It doesn’t involve scary cysts
PCOS occurs when a woman has a lot of resting follicles (fluid collections that hold eggs), but doesn’t actually ovulate. Typically, one of those follicles releases an egg from the ovary during ovulation, but this doesn’t happen with polycystic ovaries. “Most women have 10 to 15 total resting follicles on ultrasound, but women with polycystic ovary (ovarian) syndrome may have 10 to 20 on both ovaries – 20 to 40 or more total,” says reproductive endocrinologist, Dr Lora Shahine. Dr Shahine also says that some patients wrongly associate cysts with disease, but women have ‘cysts’ every cycle – it becomes an issue when the number of follicles are extremely high.
It isn’t easily diagnosed
Polycystic ovary syndrome is very common, but not easily diagnosed. Providers use the Rotterdam criteria, meaning patients must have two out of three symptoms: irregular menstrual cycles from irregular ovulation, excess androgen activity, and polycystic ovaries. Often, the combination of symptoms goes unnoticed because patients speak with separate doctors about these issues individually, causing an information gap. For example, you might see a dermatologist for acne, but not think to talk to your gynaecologist about it.
Doctors don’t know what causes it
According to the American College of Gynaecologists and Obstetricians (ACOG), the cause of polycystic ovary syndrome is not known, but it may be related to many different factors working together. In addition to an irregular menstrual cycle and increased levels of androgens that interfere with ovulation, another factor may be insulin resistance. Up to 80 per cent of women with the syndrome are obese, and insulin resistance (a problem with how food is converted to energy) is also common in people with obesity. Insulin resistance may increase androgens; but it’s still unclear exactly how all the factors are connected.