PCOS is a complex medical condition that can show up differently in different women. In fact, you don’t have to have all the symptoms of PCOS to be diagnosed. Since symptoms such as irregular periods, acne and weight gain overlap with many other conditions, PCOS diagnosis is often delayed or overlooked until the symptoms become obvious.
Although PCOS affects nearly 1 in 5 women in India, it is still not completely understood by research as to what is the exact cause of this chronic condition.
With any chronic condition, the earlier you get diagnosed and start your treatment, the better are the outcomes. However, if you’ve not yet been tested or supect having PCOS, the first step is to speak to a doctor who can recommend appropriate tests for your diagnosis.
Living with PCOS can be tough – but understanding the condition, the causes and your treatment options can help you make an informed choice.
What causes PCOS?
While there is still on-going research to understand the exact causes of PCOS, currently we know that PCOS is a result of a combination of causes including hormonal imbalance, genetics and lifestyle factors.
- Elevated levels of androgen
Androgens, also called the male hormones, are present in both men and women, but in much lower quantities in women. In women, the ovaries produce the main female sex hormones – estrogen and progesterone. However, it also naturally produces small quantities of androgens. It is when there is an imbalance in the level of androgens produced, it can lead to conditions such as hirsutism. Hirsutism is a common clinical feature of PCOS that shows up as excess facial and body hair. High levels of androgens can also cause acne, especially around the jawline and chin and scalp hair loss, also called androgenic alopecia.
Apart from the effects on skin hair, elevated levels of androgens can interfere with your menstrual cycle too and cause irregular ovulation. This can make it difficult to conceive.
- Elevated levels of insulin
Around 70% of women with PCOS have some degree of insulin resistance and it is responsible for a range of PCOS symptoms. Insulin is a hormone that helps keep your blood sugar levels stable by helping the sugar move into the cells where required, and use it as a source of energy. If you have insulin resistance, the body stops responding to insulin and does not allow sugar to enter the cells. When insulin is not working properly, the body tries to compensate for it by producing more insulin to help clear the excess sugar. As a result, you end up having high levels of insulin and elevated blood sugar levels which can cause weight gain, fatigue, and cravings. Insulin resistance if left untreated can eventually lead to type 2 diabetes.
In fact, high levels of insulin can also trigger an increase in androgen production, which can then cause other symptoms of PCOS such as hirsutism and acne. Insulin resistance is also linked to acanthosis nigricans, which show up as dark, velvety patches of skin near the neck and armpits.
Certain studies have indicated that PCOS can have a genetic component — so if you have a mother or sister with this condition, you may be at increased risk of developing PCOS. However, research is still inconclusive in determining the exact genes or mutations involved.
- Lifestyle factors
The first line of treatment for PCOS is often lifestyle modifications, which includes weight loss, clean eating, exercise, managing stress and getting good sleep. If you are overweight, losing even 5% to 10% of your bodyweight can help improve symptoms. Although researchers are still underrstanding the relationship between obesity and PCOS, it is not yet clear if being overweight increases the chances of getting PCOS or is a result of having PCOS. However, it is also important to remember that not all women who are overweight or obese have PCOS — women with normal weight or who are lean can also develop PCOS. Unhealthy lifestyle such as being sedentary or following a diet that is high in processed and sugary foods can lead to insulin resistance and increase your risk of developing PCOS.