Polycystic Ovary Syndrome (PCOS) is one of the more common hormonal disorders seen in women of reproductive age, nevertheless has a complex and misunderstood condition.
When myths and misunderstandings about PCOS start to circulate, it can result in trepidation, misdiagnosis, and unnecessary worry. By clarifying misunderstandings we can enhance awareness around the reality of PCOS, the impact on health and well-being, and ways to manage it effectively.
Myth 1: PCOS Always Implies Cysts In The Ovaries
One of the largest fallacies is the idea that PCOS inherently implies cysts in the ovaries. Indeed, the term ‘cysts’ is something of a misnomer. Those minute fluid-filled structures seen so commonly by ultrasound actually represent not cysts at all, but rather non-ovulated immature follicles. Moreover, not every woman with PCOS will exhibit this finding at ultrasound. Recent diagnostic criteria, for instance, those from Rotterdam consensus or from NIH, emphasise a combination of dysfunction of ovulation, symptoms of hyperandrogenism, and polycystic ovarian morphology. Exclusion of all diagnostic consideration based upon ultrasound alone can provoke over-diagnosis as much as under-diagnosis.
Myth 2: PCOS Is Only A Reproductive Issue
While PCOS is typically discussed in reference to irregular menstrual cycles and infertility, it is so much more than a gynecologic disorder. It is indeed a systemic metabolic disease with systemic significance. PCOS is also related to a heightened risk of insulin resistance, type 2 diabetes mellitus, dyslipidemia, and non-alcoholic fatty liver disease. Cardiovascular risk is also heightened, for which long-term follow-up is thus of paramount importance. PCOS is also connected with psychological issues, including anxiety, depression, and body image concerns. Treatment thus needs to go beyond menstrual cycle regulation and infertility to metabolic and mental health.
Myth 3: Only Overweight Or Obese Women Get PCOS
Another frequent misconception is that PCOS can only be found in overweight women. While overweight can worsen symptoms and comorbidities, PCOS is also found in women with normal BMI. Thin PCOS, as it is called, particularly in Asian women, has the same disturbances in hormones, including hyperandrogenism and insulin resistance. Thus, clinicians must be careful and not rule out PCOS in women of normal BMI.
Myth 4: Irregular Menstrual Cycles Always Mean PCOS
Irregular or absent menstrual periods are generally considered to be diagnostic of PCOS, although the symptom alone is not diagnostic. Nearly all of the conditions below can cause suppression of menstrual regularity: thyroid dysfunction, hyperprolactinemia, eating disorders, and stress. Some patients with PCOS may experience regular menstrual cycles despite extra features of the disorder. Systematic workup with biochemical and metabolic testing is therefore appropriate.
Myth 5: Women With PCOS Cannot Be Pregnant
PCOS is the leading cause of infertility, yet it is not necessarily that pregnancy is unattainable. Of course, many women with PCOS do become pregnant, although later. Fertility outcomes are excellent by making lifestyle modifications, medical treatment, or assisted reproduction. Counselling must be reassuring to women that PCOS is manageable and not necessarily a lifetime barrier to pregnancy.
Dr. Jatin Kumar Majhi is Associate Consultant Endocrinology at Manipal Hospital, Bhubaneswar