PCOS and its symptoms The signs and symptoms that occur with PCOS including some of the associated conditions and some of the signs and symptoms of those associated conditions as well. So, let’s look at a lot of signs and symptoms that can occur in patients who have PCOS.
What is PCOS?
It is actually the most common endocrinological disorder in reproductive age women worldwide or in individuals who have ovaries in a uterus. Now its prevalence is estimated to be anywhere between 5% to 15%. So, it affects a significant portion of the population and the underlying mechanism as to why PCOS occurs is complex and is a multifactorial disease. It involves functional ovarian hyperandrogenism which means that high levels of androgens or what would be classically referred to as male hormones are elevated. Some examples of androgens include testosterone and these androgens are at higher levels than they should and this leads to altered gonadotropin levels.
So, the hypothalamus releases venatropin releasing hormone which helps regulate the menstrual cycle. But because of these high androgen levels, those hormones from our brain from our hypothalamus in our brain are altered and this leads to dysregulated ovulation. And this is really the crux as to why this condition occurs. The most part what happens is there is ovulation or issues with ovulation so ovulation generally occurs on average around day 14 in an average menstrual cycle an average menstrual cycle lasts about 28 days. But what we find is that because there are issues with ovulation the menstrual cycle can be altered and this can increase the length of a menstrual cycle.
So, we can see issues with oligomenorrhea. So, oligomenorrhea is what we define as less than nine menstrual periods per year and we often see menstruation intervals 35 days or greater. Or, we can also see amenorrhea more specifically as secondary amenorrhea. So what does that mean? That means that there is no menstrual period for at least six months so secondary amenorrhea means that they’ve had their menstrual period before so they’ve had it normally and then all of a sudden it stops for at least six months is secondary amenorrhea. Primary amenorrhea means that they’ve never had a menstrual period ever and that has other underlying causes.
So, either of these can occur with PCOS oleo menorrhea or amenorrhea and what’s also important to note is that most often this menstrual dysfunction this oligomeric or secondary amenorrhea occurs early on in a patient’s life. Oftentimes present a sense of menarche or the patient’s first menstrual period so we start to see issues early on as opposed to something occurring later on in the patient’s life. Although this can occur later on most times it’s going to be something that occurs early on other associated issues with this menstrual irregularity include infertility. So, again this is due to that menstrual irregularity and it’s more specifically due to chronic ovulation. So, that means that the patient is not ovulating at all and that with that secondary amino area.
So, they’re not ovulating they’re not releasing an egg. They’re not going to be able to get pregnant they can also have issues with intermittent ovulation as well. So, it can be difficult to time when fertilization can occur and even if patients do get pregnant, they have a higher risk of miscarriage than other patients. So, the risk of miscarriage is also increased in PCOS patients and then along with the issue of ovulation, we can see polycystic ovaries.
PCOS and its symptoms
So, this is again due to anovulation and what is noted is there are multiple cysts within the ovaries and one can only see with ultrasound so it’s not something that’s going to be detected. Although in some cases, the ovaries can be enlarged they can have so many cysts that the ovaries can be enlarged. And they may have an abdominal mass.
Although this is very rare so most cases are not going to happen like this. So, again infertility and polycystic ovaries again due to anovulation now we talked about hyperandrogenism or that high level of androgens like testosterone and this is going to cause other signs of symptoms that are important to note as well. One of them is acne vulgaris so issues with acne can be a sign of PCOS.
Again this is due to elevated androgen levels so higher engine levels can lead to increased sebum production leading to acne in patients. There can also be issues with hirsutism. Hirsutism is the increased growth of terminal hair. So terminal hair is that dark thicker hair we can see on particular areas in the body including the face upper lip chin neck and lower abdomen along the linea alba. And again, this is due to elevated androgen levels as well. Elevated android levels cause particular signs and symptoms. Some other signs or symptoms are because of this high level of androgens and include alopecia.
So, alopecia is hair thinning and more specifically because of those high androgen levels we can say issues of androgenic alopecia or male pattern baldness. Particular areas of the head where a male may have thinning of their hair can occur in women that have PCOS as well and again this is due to increased levels of androgens and then something else that can occur with PCOS is known as hyperthecosis occurs in severe cases of PCOS. This is when there are very high levels of androgens and these very high levels of androgens cause increased masculinization increased alterations in the physiology that lead to masculine features.
Some of these include the following increased muscle mass is one of them. So, this very high level of androgens can lead to increased muscles or muscle mass. And then we can also see a deepening of voice in some patients as well so in some women who have very high levels of androgens. They can have this hyperthecosis this represents a severe case of PCOS and they can have increased muscle mass and deepening of their voice. Now another associated condition of PCOS is acanthosis nigricans.
So, acanthus niger cans is a condition involving thick velvety plaques on the skin that are great to brown in colouration. So, this is acanthosis nigricans this kind of very thick velvety darkened area in the skin and it affects certain sites more often than others some of these include the back of the neck sides of the neck. The axela are the armpits so there is some of the more common sites where you can see this type of plaque on the skin some other affected sites include the lips.