This is the 2nd post in my series on PCOS. Here’s the link for Part 1.
Most women with PCOS, Poly Cystic Ovarian Syndrome, see a health care provider for a few common reasons. Either they aren’t having periods, their periods come infrequently, or they have heavy bleeding.
We used to think that the biggest issue with PCOS was the multiple cysts within each ovary, which prevented ovulation, normal periods and caused infertility. We now know that PCOS is a complicated endocrine condition with multiple challenges for women.
If you’ve just been diagnosed, let me first say that it’s completely normal to feel completely overwhelmed right now. I’ll try to provide you with the same information that I give my patients so that you can be your healthiest.
This is what PCOS looks like with an ultrasound.
Notice that there are many small black areas within the ovary. Each of these black appearing areas are cysts that are filled with fluid. It’s not unusual to see 10 – 12 cysts on each side. Each month more cysts begin as others regress.
Most women do not feel these cysts. These cysts are usually small and rare burst causing pain.
Poly = Many. There are many cysts within the ovary.
These cysts are not producing the hormones estrogen and progesterone in the same way that women who don’t have PCOS do. There’s an imbalance in hormones that leads to:
- Irregular or absent menstrual periods from lack of ovulation, known as anovulation
- More acne and hair growth
- Difficulty losing weight
Irregular menstrual periods
In order to understand what happens with PCOS, let’s briefly review what happens in a typical menstrual cycle.
This is a simplified version of the cycle.
- When a woman starts her period, the ovary is also active.
- Several follicles, which are where the eggs develop begin to grow under the influence of FSH (follicle stimulating hormone)
- These follicles produce the hormone Estrogen
- One of the follicles really grows fast, producing the most Estrogen and it becomes known as the dominant follicle, which will ultimately release the egg
- This high level of Estrogen triggers the release of LH (luteinizing hormone)
- About midway through the cycle, there is a surge in LH which causes the egg to be released about 24-36 hours later
- Having only 1 dominant follicle prevents multiple eggs from being released, and
- The follicle is now known as the corpus luteum and it produces Progesterone.
- As the corpus luteum decreases in size, the levels of Estrogen and Progesterone also decrease dramatically.
- The drop in hormone levels trigger a menstrual period and the cycle begins again.
The Quickest Explanation
FSH ––> Estrogen ––> LH ––> Ovulation ––> Progesterone
What Happens With PCOS?
For women with PCOS, there are complex biochemical imbalances within the ovary that:
- Prevent the ovary from making one dominant follicle with the highest level of Estrogen
- Without one dominant follicle, there is no LH surge
- With everything is out of balance, the LH levels don’t surge, but they are much higher than the FSH levels
- No surge in LH means no ovulation and little Progesterone secretion
- There are multiple cysts all secreting Estrogen, without a balance in progesterone
- Without progesterone to balance the estrogen, the uterine lining may grow an unstable lining, which often leads to irregular, heavy and prolonged bleeding
Meanwhile, other hormones are being produced
- In the ovary and elsewhere in the body, some of the excess Estrogen is converted to more androgenic (male-type) hormones such as DHEA, DHEAS, and Testosterone
- This conversion of hormones into androgenic ones leads to more hair growth and acne
Women with PCOS are understandably challenged with added hair growth, more acne and irregular periods. We’ll cover the treatments for those and other issues in other posts.