What exactly is PCOS?

Polycystic ovary syndrome ( PCOS ) is a common but still poorly understood condition. It is often confused with other gynecological disorders and frequently associated with infertility, although the reality is somewhat more complex.

According to the World Health Organization (WHO), 6 to 13% of women of reproductive age suffer from PCOS : that's almost one in ten women! It's extremely important to talk about it, not only to destigmatize the condition but also to encourage all women to take control of their health.

The biggest problem with PCOS is that it is still largely underdiagnosed. According to the WHO, 70% of affected women are still undiagnosed and therefore suffer the effects of polycystic ovary syndrome on their daily lives.

We explain how to detect it and how to treat it!

PCOS: definition and diagnosis

Understanding PCOS

Let's start by clearly defining PCOS to begin on the right foot. Polycystic ovary syndrome is a hormonal disorder with very real physical and psychological consequences .

The first thing to know is that PCOS is rather misnamed. In fact, if you have an ultrasound of a woman with PCOS, you can see about ten small lumps around her ovaries . While they may look like cysts, they are not! They are actually immature follicles that have stopped developing .

PCOS was unfortunately named before it was known that it wasn't caused by cysts . And despite the insistence of doctors and research groups, the condition hasn't been renamed since…

If you don't have PCOS, the pituitary gland (located in the brain) stimulates the production of FSH and then LH to regulate your menstrual cycle . These hormones stimulate the production and maturation of follicles . The largest follicle is released at the time of ovulation .

In PCOS, several follicles begin to mature, but none takes the lead or is sufficiently developed to become an egg. As the cycles progress, these immature follicles accumulate in the ovaries. These are the ones that can be seen on ultrasound.

The thing is, these famous follicles secrete hormones continuously , which causes a whole host of symptoms and completely disrupts the menstrual cycle.

PCOS: How is it diagnosed?

Health authorities (including Inserm ) have agreed on the diagnostic criteria for PCOS. A woman is considered to have this syndrome if she presents at least two of the three criteria below, known as the Rotterdam criteria :

• Hyperandrogenism : an excessive presence of so-called "male" hormones, androgens (such as testosterone), linked to hormonal imbalance. This hyperandrogenism can be observed physically through the presence of masculine characteristics (body hair, acne, alopecia), through blood tests, or both.

• Observation of immature follicles in the ovaries.

• Ovulation disorders with irregular menstrual cycles : cycles are erratic, difficult to track, and some are even anovulatory. Amenorrhea is defined as the absence of menstruation for three months.

Living with PCOS on a daily basis

The physical symptoms of PCOS

Beyond irregular menstrual cycles, PCOS is also known for its particularly difficult-to-live-with physical symptoms . These include:

• The hyperandrogenism we mentioned earlier. This overproduction of male hormones leads to physical changes such as the appearance of hair on the lower face (hirsutism) or hair loss (alopecia).

• Metabolic syndrome with localized fat accumulation in the abdominal area.

• A risk of type 2 diabetes is partly responsible for the weight gain. More than 60% of women with PCOS are overweight and have great difficulty regulating this metabolic consequence.

• Indirectly, PCOS is therefore also responsible for a greater exposure to the risk of high blood pressure and cardiovascular disease .

PCOS is indeed a gynecological condition, but with a global impact that extends beyond the intimate sphere . This is where we realize the power of our hormones over our entire system. PCOS or not, it's in our best interest to take care of them.

PCOS and fertility: answers to your questions

What is the impact of PCOS on fertility?

Before answering this question, we want to clearly define the concept of fertility. Infertility and sterility are often confused or used interchangeably, even though they are not the same thing.

1. Sterility is the total inability to spontaneously conceive a child.

2. Infertility is the difficulty a woman (or couple) experiences in conceiving spontaneously. Infertility is diagnosed when a couple has been trying to conceive naturally for at least 12 months without success.

PCOS is indeed the leading cause of female infertility . But while many women suffer from it, it's not always the case! The menstrual cycle is irregular, some cycles are anovulatory and therefore offer no possibility of fertilization.

In addition to cycle and ovulation problems, PCOS symptoms don't really help promote pregnancy … For example, fecundability is reduced by 8 to 18% in women with weight problems.

Similarly, hormonal imbalances completely destabilize libido and all the wonderful mechanisms that allow you to enjoy your sexuality: arousal, lubrication, pleasure…

While you're often advised to pay attention to your body's signals to better understand your cycle , this is much more difficult with PCOS. The body doesn't really follow a set pattern ; it does what it can!

However, if you do not wish to become pregnant, remember to use protection ! Just because you have PCOS does not mean you are infertile; you can still conceive naturally.

The impact of PCOS on mental health

It is impossible to talk about PCOS without mentioning its consequences on mental health.

On the one hand, high androgen levels increase the risk of anxiety and decrease your stress resistance. On the other hand, the appearance of masculine characteristics significantly undermines self-esteem . Body hair growth, hair loss, acne, and weight gain are all symptoms that are difficult for a woman to cope with.

Current beauty standards completely contradict this representation. Women with PCOS often feel powerless in the face of these symptoms; they no longer understand their bodies, no longer feel desirable or desired. Some even decide to disengage from their sexuality…

“The way others see you can be a source of stress for women with PCOS. Many report withdrawing into themselves, avoiding social interactions for fear of judgment. This tendency can lead to isolation, further exacerbating anxiety and depression. ” The Psychological Impact of PCOS, PCOS Association

In their review “ The psychosocial impact of polycystic ovary syndrome ”, Virginie Simon and Maëliss Peigné remind us that women with PCOS are more exposed to the risk of depression , from the onset of the first symptoms.

How to manage PCOS?

Drug solutions

Currently, there is no specific treatment for PCOS , primarily because researchers have not yet identified the causes of this condition. Several avenues are being explored, including the possibility of a genetic syndrome , but no definitive conclusions have been reached.

However, doctors offer symptomatic and tailored care to allow all affected women to regain their quality of life.

• Anti-androgen treatment helps to alleviate the manifestations of hyper-androgenism but is often accompanied by some undesirable side effects.

• Insulin therapy is indicated for women who suffer from type 2 diabetes.

If you are experiencing difficulties conceiving, your healthcare provider will guide you towards an assisted reproductive technology (ART) program. ( Assisted Reproductive Technology ). There are many solutions to explore: ovarian stimulation, IVF , or ovarian drilling can be considered in the case of PCOS. Talk to your medical team and your partner!

Surround yourself with a trusted team

Multidisciplinary support is essential if you are affected by PCOS. We know it's not fair, but you need to rethink your lifestyle to alleviate the most bothersome symptoms of the syndrome. Your diet and exercise, in particular, play a key role in supporting your body and regulating your endocrine system .

• Regarding diet, the recommendations are fairly standard. Avoid highly processed foods and saturated fats as much as possible. Opt for natural products rich in nutrients and minerals.

• Physical activity is essential, not only to limit weight gain, but also to reduce insulin resistance and release endorphins: that hormone so precious for your mental health. Isn't it said that a jog is worth 10 orgasms? (No, we don't say that, no).

Multidisciplinary support allows you to benefit from the guidance of a psychologist, a sexologist , an endocrinologist, dietary support… Don’t stay alone and don’t be ashamed to talk about your symptoms .

We're reminding you because it's crucial: one in ten women is affected by PCOS. There are concrete solutions to help you regain your mobility, independence, and the intimacy you deserve. Take care of yourself.