Polycystic ovaries are abnormally enlarged ovaries whose surfaces are dotted with small cysts (hence the name polycystic ovary). The abnormal ovaries in women suffering from polycystic ovarian syndrome (abbreviated as PCOS) are associated hormonal disturbances that disrupt the menstrual cycle, ovulation, fertility, and pregnancy. Despite the name, cysts may not always be present in all cases of polycystic ovarian syndrome. However, women with polycystic ovarian syndrome almost always have disturbances in menstrual cycle.
Read more about PCOS.
The exact cause of polycystic ovarian syndrome is not clearly understood. However, polycystic ovaries are associated with high androgen levels in the body. There is an excess of luteinizing hormone (commonly abbreviated as LH) in the bodies of women who suffer from polycystic ovarian syndrome. The levels of follicle-stimulating hormone (commonly abbreviated as FSH) and estrogen are lower than normal. These hormonal changes affect multiple processes in the body, including ovulation and menstrual cycle.
Signs and Symptoms of PCOS
The hormonal disturbances that are a characteristic feature of polycystic ovarian syndrome give rise to a variety of signs and symptoms. The three main clinical features associated with polycystic ovarian syndrome are:
- Irregular menstrual cycles.
- Presence of abnormally high levels of androgens in the body.
- Presence of cysts on the ovaries.
These clinical features may lead to the following signs and symptoms:
- Pain in the ovaries or pain during periods.
- Very light to heavy menstrual bleeding that may be irregular.
- Menstrual bleeding may be absent in some cases.
- Pregnancy failures and infertility.
Women often seek medical help for pain, irregular periods, and infertility. During the checkup, polycystic ovarian syndrome may get diagnosed. It is important to note that not all women who have polycystic ovarian syndrome suffer from pain, infertility, and even ovarian cysts. However, irregularities in the menstrual cycle are almost always present.
Read more about do you have PCOS?
Irregular menstrual cycles or periods
As mentioned earlier, irregularities in menstrual cycles are usually present in almost all cases of polycystic ovarian syndrome. The type of irregularity in the menstrual cycle varies a lot among individual patients. For example, the onset of menstruation (also known as menarche) may get delayed in young girls with polycystic ovarian syndrome. Delayed menarche is also referred to as primary amenorrhea.
Women or girls with polycystic ovarian syndrome may also suffer from secondary amenorrhea. This type of amenorrhea occurs in women who are already menstruating. Secondary amenorrhea is characterized by a cessation of menstruation for 3 or more months at a time. Periods may eventually resume in secondary amenorrhea. However, the menstrual cycles tend to become irregular.
In some cases, menstrual cycles may become very infrequent (a condition known as oligomenorrhea). Periods, when they do occur, may be characterized by either very light or extremely heavy bleeding (known as menorrhagia). The condition may also be characterized by the presence of excessive blood clots.
Severe pain during periods or ovulation
The second common feature of polycystic ovarian syndrome is persistent pain caused by ovulation or menstruation. Painful periods are also referred to as dysmenorrhea. Pain caused by ovaries can be felt in the lateral abdominal walls in the lower region of the abdomen. This pain may get exacerbated by the process of ovulation or menstruation. However, ovulatory pain may be present even in the absence of menstruation.
The pain in polycystic ovarian syndrome may be severe enough to cause nausea, vomiting, and syncope (or fainting). A common misconception in society is the idea that pain during ovulation and menstruation is normal. This frequently causes a delay in seeking appropriate treatment. It is not uncommon for these processes to be accompanied by a slight discomfort caused by mild cramps and mild pain. However, severe pain accompanying these processes is not normal, and must be investigated by a medical professional.
Problems with falling pregnant
The third common feature of polycystic ovarian syndrome is infertility. However, this does not happen in every case. A common fertility problem in polycystic ovarian syndrome is the occurrence of an anovulatory cycle. In such cases, the majority of menstrual cycles are not accompanied by ovulation. There may be intermittent ovulation that could lead to pregnancy. However, the presence of anovulatory cycles means that it takes longer than normal to conceive. A minority of women with polycystic ovaries may never conceive.
Polycystic ovarian syndrome often gets diagnosed when women seek medical treatment for their inability to conceive. These women are often unaware of their polycystic ovaries because the signs and symptoms of polycystic ovarian syndrome may not have been bothersome enough to seek a medical opinion. Even when the signs and symptoms are blatantly obvious, many women tend to ignore them.
Other signs and symptoms
The following are some of the other signs and symptoms that may be found in some cases of polycystic ovarian syndrome:
- Skin problems: Women with polycystic ovaries may also exhibit skin problems such as excessively oily skin, acne, hyperpigmentation of the skin (especially in the skin folds and the nape of the neck), and dandruff.
- Hair problems: Due to the presence of excessive androgens in women with polycystic ovaries, there may be excessive growth of hair on various parts of the body, such as face, chest, abdomen and back. This male-pattern hair growth in women is also known as hirsutism. Hormonal changes in women with polycystic ovaries may also result in male-pattern hair loss or baldness (androgenic alopecia).
- Abnormal weight gain: Women with polycystic ovaries may also exhibit weight gain and obesity in the abdominal region.
Diagnostic Tests for PCOS
The following are some of the tests that can reveal the existence of polycystic ovarian syndrome:
- Blood tests: Changes in the levels of several hormones is a characteristic feature of polycystic ovarian syndrome. Changes in hormonal levels can be detected through various blood tests. Hormones that are present in abnormally high levels in polycystic ovarian syndrome include androgens (such as free testosterone), prolactin, and luteinizing hormone (commonly abbreviated as LH). In addition, women with polycystic ovaries may also have high levels of blood cholesterol (technically referred to as hypercholesterolemia), insulin (technically referred to as hyperinsulinemia), and glucose (technically referred to as hyperglycemia). Insulin resistance may also be present.
- Transvaginal ultrasound: Transvaginal ultrasound may be used to check the morphological status of the ovaries. This test may reveal the presence of enlarged ovaries (more than 10 cm3 in size) and multiple ovarian cysts (> 12) with sizes between 5-15mm.