Polycystic Ovary Syndrome: Symptoms, Diagnosis, and Treatment

Polycystic Ovary Syndrome (PCOS)

Hello Doctor, I am 22 years old.
I got my first period at the age of 12, and my menstrual flow typically lasts about 3-4 days with a normal amount, neither too heavy nor too light.
Since I started menstruating, I have been gaining weight; initially, it was a gradual increase of about 4-5 kilograms per year.
I once consulted a traditional Chinese medicine practitioner to help with my condition.
The practitioner suggested that my continuous weight gain and the growth of hair on my abdomen might be due to polycystic ovary syndrome (PCOS), but I still needed to get checked at a hospital.
However, I did not pay much attention to it afterward.
In recent years, my weight gain has accelerated dramatically, reaching about 10 kilograms per year.
I currently weigh 76 kilograms (I was 80 kilograms but lost some weight by not eating).
Additionally, I have suddenly developed severe acne on my face (I hardly had any acne before graduating high school, but it started after I began gaining weight; this shouldn't be just puberty, right?).
Over the past few months, my menstrual blood flow has decreased significantly, and I have been experiencing blood clots.
I have even noticed fine hair growing on my chest, and I can see pores on my chest and abdomen, which is quite frightening! After researching PCOS online, I found that my symptoms seem similar, including weight gain, acne, and hirsutism.
I also read that some people say treatment can wait until one wants to conceive.
Do I need to see a gynecologist for examination and treatment? If I undergo treatment, is it possible for me to lose weight? Will the hair on my chest and the pores disappear, or are they permanent? Additionally, I am planning to visit a weight loss clinic soon; will this conflict with the treatment for PCOS? Thank you, Doctor, for taking the time to read and respond.

Xiao Fei, 20~29 year old female. Ask Date: 2015/06/16

Dr. Zhong Wenzhen reply Obstetrics and Gynecology

Your description is generally in line with your intuition; a definitive diagnosis should be made by a physician, and the treatment plan should also be arranged by a doctor.
It is advisable to start by consulting an obstetrician-gynecologist for treatment options.

Reply Date: 2015/06/16

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age. It is characterized by a combination of symptoms that can include irregular menstrual cycles, excess androgen levels (which can lead to symptoms such as acne, hirsutism, and hair thinning), and polycystic ovaries visible on ultrasound. Understanding PCOS is crucial for managing its symptoms and improving overall health.

Symptoms of PCOS
The symptoms of PCOS can vary widely among individuals, but common signs include:
1. Irregular Menstrual Cycles: Women with PCOS may experience infrequent, irregular, or prolonged menstrual cycles. This can lead to challenges in ovulation and fertility.

2. Excess Androgens: Elevated levels of male hormones can result in physical symptoms such as:
- Hirsutism: Excessive hair growth in areas where men typically grow hair, such as the face, chest, and back.

- Acne: Increased oil production can lead to breakouts, particularly on the face and back.

- Scalp Hair Thinning: Some women may experience thinning hair on the scalp, similar to male-pattern baldness.

3. Weight Gain: Many women with PCOS struggle with weight gain or obesity, which can exacerbate other symptoms and lead to metabolic issues.

4. Skin Changes: Dark patches of skin (acanthosis nigricans) may develop, particularly in areas such as the neck, armpits, and groin.

5. Fertility Issues: PCOS is one of the leading causes of infertility in women due to irregular ovulation.

Diagnosis of PCOS
To diagnose PCOS, healthcare providers typically consider the following criteria, often referred to as the Rotterdam criteria:
1. Irregular Ovulation: This can be assessed through menstrual history or hormone testing.

2. Excess Androgens: This can be confirmed through blood tests measuring hormone levels, particularly testosterone and other androgens.

3. Polycystic Ovaries: An ultrasound may reveal enlarged ovaries with multiple small cysts.

A healthcare provider may also conduct a physical examination and take a detailed medical history to rule out other conditions that may mimic PCOS.

Treatment Options
While there is currently no cure for PCOS, various treatment options can help manage symptoms:
1. Lifestyle Changes: Weight management through diet and exercise is often the first line of treatment. Even a modest weight loss of 5-10% can help regulate menstrual cycles and improve insulin sensitivity.

2. Medications:
- Hormonal Birth Control: Oral contraceptives can help regulate menstrual cycles, reduce acne, and manage hirsutism.

- Anti-androgens: Medications like spironolactone can help reduce hair growth and acne.

- Insulin Sensitizers: Metformin is often prescribed to help manage insulin resistance, which is common in women with PCOS.

3. Fertility Treatments: If pregnancy is desired, treatments may include ovulation induction medications or assisted reproductive technologies.

Addressing Your Concerns
Given your symptoms of weight gain, acne, irregular menstrual cycles, and hirsutism, it is advisable to consult a gynecologist or an endocrinologist for a thorough evaluation. They can perform the necessary tests to confirm a diagnosis of PCOS and discuss appropriate treatment options tailored to your needs.

Regarding your concerns about weight loss and hirsutism, many women with PCOS find that weight loss can significantly improve their symptoms, including menstrual regularity and skin issues. However, the hair growth that has already occurred may not completely reverse, but treatments like laser hair removal can help manage it.

Visiting a weight loss clinic can complement your PCOS treatment, as lifestyle changes are crucial in managing the syndrome. It is essential to communicate your PCOS diagnosis to the weight loss clinic so they can tailor their approach to your specific needs.

In summary, PCOS is a manageable condition, and with the right support and treatment, you can improve your symptoms and overall quality of life.

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