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PCOS

PCOS impacts 6-12% of women of reproductive age in the U.S., making it one of the most common endocrine disorders in young women. It affects several body systems including the menstrual cycle, sometimes causing anovulation (not releasing an egg every month). 

Your menstrual cycle is (in part) dependent on hormone changes that come with ovulation. So when you don’t ovulate, your period is often delayed, irregular, or absent. There are other health issues that come with PCOS that range from annoying to life-altering, and because it’s a syndrome, not everyone with PCOS will have the same symptoms.

PCOS has a complex genetic inheritance pattern, meaning, it is more common in people who have a family history of the condition, but it isn’t identified in a single gene passed from generation to generation. It is also possible to be the first person in your family to have PCOS. There are some indications that if your mother had higher levels of androgens (typically labeled male hormones) in her body while pregnant with you, then you may be at an increased risk for developing PCOS. 

Receiving Polycystic Ovary Syndrome diagnosis can be hard to process. It’s overwhelming to hear your body isn’t working the way you need it to and frustrating to know that some of the reasons for this are out of your control. And at the same time, for many there is a sense of relief that comes with a PCOS diagnosis. It offers a name for what you’ve been going through and options for moving forward. Most importantly, it’s essential that you know that PCOS isn’t a failure or fault of yours in any way. 

If you’ve been diagnosed with PCOS, support is available. And if you’re trying to conceive now or thinking about it in the future, for many, pregnancy is still an option. As with any new diagnosis, information empowers you to know about your body and to advocate for your own health. 

PCOS Diagnosis

Because PCOS involves many body systems, it can spur a wide range of symptoms which can mean lots of testing before you get a diagnosis. Some common symptoms you may experience are:

  • Irregular periods
  • Excess body and facial hair
  • Mood swings
  • Thinning of hair on the head
  • Trouble conceiving
  • Abnormal bleeding from the uterus
  • Weight gain
  • Acne
  • Darkening patches of skin

PCOS symptoms can worsen over time if left untreated, so if any of these symptoms sound familiar, it’s a good idea to bring them up with your provider. And a word on choosing your provider: PCOS is both a reproductive and endocrine issue, so work with a provider who is very familiar with both body systems to get the best possible care.

Impact on fertility 

PCOS causes an excess of androgens (typically referred to as male hormones) including testosterone, which can shift the menstrual cycle hormone levels and prevent the ovaries from releasing mature eggs (ovulating). Eggs that remain inside the ovaries are unable to be fertilized by sperm. They can accumulate on the ovary in the form of small cysts, hence the name of the syndrome. That said, many people with PCOS don’t have multiple ovarian cysts and not everyone with PCOS experiences anovulation. 

Other common conditions those with PCOS might experience are high cholesterol and insulin resistance, diabetes, and heart disease. Early and effective treatment is very important for your long term health.

There are many possible treatments for PCOS, and developing an individualized plan together with your provider can improve your health outcomes. 

It’s important to acknowledge that PCOS is a diagnosis that often carries a lot of fatphobic misinformation regarding causes and treatments. So you may need to practice some self-advocacy and make sure you and your provider develop a plan that is evidence-based and not simply focused on weight loss. To prepare for a discussion like this, here are a few things you might want to learn more about before your next visit.

  • Physical activity. The available research supports regular physical activity as a prevention measure against cardiovascular disease. Because this is a significant risk factor for those with PCOS as they age, finding movement that brings you joy, makes you feel good, that you want to keep doing is a great intervention to add to your treatment plan. Exercise can improve your insulin sensitivity, which is associated with more regular ovulation and menstrual cycles, so if you haven’t been ovulating and are TTC, it can improve your chances. 
  • Focusing on nutrition. Many of those who conceive naturally with PCOS eat a gluten-free diet. They also eliminate processed foods, reduce added sugar and grains, increase fiber, and balance blood sugar with multiple small meals throughout the day.
  • Taking medication that decreases the androgen levels in your body. Medications such as spironolactone can decrease your body’s testosterone levels. It’s important to know that some medications are not safe to take during pregnancy, so talk to your provider. And if you think you’re pregnant, call right away to see if and how you need to adjust any medications you’re taking.
  • Taking medication that increases your body’s sensitivity to insulin. These types of drugs were developed originally for those with diabetes. They work by making your body more responsive to insulin, which helps you maintain healthy blood sugar levels. Incidentally, this medication has been found to increase the chances of ovulating, making periods more regular for those with PCOS. 
  • Taking medication that encourages ovulation. Recent research has found an increased rate of live births in women with PCOS who were prescribed Letrozole for ovulation induction. When discussing the use of medications like this with your provider, it’s important to know they also carry a higher likelihood of multiple pregnancies, like twins. 
  • Taking medication to give you more predictable periods. Hormonal birth control, though not a helpful choice when TTC, has been found to help give you lighter, more regular periods and can help reduce excess hair growth as well. However, this treatment can in some cases be a band aid on the bigger issue. Some providers will prescribe birth control for irregular periods without investigating a diagnosis like PCOS. Do advocate for yourself to get testing, diagnosis, and treatments that will enhance your health in the long run. 

Regardless of how you decide to treat your PCOS, you are not alone. There are millions of people working through the same symptoms as you and great providers who are prepared to help. Speak with your doctor about how to best support your body as you are TTC.

Read more

Sources

  • “Abnormal Uterine Bleeding.” ASRM. American Society for Reproductive Medicine, n.d. Web.
  • Dr. Walter Willett. “Nurses’ Health Study II.” National Institutes of Health. United States, 1989-. Web.
  • Kort JD, Winget C, Kim SH, Lathi RB. “A retrospective cohort study to evaluate the impact of meaningful weight loss on fertility outcomes in an overweight population with infertility.” Fertility & Sterility. 101(5):1400-3. Web. 5/14/2015.
  • “Polycystic Ovarian Syndrome (PCOS).” American Diabetes Association. American Diabetes Association, 7/2/2014. Web.
  • Li TC, Saravelos H, Chow MS, Chisabingo R, Cooke ID. “Factors affecting the outcome of laparoscopic ovarian drilling for polycystic ovarian syndrome in women with anovulatory infertility.” British Journal of Obstetrics. 105:3. pg 338-44. Web. Mar-98.

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