What is PCOS?
According to the Office on Women’s Health, PCOS, or Polycystic Ovarian Syndrome, affects about 10% of people with ovaries between the ages of 15 - 44 with most being diagnosed sometime in their 20’s or 30’s. While a concrete cause of PCOS has yet to be determined, some combination of higher levels of androgens (such as testosterone) and insulin resistance along with genetics and lifestyle habits seem to factor together.
PCOS symptoms may frequently include:
Irregular menstrual cycles
Pelvic pain
Hair growth patterns on face and chest impact up to 70 - 80% of people with PCOS
Acne on face, chest, and upper back that’s resistant to treatment
Thinning hair on scalp or hair loss
Weight gain or challenges with losing weight
Hyperpigmentation, or darkening of skin at neck creases, in the groin, and/ or underneath breasts
Anxiety and Depression
At this time, there’s no singular test to determine whether someone has PCOS, so once other conditions are ruled out by a doctor, PCOS may be diagnosed if there are multiple indicators that there are high levels of androgens present, irregular menstrual cycles, and/or cysts present on one or both ovaries. The Rotterdam Criteria is currently the tool most frequently used to diagnose PCOS and is more nuanced than this overview. (Perla Health offers a good primer of the criteria for those that want to dive deeper)
Some PCOS Treatment Options:
Just as there is no one test for PCOS, there’s no one simple treatment and treatment plans should be customized to what the goals and needs of each individual. Working with one’s care team to identify goals and have regular check-ins around reproductive health and addressing the symptoms deemed the most personally significant is key.
For people that do not wish to become pregnant, hormonal birth control options can be helpful insofar as they can help regulate menstrual cycles. Additionally, birth control options that contain both estrogen and progesterone can help rebalance hormones and may improve acne and reduce extra, unwanted hairs on facial and body areas. You can connect with your primary care doctor to help you determine a prescription for a birth control option and soon hopefully there will be more over the counter access which would not require a prescription.
Anti-androgen therapy can also help with some common symptoms of PCOS. Androgens are often thought of as male sex hormones, the most well known being testosterone, but all bodies produce varying amounts of the hormone and more androgen present in some bodies, could mean a higher instance of facial / body hair, male-pattern baldness, or acne. Anti-androgen medications function by blocking the androgen receptors, reducing androgen production, and reducing insulin resistance. This intervention can help reduce unwanted male-pattern hair growth that is frequently a symptom for those with PCOS and can also assist with acne that is resistant to other treatments.
Laser hair removal is also a helpful way of managing male pattern hair growth on the face and chest that is frequently a symptom of PCOS. Unwanted and pervasive hair growth is not good or bad in and of itself, but it can cause body dysphoria and discomfort for some people and is something that can be addressed. Laser hair removal creates a small heat damage so that each follicle is unable to produce another hair. You can learn more and receive customized information here. For people with PCOS, androgens trigger hair growth. Laser hair removal is still an effective option for those with PCOS, but more maintenance sessions may be useful after a complete series on a consistent schedule. In a study published by the National Library of Medicine that included women with both PCOS and androgen-related hair growth, both groups experienced a measurable reduction in hair shaft density, color, and overall number of hairs. Laser hair removal can reduce the overall number of hairs and future regrowth can be lighter in color and finer in texture, which is particularly true with laser hair removal in conjunction with interventions such as hormonal birth control and/ or anti- androgen medications.
Diet and exercise can affect and may alleviate some symptoms of PCOS, but it is important to remember that there is likely not a magic fix or a cure-all, especially if someone online is trying to sell you one. Working with a medical professional is likely a great first step.
Every body is unique, so treatment plans are often most effective when customized with one’s health care team and when regular check-ins are an option to evaluate progress and determine if a different course of treatment is preferred.
Sources:
https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
https://perlahealth.com/the-rotterdam-criteria-for-diagnosing-pcos/