Often times, the skin can be a window to what is happening in your body. For women with polycystic ovarian syndrome or PCOS, it can mean acne, hair loss, excessive hair growth on the face or body, dark spots on the skin, or a combination of these problems.
What is PCOS?
Skin and hair problems can be the most easily noticeable features of PCOS, and therefore sometimes the reason for seeking medical care. However, characteristics of PCOS also include menstrual irregularities, polycystic ovaries (when the ovaries develop multiple small follicles and don’t release eggs regularly), obesity, and insulin resistance (when cells don’t respond well to insulin).
The cause of PCOS is not fully understood, but scientific evidence points to hormonal imbalances, particularly excess testosterone (also known as hyperandrogenism) and insulin resistance. PCOS is the leading cause of infertility in women. The hormonal imbalances in PCOS interfere with ovulation and pregnancy is impossible without ovulation. PCOS exists on a spectrum, which means that not every woman with PCOS will have the same signs and symptoms. Due to the different characteristics of this syndrome, diagnosis can be difficult.
How do I know if I have PCOS?
There is no specific test that can be used to diagnose PCOS. Therefore, careful and thorough work-up is required, including laboratory testing and imaging. Laboratory tests typically include measuring levels of various hormones, such as androgens. Imaging tests may include ultrasound of the ovaries. The diagnosis can be made by an experienced team, including general practitioners, gynecologists, endocrinologists, and dermatologists.
What are the skin manifestations of PCOS?
PCOS-related acne is common in the lower area, including the jaw, chin, and upper neck. While this is not a hard and fast rule, these areas are considered a hormonal pattern for acne. Women with PCOS may find that acne lesions are deeper, larger, and slower to resolve. Acne in PCOS usually worsens around the time of menstruation. Dermatologists often recommend using oral contraceptive pills or a drug called spironolactone to treat this type of acne. These treatments can be very helpful in the proper management of acne when used in the right patients for whom there are no contraindications.
Hirsutism, or excessive hair growth in areas where there is normally no or minimal hair, is another dermatological sign of PCOS. Common areas of hirsutism are the chin, neck, abdomen, chest, or back. However, baldness or thinning of the hair can be seen on the scalp. Both hair problems are caused by excess testosterone.
Occasionally, another skin condition called acanthosis nigricans will occur. These are dark, velvety areas of skin, usually in folds of skin such as the neck and forearms. This type of skin condition is also linked to insulin resistance and can result from insulin stimulating skin cells, causing them to overgrow.
Treatment options and a tailored approach
While there is no cure for PCOS, there are many treatment options available to treat various symptoms of this syndrome. The type of treatments will depend on a woman’s priorities and symptoms. For example, a healthy weight can lead to an improvement in symptoms, so lifestyle changes related to diet and exercise can be helpful. Hirsutism can be treated with laser hair removal or electrolysis. Some patients may try birth control pills to improve menstrual regularity. Metformin, a commonly used drug for diabetes, can be used to improve the body’s response to insulin.
Treatment planning is tailored to each person and depends on whether or not pregnancy is a short-term goal. Certain medications, including spironolactone and retinoids for acne, should be avoided when a woman is trying to get pregnant.