Debunking PCOS myths: fact or fiction?
Photo by Siobhan Calder
Polycystic ovary syndrome (PCOS) is a complex and often misunderstood condition. While it's relatively common, impacting between 10-13% (1), there are many myths and misconceptions surrounding PCOS.
Let’s debunk some of the most prevalent myths...
all women with pcos have ovarian cysts
Fiction. PCOS is often associated with ovarian “cysts”. These are actually follicles, which are underdeveloped fluid-filled sacs in which the eggs develop. These can be detected on an ultrasound scan, where Poly Cystic Ovaries (PCO) are determined if slightly enlarged ovaries or a certain number of follicles are detected per ovary. However, not everyone with PCOS develops these fluid-filled sacs on their ovaries. PCOS is defined by a combination of symptoms, including irregular periods, hormonal imbalances, and other metabolic issues. So, while “cysts” can be a part of the picture, they are not a universal feature of PCOS.
It's important to recognise that PCOS is a multifaceted condition with a wide range of presentations. Some individuals may have cysts, while others do not. Understanding this diversity is crucial for accurate diagnosis and effective management.
2. An irregular menstrual cycle means you have PCOS
Fiction. Firstly, what is an irregular menstrual cycle?
Irregular cycles can be expected in the the first year after you start menstruating (menarche), so anything <90 days for any 1 cycle is seen as ‘normal’.
1-3 years post-menarche <21 or >45 days are seen as irregular.
3 years post-menarch to peri-menopause <21 days or >35 days, or <8 cycles/year are defined as irregular cycles (1).
Whilst it's true that irregular periods are a common symptom of PCOS, they are not exclusive to this condition. Many factors can lead to menstrual irregularities, including stress, lifestyle, thyroid conditions, and other underlying health issues. PCOS involves more than just irregular cycles; it encompasses hormonal imbalances and metabolic changes.If you're experiencing irregular periods, it's essential to consult with a healthcare professional for a thorough evaluation. PCOS is diagnosed based on a combination of symptoms and medical tests, not just menstrual irregularities.
3. PCOS only impacts reproductive health
Fiction. While PCOS can certainly affect reproductive health, its impact goes far beyond fertility. PCOS is associated with a range of symptoms and potential health complications. These can include insulin resistance, weight gain, acne, hirsutism (excess hair growth), and mood disturbances.
In fact, a 2023 research paper highlighted the need to strengthen the recognition of broader features of PCOS including metabolic risk factors, cardiovascular disease risk, sleep apnea, and high prevalence of psychological features such as depression and anxiety in those experiencing PCOS (1). Understanding that PCOS is a systemic condition is crucial. Managing PCOS involves addressing not only fertility concerns but also overall health and well-being.
But the positive news is that although PCOS is considered a lifelong diagnosis, the progress and consequences of PCOS are seen as largely modifiable with lifestyle, diet patterns, and the targeted selection of supportive supplements (2).
4. pcos can be diagnosed with ultrasound alone
Fiction. Ultrasound can be a useful tool, a transvaginal ultrasound is considered the most accurate to assess for PCO, however transabdominal ultrasounds may also be used. In patients with irregular menstrual cycles and hyperandrogenism, an ultrasound isn’t necessary to make a PCOS diagnosis.
Remember, polycystic ovaries do not need to be present to make a diagnosis (myth 1) and the finding of polycystic ovaries does not alone establish the diagnosis (3). Relying solely on ultrasound without considering other factors can lead to misdiagnosis.
5. All PCOS is driven by insulin-resistance
Fiction. Insulin resistance is a common feature of PCOS impacting 65-70% of those with PCOS (4), but it's not the sole driver of the condition. PCOS is a heterogeneous condition, meaning it can manifest differently in different individuals. While insulin resistance plays a significant role in some cases, other factors like hormonal imbalances, post-pill, and genetic predisposition also contribute. It is also important to know that fasting insulin and glucose levels, as well as calculations based on these markers are said to not be sensitive and specific for the diagnosis of insulin resistance. A study found there was no data to support treating all women with PCOS with metformin on the assumption they are insulin-resistant (5). Ask your Dr about these aspects and truly understand if insulin-resistance is a feature of your PCOS.
Understanding the complexity of PCOS is essential for personalised diagnosis and treatment. Not all individuals with PCOS will have the same underlying factors at play. I always work to uncover my clients unique key drivers, as this is what can really help you to support and manage your PCOS.
Photo by Siobhan Calder
In conclusion, PCOS is a multifaceted condition that defies simple categorisation. Debunking these myths helps shed light on the true nature of PCOS, allowing for more accurate diagnoses and personalised care. If you suspect you have PCOS or have been diagnosed with it, feel free to book in a free discovery call with me as the first step toward effective management and improved wellbeing.
I truly believe that knowledge is power, and by dispelling these myths, we can empower individuals to take control of their health and navigate their PCOS journey with confidence.