Polycystic Ovary Syndrome (also known as PCOS) is a health condition that about 10 million, or 5-10% of all women in the world, suffer from. Considered a hormonal problem, it only affects women who are of reproductive age. Most women are diagnosed in their 20s or 30s when they have problems getting pregnant; however, PCOS can occur at any age after puberty.
Women with PCOS experience irregular menstrual cycles and an excess of androgen (male hormone) levels. While females do naturally make androgen, women with PCOS experience levels of androgen that are too high. Additionally, the ovaries develop many small areas of fluid (known as a cyst - a fluid-filled sac), and then fail to release any eggs - making PCOS the leading cause of female infertility.
Signs and Symptoms
PCOS affects specific hormones in the body, causing an array of signs and symptoms. Since androgen levels can increase from PCOS, women may experience side effects such as acne, excess/unwanted hair (also known as hirsutism, which affects about 70% of women diagnosed with PCOS), thinning hair (similar to male-pattern baldness), or irregular periods.
PCOS also affects insulin production in the body - insulin is responsible for helping cells absorb glucose for energy. PCOS causes the body to not be quite as responsive to insulin, so instead of glucose being absorbed into cells, it stays in the bloodstream and causes higher blood glucose levels. The body responds by producing more insulin, which in turn causes more androgen to be produced. The insulin problems often result in diabetes or pre-diabetes, which can also play a role with weight. Many sufferers of PCOS struggle with weight gain and managing their weight.
In general, some symptoms of PCOS also include:
- Poor sleep, including insomnia or sleep apnea
- Mood changes (including mood swings and depression)
- Pelvic pain (associated with heavy menstrual bleeding, but can also occur outside of periods)
- Headaches as a result of hormonal changes
- Ovarian cysts (though not all women with PCOS develop these, despite the name of the syndrome implying it)
Women who try to get pregnant and have PCOS may have problems getting pregnant (some end up using IVF or surgery to temporarily restore ovulation), or be unable to become pregnant. If a woman who has PCOS does become pregnant, there is a higher risk of miscarriage, gestational diabetes, and preeclampsia during the pregnancy.
Unfortunately, there is not one definitive test to determine if a patient has PCOS. The best way to start the diagnosis is by getting information about the patient’s history of symptoms, especially those involving an irregular menstrual cycle. Lab tests could be ordered to check blood sugar and androgen levels to help make the diagnosis. Additionally, a transvaginal ultrasound could be used to check the ovaries for any cysts and the thickness of the uterine lining, along with a manual pelvic exam checking for growths or other abnormalities.
If a diagnosis of PCOS is confirmed, a doctor might want to further check the patient for complications that can arise from PCOS. This could include monitoring blood pressure, blood glucose levels, and cholesterol. The doctor may also want to do screenings for depression, anxiety, and sleep apnea as time goes on.
Treatment for PCOS varies depending on the symptoms the patient is suffering from and the specific concerns of the patient. Treatment can include both medications and lifestyle changes.
Medications are focused on regulating the menstrual cycle (including ovulation). Birth control pills that contain estrogen and progestin are helpful for decreasing androgen levels and regulating estrogen - this can help fix abnormal bleeding, excess hair growth, and acne. Progestin therapy is another hormone treatment that helps regulate periods, but is not considered a birth control since it doesn’t protect against pregnancy. Other medications that affect hormone levels can also be used, such as an anti-estrogen medication, or one to stimulate ovaries to release eggs.
Oral medication for type 2 diabetes may also be prescribed to help lower insulin levels, and slow progression of pre-diabetes and help with weight loss. Certain medications can be prescribed for specific side effects, such as skin medications (to stop the effects of excess androgen causing acne), a cream to help slow facial hair growth, or electrolysis to remove unwanted hair.
Lifestyle changes include working to maintain a healthy weight, which can lower insulin and androgen levels. Women with PCOS are recommended to eat a low-carb diet, since carbohydrates are known to increase insulin levels. Sometimes PCOS can cause bloating that is made worse by specific foods, so women can try eliminating foods that cause bloating. Exercising regularly also helps lower blood sugar and keep weight under control.
PCOS and EMS
It is possible you could have a patient who has PCOS and either knows it, or doesn’t know she has it. Since it can present with pelvic pain, that could be any number of diseases, disorders, or conditions. As with any female of childbearing age, find out about their last menstrual cycle and possibility of being pregnant during your assessment. If it’s a symptom of PCOS, asking about whether it’s happened before can be helpful information. It’s important to take abdominal pain seriously, since it could be a sign of many things that should be checked out at a hospital.
Sources and More Information
Mayo Clinic, “Polycystic ovary syndrome (PCOS)” https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
NIH US Library of Medicine - Medline Plus, “Polycystic Ovary Syndrome” https://medlineplus.gov/polycysticovarysyndrome.html
Office on Women’s Health, “Polycystic ovary syndrome” https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
PCOS Awareness Association, http://www.pcosaa.org/symptoms
Jenny Ewen, BA, EMT