What is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovarian Syndrome (PCOS) is a metabolic syndrome that is diagnosed in 5-10 percent of women in Australia. Symptoms of PCOS can manifest at any age, ranging from childhood to adolescence to even later in life.
Polycystic ovary syndrome (PCOS) is a common condition characterised by menstrual abnormalities and clinical or biochemical features of hyperandrogenism. What does that mean? Essentially too many androgens or “male hormones” circulating in the female body.
PCOS occurs when the endocrine system is out of balance, causing ovulation disturbances by making them rare and irregular whilst also causing other major changes in the body.
It is currently not well understood why PCOS affects hormones to such a degree. Hormones are chemical messengers that trigger many different processes including hunger, growth of hair/skin/nails, energy production and many more functions. Often, the job of one hormone is to signal the release of another hormone and so an imbalanced endocrine system can wreak havoc on critical processes within the body.
One hormone change can trigger another, which can trigger another and so on.
When sex hormones function normally, the ovaries produce a tiny amount of male sex hormones (androgens). With sufferers of PCOS, they start producing an elevated and abnormal number of androgens. This rise in androgens signal the ovaries to slow production down, causing fertility issues in many cases and causes the sufferer to become more prone to acne breakouts, and excessive facial and body hair.
Sufferers of PCOS may experience difficulty controlling blood sugar, due developing symptoms of insulin resistance. This can make weight loss very difficult, and weight gain an almost certainty. When the body cannot use insulin well, blood sugar levels can become difficult to control causing major changes in hunger, appetite and metabolism. Over time, elevated insulin levels can increase your chances of developing diabetes.
The causes of PCOS are related to genetics and lifestyle, which lead to excess male-type hormones and insulin resistance in the body. When the body’s insulin is not as effective as it should be, the body compensates by producing more insulin. Elevated insulin levels trigger rapid weight gain and can signal an increase in male hormones which disrupt the normal ovulation cycle, causing eggs in the ovary to stop mid-way through development. On an ultrasound screen, these look like small cysts within the ovary. The eggs do not ovulate, leading to some of the PCOS symptoms.
What are the symptoms of Polycystic Ovarian Syndrome (PCOS)?
Women with PCOS may suffer from a variety of symptoms and also have a variety of different physical signs, all of which can be due to a number of different causes.
PCOS is a hormonal disorder with a collection of metabolic, reproductive and psychological effects. The symptoms of PCOS are caused by fluctuations in hormone levels and there may be one or more causes for the hormone fluctuations.
Symptoms can include any or all of the following:
- Hirsutism (excessive hair growth on face,chest, abdomen, back…) This hair is different from the hair that some women have on their upper lip, chin, breasts, stomach or the fine “baby” hair all over their body, tending to be longer and more coarse
- Androgneic alopecia (hair loss). Thinning hair on the scalp.
- Irregular periods
- Absent periods
- Fertility Issues. Infertility or reduced fertility.
- Obesity. Weight gain and trouble losing weight
- Polycystic ovaries
Those with PCOS are also subject to higher blood pressure and elevated insulin levels. PCOS may also cause unwanted changes in the way you look. If it is not treated, over time it can lead to serious health problems, such as diabetes, kidney issues and heart disease.
Health risk associated with PCOS
Infertility or sub fertility
PCOS is the most common endocrine disorder causing female infertility regardless of ethnicity. Many women discover they have PCOS after failing to fall pregnant. Infertility or subfertility (reduced fertility) is a common problem for women with PCOS. The sub or infertility is generally due to hormonal imbalances that prevent regular ovulation. Ovulation may occur but it can be generally infrequent and make conception difficult.
PCOS may also trigger infertility by causing excess stress hormones such as cortisol to rise and other psychosocial factors including distress, depression, anxiety, sexual problems, marital, and social maladjustment, loss of control, and lowered self-esteem.
Insulin Resistance/Type II Diabetes
Insulin is a chemical (hormone) that is produced in the pancreas. The main role of insulin is to control your blood sugar level by shuttling nutrients to most cells in the body. Insulin acts mainly on fat and muscle cells, causing them to take in sugar (glucose) when your blood sugar level rises. Another effect of insulin is to act on the ovaries to cause them to produce the male hormone testosterone. A common disorder of PCOS is insulin resistance. This means that your body is resistant to the blood sugar lowering effect of insulin and as a result, your pancreas has to work very hard to keep blood sugar levels normal. It is for this reason that you are at risk for developing diabetes (type 2 diabetes) and other complications.
High Cholesterol Levels/Cardiovascular Disease
High levels of Testosterone can increase levels of LDL which is commonly known as “bad cholesterol”. It can also decrease your levels of HDL which is the “good cholesterol”.
High Blood Pressure
There is a direct correlation between insulin resistance and high blood pressure. When blood sugars are constantly high, the blood vessels restrict blood flow to the extremities (hands, feet, sexual organs) and concentrate themselves on disposing the excess glucose (blood sugar) in circulation. This constant restriction of blood flow generates increases in high blood pressure. If left untreated, high blood pressure can cause serious damage to the kidneys.
Cancer of the Endometrium
As women with PCOS have infrequent ovulation, they often have infrequent menstruation. This irregular shedding of the uterus lining can increase the chances of the uterine lining (endometrium) producing abnormal and cancerous cells.
Elevated androgen levels associated with PCOS cause the production of dihydrotestosterone (DHT), and this can lead to increased aggression, acne and oily skin. If there is also an underlying insulin resistance issue, this compounds the problem and triggers even more increases in androgens; as you can see, it is a vicious cycle. When looking for a skincare routine, whether you have PCOS or not, treatment would be the same. Seek professional advice to ensure you use the most effective products to suit your skin type.
Medications such as the oral contraceptive pill can help in the treatment of acne by helping to balance hormones, however always seek medical advice from your doctor for endocrine issues.
Hirsutism- excess & unwanted hair
For many, excess hair is one of the most annoying symptoms they experience and can lead to all sorts of emotional issues such as depression from constantly dealing with something that they just wish would go away.
Hirsuitism is excess body hair, such as on chin, chest and neck and can be a sign of an underlying androgen or a metabolic problem. Hirsuitism is caused by hair follicles that are overly sensitive to male hormones (called androgens), or when there are abnormally high levels of these hormones as is the case with PCOS. High levels of the male hormone, testosterone for example causes excessive hair growth in both men and women. When follicles build up on the ovary – instead of being released each month, like they do in polycystic ovary syndrome – the follicles begin to produce testosterone. This excess male hormone can trigger excess hair growth, acne, and even scalp hair loss. Treatment is usually various types of anti-androgen medications which reduce the testosterone levels that cause the male like hair growth.
What are some hair removal methods?
Some ladies resort to daily shaving, which is a quick and cheap solution to getting rid of excess hair but if you have fast re-growth, you may encounter stubble merely a few hours later. Shaving is a temporary measure for hair removal; you may need to do it daily, or every second day.
Very time consuming, it may leave some temporary red marks – but will remove the hair, root and all. Not practical for large areas such as the chest, back or legs.
Bleaching and depilatory creams:
Both are short-term options. Bleaching simply lightens the hairs & depilatory creams provide temporary relief by chemically removing the hair just below the skin’s surface. This technique is used on the legs and face. But many women find it irritates their skin.
A cheap option, for some women it is a little uncomfortable. Re-growth can take up to 5-6 weeks, for some women it may just be weeks.
A tiny needle is passed down the hair follicle, to burn the follicle – permanently destroying the hair root. This is time consuming, and can be extremely uncomfortable due to the high pain that is experienced during this treatment.
Laser Hair Removal – the best solution
All the above methods of hair removal are only temporary and in some cases may even need to be repeated on a daily basis. Although shaving, waxing and threading can solve the problem temporarily, most women with PCOS are looking for a longer term solution.
Laser hair removal treatment is an excellent and effective treatment option for women with PCOS, however as the unwanted hair growth is hormonally driven, hair growth may continue even with laser hair removal treatments.
While for most women laser hair removal may offer a permanent reduction, it is an ongoing management treatment to keep the hair growth under control as PCOS causes hair follicles to be created at a much faster rate than in those who do not have PCOS. However treatments will significantly reduce the amount of hair present & slow down re growth.
Laser hair removal works because the light is attracted to the pigment (melanin) in the hair. Dark pigment absorbs the light and the converts it to heat. The heat then affects the hair follicles to prevent hair growth. Hair growth undergoes 3 different stages, anagen (the active growth phase), catagen (the transition phase), telogen (the resting phase). With laser hair removal treatments we can only aim to destroy the hairs at the active growing stage & because not all hairs grow at the same time a course of treatments will be required. Any treated hairs that are in the active stage of growth & treated at the required level of heat may be destroyed permanently.
Treatments are quick and simple, a full face treatment will take as little as 10 minutes! Treatments for body areas are every 6-8 weeks apart & treatments for the face area are every 3-4 weeks apart, undergoing treatments sooner then the recommended times does not give you a more effective treatment, by having treatments at those intervals mentioned above you have more hairs at the active growing phase therefore a more effective treatment. On average a minimum of 6-12 treatments is required and any re growth between treatments are lighter and finer. For those women that shave on a daily basis they may find that they don’t need to shave in between treatments & once the hairs do start to grow back you would generally be due for your next treatment.
Victorian Cosmetic Dermal Clinics is committed to helping sufferers with PCOS by offering 10% off all laser hair removal for eligible clients*
The top 4 myths of PCOS
Myth 1: All women with PCOS have polycystic ovaries
Some PCOS patients do not have any cysts at all. Most doctors will check if you have polycystic ovaries as part of their investigation into PCOS however if they are not present you may still have the syndrome. PCOS is diagnosed by its symptoms and blood tests, however an ultrasound is not always necessary, as the presence or absence of polycystic ovaries is irrelevant for diagnosis purposes.
Myth 2: You will never have children
This is untrue as many women with PCOS still manage to conceive naturally and others will need medical assistance to become pregnant.
Myth 3: All women with PCOS are overweight/obese
Many women with PCOS do have an excess weight problem however there is also a percentage of suffers of PCOS who do not experience the related weight gain issues.
Myth 4: Lose weight and PCOS will go away
For women with PCOS, losing some weight even as little as 5% of total body weight can assist to balance hormone levels, improve symptoms and may help restore or boost fertility. Losing weight with PCOS however is not a simple process and many women with PCOS find it extremely hard to lose weight as a result of their condition.
PCOS Diagnosis & Treatment
The first step in diagnosing PCOS is to have a complete history and physical examination performed by your doctor. A careful history and physical examination can detect whether excess androgens are causing male-pattern hair growth (hirsutism), acne or hair loss and whether ovulation is occurring normally. Physical examination also can detect high blood pressure and increased chances for obesity as these are risk factors for diabetes and cardiovascular disease in individuals who are overweight.
Blood tests can then be performed to determine whether the ovaries are functioning normally or producing excess amounts of androgens. An ovarian ultrasound also can be performed to determine whether they have a polycystic appearance.
The best way to manage insulin resistance and metabolism derangements caused by PCOS is to adjust your lifestyle.
Diet – exercise can greatly improve insulin sensitivity which can help to keep weight off, and following a diet which is lower in carbohydrates and richer in proteins, vegetables and healthy dietary fat can significantly control weight issues and improve blood sugar management. By controlling these key metabolic functions, the amount of excess androgens that are produced can be managed with greater success.
Medications and dietary supplements that improve insulin sensitivity may also be effective in restoring menstruation and reducing some of the health risks associated with PCOS. It can also lead to the reduction of excess testosterone, thus diminishing many of the symptoms associated with excess testosterone such as hair growth on body, alopecia (hair loss on head), acne, obesity and cardiovascular risk.
Always seek medical advice from your doctor before considering any treatments.
If you are interested in consulting with one of our experts, please get in touch.