Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women of reproductive age, impacting 5% to 10% of premenopausal women[1]McGowan M. Polycystic Ovary Syndrome: A Common Endocrine Disorder And Risk Factor For Vascular Disease. Current Treatment Options in Cardiovascular Medicine. 2011;13(4):289-301. . While the condition can result in serious complications and long term health effects, there are treatments available to help manage symptoms.
Here’s what you should know about living with PCOS and finding the right treatment for you.
What Is PCOS?
PCOS is a condition affecting as many as five million U.S. women in their childbearing years[2]PCOS (Polycystic Ovary Syndrome) and Diabetes . Centers for Disease Control. Accessed 11/1/2021. . While there is no definitive cause, the ovaries and adrenal glands of women with PCOS produce more male hormones than what is considered normal. This results in a range of symptoms including acne, excess facial hair, weight gain and infertility.
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“[PCOS] begins at puberty in most cases, and will almost always appear by the mid-twenties,” says Yen Tran, D.O, an OB-GYN at MemorialCare Orange Coast Medical Center in Fountain Valley, California. “This is an affliction of young women and left untreated, its effects will last a lifetime.”
Beyond reproductive age, women with PCOS have a greater likelihood of developing a number of health issues, and the risk of complications increases if they are overweight or obese. These conditions, according to the Centers for Disease Control and Prevention (CDC), include:
- Diabetes and gestational diabetes
- High blood pressure
- Cardiovascular disease
- High LDL (“bad”) cholesterol and low HDL (“good”) cholesterol
- Sleep apnea
- Stroke
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Causes of PCOS
The root cause of PCOS may be tied to a combination of insulin resistance (which is when your body can’t use insulin effectively), irregular menstruation and excess male hormones, according to the American College of Obstetrics and Gynecology (ACOG). There may also be a hereditary link, as people with a mother, sister or aunt diagnosed with PCOS are at a higher risk of diagnosis themselves.
Symptoms of PCOS
PCOS is one of the most common causes of female infertility, according to ACOG. Other symptoms associated with PCOS can include:
- Ovarian cysts
- Irregular menstruation
- Pelvic pain
- Excessive hair growth on face, chest, abdomen or upper thighs
- Weight gain
- Acne or oily skin
There is no definitive test to diagnose a patient with PCOS, says Erika Munch, M.D., a reproductive endocrinologist at the Texas Fertility Center in San Antonio. Rather, she describes diagnosis as one of exclusion, “meaning many other things can masquerade as PCOS.”
“With a thorough medical history and a few well-chosen tests, a reproductive or medical endocrinologist or OB-GYN can accurately diagnose the condition,” she says. “Some of these tests include bloodwork to look at hormone levels and a pelvic ultrasound to evaluate the ovaries.”
Treatments for PCOS
As there is no cure for the condition, treatment for PCOS is all about managing symptoms.
The treatment largely depends on a patient’s stage of life and their hopes for their reproductive future, adds Dr. Munch, and can include the following:
- Fertility Medications: “For women who hope to conceive and are unable to ovulate regularly, fertility medications like clomiphene citrate (Clomid) and letrozole (Femara) can help stimulate the ovaries to make ovulation happen more predictably,” says Dr. Munch. She also adds women without plans for conceiving may wish to address missing or irregular periods as well.
- Birth Control: By not seeking treatment for irregular or missing periods, patients may experience complications of “lining overgrowth” within the uterus, says Dr. Munch. If left untreated, this overgrowth may become precancerous or cancerous, she notes. “Most people not wanting to conceive right now will choose to be on birth control, which minimizes the risk of that overgrowth, as well as [easing] some of the symptoms like excess hair growth,” she adds.
- Weight Loss: “For some women with PCOS who carry extra weight, even weight loss of 10 to 20 pounds may help [regulate] their cycles,” says Dr. Munch. She notes weight management may also help reduce the risk of developing conditions often associated with PCOS, like diabetes and hypertension. In fact, studies have found PCOS sufferers who lost 5% to 10% of their body weight were able to improve symptoms such as male hormone levels, insulin resistance and ovulation, among others[3]Moran L, Lombard C, Lim S, et al. Polycystic Ovary Syndrome And Weight Management. Women’s Health. 2010;6(2):271-283. .
How Does PCOS Affect Fertility and Pregnancy?
“Women who have PCOS can produce high levels of androgens (like testosterone) which can interfere with the development and release of mature eggs,” says Dr. Munch. Without releasing eggs reliably, it can be difficult to time intercourse for a high chance of conceiving, she says.
But women with PCOS are not without hope—with the right help, most patients can get pregnant successfully, Dr. Munch adds.
If you have a PCOS diagnosis and are newly pregnant or hoping to conceive, it’s imperative you work closely with your health care provider to monitor your health and that of your developing fetus.
Pregnant people with PCOS are at greater risk for developing preeclampsia, a serious pregnancy complication, and delivering a preterm infant. Additionally, PCOS may double the risk of developing gestational diabetes, and increase the risk of complications at delivery and birth.
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When to See a Doctor
As to when women should seek medical help about a potential case of PCOS, the answer is immediately, says Dr. Tran. “Younger women should not be suffering in silence,” she adds. Women with irregular menses or other signs of PCOS who are trying to conceive should speak with a board-certified fertility doctor right away to discuss their treatment options. With the right care, women impacted by this condition can alleviate symptoms, increase the likelihood of pregnancy and improve their overall quality of life.
