The name Polycystic Ovary Syndrome (PCOS) is so confusing that the medical community is thinking of changing the name (source). While the name implies that it is a disease of the ovaries, it is actually an endocrine disorder that has multiple side effects.
Since the symptoms vary significantly in individual women, it is often misdiagnosed or remains undiagnosed. Out of the 5-10% of women who have PCOS, it is thought to be undiagnosed in up to 70% of the women (source). It is also the most common cause in women for infertility. Due to the hormonal imbalances, many women with PCOS do not ovulate regularly, which is why women typically find out that they have PCOS when they are trying to get pregnant.
If you suspect that you have PCOS or you have been diagnosed with PCOS, it may seem overwhelming, but please know that the symptoms can be managed and you most likely can get pregnant. This month, in lieu of PCOS Awareness Month, we met with expert in Women's Health, Dr. Don Aptekar, to get to the bottom of what it means to have PCOS and how it affects trying to get pregnant.
Q. Do all women with PCOS have cysts on their ovaries?
No, not all women with PCOS have cysts on their ovaries. While PCOS is often known to cause enlarged ovaries that contain cysts, the cysts are not causing the symptoms, but are a result of the hormonal imbalance. Some women with PCOS may not even have cysts on their ovaries while some women with cysts on their ovaries do not have PCOS.
Q: What are the symptoms or signs of PCOS?
The most common signs of PCOS include cysts on the ovaries, acne, obesity, thinning hair, hair in places such as around the nipples or above the lip, and heavy or irregular periods. Like the cysts, the other symptoms may or may not be occurring. PCOS presents itself differently in each case. Some irregularity in your period is the most common sign of PCOS. To be diagnosed with PCOS women need to meet 2 out of 3 criteria:
- Elevated males sex hormones
- Irregular or absent periods
- Multiple follicular cysts on one or both ovaries.
Q: What is the cause of PCOS?
The exact cause is unknown. It is likely to run in the family, but doctors don’t know what causes it in the first place. Research is showing that too much insulin may be involved.
Q: Is there a downside to not getting treated for PCOS?
It’s essential to manage PCOS. There may be long term health problems, some even life-threatening, if you do not get treated. While PCOS can not be cured, there are treatments to help you get and stay healthy.
Q: What are my treatment options?
I highly recommend weight loss if you are overweight. You actually don’t need to lose a lot of weight to improve ovulation and insulin sensitivity.
Treatment options typically include: diet and exercise to help with insulin sensitivity and ovulation. Metapharm is used for insulin resistance and can be used to correct the hormone imbalanced. Often that alone will correct infertility due to PCOS.
There are also other medications to treat the hormonal imbalance such as spironolactone, progesterone and thyroid medication. For when you are not trying to conceive, birth control pills help lower androgen levels and protect the inner lining of the uterus.
Talk to your doctor or a specialist about your options for while you are trying to conceive and pregnant.
Q: Will I still need medications if I get pregnant?
Even if you end up not needing any medication to get pregnant, if have been diagnosed with PCOS, it is essential that you monitor and prevent metabolic syndrome. Your doctor will take extra precautions to prevent gestational diabetes or treat you for Type 2 diabetes if you already have it. After you have your baby, please see the above answer for sample treatment options.
Q. If I have PCOS, does that mean I have to use fertility treatment to get pregnant?
There is no reason to believe that you can’t conceive. If you do not want to take fertility drugs, talk to your doctor about whether or not you should try for up to a year to see if you can conceive without them. It may take you longer to get pregnant because women with PCOS tend to ovulate less frequently.
It’s also a good idea to see if your partner is fertile before taking fertility drugs to make sure he has viable sperm.
If you are not ovulating, you may want to talk to your doctor about weight loss (if you are overweight) and fertility options such as Clomid, to make you ovulate. I have patients who don’t want to use Clomid because they are concerned with having multiples. My recommendation then is to try losing weight first. Weight loss often improves estrogen levels and helps enhance fertility in general.
Be sure to meet with your doctor to make sure that you are not hypertensive or diabetic and monitor that closely.
Q. Why does having PCOS make it more difficult to get pregnant?
Having PCOS means that you have a hormonal imbalance and the excess androgen can cause the follicles in your ovaries to not develop and mature properly. When this happens, there is no ovulation. Also, the ovaries produce more testosterone and that combination may cause an inhibition of ovulation. The increased insulin resistance in women with PCOS also interferes with ovulation.
Q: I haven’t been diagnosed with it yet, how can I tell I have PCOS?
The classic PCOS symptoms include irregular cycles, hair in unwanted areas such as above the lips, around the nipples and being overweight. Other symptoms include being hypertensive and diabetic. If you have women in your family with PCOS or suspect that you have it, talk to your health care provider or an endocrinologist.
Most women with PCOS can ovulate and get pregnant, but if they’re not ovulating as often, their ability to conceive is based on the time that they ovulate. The good news is that you can meet with your doctor to find out if you are ovulating or not and the treatments to induce ovulation work. Once you start ovulating and pinpoint your fertile window, you should be able to get pregnant.