PCOS: Symptoms, treatments and why it’s underdiagnosed

Coping with a variety of symptoms, from weight gain to fertility issues, about 5% to 10% of women of childbearing age in the U.S. — or 5 to 6 million people — have polycystic ovary syndrome (PCOS). Considered a hormonal disorder, many struggle with the condition and the impact it has on their lives.

“PCOS can cause a myriad of symptoms,” says Dr. Ashlee Schlesier, a Sharp Community Medical Group board-certified OBGYN affiliated with Sharp Grossmont Hospital. “The most common are menstrual irregularities, facial or body hair, acne, weight gain, ovarian cysts and fertility issues.”

PCOS, sometimes underdiagnosed

According to the World Health Organization, up to 70% of women worldwide remain undiagnosed, commonly due to the wide range of symptoms. Often, a woman may delay seeking treatment if she has mild symptoms.

“There are patients who may not come to a doctor until they have difficulty getting pregnant or start gaining weight without any evident cause,” says Dr. Schlesier. “In recent years, there’s more of a focus on women’s health, so diagnoses are being made sooner.”

Additionally, more education should be available, Dr. Schlesier adds, to help women recognize signs of PCOS earlier.

Causes and symptoms of PCOS

According to Dr. Schlesier, the exact cause of PCOS is unknown. It’s likely a mix of environmental and genetic factors that may lead to the syndrome. PCOS also tends to run in families.

Signs of PCOS may include:

• Menstrual irregularities: Irregular, infrequent, absent or light periods

• Fertility: Difficulty getting pregnant due to irregular or absent ovulation

• Excessive hair growth: Known as hirsutism and can include hair on the face, chest, back, or buttocks

• Weight gain: Especially around the belly

• Thinning hair: Including male-pattern baldness

• Skin issues: Acne, oily skin, skin tags, or dark or thick skin patches on the neck, armpits or under the breasts

• Pelvic pain: During or between periods and accompanied by heavy bleeding

How PCOS is diagnosed

PCOS may be diagnosed based on symptoms alone or with laboratory tests and a pelvic ultrasound. It’s usually diagnosed when a woman has two of the following:

1. Irregular menstrual cycles: Fewer menstrual cycles or bleeding longer than is typical during a usual period

2. Excess androgen (male sex hormones): Excess androgen may cause excess facial or body hair, cystic acne or male-pattern hair loss

3. Polycystic ovaries: Enlarged ovaries with small cysts around the edges

Treatment for PCOS

There is no known cure for PCOS. Instead, treatment focuses on the management of androgenic symptoms, regulation of menstrual cycles, improvement in fertility outcomes, and prevention of long-term potential complications of PCOS.

“Among the first steps are lifestyle changes,” Dr. Schlesier says. “Your doctor may recommend a specific PCOS diet or exercise routine.”

According to Dr. Schlesier, people tend to underestimate the importance of sleep. However, improving sleep quality can be beneficial in preventing long-term cardiovascular and metabolic disease.

“Additionally, the use of oral contraceptive pills can regulate menstrual cycles as well as provide contraception,” Dr. Schlesier says. “They also increase the amount of a protein called sex hormone binding globulin that can reduce levels of androgens, which tends to reduce acne and hair loss, and can prevent new growth of facial or body hair.”

The only way to treat existing body hair is through hair removal methods, such as laser hair removal. Other anti-androgenic medications, alongside oral contraceptive pills, are used if necessary.

People with PCOS are also screened more often for diabetes, cholesterol issues and high blood pressure because they are at higher risk of metabolic and cardiovascular diseases.

How PCOS affects fertility

PCOS is a leading cause of infertility, Dr. Schlesier says. However, there are steps women with PCOS can take.

Weight loss is an essential first step for women pursuing pregnancy. Even a 5% weight loss can help regulate cycles and restore ovulation, Dr. Schlesier says. Weight loss also helps reduce the likelihood of pregnancy complications.

“Inositol is a supplement that has also been shown to improve ovulation rates two-fold in patients with PCOS,” Dr. Schlesier adds.

If you’re having difficulty getting pregnant, it’s essential to talk with your OBGYN as soon as possible. If necessary, your care can be managed in conjunction with a fertility specialist.

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