The symptoms of PCOS vary among women based on their age. Younger women may experience irregular, light, or missed menstrual periods along with mood swings, while older women may suffer from metabolic disorders such as weight gain and insulin resistance. The severity of the symptoms also varies according to individual health. Some common signs and symptoms of polycystic ovarian syndrome (PCOS) include:

• Hair growth: Most women affected by PCOS experience excessive hair growth on their face and body due to excess male hormone androgen. This condition, known as hirsutism, can occur on the face, belly, back, and chest.
• Acne: Increased androgen levels can lead to oil breakouts, resulting in oily skin and acne on the face and upper body.
• Skin darkening: Women with PCOS may experience acanthosis nigricans, characterized by patches of thick, dark, and velvety skin, particularly in skin folds and creases such as the neck, under the breast, and in the groin area due to insulin resistance.
• Weight gain: A sudden increase in weight is a common symptom of PCOS. Insulin resistance raises levels of male hormones called androgens, which can lead to weight gain.
• Headache: Hormonal imbalances may cause headaches and a feeling of heaviness in the head, although it can be difficult to determine if a headache is specifically caused by PCOS.
• Irregular menstrual cycle: Women with PCOS may ovulate only occasionally, leading to irregular or missed menstrual periods. The lack of ovulation makes polycystic ovary syndrome one of the most common causes of infertility in women.
• Sleeping disorders: Women with PCOS may experience sleep disturbances, such as feeling excessively sleepy during the day, difficulty falling asleep at night, or waking frequently during the night.
• Mood swings: Hormonal imbalances can lead to sudden mood changes, including episodes of irritability or depression.
• Fatigue: PCOS can result in low energy levels and a general feeling of tiredness, often accompanied by pain in the calves and arms at night.
• Pelvic pain: This less common symptom is attributed to the presence of cysts in the ovaries, causing dull or sharp pain in the lower abdominal area that often comes and goes.
• Infertility: Prolonged lack of ovulation can lead to difficulties in becoming pregnant, resulting in infertility.

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The exact causes of PCOS are not known yet. However, hormonal imbalances are considered the most potential cause of this medical condition. The following are some of the probable causes of PCOS that have been proposed as major factors resulting in the occurrence of PCOS in women after puberty.

1. Hormonal imbalance

   Hormonal imbalance is considered one of the most probable causes of PCOS. Women suffering from the following hormonal imbalances may experience PCOS during their reproductive age:

   • Increased prolactin levels: Prolactin is the hormone that stimulates the production of milk in the breast glands. Increased prolactin levels may cause PCOS.
   • Increased testosterone levels: Testosterone is a male hormone that is usually present in small quantities in women. Higher levels of testosterone in women may result in PCOS.
   • Increased luteinizing hormone (LH) levels: Luteinizing hormones stimulate ovulation; their presence in increased amounts may cause heavy bleeding and irregular menstrual periods.
   • Decreased sex hormone-binding globulin (SHBG) levels: SHBG is a protein that binds testosterone in blood to reduce its effect. The presence of SHBG in decreased amounts may result in an increased concentration of testosterone in women.
2. Genes

   It is believed that PCOS may pass from one generation to another, as this condition has been observed among women with a family history of the disease. Researchers have not yet identified the exact genes that cause PCOS. However, the role of genes is considered one of its potential causes.

3. Inflammation

   Inflammation is a normal phenomenon of the body’s immune system to fight infections by producing white blood cells. It has been observed that women suffering from PCOS have low-grade inflammation in their bodies, causing polycystic ovaries to produce excessive amounts of the male hormone. However, the link between inflammation and PCOS has not been established concretely yet.

Several factors can increase your risk of having PCOS. Some notable factors that elevate your risk for this medical condition include:

• Family history of PCOS: You may have a higher risk of developing PCOS if your sister, mother, or grandmother had it. A woman is more likely to have PCOS if her mother or sister suffers from the same condition. However, the severity of this medical condition can vary among individuals.
• High stress levels: Psychological stress is another factor that increases the risk of developing PCOS. It is often observed that women with PCOS also experience depression, anxiety, and frequent mood swings.
• Higher insulin levels: Elevated levels of insulin in the body can increase the risk of PCOS. Higher insulin levels may stimulate the increased production of androgens in the body.
• Obesity: Women who are obese or overweight are more likely to suffer from PCOS. Obesity can cause hormonal imbalances, and managing weight can lower the risk of PCOS complications.
• Use of birth control pills: The use of contraceptive pills can increase the risk of developing bilateral polycystic ovaries due to altered hormonal activities in the body. This condition may involve infrequent, irregular, or prolonged menstrual cycles. Women who previously had no issues may experience some PCOS symptoms after discontinuing the contraceptive pill.
• Endocrine disrupting chemicals: PCOS may be related to or exacerbated by exposure to endocrine disrupting chemicals such as bisphenol A (BPA) and certain phthalates.

Polycystic ovary syndrome is one of the common causes of infertility and pelvic pain in women. It can also trigger diabetes if left untreated. If you are experiencing specific symptoms such as irregular or missed periods, frequent mood changes, or abnormal hair growth on your face or upper body, consult a doctor to determine whether you are suffering from PCOS. Your doctor may ask you to undergo the Polycystic ovarian disease panel, which includes the following tests to ascertain the presence of the medical condition.

• Fasting glucose level: A blood sample is collected after overnight fasting. A result of less than 100 mg/dL is considered normal, whereas results between 100 and 125 mg/dL indicate prediabetes, and a level of 126 mg/dL or more shows diabetes. Women with PCOS are prone to high glucose levels.
• Insulin fasting: This test measures the level of insulin in the body to diagnose insulin resistance. It also requires overnight fasting before sample collection. A typical insulin level ranges from 2.6 to 24.9 mcIU/mL. Insulin resistance is common in women with PCOS.
• Luteinizing hormone (LH): This test measures the amount of luteinizing hormone in the blood to assess the normalcy of the menstrual cycle. The amount of luteinizing hormone increases with ovulation. Higher levels may indicate PCOS.
• Testosterone total: This test determines the testosterone level in the blood, which is the primary sex hormone in males. Elevated testosterone levels may indicate the presence of PCOS.
• Thyroid-stimulating hormone (TSH): This blood test measures TSH levels. PCOS is associated with a high incidence of hypothyroidism or low thyroid levels.
• Follicle-stimulating hormone (FSH): This test measures FSH levels in the blood, which play a significant role in regulating menstruation and the growth of eggs in women. In women with PCOS, FSH levels may be lower than normal.

Other tests

• Gynecologic ultrasonography: This imaging test specifically looks for small ovarian follicles. According to the Rotterdam criteria, which are widely used for diagnosis, 12 or more small follicles should be seen in an ovary on ultrasound examination. Recent research suggests that there should be at least 25 follicles in an ovary to designate it as having polycystic ovarian morphology (PCOM) in women aged 18–35 years.
• Laparoscopic examination: This may reveal a thickened, smooth, pearl-white outer surface of the ovary. This finding is usually incidental if laparoscopy is performed for another reason, as it is not routine to examine the ovaries in this manner to confirm a diagnosis of PCOS.

Following are a few tips and tricks which can help you prevent and manage PCOS.

1. Make healthy changes to your diet

A nutritious and healthy diet helps you manage PCOS symptoms and complications. The right diet changes help you regularize your menstrual cycle and mitigate abrupt mood changes by maintaining your hormonal levels. Following diet changes can assist you with PCOS issues.

• Add anti-inflammatory foods: To keep inflammation in check, increase the intake of anti-inflammatory foods such as tomatoes, leafy greens, olive oil, and tree nuts.
• Increase your iron intake: Some women experience heavy bleeding while battling PCOS, leading to a lack of iron in the body and causing anemia. It is essential to boost your iron intake with iron-rich foods like eggs, spinach, beans, seafood, peas, and dried fruits.
• Balance carbohydrates and proteins: The right amounts of carbohydrates and proteins can help stimulate insulin production. To manage PCOS symptoms, balance low carbohydrates with high protein intake to optimize energy and hormone levels.
• Add whole foods: Whole foods are unprocessed and free from added sugars and preservatives. Incorporate whole foods like fruits, nuts, legumes, and green vegetables into your diet to maintain hormone and sugar levels.
• Increase fiber intake: Fiber-rich foods aid digestion and help regulate metabolism. To avoid PCOS symptoms, include fiber-rich foods like nuts, bananas, yogurt, broccoli, sprouts, and avocados.
• Reduce caffeine consumption: Caffeine can affect hormonal activities in your body. Substitute caffeine intake with herbal tea, green tea, or lemon-ginger water.

2. Maintain a healthy weight

The right body mass index (BMI) helps regulate insulin levels and the menstrual cycle. Aim to maintain a healthy weight for relief from PCOS symptoms. However, avoid excessive workouts, as they can hinder hormonal functions. Gentle exercises such as Pilates, yoga, light aerobics, and swimming are recommended.

3. Have at least 8 hours of sleep

Your sleep routine significantly affects your stress and energy levels, as well as your hormones. Aim for 8-9 hours of sleep each day. Establishing a regular sleep routine can be beneficial. Consider going to bed with a light stomach to promote sound sleep.

4. Avoid stress

Stress negatively impacts your health, especially if you are suffering from polycystic ovarian disease. It adversely affects hormonal balance and mental state. To manage stress, practice meditation, yoga, or take walks. Additionally, ensure adequate sleep and reduce coffee consumption. Joining social support groups can also help manage stress.

PCOS treatment depends on various factors such as symptoms, medical family history, other health conditions, and whether you want to get pregnant. While PCOS cannot be cured, it can be managed through medications and lifestyle changes.

1. Weight Control and Healthy Diet

Before initiating hormonal birth control, doctors often recommend dietary and lifestyle changes to improve overall health. These changes can help maintain healthy glucose levels and a healthy weight, which in turn aids in regulating menstruation.

2. Medications to Regulate Ovulation

Pharmacological treatments are indicated for issues such as anovulation, hirsutism, and menstrual irregularities. First-line medical therapy typically involves an oral contraceptive to induce regular menses. If symptoms like hirsutism are not adequately managed, an androgen-blocking agent may be added. For ovulation induction when fertility is desired, letrozole or clomiphene is commonly used. Medications used in the management of PCOS symptoms include:

• Hormonal birth control pills such as etonogestrel, ethinyl estradiol, and medroxyprogesterone acetate
• Antiandrogens or androgen-blocking medications like spironolactone, leuprolide, and finasteride
• Selective estrogen receptor modulators such as clomiphene citrate
• Topical hair-removal agents like eflornithine
• Topical acne agents including benzoyl peroxide, tretinoin, adapalene, erythromycin, clindamycin, and sodium sulfacetamide
• Hypoglycemic agents like metformin and insulin, with other similar drugs such as repaglinide, canagliflozin, and dapagliflozin

3. Ovarian Drilling

This surgical procedure stimulates ovulation by removing ovarian tissues that produce the male hormone androgen in females. It is recommended for women who do not ovulate despite weight reduction and attempts at fertility treatments.

4. Supplements

Certain supplements, such as inositol, are often prescribed to enhance ovarian function and regulate menstrual cycles, facilitating conception. Inositol is a vitamin-like substance found in citrus fruits, beans, brown rice, and wheat bran. Omega-3 supplements are also advised to lower the risk of inflammatory diseases and depression. Chromium supplements may be prescribed to help reduce blood sugar levels and enhance insulin sensitivity.

Home-care For Polycystic Ovarian Syndrome (PCOS)

PCOS is a complex health condition that requires immediate attention and comprehensive care. It is possible to take care of your loved one suffering from PCOS at home with the following do's and don'ts.

Do's

• Exercise at least three times a week to manage weight.
• Ensure adequate sleep, aiming for 8-10 hours each night and going to bed early.
• Enhance your diet with fruits, leafy vegetables, whole grains, iron-rich foods, fiber, and anti-inflammatory options like cucumber and yogurt.
• Practice meditation for at least 20 minutes daily to reduce stress levels.
• Incorporate antioxidants such as nuts and avocados into your diet.
• Increase the intake of low-fat dairy products.

Don'ts

• Avoid smoking.
• Refrain from consuming alcohol.
• Limit processed food intake.
• Reduce carbohydrate consumption.
• Avoid stress.

• Infertility: A medical condition of the reproductive system that affects a woman's chances of getting pregnant.
• Miscarriage: A sudden loss of pregnancy before the 20th week, causing both physical and emotional distress.
• Premature childbirth: Childbirth occurring before the 37th week of pregnancy, potentially resulting in a child with immature vital organs such as lungs and heart.
• Type 2 diabetes: A chronic condition where the body either does not produce insulin or becomes insulin resistant.
• Dyslipidemia: Disorders of lipid metabolism that may be common in women with PCOS who are insulin resistant.
• Heart diseases: Common conditions include high blood pressure, heart failure, coronary artery disease, heart valve disease, and arrhythmia.
• Depression and anxiety: Common mental health conditions characterized by a loss of joy.
• Endometrial cancer: A type of cancer affecting the lining of the uterus (womb) in females.
• Abnormal uterine bleeding: Irregular and heavy bleeding between and/or during menstrual periods.
• Stroke: PCOS is associated with a significantly higher risk for stroke, a condition where the blood supply to the brain is disrupted.
• Sleep apnea: Patients with PCOS are at a higher risk of developing sleep apnea, characterized by pauses in breathing during sleep that can occur multiple times throughout the night.
• Non-alcoholic fatty liver disease: This condition can be observed in women with PCOS, particularly if they are obese.

Home remedies for PCOS

Following are some of the home remedies which you can try for treating PCOS:

• Fenugreek (Methi): Fenugreek can help reduce cyst size and regulate menstrual cycles in females. You can consume fenugreek by boiling it in water and straining its grains. Additionally, you can add methi leaves to your vegetables or parathas.
• Cinnamon (Dalchini): Cinnamon is known for regulating menstrual irregularities. You can take cinnamon powder with a spoon of honey or mix it with lukewarm water.
• Flax seeds (Alsi): These small seeds are high in fiber, protein, and omega-3 fatty acids. Consuming flax seeds helps reduce testosterone levels in the body.
• Cumin seeds (Jeera): Jeera is an Indian spice that acts as an excellent antioxidant and helps manage blood glucose levels in the body.
• Green tea: Rich in antioxidants, green tea helps relax hormone levels in the body and is known to be effective for PCOS symptoms.
• Apple cider vinegar: It helps manage PCOS symptoms by regulating insulin levels in the body. You can mix one teaspoon of apple cider vinegar in lukewarm water and consume it on an empty stomach. It also aids in weight loss and control.

Yoga for PCOS

Symptoms of bilateral polycystic ovaries can also be treated with the help of the following yoga asanas:

• Garland pose (Malasana): This pose helps strengthen the pelvic and abdominal muscles.
• Bridge pose (Setu Bandhasana): This pose helps reduce stress levels and anxiety, contributing to PCOS management.
• Bow pose (Dhanurasana): This pose helps relieve pelvic pain and menstrual discomfort by stimulating normal menstrual flow.
• Cat-Cow pose (Chakravakasana): This pose helps relieve muscle pain.

Living with PCOS is not easy. The abrupt mood swings, fatigue, and physiological distress further add to the agony caused by hormonal and menstrual disturbances. However, its effects can be managed and reduced with simple lifestyle changes if you are experiencing mild PCOS symptoms. It includes:

• Eat a filling breakfast: Breakfast is the first meal of the day, and it must be a good one so that you can keep yourself energized throughout the day.
• Substitute cups of coffee with green tea: Today, green tea is available in a wide array of flavors to meet the different taste preferences of individuals. Choose your favorite flavor and start substituting your high caffeine consumption with it.
• Supplement your food with curd, yogurt, and probiotics: These dairy products are rich in fiber, which eases your digestion process and enhances the number of good bacteria in your gut.
• Go for a morning walk: You can begin by walking for 15 minutes and then gradually increase it to 30 minutes or an hour. If a morning walk is not possible, try going for short walks after meals. Alternatively, you can also start running on a treadmill.
• Get a hobby: Hobbies are one of the finest and most effective ways of keeping yourself happy and in a good mood. You can sing, dance, or join a sport of your choice.
• Join a support group: This is where you can meet others suffering from the same condition. Sharing your experiences with them will provide emotional support.

If you have been suffering from polycystic ovaries for a long time and have not experienced any improvement in the condition, it would be prudent to consult a doctor and seek professional advice to get some relief from the physical and emotional discomfort.

Long-term PCOS affects the psychological health of women, too. It increases the risk of depression, anxiety, bipolar disorder, and obsessive-compulsive disorder. It is, therefore, essential to follow a personalized mental healthcare program that will help women deal with their psychological issues and lead a healthy life. They could consult a psychiatrist who may prescribe antidepressants or anti-anxiety medications to control their anxiety symptoms. Alternatively, they could try therapies such as acupuncture, yoga, mindfulness techniques, guided relaxation techniques, and breathing exercises that help control the mind and reduce symptoms of anxiety and depression.