The Biology of PCOS: Simplified

Polycystic Ovarian Syndrome is the commonest hormonal imbalance in women across the world. 

Although the name suggests the presence of cysts in ovaries of all those affected, this is simply not true. The syndrome causes a cluster of symptoms and any affected person may have none, one or more symptoms in any combination. 

The syndrome mainly does three things, which have a complex cause-effect relationship with the other:

1) Resistance of cells to the effect of the hormone Insulin, which causes disturbance of digestion of sugars. This in turn can cause diabetes and storage of eaten sugars as fat. Insulin resistance contributes to acne, weight gain and other symptoms.

2) Excessive production of male hormones or androgens in the female body, which is exaggerated in the presence of excess fat, especially around the abdomen. The presence of excess amounts of male hormones causes unwanted facial and body hair, acne and hair loss from the scalp.

3) The disturbance of hormone profiles is in turn associated with a disruption of the normal menstrual cycle. The usual process of ovulation is interrupted, causing anovulatory cycles, which further changes the pattern of secretion of male and female hormones in the body. 

Problems in conception, irregularities of timing, heavy painful periods and cramps may or may not be seen in these anovulatory cycles. 

Keeping the above in mind, some experts opine that 'Anovulatory Androgen Excess' is a better terminology than PCOS for this condition. Research shows that despite the common occurrence of the syndrome, up to fifty percent of women with PCOS are not aware of their diagnosis. Thus it is imperative to work towards creating an increased awareness of the symptoms, as well as acceptance of the diagnosis and instillation of hope in women exasperated by these seemingly disconnected and vague symptoms. 

PCOS is a challenge that can easily be vanquished with appropriate lifestyle modification and treatment. To this end, PCOS Initiative aims to work towards providing support and education about this condition, to help women take charge of their own well-being, and overcome the impact of PCOS on their lives. We choose to focus on the cosmetic changes of PCOS, namely the changes in skin, hair and body weight, which can the affect the self-esteem of affected women and in some cases also their personal and professional lives. 

What Causes PCOS:

The exact cause of PCOS remains a subject of research. A number of factors have been identified which influence the appearance and course of the condition.

Image: Teede et Al, BMC Medicine 2010

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Image: Rotstein, Srinivasan and Won

Not all patients with PCOS would have evidence of cysts in the ovaries on ultrasound, just as not all of them would have all the skin/hair/fertility/weight/period related symptoms of PCOS.

Where do the androgens come from?

Androgens or male hormones are produced in the ovaries, due to a disturbance in ovulation.

Image: utendocrinology.com

Image: Hector F, Escobar-Morreale

Image: Implementdesignism.org

What is Insulin Resistance?

Insulin is a hormone produced by the pancreas in our body. Insulin Resistance means that the tissues of an individual are resistant to the action of insulin. The major action of insulin is to digest glucose or sugar. Thus, simply put, Insulin Resistance means that a person is unable to digest sugar properly, leading to various symptoms, and storage of sugar as fat.

Image: singhealth.com