Could your missing period be due to PCOS?
If you have consistently been skipping periods or you have 40+ day cycles you might have polycystic ovarian syndrome (PCOS). PCOS is just one condition that can explain regularly missed periods and these irregular periods can make it hard for you to become pregnant.
What is PCOS?
PCOS is a collection of symptoms that includes missed periods and you don’t need to have cysts on your ovaries to be diagnosed with this condition. The official diagnosis includes 2 of the 3 symptoms outlined below:
Many months with skipped periods or longer than normal cycles
Increased androgen hormones (typically seen by testing total testosterone and/or DHEA sulfate levels)
Many cysts on your ovaries seen with a pelvic ultrasound
What causes PCOS?
No one knows the exact cause of PCOS, but women with PCOS usually have complications with the breakdown of androgen hormones (testosterone and DHEA) and abnormal estrogen hormones. Women with PCOS can also have issues with their blood sugar and insulin hormone.
First a couple of terms that I will be discussing a lot:
Ovarian follicle: fluid-filled sac that contains an immature egg
Luteinizing hormone (LH): a hormone produced by the pituitary gland in your brain
that triggers ovulation
Follicular stimulating hormone (FSH): the hormone that is responsible for the growth of ovarian follicles
Hormonal causes:
What is thought to happen is that LH activity is high leading to overreaction of the ovarian cells that produce androgen hormones. And because there is too much LH activity compared to FSH less androgen hormones are being converted to estrogens. Estrogen is one hormone needed to stimulate ovulation, so without enough ovulation sometimes doesn’t occur and you need ovulation to happen if you want to become pregnant. Complicated and tricky!
Insulin and blood sugar:
Making things worse, your blood sugar can become involved and affect hormones. Excess weight can also cause hormonal changes because it worsens insulin resistance. Insulin helps to take sugar out of your blood stream, essentially with insulin resistance, insulin has worked so hard at this same task day in and day out that it becomes resentful and says, “hey, I am sick and tired of cleaning up extra sugar from your blood stream and I quit!”. This elevated insulin and blood sugar can lead to higher levels of those androgen hormones that will stop ovulation. Some women can have insulin and blood sugar issues and be at a normal weight and have issues with fertility at the same time. Again, complicated and tricky.
Adrenal gland and PCOS:
Elevated insulin can also affect your adrenal glands. Adrenal glands sit on top of your kidneys and are responsible for a number of things - blood pressure, stress management, and hormone production. The elevated insulin can cause your adrenal glands to make more androgen hormones. These androgens are made into a type of estrogen in fatty tissue, which causes production of higher amounts of LH and the LH triggers ovarian androgen production. So, in PCOS, not only do we have increased production of these androgen hormones from the ovaries, but now from the adrenal glands too.
How is PCOS diagnosed?
As discussed above, you need to have 2 of the 3 symptoms in order to have the diagnosis of PCOS - missed periods, cysts on your ovaries, and elevated androgen hormones which is most reliably tested via bloodwork. If someone comes to see me with irregular and missed periods then we start with blood work to see if she has elevated androgen hormones. If I have a patient who is having a hard time getting pregnant, but she is having regular periods then we will do blood work to check for elevated androgen hormones and the vaginal/pelvic ultrasound to check for multiple cysts on the ovaries.
I also include screening to rule out other conditions that can mimic PCOS, like underactive thyroid function, too much prolactin hormone, and overactive stress hormone production.
Associated conditions:
Diabetes and heart disease
Women with diagnosed PCOS are more at risk for developing high blood pressure and diabetes because of the related blood sugar and insulin issues. It is important that PCOS is treated and well managed in order to prevent these issues from developing and becoming a serious concern.
Infertility
Many of the women that I diagnose with PCOS come to see me because they are trying to get pregnant. Some of these women are having regular periods, but not ovulating because of the hormonal changes associated with PCOS and other women are having difficulty timing intercourse because their periods are so irregular because of the PCOS.
So, where your period at?
Part II of this PCOS series will cover a variety of treatments from prescription medications to natural treatments (my favorite!). And Part III will share some of the cases of PCOS that I have worked with, so stay tuned!
References
https://emedicine.medscape.com/article/256806-overview#a4
Tricky, Ruth 2003 Women, Hormones, and the Menstrual Cycle. Allen and Unwin, Australia.
