POCS is a condition where the functions of the female reproductive system get compromised, leading to severe distress—mentally, physically, and emotionally.
The ovarian female reproductive system does a lot for us, all the time. Take ovulation and menstruation that happens every month, for example. The key players in menstrual cycle regulation are hormones such as the follicle-stimulating hormone (FSH) or luteinizing hormone (LH). These hormones aid the well-known ovulation process in which follicles stored in the ovary grow and eventually become viable eggs (ova).
However, like any other biological system, things can go wrong, and the female reproductive system is no exception. So, what happens when ovulation ceases to take place due to substantial hormonal imbalance?
What Is PCOS?
Polycystic Ovarian Syndrome (PCOS) is a group of symptoms attributable to hormonal imbalances in females. It is a collection of symptoms from varying hormone imbalances grouped under a general term — PCOS.
Though the causes of PCOS aren’t established, it’s usually related to high levels of LH, androgen, testosterone, or prolactin concentrations. The deviation of hormone release from normal comes at the cost of a flawed ovulation mechanism. Without ovulation, follicles are left to enlarge and eventually turn into cysts.
As there concentrations of androgen, a male sex hormone, is high in women with PCOS, most symptoms of PCOS are related to secondary sexual characteristic. Here are some of the most common PCOS symptoms [1]:
- Facial acne
- Hair loss
- Unexplained increase in body weight
- Abnormal hair growth pattern (especially on the upper lip, chin, sideburn area, chest, or belly area)
- Fertility difficulties
The experience of PCOS is diverse in terms of symptoms, type, and also the severity. Nevertheless, PCOS is clinically diagnosed in the presence of at least two of the following standardized criteria [2]:
- Absence or irregularity of menstrual cycle (fewer than 8 periods a year)
- Evidence of high levels of androgen hormones (signs, symptoms, or pathology results)
- Pelvic ultrasound indicating the presence of cyst (liquid-filled blister-like substances) in one or both ovaries
Types Of PCOS
PCOS is further categorized into several different types based on physiological changes [3]. However, people still get the diagnosis of PCOS without any specific information or tests to figure out their PCOS group.
Though the medical management is similar between each type of PCOS for the most part, it doesn’t hurt to know the specific type of PCOS you’re having. Moreover, knowing the type of PCOS you’re having in detail will help you personalize your lifestyle management.
Insulin-resistant PCOS
In some women with PCOS, releasing high insulin levels seems to be the body’s coping mechanism against compromises in ovarian function. Though the exact reason behind this remains unknown, we do know the consequences of it. Insulin is a hormone released by the pancreas to regulate glucose levels; however, glucose levels will remain elevated in insulin-resistant PCOS even with an abundance of insulin.
Since this same scenario applies to the biology of Type 2 Diabetes, the symptoms of insulin-resistant PCOS may overlap with Type 2 Diabetes. Additionally, a high insulin level triggers the further release of androgens, a male sex steroid hormone [4].
If you’re wondering how a male sex hormone ends up in your body, here’s a surprise: androgen is naturally present in females and mediates over 200 types of biological activities.
The problem with androgen only arises when it’s present in excess in female bodies, causing changes to the female secondary sexual characteristic. To verify if you have insulin-resistant PCOS, you’d have to undertake blood tests that precisely measure insulin, HbA1c, androgen, and glucose levels. If these values appear elevated, discuss with your healthcare provider to confirm if it’s insulin-resistant PCOS.
Post-pill PCOS
More than reproductive rights, contraceptive pills help women manage acne, heavy menstrual bleeding, or endometriosis. These pills primarily work by being a source of synthetic female hormone progesterone and estrogen.
Unfortunately, there are some reports from women coming off the medication being pushed into a state of high androgen levels or PCOS. Clinically, there isn’t any evidence on the correlation between PCOS and birth control pills. But that doesn’t mean we should invalidate the possibility of PCOS development due to birth control discontinuation [5].
Instead, we should question PCOS as a plausible adverse effect of birth control pills and keep an eye out for new evidence suggesting the link. Ironically, birth control pills are one of the first-line treatments for PCOS; nevertheless, we cannot exempt them from the question of safety.
Hence, if you’ve recently weaned off contraceptive pills before being diagnosed with PCOS, talk to your healthcare provider about the possibility of the tablets being the causative agent.
Inflammatory PCOS
Inflammation is a protective reaction to an injury, infection, or trauma. Women with PCOS tend to have higher levels of inflammation; therefore, there is a chance for chronic inflammation to be the underlying cause [6].
Apart from white blood cells and inflammatory mediators, the production of testosterone hormones also rises. Testosterone, a steroid hormone, inevitably leads to worsening PCOS symptoms.
You can identify inflammatory PCOS by having a close consideration of your symptoms. On top of PCOS symptoms, you may also have:
- Headache and fatigue
- Joint pain
- Skin conditions (eczema, psoriasis, hives)
- Bowel problems
- Abdominal or chest pain
If you notice any inflammatory PCOS symptoms, we highly encourage you to consult your doctor and talk about these symptoms because chronic inflammation, when untreated, may cause adverse complications.
Adrenal PCOS
Though the exact gene remains unidentified, genetics and family history are often linked to PCOS development. Adrenal PCOS means that androgens are automatically converted to male steroid hormones without any input from the ovary or high insulin levels.
In short, your ovary function and insulin sensitivity are normal, but the high androgen level has caused the symptoms of PCOS. Adrenal PCOS is a very rare type of PCOS, and it only accounts for 10% of PCOS worldwide.
If you’d like to confirm if you have adrenal PCOS, make a blood test appointment at your nearest healthcare facility. Make sure to check your DHEA-S levels (a different type of androgen). In your results, if your DHEA-S levels are high while testosterone and aldosterone are normal, you may have adrenal PCOS.
PCOS Support And Resources
If you’re having PCOS (pre-existing or newly diagnosed), it helps to know that you’re not alone; roughly 1 in 10 women worldwide have PCOS [7]. Here are some resources to empower yourself by educating yourself, sharing your story, and taking care of yourself:
PCOS Challenge: The National Polycystic Ovary Syndrome Association
This well-established non-profit organization serves to support women with PCOS globally through advocacy, education, grants, and also emotional assistance. This year, they have organized a virtual run-walk, the biggest national campaign aiming to raise funds and awareness amongst the public about PCOS.
PCOS Facebook Group
As of writing this article, this Facebook group has over 80,000 community members and the numbers continue to grow. This Facebook page helps people to support one another, learn and also obtain guidance in managing PCOS.
PCOS Support Groups
There are currently numerous community support groups that serve as a platform for women with PCOS to come together, share information, support each other, end the stigma, advocate for PCOS awareness, and learn from experts. If interested, do a quick Google search or seek recommendations from your local healthcare professional. Who knows, you might find a support group with members that can support and walk with you through your journey.
Bottomline: Types of PCOS
PCOS isn’t something new, yet research on the condition is still lacking. The truth is, many healthcare professionals don’t have all the answers to the questions that surround this condition. Nevertheless, PCOS is still manageable, and becoming a part of a supportive community can positively impact your life post-diagnosis. Moreover, knowing PCOS type may help your healthcare professional steer your treatment more precisely.
That said, evidence and recommendations on treating PCOS are constantly improving and changing. Therefore, we’d recommend you always be on the lookout for enhanced treatment options. It may be tough to maintain a positive mindset all the time, but you may realize you’re stronger than you give yourself credit for! More importantly, remember that you don’t have to walk this journey alone.
Disclaimer: This article is only a guide. It does not substitute the advice given by your own healthcare professional. Before making any health-related decision, consult your healthcare professional.
Editorial References And Fact-Checking
- UpToDate. (2022). Patient education: Polycystic ovary syndrome (PCOS) (Beyond the Basics). Retrieved August 19, 2022, from https://www.uptodate.com/contents/polycystic-ovary-syndrome-pcos-beyond-the-basics
- NICHD – Eunice Kennedy Shriver National Institute of Child Health and Human Development. (2022). Polycystic Ovary Syndrome (PCOS). National Institute of Child Health and Human Development. Retrieved August 19, 2022, from https://www.nichd.nih.gov/health/topics/factsheets/pcos#
- Clark, N. M., Podolski, A. J., Brooks, E. D., Chizen, D. R., Pierson, R. A., Lehotay, D. C., & Lujan, M. E. (2014). Prevalence of Polycystic Ovary Syndrome Phenotypes Using Updated Criteria for Polycystic Ovarian Morphology: An Assessment of Over 100 Consecutive Women Self-reporting Features of Polycystic Ovary Syndrome. Reproductive sciences (Thousand Oaks, Calif.), 21(8), 1034–1043. https://doi.org/10.1177/1933719114522525
- Dunaif A. (1997). Insulin resistance and the polycystic ovary syndrome: mechanism and implications for pathogenesis. Endocrine reviews, 18(6), 774–800. https://doi.org/10.1210/edrv.18.6.0318
- Herndon, M. J. S. (2021, June 14). Can the Pill Cause Polycystic Ovary Syndrome (PCOS)? Healthline. Retrieved August 19, 2022, from https://www.healthline.com/health/womens-health/pill-induced-pcos
- Aboeldalyl, S., James, C., Seyam, E., Ibrahim, E. M., Shawki, H. E., & Amer, S. (2021). The Role of Chronic Inflammation in Polycystic Ovarian Syndrome-A Systematic Review and Meta-Analysis. International journal of molecular sciences, 22(5), 2734. https://doi.org/10.3390/ijms22052734
- Cioana, M., Deng, J., Nadarajah, A., Hou, M., Qiu, Y., Chen, S., Rivas, A., Banfield, L., Alfaraidi, H., Alotaibi, A., Thabane, L., & Samaan, M. C. (2022). Prevalence of Polycystic Ovary Syndrome in Patients With Pediatric Type 2 Diabetes: A Systematic Review and Meta-analysis. JAMA network open, 5(2), e2147454. https://doi.org/10.1001/jamanetworkopen.2021.47454
