Symptoms of PCOS
Venus with blemishes: The body of Venus of Malos (Venus de Milo, a centerpiece exhibit at the Louvre Museum) and the face of a latter day Venus. The more severe the PCOS, the higher the concentration of lutenizing hormone of testosterone.
Obesity
Fat cells and their precursor cells in different parts of the human body are not created equal. Those around the midriff and inside the tummy are particularly sensitive to the effects of insulin compared with those in the rest of the body.
One of insulin’s most powerful actions is to inhibit the release of fat from fat stores, making it difficult to call on abdominal fat as a source of fuel. In this way, midriff fat gradually accumulates around the waist, a sign that is typical of women and girls with PCOS. In fact, it is one of the most obvious and typical signs of insulin resistance in both women and men.
But this is only the visible consequence of insulin resistance, as muscle (including the heart) as well as the liver are infiltrated by fat even in mild insulin resistance. This is apparently the result of variations in the pathways whereby insulin exerts its action on glucose and fatty acid metabolism.
Although traditionally almost 50% of women with PCOS are overweight, we nowadays tend to see slimmer clientele with some of the classic PCOS symptoms and small-moderate increase in weight (central) despite their best efforts. Obesity tends to enhance abnormal estrogen and androgen production in PCOS, which further magnifies the problems of irregular bleeding and excessive hair growth.
Menstrual Irregularities
Constant estrogen production stimulates growth of the uterine lining, the endometrium. As the lining grows and becomes abnormally thickened, there can be spontaneous shedding of the endometrium. This process, together with the lack of regular ovulation, leads to irregular and, sometimes, very heavy uterine bleeding. The bleeding episodes may occur after long gaps of time (oligomenorrhea) or, for some women, not at all (amenorrhea).
Irregular periods are a nuisance and suggest some hormonal disorder or risk of endometrial thickening. Such irregular bleeding requires medical attention.
Impaired Fertility
Infertility and lack of regular ovulation is a typical PCOS scenario. As a consequence of incomplete follicular development ovulation does not occur, leading to a failure to conceive. Even though the woman might have regular periods, she may ovulate occasionally or not at all (anovulation). Irregular cycles usually reflect anovulation (no ovulation) or indeed infrequent ovulation. Amenorrhoea (no periods at all) is usually an indication of anovulation. Irregular ovulation and indeed anovulation usually means that pregnancy is more difficult to achieve. In most women with PCOS, some form of treatment to re-establish predictable ovulation is necessary for achieving fertility.
It has recently been found that a percentage of women with PCOS ovulate predictably. These women are, nevertheless, insulin resistant and require medical attention for the metabolic impact of PCOS.
Hair and Skin Problems
Androgen (male hormone) is produced by normal ovaries, albeit in small amounts. In PCOS the production of androgen, such as testosterone, is increased resulting in hair growth in a male type pattern, sometimes excessive, as well as production of facial spots and acne.
The assessment of excessive hair growth (or hirsutism) can be difficult. There are wide racial and ethnic variations in normal hair distribution and growth as much as there are differences according to the complexion of a person, between blondes and brunettes. What is important is to recognize the progression of hair growth on the face, lower abdomen and upper thighs and its spread to areas where no growth had been noticed in the past.
Disordered sleep
There is a very strong correlation between the severity of insulin resistance and sleep abnormalities, which are quite common in women with PCOS. These abnormalities of sleep are independent of snoring, which tends to afflict larger women. Both types of sleep disorders improve with low glycemic eating and weight loss.
As a result of disordered sleep, women with PCOS do not feel refreshed by a ”good” night’s sleep. Disordered sleep also contributes to sleepiness in the early afternoon and impairment in concentration and memory, all of which are improved by the management program.