What is the real nature of PCOS?
You should know your problem in detail. You may have different, seemingly unrelated problems, but most of them may be due to PCOS. There are a lot of confusions in the name itself. The name “PCOS” is traditionally used, even though the problem is commonly seen without any cysts in the ovaries. The term “PCOD” is used when an ultrasound scan shows cysts in the ovaries. Sometimes this confusion causes errors in treatments in a conventional way. A woman with normal periods, and normal ovaries may have hair loss, migraine, black neck, and pimples and infertility. She may seek treatment for infertility, and she will be informed that ‘there is no problem”, in spite of her PCOS. For us, we consider all victims with few or many of the 28 features as PCOS patient or potential PCOS patient. It is not important, whether you have few or many symptoms.
We can group PCOS problems to 4 based on the origin of the hormone/metabolic abnormality. There are lot of confusions in the grouping and setting diagnostic criteria for PCOS. In common diseases, there will be a fixed set of symptoms, in PCOS; there are highly variable combinations of symptoms - it may be 3 symptoms for person A, it may be another 4 symptoms for person B.
Group 1
Problems caused by the imbalances of Leptin and insulin actions.
These are common in PCOS. Even though these problems are grouped together, it doesn’t mean that all problems are seen in the same person.
Weight gain.
Weight gain occurs in 40% of patients. This can be either total weight gain or abdominal weight gain. The third type - the upper body weight gain, is caused by steroid abnormalities and will be explained separately. Abdominal weight gain is due to excessive insulin resistance. Sometime, total body obesity can turn into abdominal type later
Total weight gain is commoner than abdominal weight gain. It is common in early ages. It can be either due to a direct effect of PCOS, hypothyroidism may be a contributing factor.
Any recent onset weight gain is important. if accompanied by color darkening in the back of neck. This is an early warning sign.
Weight loss
Contrary to common belief, weight loss is common in PCOS. These thin patients are prone to have more severe disease, with wide gaps of 3-5 months between periods. Many people (including doctors) wrongly believe that weight as the cause of PCOS. Wrong! Weight gain or loss, is the effect of PCOS, due to abnormalities in leptin and insulin function.
Black neck/ loss of complexion
Any darkening of skin is a symptom of PCOS. Darkening of the backside of neck, a very common and important feature, called as acanthosis nigricans. This is also seen in joint folds like elbow, back side of knee etc. Sometimes a generalized darkness is seen all over the skin, and girls wonder why they quickly lost their complexion in weeks.
In some, this dark skin can become rough, and leather like. The skin become hard, brittle, and sometime it may develop fissures. These fissures are itchy usually due to salt from sweat irritating the raw area.
Skin tags
In some, the skin makes small nodules, in frictional areas or neck, called as skin tags (the scientific name is Acrochordon)
Tiredness (lethargy)
Tiredness is common. Patients feel tired, and always wanted to lie down or sit somewhere. They feel no energy. They try to eat sugary drinks to counteract this, but the sudden hike in blood sugar level is accompanied by a further dip, and more tiredness. They look sleepy but actually they may not get good quality sleep too.
Depression and anger.
The patient often feels tired and the mood is usually in trouble. They will be short tempered and get angry at tiny reasons. Sometimes the anger is followed by bouts of sadness. This can progress to depression (sometimes, severe depression). Some patients develop autoimmune thyroiditis and the resultant hypothyroidism causes worsening of depression.
Weight gain, mood changes, tiredness, breathlessness on exertion etc. can interact and worsen each other. As the person gain more weight, and more lethargic, she feel difficulty in moving, and she eats more sugary foods to counter tiredness, and to get a kick from high-energy foods. This adds more weight, more tiredness and more depression and a vicious cycle sets in. External factors like loss of self-esteem, disfigurement, infertility, job and relationship problems etc., can also worsen depression.
Since the mood swings or depression are very common along with probable contribution from co-existing autoimmune hypothyroidism, women from age 12-45 with depression or mood swings must have an evaluation for PCOS, even if no other problems are apparent. Don’t forget the fact that PCOS is very common, but depression/mood problems from other causes are rare.
Breathlessness on exertion
Shortness of breath can be caused by PCOS. Climbing steps, walking, any other common physical activity can result in breathlessness. This can be severe or mild.
Edema in legs esp. foot.
This is rare, seen either independently, or in association with breathlessness.
Migraine
Migraine with different severity and types are seen in PCOS. These headaches may be associated with vertigo. In between the episodes of headaches, patients may feel tightness over the head. In most cases, treatment is taken in the form of anti-migraine tablets. Sometimes, antidepressants are given, which may aggravate PCOS.
Muscle and joint pains, skin painful to touch.
This is not uncommon. Some patients have muscle pains, joint pains and skin pains. There will be morning stiffness too. Skin will be painful on touch. The exact cause of this skin phenomenon is not known. Sometimes autoimmune diseases can coexist with PCOS. Along with this pain and stiffness, muscles may be weak too. This weakness can cause secondary joint problems and degenerative arthritis can set in.
Weight Gain in upper body
Weight gain in upper body is a specific feature of steroid abnormality. Shoulder bulging, fatty neck and chest, fatty hands are common. Even there can be a normal belly and waist circumference, with fat filling in the shoulders and arms.
Moon face
Moon face is due fat accumulation in the lower half of face. In face the forehead shows normal figure and bulging starts at the level of eye with swollen cheeks and chin. If PCOs affects you in the growth time and puberty, your check bones (maxilla and mandible can grow out and front, with a bulged cheek and protruding dentition.
Buffalo hump
Some times patients with PCOS shows a hump like prominence at the back of the neck. This is a clear characteristic of steroid excess.
Striae\stretch marks
Stretch marks can be present any where in the body, mainly abdomen, buttocks, thighs and hands. This is due to easy breakability and thinning of skin and sudden increase in fat.
Group 2
Problems caused by Steroid Hormone Excess
These symptoms can be very mild or undetectable with a blood level elevation of cortisol may be the only detectable feature. Or the patient may have very marked symptoms of steroid excess with normal cortisol levels. Some pateints may have excessive ACTH production causing physiologic hypertrophy of anterior pitutary mimiking a tumour.
Group 3
Male Hormone abnormalities
All women normally have some small quantity of male hormones. This is increased in PCOS. This increase causes some permanent change in hair follicles making them thick forever.
Hair loss and baldness
Hair loss is common in PCOS. This is of two reasons-one is the generalized hair loss due to metabolic syndrome and male pattern hair loss due to increase in male hormones. Often this can be the first symptom. The male pattern baldness is typically present in the forehead as a receding hairline.
Abnormal and excess hair growth
This is the most troublesome problem in PCOS. Hair can grow in the body and face like males. This may be very localized too. Once your hair get the signal to grow like a male hair, the change can be permanent, and the changed hair follicle may continue to grow like a thick male hair even if you correct the hormone status.
Oiliness of face
This can be a good sign for the presence of PCOS. If oiliness is present, you can look into the progress of oiliness as a guide to your treatment. The oiliness can be in the entire face, or in the nose only.
Pimples-scarring type.
These pimples may be seen in the face, or anywhere in the body. Normal puberty related pimples leave without scarring, but PCOS pimples make small dark scarring.
Group 4
Female Hormone abnormalities
Normal women need a fine balance between the multiple hormones working cyclically. These hormonal functions will become fine-tuned once menarche starts. They become further complicated in pregnancies. PCOS affects all these hormone functions, resulting in big problems.
Irregular periods
This is one of the easily noticed problems. This can be in different patterns-one common pattern is have repeated missing periods, with gaps ranging from I month to many months. The other abnormalities are irregular bleeding in between periods, and passing clots.
Painful periods
This is common. Even though a minimal pain and discomfort in the period’s time is usual in all normal females, painful periods can be a symptom in PCOS. However, if it is the only problem without any other PCOS symptoms, it is unimportant.
Cysts in the ovaries
This is the problem, which gave the characteristic name to the disease, (this naming caused a lot of confusion because the cysts are the result not the cause of the disease). There can be multiple small cysts in the ovaries. This is an ultrasound finding. The cysts present today may be there in the next year, or they may disappear altogether. There is no point in repeatedly scanning the ovaries to make sure that the treatment is working, since the cysts already present may continue to be there.
Infertility
This can be trouble some and PCOS related infertility is the commonest cause of all infertilities. Most conventional infertility treatment centers focus on IVF or ICSI as the option for all infertilities, including PCOS related infertility. It is foolish to treat PCOS infertilities with IVF or ICSI, because, PCOS infertility is an entirely different phenomenon, and correction of PCOS alone is needed for pregnancy as well as the general health of the patient. If a PCOS woman gets pregnant in the presence of the disease and related overweight, she is facing the risks of diabetes, hypertension and first trimester (less than 90 days) miscarriage.
Gestational Diabetes
It is common in most PCOS patients. It can get corrected after pregnancy, or it can continue as diabetes type 2. See the complications page to know more about diabetes from PCOS.
Miscarriages <90 days
This is an uncommon but significant problem in PCOS. Some PCOS patients may not have any problem in getting pregnant, but they lose the pregnancy within the 90 days. If they go for treatments, (usually they get repeated IVFs) the IVF pregnancies also have the same fate-to be lost within 90 days. This results in mental, physical and economic trauma. Ideally the PCOS patients should correct PCOS first, even if they do want to go for IVF.
Pregnancy Hypertension/ eclampsia
This is not rare. This can be mild or serious. However, once the pregnancy is over, hypertension disappears. Patients with PCOs related pregnancy hypertension have higher risk for diabetes in later life.
Pelvic pain & painful intercourse
It is a rare but troublesome problem. It is difficult to treat with conventional antibiotics and other drugs. If it is PCOS related, correction PCOS corrects the problem.
PCOS causes 28 multiple symptoms
PCOS can appear as different illnesses.
It can be either an irregular period problem. or it can be a headache problem.
Or it can be any symptom out of the 28 known symptoms of PCOS!.
