TLC Fertility Blog

What is PCOS?

Polycystic ovary syndrome, or PCOS, is a condition in which the ovaries produce an abnormal amount of androgens, which are male hormones that normally exist in women in small amounts.The word “polycystic” describes the numerous small fluid-filled cysts that form in the ovaries that may contribute to androgen production. The cysts are often perceived as bad, but they are just very small follicles containing eggs. The follicles stop developing in the early stages and the eggs can not come out of them. Under normal circumstances, the follicles develop into larger cysts that then ovulate (pop open) and release the eggs out of the ovary. This is how eggs become available for fertilization.PCOS is a common cause of infertility. Women who have PCOS don’t have enough hormones to trigger ovulation and mature follicles. Therefore, ovulation doesn’t work properly, and in turn, the ovaries develop many small cysts. These cysts can then produce more hormones called androgens, while progesterone levels do not adequately increase. As a result, women with PCOS often have elevated levels of androgens. Thus, the hormone imbalance disrupts the menstrual cycle and without ovulation, conception is not possible.Studies have found 2.2 and 26.7% of women during their childbearing years (ages 15 to 44) have PCOS. However, in one study, about 70% of women with PCOS had not been diagnosed.The difficulty is that PCOS comes in different forms and severity. Some patients have very mild and settle forms of PCOS and some have very profound symptoms. They do not always go along with elevated androgens or insulin resistance, but those are commonly associated with PCOS.

What causes PCOS?

The exact cause of PCOS is unknown. However, women with PCOS are often insulin resistant. Insulin is a hormone in the pancreas that is produced to help the body use sugar from foods for energy.Women with this disorder can produce insulin but cannot use it effectively. Extra insulin triggers the ovaries to produce more androgens, a male sex hormone, which can then cause irregular periods, acne, thinning scalp hair, and excess hair growth on the face and body. High insulin levels may darken the skin in the armpits and at the neck.Genetics could also play a key role as women with PCOS are more likely to have a mother or sister with PCOS. However, there is still a lot more research that needs to be done to truly understand the cause of PCOS.

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PCOS Symptoms

Some women start seeing symptoms around the time of their first period. Others only find they have PCOS after they’ve gained a lot of weight or they’ve had trouble getting pregnant. Usually, a diagnosis of PCOS can be determined when you experience two of three signs:Irregular periods. Women with PCOS typically have irregular periods as a result of not ovulating. They might have less than twelve periods a year or none at all. Some patients with mild PCOS have slightly extended cycles.Polycystic ovaries. Women’s ovaries might be enlarged and contain follicles that surround the eggs. As a result, the ovaries might fail to function regularly.Excess androgen. Higher levels of male hormones can lead to physical signs, such as hair growth on the face or body, back, belly, and chest. Also, it can cause acne and male pattern baldness.Other symptoms include:Weight gain. About half of women with PCOS are overweight or have obesity which is difficult to manageDarkening of the skin. You may see dark patches of skin formed on the back of your neck and under your breast and arm and groin.Acne. PCOS can cause acne on the back, chest, and face. This acne may continue past the teenage years and may be difficult to treat.Headaches. Hormonal changes can trigger headaches.Pelvic pain. Pelvic pain may occur with periods, along with heavy bleeding. It may also occur when a woman isn’t bleeding.Sleep problems. PCOS has been connected to a sleep disorder called sleep apnea. Some people will stop breathing for short periods.Fatigue. Poor sleep can contribute to feeling fatigued.Mood changes. Having PCOS can increase the likelihood of mood swings, depression, and anxiety.Heavy bleeding. The uterine lining builds up for a longer period of time, so the periods can get can heavier than usual.Thinning hair. People with PCOS start to lose patches of hair on their heads.Infertility. PCOS is the most common cause of female infertility. Decreased frequency of ovulation can reduce the probability of conceiving.

How is PCOS diagnosed?

Your doctor will ask you about your medical history and symptoms, including your family’s medical history. Next you will have a physical exam for checking your facial hair, acne, and discolored skin. Next, the doctor will perform a pelvic exam to look for swollen ovaries or other growths in your uterus.You may have tested with a blood test, and ultrasound to look for cysts in your body and check the thickness of the lining of your uterus.

How is PCOS treated?

Treatment for PCOS depends on several factors, such as your age and the health of your reproductive organs. PCOS is usually managed with medications. Although medications cannot cure PCOS, they will alleviate some of the symptoms and improve any other health issues. If you have a plan to become pregnant, you will be advised of the following:- A change in diet and losing weight. According to a study, losing up to 10% of your body weight can help regulate your menstrual cycle, and alleviate PCOS symptoms. It also lowers insulin levels and the risk for diabetes and heart disease.- Exercise. Exercise can help patients lose more weight, and it reduces the risks of diabetes and heart disease.- Medication can help regulate ovulation. However, some risks include increasing the probability of multiple pregnancies and causing ovarian hyperstimulation.- In vitro fertilization (IVF). Your egg is fertilized with your partner’s sperm in the lab and then transferred to your uterus. This is an option for women with PCOS when ovulation is not regulated with medication.If you do not plan to become pregnant, your treatment may include:- Birth control pills. These help to lower androgen levels and control the menstrual period. It will also protect the endometrium (inner lining of the uterus) against abnormal cell growth.- Medications to help reduce symptoms. Metformin can help lower elevated insulin levels. Clomiphene (Clomid) and Letrozole (Femara) is the most common medication that can induce ovulation.

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