Carolina Venturi, 4th year medical student at Tilman J Fertitta Family College of Medicine at University of Houston
Carolina Venturi, Period Pro
Is your menstrual cycle irregular? Do you struggle with excess hair growth or acne? What about difficulty losing weight?
It might seem that these events are not interrelated; however, as a cluster (and sometimes individually), these issues pose concern for polycystic ovary syndrome, or PCOS.
What is PCOS, and what causes it?
PCOS is a hormonal imbalance that results in an array of symptoms. Although the exact cause is unknown, PCOS is thought to result from a complex interaction between genes, increased levels of androgens (a group of hormones that includes testosterone), and insulin resistance.
When should I be concerned about PCOS? What are the symptoms?
PCOS affects individuals differently, so not everyone will experience the same symptoms. Here are some features to watch for.
Effects on the reproductive system
Because of the hormone imbalance, follicles in the ovaries do not develop properly (often seen as multiple, fluid-filled sacs in the ovaries on ultrasound), and eggs are not released as expected. As a consequence of the underlying hormonal shift, menstrual cycles are often affected. For some, that might mean irregular or missed cycles.
But what is a “regular” cycle?
Well, for youth, and at the start of menstruation, cycle length (1st day of one period to the 1st day of the next period) typically varies between 21 to 45 days (3-6 weeks).
Sometimes, as a teen, you may skip a month. If your period starts on February 26th and your next period starts on April 1, you have skipped March but stayed within the 3 to 6 week window. After a few years into menstruation, cycles become shorter, and the average cycle length for adults is 28 to 35 days (4-5 weeks).
So, what is irregular?
Now that we know typical cycle lengths, one way we can define irregular cycles is those that fall out of that range. Menstruators with PCOS typically miss periods. So, remember to track your cycle days – this will help when trying to decide whether your cycles are irregular! If you ever miss more than 90 days, that’s a definite sign to check in with your health care provider.
It’s also important to keep in mind that menstrual irregularity can also refer to blood flow or amount of blood– take note of whether your cycles are light or heavy. Check out this blog: How Heavy is too Heavy, to learn more!
Effects on metabolism
PCOS is associated with insulin resistance. Insulin is a crucial hormone for regulating our blood sugar levels. When our bodies do not respond optimally to insulin, this leads to dysregulated blood sugar levels. In turn, the effects are associated with obesity, excess weight gain, and difficulty losing weight.
Effects on skin
As mentioned earlier, PCOS is associated with increased androgens. As a group, androgens are responsible for the development of physical traits associated with the male sex, like facial and body hair. With this in mind, individuals with PCOS can experience increased growth of thick, dark hair in areas where hair might typically be sparse and thin such as the face, abdomen, and thighs. Elevated androgen levels are also associated with oily skin and severe acne. Unlike common pimple breakouts, acne associated with PCOS is often characterized by painful lesions (usually on the lower face – chin, lower cheeks, jawline) that appear larger, deeper under the skin, and take longer to heal. When combined with insulin resistance, individuals may also develop patches of thickened, dark skin – or acanthosis nigricans – that can appear on the nape of the neck or in the underarms.
I’m worried… what should I do?
PCOS affects an individual’s health far beyond the ovaries and uterus. Namely, it has implications for one’s metabolism, heart and blood vessels, sleep, and mental health. So, if you’re concerned that these signs of PCOS apply to you, reach out to your doctor! They will be able to walk you through the diagnosis and treatment of PCOS or related symptoms.
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