Polycystic Ovarian Syndrome (PCOS) is a prevalent but often misunderstood condition that affects millions of women worldwide. It is commonly associated with irregular menstrual cycles, excessive hair growth, and obesity, although not always, making this condition often difficult to diagnose. From hormonal imbalances to fertility issues, PCOS manifests in a variety of ways, each influencing different aspects of a woman’s health. Understanding how PCOS affects your well-being is essential for managing the condition and improving your overall quality of life.

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a very common cause of abnormal menstruation. It can become apparent as early as puberty and is characterized by irregular or absent menstrual cycles often accompanied by coarse midline hair growth on the face, chest, abdomen, and buttocks resulting from excess production of androgens (“Male” hormones) from the ovaries and adrenal glands. It is also often associated with insulin resistance and an increased risk of developing metabolic syndrome (High blood pressure, high cholesterol, and diabetes).

According to the World Health Organization (WHO), PCOS affects an estimated 8-13% of reproductive-age women with 70% of affected women going undiagnosed worldwide. It is the most common cause of ovulatory dysfunction and is a leading cause of infertility.

Physical Symptoms and Health Risks

Irregular Menstrual Cycles

PCOS is the most common cause of irregular or absent periods and is a common cause of infertility. Menstrual irregularity reflects underlying ovulatory dysfunction, meaning that eggs are not ovulated in a regular and consistent pattern, making conception more difficult. Abnormal menstrual cycles also impact the health of the cells that line the uterine cavity. When menstrual cycles and ovulation are absent, the lining of the uterus becomes vulnerable to cellular “overgrowth”, which when prolonged, can lead to a precancerous condition. Dysfunctional ovulation also negatively affects bone health due to the absence of cyclic estrogen production.   

Excess Hair Growth and Skin Changes

Hirsutism is excessive hair growth on the face, chest, abdomen, and back and is another common symptom of PCOS. This occurs due to elevated androgens (“male” hormones) due to overproduction in the ovary and adrenal glands. In addition to hirsutism, women with PCOS may also experience acne, oily skin, and even scalp thinning. 

Weight Gain and Insulin Resistance

Insulin resistance is also commonly seen with PCOS, where there is a “resistance” to the effects of insulin in driving glucose out of the bloodstream into the cells of the tissues to be used as fuel. When glucose is not being utilized by the cells and tissues, it is instead stored as fat. This leads to higher levels of insulin in the bloodstream to control blood glucose levels and can be associated with weight gain and greater difficulty with weight loss efforts. When insulin resistance is prolonged and severe, there is an increased risk of developing omen metabolic syndrome, a condition characterized by high blood pressure, high cholesterol, and type 2 diabetes.

Fertility Issues

PCOS is a leading cause of infertility. The irregular ovulation associated with PCOS makes it more difficult for women to get pregnant. While some women with PCOS may still ovulate sporadically, others may experience anovulation (lack of ovulation), making conception challenging. Fortunately, fertility treatments such as ovulation induction medication can help women with PCOS achieve pregnancy.

How PCOS Affects Athletic Performance

For women who are athletes or active individuals, PCOS can have specific implications for physical performance. The hormonal imbalances associated with PCOS may affect endurance, strength, and recovery. Some studies suggest that women with PCOS may have an advantage in strength-based sports due to higher testosterone levels, while others may experience reduced cardiovascular performance. Study in this area is sparse, but interest is growing given the high prevalence of PCOS in the female population. 

The presence of insulin resistance also complicates fueling strategies for athletes. Women with PCOS may need to adjust their carbohydrate intake or focus on fat-based fuels to optimize energy levels during training. Maintaining energy balance is critical, as low energy availability (LEA) can worsen menstrual irregularities and overall health. Again, there is a high level of variation in the manifestations of PCOS from woman to woman and athlete to athlete where more study is needed so that we may coach and counsel women appropriately

The answers to these questions are not straightforward as there is a wide spectrum of degrees of insulin resistance (if any) in these athletes, differences in the types of sports that these athletes engage in, and body type (ectomorph, endomorph, mesomorph). But as with many areas of women’s endocrinology, an individualized approach will best help athletic women with PCOS achieve their health and performance goals. 

Managing PCOS and Improving Quality of Life

While PCOS can present significant challenges, there are effective strategies for managing this condition and improving quality of life. Treatment options vary depending on the severity of the condition and the symptoms experienced.

Lifestyle Modifications

For women with insulin resistance or obesity, lifestyle changes such as adopting a low-glycemic diet and increasing physical activity can help regulate menstrual cycles and reduce the risk of metabolic syndrome. Even lean women with PCOS may benefit from a tailored fitness and nutrition plan to manage insulin sensitivity and improve lipid profiles.

Medical Treatments

Oral contraceptives (OCPs) are often prescribed to regulate menstrual cycles, manage symptoms like acne and excessive hair growth, and protect the bones and uterine lining from the negative effects of dysfunctional or absent ovulation. For women struggling with fertility, ovulation induction medications can help increase ovulatory efficiency and increase the chances of conception. In addition, insulin-sensitizing agents are also commonly used to improve glucose control and regulate menstrual cycles.

PCOS is a complex condition that affects many aspects of a woman’s health, from menstrual cycles and fertility to metabolic function. While this condition can present challenges, lifestyle modifications, and medical treatment as necessary can help women manage their symptoms and improve their quality of life. If you’re struggling with PCOS, it’s important to consult with a healthcare provider who can help guide you through a personalized treatment plan. Dr. Carla DiGirolamo can offer expert advice on managing PCOS and ensuring that your body and mind are supported through this condition.