What is PCOS and Who can it affect?
What is PCOS?
The medical definition for PCOS says that it’s a complex chronic endocrine condition defined by a group of signs & symptoms such as irregular periods, extreme mood swings, hirsutism (excessive hair growth on your face & body), weight gain, trouble gaining weight (a.k.a, Lean PCOS), fertility issues, hair loss ( alopecia) , chronic fatigue, acne, low libido. These are symptoms that may indicate one has PCOS and one must see a gynecologist to confirm their diagnosis.
Since PCOS affects our endocrine function i.e., the glands & organs that make & release the crucial hormones in our bodies that means PCOS is not just a problem of our ovaries or reproductive health, it could affect our gut health, oral health, cardiovascular health, our mental health, bone health, skin & hair, fertility & even our sexual health. PCOS can affect our entire body because our endocrine system literally coordinates our body's metabolism, growth, development, moods, energy levels, reproduction, gut health, and response to stress
PCOS can affect each of us differently and interestingly the symptoms might change as we grow older. If you have PCOS you could notice some or many of the below symptoms
Irregular periods or missing periods
Cystic Acne (especially around the jaw line)
Excess facial and body hair
Acanthosis nigricans (darkening of skin behind neck, underarms , groin)
Weight gain (obesity ) / Trouble losing weight ( Lean PCOS)
Alopecia (Scalp hair loss)
Fertility issues (Poor Egg quality, Ovulatory dysfunction)
Sleep disturbances
Chronic fatigue/ Daytime sleepiness
Mental health issues (mood swings, anxiety , depression)
Sleep disorders (Sleep Apnea)
Sexual Dysfunction (Low / high libido, vaginal dryness)
Who can it affect?
Now PCOS can affect any person with a vulva. As per the latest international pcos guidelines 2023 , 1 in 10 percent women worldwide could have PCOS. Sadly, an astonishing 70% of affected women remain undiagnosed!!! PCOS is the most common cause of infertility and anovulation and PCOS can change as we age. This means that PCOS could affect us even after menopause. In fact, post menopause your pcos history can still affect your health – it's unfortunate we don’t talk about it enough!
PCOS diagnosis can be very complicated because of various reasons. The condition itself is a complex condition and can take several tests and blood work to arrive at a conclusion. Unfortunately as much as we'd like it to be, not many health providers are up to date with the latest science related to PCOS. Also, there are high cases of medical gaslighting that PCOS patients experience which makes the diagnosis or treatment delayed or unsatisfactory. As per a survey in 2022, 41% women had to see atleast 3 or more doctors before attaining a PCOS diagnosis and 42% women DID NOT receive any information about the lifestyle change management !!!
We cannot disagree on the fact that PCOS affecting 1 in 10 women across the globe , is still regarded as a stigmatised condition just coz its related to periods and menstrual health and this restricts the access to health care for a lot of women !
Getting the PCOS diagnosis right!
Rotterdam criteria is the most highly accepted criteria used by health practitioners across the globe and suggested by the Latest International PCOS guidelines 2023. The criteria suggests that if you have any two of the mentioned signs or symptoms:
Irregular periods that are between 21 to 35 days or less than 8 period cycles per year
Bulky ovaries more than 10ml in atleast one ovary and/or presence of polycystic ovaries >= atleast 20 follicle in atleast one ovary confirmed via an ultrasound OR elevated anti-mullerian hormone (AMH) levels
Hyperandrogenism (free testosterone, free androgen index or calculated bioavailable testosterone should be used to assess biochemical hyperandrogenism in the diagnosis of PCOS) . DHEAS could be considered if total or free testosterone are not elevated
Also before a diagnosis is made, its important to rule out conditions that may seem like PCOS must be done thyroid disease, hyperprolactinemia (high levels of prolactin). In case of more severe PCOS symptoms, exclusion of Cushing’s disease, or androgen producing tumours is also recommended.
Its important to mention in the light of recent updates, there is no difference between PCOD and PCOS. Infact PCOS is the updated medical term for PCOD.
An important note for PCOS diagnosis in Adolescents
WHO defines Adolescence, as the period between 10 & 19 years of age that includes critical changes in growth, development, and puberty for a young girl. Unfortunately, the PCOS diagnosis during for adolescents could be challenging due to the overlap of normal pubertal features/ changes (such as irregular menstrual cycles, acne & polycystic ovaries on pelvic ultrasound) with the adult PCOS diagnostic criteria.
Hence, there is a high chance that many young girls may end up getting over-diagnosed for PCOS.
The Latest International evidence based PCOS guidelines 2023 suggests that the Pelvic Ultrasound and AMH should NOT be included for PCOS diagnosis in adolescents until 8 years post menarche due to the high incidence of multi-follicular ovaries in this life stage
PCOS could show up differently for each of us and we may experience different set of symptoms, so its highly crucial to see a gynaecologist to confirm your diagnosis. In order to make the most out of your doctor’s appointment, I would highly recommend you note down all of your symptoms before you see your doctor so that you don’t forget them all. Also my podcast episode with Dr Nitu Bajekal explains all the right questions you must ask your doctor .
To know more about ways to reverse your symptoms and manage your PCOS, keep reading and follow me on Instagram, YouTube and my new Podcast PCOS & “You”!
Be #strongerthanpcos !
Nidhi S.
PCOS Coach & Holistic Nutritionist
