The Symptoms, Causes, and Treatment of Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS)
What is Polycystic Ovary Syndrome (PCOS)?
PCOS is one of the most common, but treatable, causes of infertility in women . Between 5% and 10% of women between 15 and 44, or during the years you can have children, have PCOS. Most women find out they have this in their 20s and 30s when they have problems getting pregnant and see their doctor. But PCOS can happen at any age after puberty. Women of all races and ethnicities are at risk. Your risk may be higher if you have obesity or if you have a mother, sister, or aunt with PCOS.
Polycystic ovary syndrome ( often referred to as PCOS) is a common hormone disorder that affects 5%-10% of women. Like all syndromes, PCOS is a collection of problems that are found together and not all women have all the same symptoms. To be diagnosed with PCOS, a woman must have 2 of 3 possible issues:
- chronic lack of ovulation (anovulation),
- chronic high testosterone (hormone) levels (hyperandrogenism), and
- ovaries that have multiple small cysts containing eggs (polycystic).
PCOS is a disruptive problem that impacts many aspects of a woman’s health, including getting pregnant. It is a condition where women have an overabundance of eggs as a result of hormonal shifts, including testosterone. Though women with PCOS often worry they have “cysts” on their ovaries, these are technically not cysts, but antral follicles that reflect the normal fluid surrounding eggs.
There is no single cause of PCOS. But much of it relates to shifts in hormones such as LH (luteinizing hormone from the brain), testosterone (from the ovary and fat), DHEA, or dehydroepiandrosterone, (from the adrenals), and the interplay of insulin and body fat.
PCOS is estimated to affect as many as 1 in 10 women .
What are the common symptoms of PCOS?
Signs of PCOS can include painful, irregular, or absent menstrual periods, excess hair growth, severe acne, and oily skin. Women can experience a number of often frustrating symptoms starting as early as their teenage years.
According to ACOG , (American College of Obstetricians and Gynecologists), the common symptoms of polycystic ovary syndrome include the following:
- Irregular menstrual periods—Menstrual disorders can include absent periods, periods that occur infrequently or too frequently, heavy periods, or unpredictable periods.
- Infertility—PCOS is one of the most common causes of female infertility.
- Obesity—As many as 4 in 5 women with PCOS are obese.
- Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 7 in 10 women with PCOS.
- Severe acne or acne that occurs after adolescence and does not respond to usual treatments
- Oily skin
- Patches of thickened, velvety, darkened skin called acanthosis nigricans
- Multiple small fluid-filled sacs in the ovaries
Women with PCOS are not only at an increased risk of infertility, but they are also at a higher risk of health complications such as diabetes, hypertension, heart disease and endometrial (uterine) cancer.
What causes Polycystic Ovary Syndrome (PCOS)?
Polycystic ovary syndrome is a relatively common health condition in women of reproductive age. PCOS is thought to have two driving factors: excess production of testosterone and insulin resistance. It is the cause of an estimated 80 percent of infertility cases due to anovulation, which is the lack of releasing a mature egg at each menstrual cycle (ovulation).
PCOS is characterized by increased levels of the androgen testosterone (often thought of as a male sex hormone) and insulin resistance in women. Women naturally produce androgens such as testosterone. But in addition to infertility mentioned above, elevated levels can lead to menstrual abnormalities and other common symptoms such as acne, unwanted hair or even hair loss.
Insulin is a hormone that allows the body to absorb glucose (blood sugar). Insulin resistance, another contributing factor to PCOS, occurs when the body does not respond to insulin. This can lead to elevated blood glucose levels, cause the body to produce excess insulin, and result in the overproduction of testosterone.
How is PCOS Diagnosed?
Many women experience the symptoms of polycystic ovary syndrome for years before they are diagnosed – and its impact on fertility often leads women to seek help long after they’ve begun experiencing symptoms. In many cases, a comprehensive medical history can help doctors identify potential symptoms or related conditions.
Doctors can often identify with a simple blood test whether the ovaries are functioning properly and if the body is producing excess testosterone. An ultrasound can also identify if the ovary has a polycystic appearance.
At Positive Steps Fertility, using our patented Parryscope® fertility testing , women can better understand their natural gynecologic anatomy, including whether they have PCOS. The more follicles (the sac-like structures in which an egg develops inside the ovary) seen the more likely a woman has PCOS.
A woman is diagnosed with PCOS if she has two of these three issues: high testosterone levels, irregular/absent cycles, and polycystic ovaries (≥12 antral follicles on at least one ovary).
How does PCOS affect Fertility?
Polycystic ovarian syndrome is caused by an imbalance of reproductive hormones. The hormonal imbalance creates problems in the ovaries. The ovaries make the egg that is released each month as part of a healthy menstrual cycle. With PCOS, the egg may not develop as it should or it may not be released during ovulation as it should be.
Polycystic ovary syndrome is often over-simplified as a condition that causes cysts to grow on or in the ovaries, but this is just one aspect of a rather complex condition. Ovarian cysts are fluid-filled sacs that develop in or on the surface of an ovary. It’s thought that most women will have an ovarian cyst at some point during their lifetime without knowing. However, some women experience extreme discomfort and pain, particularly if a cyst has ruptured.
Women with PCOS truly have an overabundance of antral follicles instead of cysts. Cysts frequently linger and are greater than 20 mm, while antral follicles are the fluid surrounding an egg and measure 2-10 mm. Counting antral follicles is a good measure of ovarian age, where it may be normal to see 10 per ovary at age 30, seven per ovary at 35, and four per ovary at 40. One of the core findings for PCOS is to see 12 or more follicles in at least one ovary. Though patients can develop cysts, because most women with PCOS don’t have cysts, the condition needs a better name.
PCOS poses significant challenges to women trying to get pregnant. The increased androgen levels can also disrupt ovulation. This means that the ovaries rarely or irregularly release an egg. Unpredictable or absent ovulation hinders the female reproductive cell (the egg) from being fertilized by male sperm, making it difficult to become pregnant naturally.
Can I still get pregnant with PCOS?
Yes. Having PCOS does not mean you can’t get pregnant . PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). If you don’t ovulate, you can’t get pregnant.
How do you treat PCOS?
There is no cure for PCOS, but we can treat its symptoms – even infertility. Lifestyle changes such as altering diet and/or activity levels have proven helpful in symptom reduction and can also lower the risk of diabetes.
Insulin-sensitizing medicines such as metformin can help the body use insulin more effectively to improve ovulation in some patients with PCOS. This may also lower the risk of developing diabetes or metabolic syndrome.
In vitro fertilization (IVF) may help women with PCOS get pregnant if other treatments do not work.
Treatment for PCOS can also be tailored to personal lifestyle and goals. Women who are not immediately concerned about fertility or becoming pregnant can be prescribed hormone medications to treat some of their symptoms, and oral contraceptive pills to reduce symptoms like acne. Women who are not immediately concerned with becoming pregnant often see their OB/GYN for treatment.
Some women with PCOS can increase their likelihood of becoming pregnant by changing their exercise and dietary habits. Research shows that weight loss can help promote pregnancy and improve the efficacy of infertility treatment.
Related reading: When to see a fertility specialist
Oral medications can also promote ovulation and improve the chances of pregnancy. If oral medication alone does not prove effective, a fertility specialist may recommend adding intrauterine insemination (IUI ) or in vitro fertilization (IVF) . In some cases, a reproductive endocrinologist may prescribe injectable fertility medicines called gonadotropins. Gonadotropins stimulate egg growth and can increase the likelihood of success.
PCOS Next Steps: Find a solution for your symptoms
Dr. Parry works with his Positive Steps Fertility patients to develop personalized treatment plans to help address the root of the issue. Knowledge is power. Get Answers.