PCOS Explained: Why Periods Become Irregular + Acne & Excess Hair

This episode is a re‑air and the first in my three‑part PCOS summer series. 

I am dropping this episode again, along with the other two episodes on PSCO because I believe that this is such an important topic I do not want anyone to miss it.,

In this episode, I explain why PCOS is called a syndrome and review common symptoms, including irregular or absent periods, heavy bleeding, acne, unwanted facial or body hair, scalp hair thinning, weight gain, and infertility. I walk through how normal ovulation works compared to PCOS, where no dominant follicle develops—leading to multiple small cysts and the classic “string of pearls” appearance on ultrasound (you can watch on YouTube to see the slides and images).

I also connect irregular bleeding to lack of ovulation and progesterone, and explain how excess testosterone—often related to insulin imbalance—contributes to acne, hirsutism, and hair thinning.

In upcoming episodes, I’ll cover weight, long‑term health risks, diagnosis, and treatment options, including fertility support.

You can write to us at Questions@GynoInfo.net

And follow us on Instagram @gynoinfo

Transcript

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Welcome to Gyno Info, Frank Talk with Dr. Burke, the podcast dedicated to teaching everyday women what they need to know about their body and how it works to successfully deal with the healthcare system and communicate with their doctors. Each week I'll provide you with new information and practical tips about gynecology and women's health care. I want to prepare you for your doctor's appointments by teaching you what to expect, what information your doctor will need to know from you, and what questions you will need and should ask her so you can be confident and make the most out of every visit. Gynefo will give you the knowledge you need to take charge of your health and do this in a clear and frank way that you can understand without having a medical degree, one episode at a time. So now let's begin. Hello. Welcome back to Gyno Info. Josh and I decided to slow down our Gyno Info podcast a little bit over the summer and run a new episode only every other week. Then my only sister died at the beginning of July. And as you can imagine, that's happy my strength a whole lot. Grieving is hard work and leaves you exhausted. And I'm not quite ready yet to research a lot of new topics for you right now. So this week we're going to rerun three episodes on PCOS polycystic ovary syndrome that we had produced last February. Each of these three episodes deals with a different problem caused by PCOS, from too much facial hair and acne to insulin resistance and not being able to lose weight to being unable to have children. The good news is that all these issues can nowadays be dealt with quite effectively, and women with PCOS can get better skin, lose weight, and have babies. I strongly suggest that you watch all three episodes and that you do it on YouTube so you can see all the interesting slides, including the one on how polycystic ovaries actually look like on an ultrasound. So here is the second run of the first of my three episodes. Please enjoy it, learn from it, and share it around to all women you know who are suffering or might be suffering from PCOS. Hello. Welcome back to Gyno Info, the podcast about women's health in normal everyday language that normal everyday women can understand. A special welcome to those who just discovered us and are listening for the first time. You will see that this podcast there is You will see that in this podcast there is no doctor speech, the language healthcare providers find useful to communicate with each other, but that they should never use when talking to their patients. Every so often I explain where a medical word comes from, just because I find the roots of words so interesting. Today's medical word is menstruation, period bleeding. This comes from the Latin word menses for month, which only makes sense, because women usually have a period every month, and some even call their periods their monthlies. Not having monthly periods is actually today's topic, because today I'm going to begin talking about PCOS, polycystic ovary syndrome. I'm saying begin talking about because this is such a huge topic affecting about one in ten women. And so there is no way that I can teach you even the basics about PCOS in just one podcast. I think I will end up using about three podcasts by the time I'm through with it. So let's begin now with why it is called a syndrome. A lot of illnesses are defined by one symptom, one main thing that is wrong, with usually a specific but known cause. For example, blood sugar that is too high for sugar diabetes, cells that have gone crazy and no longer follow the rules of normal cells for cancer, inflamed joints, for rheumatism. A syndrome, on the other hand, is a group of symptoms that occur together to make up a specific condition, such as polycystic ovary syndrome, PCOS, or irritable bowel syndrome, IBS. The word syndrome comes from an ancient Greek word meaning running together. So a syndrome is made up not just of one symptom, but of a pattern of several symptoms that usually run and show up together. What causes these signs and symptoms, and especially why they tend to occur together, is often not known, especially at the time that the syndrome is named. The typical symptoms that make up polycystic ovary syndrome PCOS are irregular periods, instead of a period every month, only a few, no more than eight a year. These periods are then often quite heavy. This is called oligomenorrhea. Oligomenorrhea means only a few periods. Or you may not even have any periods at all in polycystic ovaries syndrome, which is called amenorrhea for a nothing, amenorrhea in Dr. Speak. Acne is another symptom, acne often quite severe, not just a couple zits before the start of the monthly period, but severe acne. And then there is growing thick dark hair on the face and on the body, but losing hair from the head. Most of the time, but not always, women with polycystic ovaries are very much overweight. And on top of all that, PCOS is one of the main causes of infertility, of not getting pregnant when one would like to have a baby. I think you are beginning to see why I cannot explain all that in just one podcast. All the symptoms I just talked about that make up polycystic ovary syndrome are caused by a mix-up in how the ovaries, the two egg production centers in a woman's body, are working. This brings us to the name. Poly means many. Cyst means fluid-filled sac. So polycystic ovary syndrome means that the ovaries are filled with many fluid-filled sacs, so-called cysts. When the ovaries are working, they produce only one egg every month, rarely two in the case of twins, but generally just one, as part of the regular four-week-long menstrual cycle that ends up either with a period bleeding or with a pregnancy. This one egg grows inside such a fluid-filled sac, inside a cyst, which doctors call a follicular cyst, or sometimes only a follicle. At the beginning of the cycle, there are actually many such follicles that all start growing together in a kind of a race that only one of them can win. This race makes up the first part of the menstrual cycle. It is called the follicular phase of the cycle and lasts about two weeks. At the beginning, all the follicles grow at roughly the same speed until they are all about the size of a small pea or a wild blueberry. When everything is going right and the ovaries are working correctly, one of these follicles then pulls ahead in the race and becomes the so-called dominant follicle, the one that will win the race and get to be the one that produces the egg for this month. This winning follicle is called also the ovulatory follicle and is about the size now of a cherry tomato. And then this ovulatory follicle pops and the egg jumps out, and that's called ovulation. After the egg is released, it is picked up by the fallopian tubes, the tubes that bring the eggs down to the womb, to the uterus, and somewhere along the way it will run into a sperm, a male seed, that can then fertilize this egg and start a pregnancy. All the other many follicles, the losers in this race, shrivel up and go away. They disappear. Then the next month, another race to become the dominant, the ovulatory follicle starts again. A woman is born with ingredients of little pre-follicles that after puberty will begin to change into follicles and participate in this race every month, from puberty to menopause. Then all the prefollicles that a woman is born with are used up and her eggs production stops. That's why menopause starts. In polycystic ovary syndrome, PCOS, there is no winning follicle. All the follicle race along head to head and fill the ovaries up with many tiny cysts that are all about the same size and never grow larger than the size of a large pea. None of them wins and can produce an egg. That is the reason why women with polycystic ovaries, if it's not treated, cannot get pregnant. It also gives the syndrome its name of polycystic ovaries, ovaries filled with many cysts. In the olden days, these polycystic ovaries were only seen during surgery. But nowadays they can be seen during an ultrasound exam. On ultrasound, they look like little black beads all of the same size and lined up like a necklace and covering both ovaries. They look like black beads because all clear fluid looks black on ultrasound, whether it is a P-filled bladder or a follicle cyst in the ovary. This is often called the string of pearl sign as a sign of polycystic ovaries. Now that you know how PCOS gets its name and how polycystic ovaries look like, I will start my way through the different sign of symptoms that make up the syndrome. Again, that's irregular periods, acne, extrafacial and body hair, loss of hair from the head where you want it, and too much weight, often an infertility. The irregular periods are easy to explain. Only if the ovaries are working correctly. There is a normal ovulation in the middle of the cycle, followed by a regular period two weeks later. In PCOS, the ovaries are not working correctly. There is no regular ovulation every month, and then there will be no regular periods. Here is why that is. The cells in the wall of all the growing follicles make a hormone called estrogen. This estrogen makes the lining of the uterus grow. Growing of tissue is called proliferation in Dr. Speak. This is why the first half of the menstrual cycle, when all these follicles grow, the follicular phase is sometimes also called the proliferative phase, the phase when the uterine lining grows. After ovulation, of all the follicles that have been growing and producing estrogen in their walls, only the empty sac of the winning ovulatory follicle remains. This turns into the so-called corpus luteum and now switches its hormone production to progesterone for the next two weeks. This is why the second half of the menstrual cycle is called the luteal phase of the cycle. The progesterone produced by the corpus luteum makes the uterine lining ready for a fertilized egg to then settle into and grow into a pregnancy. If there is no fertilized egg, progesterone organizes the shedding of the uterine lining, the period. This shedding is the menstrual bleeding at the end of the four-week cycle, which is the sign that the next cycle is about to start. And a whole new set of follicles are beginning their race. In PCOS, there is no ovulation and that there is no progesterone being produced to organize the regular shedding of the uterine lining, and so there are no regular periods. The lining of the uterus just keeps growing for a while and gets thicker and thicker and thicker until eventually it falls apart and is shed as an often quite heavy and unplanned irregular period. The other three PCOS symptoms we have time to talk about today are acne, unwanted growing of thick face and body hair, and the unwanted loss of scalp hair. You grow hair where you don't want it and lose the one you want. All three are mostly caused by too much testosterone. Testosterone is a hormone that is made in the testicles of men, but in smaller amounts also in the woman's ovaries. The main female hormone, estrogen, is produced in the lining of the follicles that we just talked about. And then after ovulation, progesterone is made in the leftover lining that is then turned into the corpus luteum that we also mentioned. Now, testosterone in women is produced in specialized cells that grow around and in between these follicles. With polycystic ovary syndrome, the ovaries are stuffed full of many, many, many poly follicles. Poly means many. Because of that, there is more tissue around and also in between these follicles than in normally functioning smaller ovaries. And because of that, much more testosterone is being produced than is usual for women. This extra testosterone then causes male-type dark and thick body hair to grow in women with PCOS. On the chin, the upper lip, the side burn area, the chest, the arms, the belly, and upper thighs. This extra hair growth is, of course, very distressing and more noticeable the darker your hair is to begin with, and the more body hair you have based on your genetic and racial makeup. Asian women tend to have less body hair than women whose ancestors come from around the Mediterranean Sea, which includes most Latino women, for instance. This extra hair growth is very typical for almost all women with PCOS and is called hairsetism, a Latin word for hairiness. Equally annoying and distressing is the loss of hair where you want it on your head. Scalp hair gets overall thinner, but can also be lost in a so-called male pattern. This is the loss of hair in women in the places where men typically lose their hair, in the front on both sides, while the hair in the middle above the forehead stays in a kind of letter M shape. And also on the crown, up here, where men have their bald spot. So women get bald spots and are not happy about that. This super distressing hair loss is not always caused by PCOS. In fact, not all women with PCOS even have it, and certainly not very severely, but some have it badly. Male pattern hair loss can also be caused by other conditions that produce too much testosterone in women, such as certain tumors. It can even happen in women who are overly sensitive to normal amounts of testosterone. As you see, hair loss in women is a major and pretty complicated topic, and I'll probably have to do a whole episode on it someday. The extra testosterone, together with a second hormonal imbalance having to do with insulin, also causes oily skin and often severe and difficult to treat acne in women with polycystic ovaries. This acne can leave lifelong deep hittus scar in the skin. And because PCOS affects many young women who are under great pressure to look pretty and have clear skin, it also leaves deep emotional scars. Again, the various acne causes and its treatment, whether related to PCOS or not, will also have to be the topic of another podcast. With this, we're running out of time for today. I will do two more podcasts on polycystic ovary syndrome in the next few weeks, where I will talk about the following things. One, why most of the time, but not always, women with PCOS are very much overweight. And also why PCOS puts you at greater risk for heart disease, diabetes, and even certain types of cancers. All this, again, is mostly related to the overweight. Then, of course, I will also talk about what lab tests and exams doctors should check to confirm the diagnosis of PCOS once they suspect the diagnosis based on your symptoms. I will tell you what you can do to treat yourself and what prescription treatment options you can get from your healthcare provider. And because PCOS is one of the main causes of infertility of not getting pregnant when one would like to have a baby, I will spend as much time as it will take me to talk about the effects of PCOS on infertility and what are promising treatment options, especially for helping women with PCOS to get pregnant, but also to lose weight. If you or any of your friends, relatives, or co-workers' life is touched by PCOS, please stay tuned to my podcasts and learn more about PCOS and what can be done about it in one of my future episodes. As doctors have learned more about PCOS over the years, there's actually quite a bit that can be done these days, and new and most importantly, more effective treatment options become available all the time. So keep listening. This is all the time there is for today. I hope you found this information about PCOS useful and will tune in next week again to GynoInfo and tell all your friends about our podcast. Please also take the time to subscribe to it since the algorithm seems to like that. When you subscribe, it makes it easier for more women to find us. And remember, you can send in any questions you might have or suggestions for future episodes to Questions at GynoInfo.net. Again, that's questions at gynoinfo.net. Goodbye, and until next time, and have a safe week. Until next time, thank you for listening and remember that you and your health are super important and deserve your full attention. Don't ever put off contacting your doctor because you're scared or embarrassed when something feels wrong about your body. Doctors are here to help you and not to judge you. And also, regular Wellwoman visits are always a good idea that you should make time for. You deserve it, and you owe it to yourself, and you owe it to your body and your health. This podcast is part of Pridehouse Media, hosted by me, Dr. Berkey, produced and edited by Josh Rosenzweig. Original music composed by Nell Balaban. If you enjoyed this episode, please subscribe wherever you listen to podcasts. And while you're there, leave us a rating and a review. It really helps others discover the show. Stay connected and join the conversation by following me on Instagram and Facebook at GynoInfo and on LinkedIn at gynoinfo podcast. Remember, any questions that I answer or information that I give you on this podcast are to be understood as information only, not treatment of your medical problems. While I'm a very knowledgeable gynecologist, I'm not your gynecologist who has talked to you and examined you personally and is therefore actually able to treat you. So please consult your own healthcare professional with any medical questions or concerns.