is associated with a number of other disorders as well as some very serious long-term complications. For example, women with PCOS are at increased risk of developing type 2 diabetes, cardiovascular disease, and endometrial cancer. They are much more likely to suffer from metabolic syndrome, sleep apnea, and hypothyroidism caused by the autoimmune disorder Hashimoto’s. They tend to have increased cardiovascular risk factors like high triglycerides, low HDL, and high levels of chronic, low-grade inflammation.
Don’t Let This Happen to You
One of the most unfortunate aspects of PCOS, explains Dr. Naumes, is that it often goes unrecognized and untreated. Because PCOS symptoms are often treated in isolation or are associated with other diseases, many women with PCOS are unaware that they have it. This not only leaves them suffering unnecessarily in the present, but it puts them at increased risk of serious, long-term complications such as heart attacks, strokes, and cancer.
If you have any of the PCOS symptoms listed above, please talk to your healthcare provider about PCOS. There’s no reason to despair if you have been diagnosed—PCOS is very responsive to a number of natural treatments, many of which have been validated by extensive research.
This article was originally published in 2015. It is regularly updated.
 Eur J Endocrinol. 2014 Oct;171(4):P1-29.J