Cracking The PCOS Code: Revealing Causes, Symptoms, And Environmental Impact

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder affecting women of reproductive age.

While PCOS can present differently, its impact on health and quality of life can be significant. It’s important to recognize the signs and consequences of this condition to receive timely diagnosis and treatment.

What symptoms indicate PCOS?

PCOS is characterized by several main symptoms, including

Irregular menstrual cycles or absence of menstruation.
Elevated levels of male hormones (androgens).
Polycystic ovaries, which can be detected by ultrasound. It is important to understand that polycystic ovaries are a consequence, not a cause, of hormonal imbalance. Therefore, the absence of polycystic ovaries cannot be a diagnostic criterion; if cysts have not yet developed, they will eventually appear without proper treatment.

There are also secondary problems related to the aforementioned symptoms, such as excessive hair growth on the face and body (hirsutism), skin rashes, changes in weight, and fertility issues.

The History of PCOS Discovery Polycystic

Ovary Syndrome (PCOS) was first described in 1935 by scientists Irving Stein and Michael Leventhal. Initially named Stein-Leventhal syndrome, they observed a similarity in the pathological condition among women exhibiting specific symptoms such as menstrual irregularities, excessive hair growth, and similar laboratory test results. Detecting polycystic ovaries was challenging at the time due to the lack of necessary equipment (ultrasound). Therefore, the term PCOS emerged after such studies began.

Subsequent research revealed that PCOS is not solely an ovarian issue but a systemic endocrine disorder associated with metabolic disturbances and insulin resistance. It affects not only reproductive function but also a woman’s overall health, increasing the risk of cardiovascular diseases, diabetes, and other conditions.

Some Statistics

According to various estimates, PCOS affects 8–15% of women of reproductive age, meaning that up to 1.4 million Canadian women may suffer from PCOS. Additionally, experts believe that about 70% of women remain undiagnosed. In a study conducted in the Canadian province of Alberta in 2023, over a third of respondents with a PCOS diagnosis waited for more than two years before receiving their diagnosis, and 41% of them consulted with three or more doctors before receiving the correct diagnosis. Women with PCOS also face various complications 2–4 times more often than women without this condition. These complications include anxiety, depression, diabetes, kidney diseases, gastrointestinal issues, and cardiovascular diseases.

When Should You Suspect PCOS?

Pay attention to how frequently this issue is diagnosed nowadays and how often it is missed even by specialists. When should you suspect that there is a deeper problem than what specialists usually find? Warning signs may manifest in changes in appearance and mental health problems such as anxiety, depression, and eating disorders. Additionally, the diagnosis of polycystic ovary syndrome (PCOS) is associated with an increased risk of developing various diseases, and the presence of these diseases in women may itself indicate the need to seek polycystic ovary syndrome:

Possible development of endometrial hyperplasia and endometrial cancer due to excessive accumulation of uterine lining and progesterone deficiency, leading to estrogen stimulation of uterine cells and a diagnosis of endometriosis.
Risk of insulin resistance and type 2 diabetes, particularly noticeable in women with PCOS, even with a not high body mass index.
Elevated blood pressure, especially in cases of overweight or during pregnancy.
Onset of depression and anxiety.
Lipid metabolism disorders, such as dyslipidemia, can lead to atherosclerosis, and the associated development of cardiovascular diseases.
Other potential complications include miscarriages, sleep apnea, non-alcoholic fatty liver disease, autoimmune thyroiditis, and iron deficiency.

Symptoms of PCOS

Once again, I want to emphasize that not all women with PCOS may experience all symptoms, and the severity of symptoms can vary significantly.

Menstrual Irregularities: Irregular or absent periods (amenorrhea), irregular cycles (oligomenorrhea), or prolonged and heavy periods may indicate disruption of the endometrium.
Hyperandrogenism: Excessive hair growth on the face, chest, and back (hirsutism), as well as on other parts of the body where women typically have minimal hair, such as the abdomen and legs.
Polycystic Ovaries: Detection of multiple small cystic structures (follicles) on the ovaries during ultrasound examination.
Insulin Resistance: High levels of insulin in the blood, which can lead to weight gain, difficulty losing weight, and an increased risk of developing type 2 diabetes.
Obesity or Overweight: Many women with PCOS have excess weight, especially around the abdomen.
Skin Problems: Acne and oily skin on the face.
Darkened Skin Patches: Dark patches on the skin, especially in areas like the neck, armpits, elbows, or pubic area, may indicate high blood sugar levels.
Hair Loss: Thinning hair on the scalp or diffuse hair loss may indicate an imbalance in androgen hormones.
Metabolic Syndrome: Increased risk of developing metabolic syndrome, including hypertension, dyslipidemia (changes in blood lipid levels), and other cardiovascular complications.
Infertility or Fertility Problems: PCOS can significantly increase the risk of infertility due to ovulation and reproductive function disturbances.
Emotional Health: PCOS can also affect a woman’s emotional state. Dealing with physical symptoms, infertility, low mood due to changes in appearance (e.g., excessive hair growth), and stress from an inability to conceive can lead to anxiety, depression, and low self-esteem.

Complications of PCOS:

PCOS can lead to the following complications:

Type 2 Diabetes: Insulin resistance, characteristic of PCOS, increases the risk of developing type 2 diabetes.
Cardiovascular Diseases: Women with PCOS have an increased risk of developing cardiovascular diseases, such as hypertension, atherosclerosis, and myocardial infarction.
Infertility: Reproductive function disturbances associated with PCOS can lead to difficulties with conception and infertility.
Obesity: Many women with PCOS are overweight, increasing the risk of developing metabolic and cardiovascular complications.
Endometriosis: Women with PCOS have an increased risk of developing endometriosis due to hormonal imbalances and reproductive function disturbances.

Types of PCOS

PCOS encompasses several types, each with different characteristics and symptoms.

Insulin-Resistant PCOS:

Features: Characterized by high insulin levels and insulin resistance, often accompanied by excess weight.
Health Impact: Increases the risk of developing type 2 diabetes. May lead to infertility and menstrual cycle disturbances.
Diagnosis: Analysis of fasting insulin and glucose levels.
Treatment: Lifestyle changes including diet and physical activity. Medications to reduce insulin levels, with metformin being potentially beneficial.

Post-Pill PCOS:

Features: Symptoms of PCOS may arise or worsen after discontinuation of contraceptive pills.
Health Impact: May cause menstrual cycle disturbances and hormonal imbalance.
Diagnosis: Based on contraceptive pill history and symptom characteristics.
Treatment: Symptom management, such as regulating the menstrual cycle and reducing androgen levels. Hormonal medications, such as natural progesterone, may be helpful.

Adrenal PCOS:

Features: Associated with hyperproduction of androgens due to adrenal dysfunction.
Health Impact: Leads to increased levels of male sex hormones and menstrual cycle disturbances. May contribute to acne and excessive hair growth.
Diagnosis: Analysis of androgen and other hormone levels in the blood.
Treatment: Use of androgen-lowering medications and normalization of adrenal function.

Inflammatory PCOS:

Features: Characterized by chronic inflammation in the body.
Health Impact: May exacerbate PCOS symptoms such as hyperandrogenism and insulin resistance. Associated with increased risk of cardiovascular diseases and diabetes.
Diagnosis: Based on analysis of inflammatory markers in the blood and other tests.
Treatment: Treatment methods focus on reducing inflammation, including lifestyle changes and the use of anti-inflammatory medications.

All these types of PCOS represent different aspects and may require an individualized approach to diagnosis and treatment in each case.

Laboratory Tests and Investigations

Laboratory tests and investigations can aid in diagnosing PCOS. They should include at least:

Assessment of fasting insulin and glucose levels to detect insulin resistance.
Ultrasonography to detect the presence of cysts and/or enlarged ovaries.
Measurement of sex hormone levels, including estradiol, progesterone, prolactin, follicle-stimulating hormone (FSH), luteinizing hormone (LH), testosterone, and others.

Calculation of FSH/LH Ratio:

The FSH/LH ratio is the ratio between the levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) in the blood. Normally, this ratio is approximately 1:1 on days 2-3 of the menstrual cycle.

During the diagnosis of PCOS, it is important to measure the levels of both hormones and calculate their ratio. In PCOS, the FSH/LH ratio is typically shifted towards an elevated LH level, resulting in an FSH/LH ratio of less than 1.Top of Form

Diagnosis of PCOS

Diagnosing PCOS can be complex for several reasons:

Variety of symptoms: PCOS manifests with diverse symptoms that can overlap with other conditions.
Lack of a unified diagnostic standard: There are no universally accepted diagnostic criteria for PCOS.
Similarity to other conditions: Many PCOS symptoms can be associated with other diseases, complicating diagnosis.

Because of these complexities, diagnosing PCOS requires a comprehensive approach and often involves the collaboration of multiple specialists, such as gynecologists, endocrinologists, and reproductive medicine experts.

Rotterdam Criteria:

The Rotterdam criteria were proposed in 2003 and are the most widely used for diagnosing PCOS. According to these criteria, a diagnosis of PCOS can be made if two or more of the following three criteria are met:

Menstrual cycle irregularities: absence of menstruation (amenorrhea) or rare and/or irregular menstruation.
Hyperandrogenism: elevated levels of androgens in the blood (e.g., testosterone) or clinical signs of hyperandrogenism, such as hirsutism (excessive hair growth), acne, and alopecia (hair loss).
Ultrasonographic features: the presence of polycystic ovaries (more than 12 cysts with a diameter of 2-9 mm or an ovarian volume exceeding 10 cubic centimetres).

Treatment and Support for PCOS:

The treatment of PCOS involves lifestyle changes, supplementation with vitamins/minerals/herbs, diet modifications, medication therapies, and physical activity. It’s important to tailor treatment based on the symptoms and needs of each woman, considering her individual issues.

Early diagnosis and treatment of PCOS are crucial for preventing complications such as type 2 diabetes, cardiovascular diseases, endometrial problems, infertility, and many other issues.

Reasons for the Increase in PCOS Cases

Polycystic ovary syndrome has been known for almost 100 years, but there is still no complete understanding of the reasons for this condition. Research shows that the prevalence of this problem is constantly rising. The following are the reasons that are most likely to contribute to this increase:

Genetic Predisposition: Hereditary factors may play a role in the development of PCOS. If there have been cases of this condition in the family, the likelihood of its occurrence in other family members may also be higher.
Lifestyle: Inadequate physical activity, improper diet, and harmful habits such as smoking can increase the risk of developing PCOS.
Hormonal Changes: Changes in hormone levels, such as insulin resistance and high levels of androgens, can contribute to the development of PCOS. These changes may be associated with excess weight, stress, and other factors.
Environment: Environmental factors such as pollution and the influence of endocrine disruptors may affect the development of PCOS.
Diet and Lifestyle: Improper nutrition, excessive consumption of high-calorie and processed foods, as well as a sedentary lifestyle, can lead to obesity and insulin resistance, which are key risk factors for developing PCOS.
Stress: Elevated levels of stress can affect the hormonal balance in the body and contribute to the development of various pathological conditions, including PCOS.
Medication Use: Some medications, such as glucocorticoids, drugs for the treatment of epilepsy, bipolar disorder, anticancer and antiviral drugs, as well as some antibiotics and antidepressants, may alter the hormonal balance and increase the risk of developing polycystic ovary syndrome (PCOS).

Environmental Factors Causing Hormonal Imbalance

Here is a list of environmental factors that may influence the development or progression of polycystic ovary syndrome (PCOS):

Plastics and Endocrine-Disrupting Chemicals: Some chemical substances found in plastic products, cosmetics, household chemicals, and other materials can mimic the action of estrogens in the body, leading to disruptions in ovarian function and exacerbation of PCOS symptoms.
Level of Environmental Pollution: High levels of air and water pollution can impact the health of the reproductive organs, including ovarian function, which may contribute to the development or worsening of PCOS symptoms.
Exposure to Endocrine Disruptors: Endocrine disruptors such as bisphenols, phthalates, and pesticides can affect hormonal balance in the body, leading to disruptions in ovarian function and contributing to the development or exacerbation of PCOS symptoms.
Exposure to Heavy Metals: High levels of heavy metals such as lead, cadmium, and mercury can affect hormonal balance in the body and impact ovarian function, which may contribute to the development or worsening of PCOS symptoms.
Radiation Exposure: Prolonged or excessive exposure to ionizing radiation, such as X-rays or radioactive substances, can affect ovarian function and hormonal balance in the body, leading to the development or exacerbation of PCOS symptoms.
Stress: Chronic stress can affect hormonal balance in the body and impact ovarian function, which may contribute to the development or worsening of PCOS symptoms.
Mold and Mycotoxins: Some types of mold can produce toxins known as mycotoxins, which can negatively affect metabolism and hormonal balance. Some studies suggest that mycotoxins can alter lipid metabolism and cause lipid metabolism dysfunction, which may affect various aspects of health, including PCOS.

Conclusion:

Polycystic ovary syndrome (PCOS) is a multifactorial condition that requires a comprehensive approach to diagnosis, treatment, and symptom management. It is important to consider the variety of environmental factors that can influence the development or progression of this condition, such as chemical substances, environmental pollution, lifestyle, stress, and others. Understanding these factors can help develop strategies for the prevention and treatment of PCOS aimed at minimizing the negative impact of the environment on women’s health.

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