What Is Polycystic Ovarian Syndrome (PCOS)?
Polycystic ovarian syndrome, or PCOS, is an endocrine disorder and a common cause of infertility in women. In PCOS, hormones that affect the reproductive system are abnormal, leading to irregular or absent ovulation. PCOS is a common disorder, affecting up to 8 percent of women.
Women with PCOS often have polycystic ovaries. This means that the ovaries have many tiny, benign and painless cysts. During an ultrasound exam, the tiny cysts may resemble a string of pearls. However, polycystic ovaries do not always point to PCOS. Studies have found that some women have polycystic ovaries, normal ovulation, and no other signs of an endocrine disorder like PCOS.
A common finding with PCOS is abnormally high levels of androgen hormones. While androgens are found in both men and women, they are considered to be primarily male hormones. High androgen levels are associated with some of the more visibly distressing symptoms of PCOS, including acne and abnormal hair growth.
What Are the Symptoms of Polycystic Ovarian Syndrome?
Symptoms of polycystic ovarian syndrome may include:
- irregular or absent ovulation (anovulation)
- amenorrhea (absence of monthly menstrual cycles) or oligomenorhhea (irregular monthly menstrual cycles)
- recurrent miscarriage
- abnormal hair growth, also known as hirsutism, found on the upper lip, chin, around the nipples, or on the abdomen
- especially oily skin and hair
- male pattern balding
- obesity (those women with PCOS can be at a normal weight)
- the presence of polycystic ovaries during ultrasound examination
- insulin resistance
- high levels of androgens, also known as hyperandrogenism
- elevated levels of the hormone LH (making at-home ovulation tests difficult to use)
You do not need to have every symptom above to be diagnosed with PCOS, and PCOS does not present itself the same way for every woman. For example, many women with PCOS do not have abnormal hair growth and are at a healthy weight. Some women with PCOS may not have a menstrual cycle for months at a time, while other women with PCOS may only have slightly irregular cycles.
Because PCOS is diagnosed by looking at the greater picture, and by excluding other potential diseases that can cause similar symptoms, it's important to see your doctor for an accurate diagnosis.
How Does Polycystic Ovarian Syndrome Cause Infertility?
The abnormal hormone levels associated with PCOS lead to problems with ovulation. These irregularities in ovulation are the main cause of infertility.
PCOS is also associated with a higher risk of early miscarriage. Research on PCOS has shown that the miscarriage rate may be as high as 20 to 40 percent, which is twice as high as in the general population.
It's not exactly clear why miscarriage is more common in women with PCOS, but some theories include the following:
- poor egg quality, related to premature or late ovulation
- insulin resistance
- a less-than-favorable environment for an embryo to implant in the uterine lining (due to abnormal hormone levels associated with PCOS)
How Is Polycystic Ovarian Syndrome Diagnosed?
Not everyone agrees on the criteria for diagnosing PCOS, and its definition has been changed over the years.
That said, the most commonly used diagnostic criteria currently being used requires two out of three of the following to apply:
- irregular or absent menstrual cycles, caused by chronic anovulation
- either blood test confirmation or outward signs of high levels of androgens (abnormal hair growth, acne)
- the presence of polycystic ovaries, as seen by ultrasound examination
In addition, other potential causes of anovulation or high androgen levels must be eliminated. This usually includes testing for congenital adrenal hyperplasia, androgen-secreting tumors, and hyperprolactinemia.
What Kind of Testing Is Involved for Polycystic Ovarian Syndrome?
Blood work will be ordered to check hormone levels, blood sugar levels (for insulin resistance), and lipid levels. Transvaginal ultrasound may be ordered, in order to see if the ovaries appear polycystic.
Taking a detailed history is also an important part of PCOS diagnosis. Your doctor will want to know about how regular your menstrual cycles are, and ask about unwanted hair growth. You may be tempted not to mention unwanted hair growth because of embarrassment, but it's important that you tell your doctor about this problem if you have it.
What Are the Potential Treatments for PCOS?
Treatment for PCOS will depend on whether or not you're trying to get pregnant. If pregnancy is not a priority, birth control pills may be ordered to help regulate your cycles and help reduce acne and unwanted hair growth.
Some women are afraid to go on birth control pills because they think it will further harm their fertility. The research on birth control hasn't yet found this to be true. Birth control shouldn't harm your longterm fertility.
However, it is also important to know that the pill doesn't "cure" your PCOS. You may start getting regular cycles while on the pill. These are artificially created. Once you stop taking the pill, if your cycles were irregular before, they will likely be irregular again.
If you're experience acne as a part of your PCOS, you should go see a dermatologist. Birth control pills can sometimes reduce acne, but not always. If you're trying to get pregnant, though, birth control would not be a good treatment option. Some acne treatments are not safe to be used when you're trying to get pregnant, so be sure to tell your doctor if you are trying to conceive.
For those trying to get pregnant, the treatment for PCOS is similar to the treatments used for treating anovulation. The first line of treatment is usually Clomid, which is used to help stimulate ovulation.
Metformin—also known as Glucophage—is a drug usually used to treat insulin resistance. Sometimes it is used to treat PCOS, even if you do not have insulin resistance.
Letrozole—a cancer medication—is sometimes used off-label to stimulate ovulation. It works similar to the way Clomid does. Letrozole may be more successful at helping women with PCOS conceive than Clomid.
If these medications do not help, then gonadotropins may be tried. These are injectable fertility drugs.
If medications alone do not work, or if there are multiple factors leading to infertility, IUI or IVF treatment may be recommended.
Some studies have shown that women who are overweight with PCOS may be able to restart ovulation naturally by losing just 10 percent of their current weight. A healthy diet and regular exercise may also help bring back regular ovulation in some, but not all, women with PCOS.
Is Pregnancy With PCOS Any Different?
Women with PCOS do have an increased risk for some pregnancy complications. Women with PCOS are significantly more likely to develop gestational diabetes, pregnancy related high blood pressure, preeclampsia, and preterm labor. Babies born to women with PCOS have an increased risk of needing NICU care after birth.
The reason for these increased risks may come from PCOS-related obesity or insulin resistance. The best way to reduce these risks is to reach a healthy (or healthier) weight before pregnancy (if possible), be sure to get regular prenatal care, and eat a healthy diet. Of course, you can do all the right things and still experience complications.