As you probably know, PCOS is the shortened version of the much more medical sounding Polycystic Ovary Syndrome. In general, PCOS is characterized by hormone imbalance leading to irregular or absence of periods, hair growth on face, chest, and back and fertility issues, among other things. 

Millions of women around the world live PCOS at any one time, with some estimates at a whopping 13% of the female population of the globe. So, it’s fair to say it’s a common condition among people who menstruate. 

The name actually refers to the fluid-filled sacs that can develop on your ovaries, although you don’t technically need to have those cysts to be diagnosed with PCOS. But because symptoms can be varied and not the same for everyone, getting a diagnosis can be difficult. 

Generally speaking, you need to have be living with two of the following three symptoms, as well as having had any other possible cause ruled  out, before a PCOS diagnosis can be reached. 

• Irregular periods, or no periods at all
  
  
• Higher levels of Androgens like Testosterone, either through blood tests, or discussion of symptoms.
• Cysts on your ovaries, shown via scan, although you may not need a scan for a diagnosis

Despite the high instance of PCOS in women, little is known about the cause. There may be a genetic component, as you’re more likely to develop PCOS if your mom also had it. But the prevailing theory is that hormone imbalance plays a huge role.

While definite causes for PCOS can be hard to pin down, there are a couple of hormones that may be more than a little responsible. The first is Testosterone, but not necessarily because you produce more of it. 

PCOS can affect Estrogen production, which usually helps regulate and keep Testosterone doing it’s job. But that means even a typical Testosterone level can suddenly feel far too high when Estrogen falls or stays low thanks to PCOS. 

Relatively Testosterone high levels can lead to hirsuitism, the male-pattern hair growth people with PCOS often see. But it can also play a role in infertility. 

The second hormone we need to talk about is Insulin. Because Insulin is also a hormone, and a crucial one at that. 

Essentially, it help regulate your blood sugar levels, as well as how well you use the energy from sugar. Too much sugar in your diet can lead to Insulin resistance, which means you need more of it to work, but it doesn’t work as well. 

That can lead to, among other things, type 2 diabetes. But for reasons no one can really understand, higher Insulin levels, coupled with Insulin resistance, can also impair your menstrual cycle and, therefore, your fertility. And insulin resistance is found in the majority of people with PCOS.

First and foremost, PCOS can affect your menstrual cycle, so you’ll likely have irregular periods, or you may not have periods. And that’s happening in part because you’re ovulating less frequently, or possibly not at all.

Infertility affects most women with PCOS because if you’re not ovulating, you cannot conceive. So what’s going on here? Well, if you do have ovarian cysts, it’s possible they’re eggs that didn’t develop properly, and were never released or discarded. 

And that’s an issue because your Ovaries, and specifically the follicles that grow your eggs, produce most of your Estrogen. 

In a typical cycle, Estrogen levels rise during the first half, in response to rising FSH levels. Several follicles start to grow, and over the course of the phase, one egg becomes dominant and will grow to maturity, while the others die back. 

Estrogen, FSH and LH peak around Ovulation, before dropping. Estrogen then briefly rises again post-Ovulation, before dropping a second time in the run-up to your period. 

With PCOS, the follicles may not develop properly, or eggs may not be released, which can mean the hormonal fluctuations that keep you cycle moving simply don’t happen. And that makes conception difficult. 

But the good news is that it can be temporary.

Most importantly, if you think you’re living with PCOS but have yet to receive a diagnosis, it’s a good idea to talk to your doctor. They can help you rule out any underlying issues as well advise on treatment options. There’s currently no cure for PCOS, but there are several therapies that’ll help reduce symptoms and may improve fertility outcomes. 

Treatments range from Ovulation-stimulating medications and IVF, to hormonal birth control, topical cream to help stop male-pattern hair growth and surgery to remove ovarian cysts. But remember, as with all things hormones, there’s no one treatment that works for everyone.

If, though, you’ve already been diagnosed with PCOS – and even if you haven’t – there are some things you can do alongside treatment that can help improve hormone and overall health. 

As you’ve likely bee told, looking after yourself is crucial. Menstrual cycles and hormones are easily upset at the best of times, and fatigue, stress, extreme exercise or dietary restrictions can exacerbate things. 

So first and foremost, improve your diet and sleep quality. Opt for lots of fiber, fresh fruit and veg, lean protein and dark leafy greens where possible. Stay hydrated, get some gentle exercise as often as you can, and sleep as much as you need to. 

Also, make sure you’re talking to someone. PCOS journeys can be stressful, and it’s important that you’re expressing how you feel. Find someone you’re comfortable with and let them know what’s going on with you. And please remember that you are not alone.