Top 5 PCOS Myths

PCOS (or Poly Cystic Ovarian Syndrome) is probably the most common reproductive disorder in women. Around 6 – 20% (that is up to one in 5) of women of reproductive age have this disease.[1] The reason for the huge range of positive cases (of 6 to 20%) depends on how you diagnose PCOS. Having said that, PCOS is associated with a group of symptoms and biochemistry which includes hirsutism, irregular menses, chronic anovulation, and if the disease gets severe, infertility. The biochemistry of these women reveals higher amounts of androgens (male hormones) impaired hypothalamic–pituitary feedback, Luteinising Hormone (LH) hypersecretion, premature granulosa cell luteinization, aberrant oocyte maturation, and premature arrest of activated primary follicles.[2]

Figure 1. The main clinical manifestations of PCOS.[3]

So, with all this known information, why is there so much confusion about PCOS? After all, loads of women suffer from this condition and there has been an explosion of interest in medical studies. We are going to examine the top 5 PCOS myths and try to give reasons why there is so much confusion about PCOS.

Myth 1 - You need to have poly cystic ovaries to have PCOS. It sounds counterintuitive, but you do not need to have cysts on your ovaries to have PCOS. The diagnosis of PCOS is confusing, but most expert guidelines have accepted that diagnosis of PCOS occurs when you meet two out of three criteria, which are 1. chronic anovulation 2. clinical or biological hyperandrogenism, and 3. polycystic ovaries morphology in the absence of any other pathology.[4] This means that if a woman suffers missed ovulation and higher male/androgen hormones, she can be diagnosed with PCOS without cysts on her ovaries.

 

Myth 2 – PCOS is a sex hormonal condition alone. While your hormones are adversely affected when you suffer PCOS, it is likely caused by something else in the first place. One of the key hormones that drive PCOS is insulin, which is why 70% of women with PCOS are insulin resistant.[5] This is why one of the most common medicines today for the treatment of PCOS is a diabetic/insulin sensitising drug (metformin).

 

Myth 3 – PCOS affects your fertility and hormones. Having PCOS leaves you at a much higher risk of developing a wide variety of diseases. Because the disease is common in women, it can not be considered something to just live with or manage. It requires quite significant intervention. Studies show that PCOS increases the risk of a plethora of quite serious diseases including obesity, type II diabetes, heart disease, depression, obstructive sleep apnea certain cancers and non-alcoholic liver disease.[6]

 

Myth 4 – PCOS is a genetic disease. This is only partly true because while there are genes that increase the risk of developing PCOS, environmental influences are much more important when it comes to developing the disease. The most common environmental factors include obesity and insulin resistance and possibly fetal androgen exposure (women that carry babies when they have elevated androgens in their bodies).[7]

 

Myth 5 – There is nothing you can do about it if you are diagnosed with PCOS. There are numerous lifestyle interventions you can do to improve your condition, along with taking all prescribed medication. This is possibly the biggest myth of them all as numerous interventions can help PCOS. The first one is to lose excessive weight. If an overweight woman loses only 7% of her body weight, she will enjoy improved menstrual irregularity along with a reduction in her often-elevated testosterone levels.[8] Going hand in hand with weight loss is exercise and sixty minutes of moderate to vigorous physical activity at least 3 times a week should be encouraged for the prevention of weight gain and maintenance of health in PCOS.[9]

The take home message

PCOS is a disease, which ranges from annoying to downright dangerous. It also has a significant negative impact on a young women's life and may seriously impact their fertility. This can compromise a young women's dream of starting a family, which can lead to serious mental health issues. PCOS also drives conditions such as acne and hirsutism, which negatively affects a woman's appearance further impacting her mental health. If left untreated, PCOS can lead to cardiovascular disease and diabetes which can be devastating for their physical health. The PCOS sufferer needs to follow all medical advice and prescriptions while including lifestyle interventions, and arming themselves with information on PCOS, which will allow the woman to make wise decisions about their treatments.

 

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References

[1] Escobar-Morreale HF. Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nat Rev Endocrinol. 2018;14(5):270–284.

[2] Palomba S, Daolio J, La Sala GB. Oocyte competence in women with polycystic ovary syndrome. Trends Endocrinol Metab. 2017;28(3):186–198.

[3] Rocha AL, Oliveira FR, Azevedo RC et al. Recent advances in the understanding and management of polycystic ovary syndrome [version 1; peer review: 3 approved]. F1000Research 2019, 8(F1000 Faculty Rev):565 (https://doi.org/10.12688/f1000research.15318.1)

[4] Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

[5] Moghetti P. Insulin Resistance and Polycystic Ovary Syndrome. Curr Pharm Des. 2016;22(36):5526-5534. doi: 10.2174/1381612822666160720155855. PMID: 27510482.

[6] Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2022 May 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/

[7] Puttabyatappa M, Padmanabhan V. Ovarian and Extra-Ovarian Mediators in the Development of Polycystic Ovary Syndrome. J Mol Endocrinol. 2018 Oct 16;61(4):R161-R184.

[8] Hoeger K, Davidson K, Kochman L, Cherry T, Kopin L, Guzick DS. The impact of metformin, oral contraceptives, and lifestyle modification on polycystic ovary syndrome in obese adolescent women in two randomized, placebo-controlled clinical trials. J Clin Endocrinol Metab. 2008;93(11):4299–4306.

[9] Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf). 2018;89(3):251–268.