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PCOS Revealed: Understanding the signs and symptoms

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Understanding PCOS and getting a clear diagnosis is half the battle. Many women and even their doctors remain perplexed by thy syndrome’s constellation of signs and symptoms, leaving women without a clear path forward. PCOS is not just a missing period and acne; it can actually lead to serious health consequences if left untreated. Women with PCOS are at an increased risk of developing heart disease, diabetes, and even cancer. Getting a clear diagnosis is the first step. 

Let’s dive into understanding just how PCOS can impact your hormones and your health to ensure you get a clear diagnosis.

For a diagnosis, we look to the Rotterdam criteria. To be diagnosed, a woman must have two of the three criteria met. The Rotterdam criteria are oligomenorrhea or anovulation, hyperandrogenism, and finally, polycystic ovaries found on ultrasound. Below you can read more about each of these criteria. 

“Insulin resistance is often an important factor for women with PCOS but is not part of the diagnosis and not present in all women.~ Dr. Guan” 

Anovulation- or in plain terms, means not ovulating. Oligomenorrhea means infrequent menses. 

Women with PCOS will often experience longer periods of time between menses, such as 45 days cycle or even three months or longer without a period. They could also have regular cycles every 28 days but not be ovulating every month. 

Without regular bleeds, women can develop a build-up of the uterine lining and then have very heavy periods. Bleeding regularly is protective and very important for the health of the uterus. Without ovulation, there will be no progesterone production. Progesterone is absolutely necessary to help buffer the growth-promoting properties of estrogen.

Hyperandrogenism– is responsible for many of the unwanted symptoms of PCOS that women experience externally such as, thinning hair, hair growing in unwanted areas, oily skin and scalp, and deep cystic acne.

Due to hormonal imbalances, sometimes women will have testosterone in the normal range but still, experience these symptoms. When testing, your doctor may check your testosterone levels but may not look at all the androgens (DHEA, DHEA-S dihydrotestosterone, and androstenedione), only giving you half the picture. We love androgens for women’s health for things such as libido, muscle mass, and fertility, but too much can cause a lot of issues, especially anovulation. 

Polycystic ovaries

I can’t tell you how many times I’ve heard, “I don’t have cysts on my ovaries, so I don’t have PCOS.” Remember, you only have to have two of the three criteria for a diagnosis, and not all women will have cysts. Plus, PCOS cysts are not your average run of the mill ovarian cysts. Rather, they are tiny follicles that have failed to fully develop and be ovulated; they are referred to not so lovingly as a “string of pearls” on an ultrasound finding. 

These are the three criteria- if you think this is something you’re experiencing, track your symptoms, and bring a copy of the Rotterdam Criteria to your provider and discuss a possible PCOS diagnosis. Once you know, you can get on track to address the root causes of PCOS and restoring your hormonal system back into balance. 

Finally, I’d add one more thing to consider, and that is the hormone Insulin. One of the driving forces for women with PCOS is insulin and glucose issues. For PCOS treatment, you’ll often hear of metformin, exercise, and low carbohydrate diets, all of these are aimed at getting Insulin and glucose into a tight range. Elevated Insulin can lead to elevated androgens and then suppress ovulation. You can ask your provider to test your fasting insulin and glucose to see if this might be an issue for you. I recommend my clients to aim for insulin levels under 6 and glucose between 75-85 fasting. Some other signs of elevated Insulin include the following

  • Resistances to weight loss
  • Brain fog, weakness, and increased hunger, and elevated blood sugar
  • Abdominal weight gain and waist larger than 35 inches. 
  • Fasting blood sugar above 100 ng/dL
  • High triglycerides, LDL, and possibly blood pressure. 

PCOS can look very different for different women, which can make getting a clear diagnosis difficult. It can be helpful for you and your provider to track your cycle and your symptoms. Bring the data to your provider and get a diagnosis so you can start working towards prevention. 

In part two of this series, we’ll dive into important testing options and lifestyle factors you can begin to use to help bring you into a state of hormone optimization and thriving, so you feel at your best even in the midst of PCOS.

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