Polycystic ovary syndrome (PCOS) is a condition that affects about one in 10 women and is one of the most common causes of infertility. Women with PCOS have an imbalance of hormones. Most researchers believe that PCOS symptoms are the result of a complicated set of circumstances, including irregular periods, insulin resistance, obesity, inflammation, and an increase in the amount of androgens (a hormone) in the body. PCOS has also been linked to ethnicity, happening more commonly in Spanish, Native American, and Mexican women.
- Pelvic pain
- Irregular periods
- Excessive hair growth in places you don’t expect it, like your face or chest (known as hirsutism)
- Skin tags or dark patches on the skin
- Being overweight or struggling to lose weight
How do you diagnose PCOS?
The diagnosis of PCOS is based on three components:
- Absence of ovulation or menstrual irregularities
- High levels of androgens; (hyperandrogenism)
- Cysts on the ovaries
The first thing your doctor will do is to take a family history. Then they will ask about your medical history, including a detailed look at your menstrual cycles. Some people with PCOS have periods that are few and far between, while others may have periods that come really close together. You may also have heavy periods.
You will also have a physical exam. This will include checking your blood pressure, weight, and BMI. They will also do a pelvic exam with an ultrasound of your ovaries to look for any cysts.
From there, your doctor will do some blood work to check your hormone levels, your blood sugar, and your cholesterol. Some blood tests are done to exclude other diseases that resemble PCOS.
One of the difficult things about diagnosing PCOS is that the symptoms are often mistaken for other conditions because they may come and go and have other underlying causes. For example, with acne or oily skin, you might be quick to write it off as the result of puberty or normal hormone changes throughout the month. Some symptoms, like an irregular period, can also be masked by other medications or illnesses. But when you see several of these symptoms together, it may be a sign of PCOS.
Treatment for PCOS
The treatment for PCOS has 2 main targets:
To relieve symptoms of PCOS, treatments include:
- Lifestyles changes to reduce weight
- Birth control pills to make menstrual periods more regular, to reduce androgens, and help clear acne
- Insulin-sensitizing agents to reduce insulin resistance and keep glucose down (metformim)
- Anti-androgens to lower androgen levels, reduce excess hair, and help clear acne
- Hair removal: drugs, mechanical removal, electrolysis
- Acne treatment with retinoids, antibacterial agents, or antibiotics
For infertility resulting from PCOS, treatments include:
- Lifestyles changes to reduce weight; losing small amounts of weight improves menstrual function and fertility
- Clomiphene, the primary medication for PCOS infertile patients
- Metformim, which increases ovulation
- Letrozole, which induces ovulation
- Gonadotropins, which induces ovulation
- Surgery, which increases the chance of ovulation (ovarian drilling)
If you are not trying to get pregnant, birth control pills or other forms of hormonal birth control can help restore a balance to your hormones, relieving some of the symptoms. You may also be prescribed a medication like Metformin (a drug often used to treat diabetes) to help with your blood sugar. And, if high androgens are an issue, sometimes medication can be used to help combat those levels. Additionally, losing weight may be recommended to help with certain symptoms.
PCOS and your health
While some of the symptoms of PCOS may get better the closer you get to menopause, like the abnormal periods, you still face certain increased health risks because of PCOS. This can include an increased risk for the following problems:
- High blood pressure
- High cholesterol
- Depression and anxiety
- Some studies also indicate that your risk is higher for endometrial cancer
Other diseases associated with PCOS are:
- Insulin resistance
- Metabolic syndrome
- Coronary artery disease
- Obstructive sleep apnea
Trying to get pregnant with PCOS
Many women do not know they have PCOS until they try to get pregnant. At this point, problems with conceiving lead them to seek medical help, and then they receive the diagnosis. This is why it’s important to tell your doctor or midwife all of your symptoms so they can potentially diagnose you before you’d like to get pregnant.
There is no one-size-fits-all fertility treatment for women trying to get pregnant with PCOS. Your treatment will be tailored to your specific symptoms. For example, if you aren’t ovulating, medications that induce ovulation may be given. For women who are overweight, sometimes losing weight will help regulate the menstrual cycle long enough that they are able to get pregnant without much other help. Some women with PCOS wind up needing surgery or using in vitro fertilization (IVF) to get pregnant. See treatments for infertility resulting from PCOS above.
Pregnancy with PCOS
Most studies show that women with PCOS have an increased risk of pregnancy complications due to the increased risk of other conditions like gestational diabetes and high blood pressure. There may also be a higher risk of miscarriage and preterm labor, though not all researchers agree. Other potential complications are c-section delivery and preeclampsia.
Infants born to mothers with PCOS are more prone to complication too, including:
- Large or small for gestational age (conflicting results)
- Increased risk of meconium aspiration
- Low Apgar score (<7) at five minutes
- Congenital abnormalities
PCOS is one of the most common endocrine (hormonal) disorders in women. While it can be blamed for a variety of symptoms, addressing these symptoms does not always mitigate the additional health risks that come with it. This is why seeking care from a knowledgeable physician early on can help you reduce your life-long health risks.