PCOS (Polycystic ovary syndrome) is a syndrome which means that it is a set of symptoms and not a disease. PCOS is caused by elevated levels of androgens (male hormones) in women and in most (but not all) cases results in cysts in the ovaries. PCOS is one of the most common hormonal problems in women which is why it is important to understand how these hormonal changes affect us.
PCOS & Hormones: What changes?
Typically, the hypothalamus in the brain makes the hormone GnRH (Gonadotropin-releasing hormone). GnRH stimulates the pituitary gland to release 2 hormones – FSH (Follicle-Stimulating Hormone) and LH (Luteinizing Hormone), which travel in the bloodstream to the ovaries. As the name suggests, FSH stimulates the growth of the follicles so that hundreds of eggs start to mature. As the eggs mature, the follicles release estrogen, which is the main female sex hormone. When the amount of estrogen in the blood reaches a certain level, the pituitary gland sends a surge of LH to the ovaries. This causes the most mature follicle to open and release the egg within it aka ovulation. The egg then travels down the fallopian tube to the uterus and if it is not fertilized, it will be shed and the woman will have her normal menstrual period.
In the case of PCOS, there is a problem right at the start of this entire process (1) due to the abnormal release of the GnRH hormone by the hypothalamus. This results in a disruption in the release of the FSH and LH hormones, so that LH increases and FSH decreases. The decrease in FSH impairs the maturation process of the follicles and instead of maturing, they turn into fluid-filled sacs called cysts. This means that no mature egg is released and ovulation does not occur.
How PCOS Hormonal Changes Affect You
- Irregular or no periods
Insulin resistance and PCOS are closely linked; in fact, 50%–70% of women (2) with this condition also have insulin resistance. If you have insulin resistance, it means that the cells in your body fail to utilize the insulin in your blood which leads to elevated insulin levels. This excess insulin along with the increased level of LH triggers and maintains high levels of androgens – the male hormones. These hormones interfere with the menstrual cycle which results in irregular or no periods (amenorrhea). It is important to note that insulin resistance impairs glucose uptake, which increases your risk of pre-diabetes and type-2 diabetes.
- Hirsutism or excessive hair growth
Hirsutism is the excess male-pattern hair growth on a woman’s face, chest, and back. PCOS is the most common cause (3) of hirsutism as it accounts for 75% of all cases. The increase in body hair growth is caused by the increased levels of testosterone.
- Weight gain
Insulin is required to convert carbs into energy within the cells of your body. Since PCOS is linked to insulin resistance, it means that the cells in your body do not utilize the glucose from your blood. When this happens, your body stores this glucose as fat, which causes weight gain and obesity.
- Difficulty getting pregnant
The fluctuating levels of hormones described above results in failure to ovulate or irregular ovulation. Since there is no egg to fertilize, you are unable to get pregnant.
- Depression and anxiety
It’s important to note that PCOS affect physical, mental, and emotional health. While scientists are unable to pinpoint specific PCOS hormonal changes that affect mental health, studies show that approximately 40 % of women with PCOS (4) suffer from depression. Stress and anxiety are also common mental health issues, especially in younger women. Furthermore, PCOS symptoms such as hirsutism and weight gain can negatively affect self-image and confidence. It is important to understand how PCOS affects your mental health as conditions such as depression, anxiety and stress will affect your relationship with others and with yourself.
Treatment for PCOS generally includes combination birth control pills containing estrogen and progestin to decrease androgen production and regulate your menstrual cycle. Your doctor may also recommend drugs such as Letrozole or Gonadotropin injections to help you ovulate. Keep in mind that these medications change the various hormone levels in your body and can cause serious side-effects.
Roland, Alison V, and Suzanne M Moenter. “Reproductive neuroendocrine dysfunction in polycystic ovary syndrome: insight from animal models.” Frontiers in neuroendocrinology vol. 35,4 (2014): 494-511. doi:10.1016/j.yfrne.2014.04.002
Sirmans, Susan M, and Kristen A Pate. “Epidemiology, diagnosis, and management of polycystic ovary syndrome.” Clinical epidemiology vol. 6 1-13. 18 Dec. 2013, doi:10.2147/CLEP.S37559
Hafsi, Wissem, and Talel Badri. “Hirsutism.” U.S. National Library of Medicine, StatPearls Publishing, 7 Jan. 2020, www.ncbi.nlm.nih.gov/books/NBK470417/
Sadeeqa, Saleha et al. “Polycystic Ovarian Syndrome-Related Depression in Adolescent Girls: A Review.” Journal of pharmacy & bioallied sciences vol. 10,2 (2018): 55-59. doi:10.4103/JPBS.JPBS_1_18