PCOS: Early signs of Polycystic Ovary Syndrome

While there is no cure for Polycystic Ovary Syndrome (PCOS), a hormonal disorder caused in women who are in the reproductive age bracket, early diagnosis and treatment can help regulate its symptoms. Catching the early signs of PCOS and going for diagnosis can be effective in warding off many further complications caused by the condition. While many women report no early symptoms of PCOS, in many cases, acne, irregular menstrual flow, as well as weight gain can be signs of PCOS. If you are experiencing these symptoms, it is important to consult your doctor. Your medical history as well as blood tests and physical examination can help the doctor diagnose your condition.

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. “In this condition, small, fluid-filled sacs called cysts develop in the ovaries. Although not all women with PCOS have these cysts,” explains gynaecologist and obstetrician Dr Suruchi Desai. The condition has a range of symptoms, including menstrual irregularities, which may lead to infertility, elevated androgen levels (male hormones), and metabolic issues.

PCOS is also known as Stein-Leventhal syndrome and is considered one of the most common hormonal disorders in women. According to the World Health Organisation, this condition impacts 8–13% of reproductive-aged women. It can lead to complications such as infertility, insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease. While the exact cause of PCOS is unknown, it is believed to involve a combination of genetic and environmental factors mainly due to wrong lifestyle and food. Check out other important details of PCOS.

What are the first symptoms of PCOS?

Early symptoms of PCOS can vary widely among women, but some of the most common early signs include:

1. Irregular menstrual cycles and hormonal imbalances

Many women with PCOS experience irregular or absent menstrual periods due to disruptions in the hormonal regulation of their menstrual cycle. “This irregularity can manifest as fewer than nine periods a year, prolonged gaps between periods, or very heavy bleeding,” explains Dr Desai. A study published in the International Journal of Cancer states that menstrual cycle irregularity and length are the two factors that define PCOS. However, some women may have PCOS with regular periods as well.

2. Elevated androgen levels

Another hallmark symptom of PCOS is elevated androgen levels. These are male hormones present in higher-than-normal amounts in women with the condition. “Elevated androgens can cause physical symptoms such as hirsutism, which is excessive hair growth on the face, chest, and back, and can also lead to male-pattern baldness or thinning hair on the scalp,” explains Dr Desai. Acne and oily skin are also common due to increased oil production from elevated androgen levels. Check out how to manage high androgen levels or hyperandrogenism.

3. Weight gain

Weight gain or difficulty in losing weight is another frequent symptom. “This is often linked to insulin resistance—a condition where the body’s cells do not respond effectively to insulin, leading to higher levels of insulin and glucose in the blood,” says Dr Desai. This insulin resistance can further contribute to the development of type 2 diabetes, which is why many women with PCOS are at increased risk for this condition. A study, published in Human Reproduction, observed that women with PCOS gained more weight annually than women without PCOS.

4. Dark patches on the skin

Some women may also experience dark, velvety patches of skin, known as acanthosis nigrans, which often appear in body folds like the neck, armpits, and groin. A study, published in the Indian Dermatology Online Journal, states that the most common site for migrants was the nape of the neck.

5. Fatigue

Fatigue is another symptom of PCOS that is experienced by many women. While it is not a direct symptom, many other symptoms of PCOS can lead to fatigue. Unmanageable fatigue can be an early sign of PCOS and needs to be dealt with immediately. Check out how PCOS fatigue can be managed.

6. Depression

Psychological symptoms such as depression and anxiety are also reported by many women with PCOS, likely due to the combination of physical symptoms and hormonal imbalances. PCOS can hurt body image and cause low self-esteem as well.

7. Other symptoms

There are a range of other symptoms such as apnea, reduced libido, and metabolic disturbances like high cholesterol and triglycerides leading to hypertension, that emerge gradually. These can vary in intensity, making early recognition and diagnosis important for managing the condition and reducing the risk of long-term complications.

When should you go to the doctor?

You should consider seeing a doctor if you experience any early signs of PCOS, such as irregular menstrual cycles, cycles suddenly becoming scanty or excessive hair growth, unexplained weight gain, or difficulty losing weight. “If you have been trying to conceive without success, or if you notice signs of insulin resistance (such as dark patches of skin or increased hunger and fatigue), it is advisable to consult a healthcare provider,” says Dr Desai. Early diagnosis and management can help reduce the risk of long-term complications such as type 2 diabetes, heart disease, and infertility.

How is PCOS diagnosed?

PCOS is diagnosed based on a combination of medical history, physical examination, and specific tests. The doctor will typically take a thorough medical history and conduct a physical exam, including a pelvic exam to check for signs of excess estrogen and androgen levels and other hormonal imbalances.

Following this, blood tests may be ordered to measure hormone levels, cholesterol, and glucose levels. Besides this, there will be an ultrasound that may be performed to examine the ovaries and check for the presence of cysts. “There is no single test for diagnosing PCOS; rather, it involves ruling out other conditions and confirming the presence of at least two of the following three criteria: irregular ovulation, elevated androgen levels, and polycystic ovaries,” explains Dr Desai.

What is the first line of treatment for PCOS?

The first line of treatment for PCOS often involves lifestyle modifications, such as a healthy diet, regular physical activity, and weight management. “For those who are overweight, even a modest weight loss can help regulate menstrual cycles and improve symptoms,” says Dr Desai.

Medications may also be used, depending on the patient’s symptoms and whether they wish to conceive. “Birth control pills are commonly prescribed to regulate menstrual cycles and reduce androgen levels, which can help manage symptoms like acne and excessive hair growth,” says Dr Desai.

For women, who wish to conceive, there are many fertility medications such as clomiphene (Clomid) or a combination of clomiphene and metformin may be recommended, says Dr Desai, adding that medications to manage insulin resistance, such as metformin, are also used. However, medical management has to strictly be under a doctor’s supervision. Besides medicines, there are many other lifestyle changes to manage PCOS.

Can PCOS be reversed if initial symptoms are treated?

Full reversal of PCOS is not possible. While there is no cure for PCOS, early intervention and treatment of initial symptoms can help manage the condition and reduce the risk of associated health issues. “Lifestyle changes such as maintaining a healthy weight, eating a balanced diet, and engaging in regular physical activity can significantly improve symptoms and help restore regular menstrual cycles,” explains Dr Desai. In some cases, these interventions can reduce the severity of symptoms and prevent the progression of the disorder, but they may not fully reverse it.

How to cure PCOS permanently?

Currently, there is no permanent cure for PCOS, says Dr Desai. The condition can be managed effectively with medication, lifestyle changes, as well as other treatments, specifically decided based on an individual’s symptoms and health goals.

Medications can help regulate menstrual cycles, reduce androgen levels, and manage insulin resistance. “Surgical options, such as ovarian drilling or the removal of cysts, was a method used mainly in the past when medications were not widely used due to unawareness,” explains Dr Desai. Women with PCOS need to work closely with their healthcare providers to develop a personalised treatment plan that addresses their specific needs.

It is important to understand that stress and anxiety can worsen PCOS, and there is no permanent cure for it. However, early signs of PCOS must be detected and treated. Excessive exposure to estrogen in patients with PCOS has been linked to pre-cancerous lesions in women in later on life hence PCOS must be treated.