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All About Polycystic Ovary Syndrome (PCOS)

Polycystic Ovary Syndrome is the most common endocrine disorder among women of reproductive age. The current estimate is ~10% of women have PCOS, but it is widely under-diagnosed and under-treated so the prevalence is likely much higher.

The exact cause of PCOS is unknown, but we know there are several root causes of PCOS including genetic and environmental factors. It is a unique condition, as women will often present with different (but similar!) symptoms.

Symptoms include:

  • weight gain

  • absent/irregular menstrual cycles

  • infertility

  • hirsutism

  • strong cravings

  • acne

  • hair thinning

  • anxiety and depression

Diagnosing PCOS

According to the Rotterdam criteria, you must have 2 of the following 3 criteria in order to diagnose PCOS:

  1. Oligo- or anovulation (irregular or absent menstruation)

  2. Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism, and/or blood tests showing high androgens)

  3. Polycystic ovaries (12 or more peripheral follicles) Did you know... they are not actually cysts, they are immature follicles!

PCOS has variable phenotypes, which we will not get into today, but it is important to know that there are four different Rotterdam phenotypes (Class A - D). In other words, women can have different presentations. Some women with PCOS actually get regular periods, and others don't have any cysts on their ovaries. So as you can imagine, there is not one cookie-cutter approach to treating PCOS!

Part of figuring out YOUR root cause and symptom management of PCOS involves analyzing your hormones...

Hormones are chemical messengers made by endocrine glands, such as the hypothalamus, pituitary gland, ovaries, adrenal glands, thyroid, and pancreas.

  • Hypothalamus - dopamine, GHRH, GnRH

  • Pituitary Gland - prolactin, LH, FSH, oxytocin, TSH

  • Ovaries - estrogen, progesterone, testosterone, AMH

  • Thyroid - T4, T3

  • Adrenals - cortisol, DHEA, DHEA-S, androstenedione, testosterone, epinephrine/norepinephrine

  • Pancreas - insulin, glucagon

  • Liver - main producer of sex-hormone binding globulin (SHBG)

All of these hormones are interconnected in various ways.