What Is PCOS And How Does It Affect Fertility?
Polycystic Ovary Syndrome (PCOS) is a hormonal condition that affects about 10 per cent of women in their reproductive years.
In this Q+A, RMA of Southern California Dr. Katherine Green breaks down everything you need to know about PCOS.
WHAT IS PCOS?
Dr. Green: PCOS is the most common hormonal abnormality in women of reproductive age. It is typically marked by three factors:
There are several hormones involved in regulating the menstrual cycle – Follicle Stimulating Hormone (FSH), Luteinizing Hormone (LH), estrogens, and progesterone. When one of these hormones is out of balance, it can disrupt ovulation and cause irregular or missing menstrual cycles.
Elevated Androgen Levels
Higher androgen levels cause many symptoms we see in patients with PCOS. Hair loss, oily skin, acne, facial hair growth – these are all caused by increased levels of androgens (like testosterone). The high levels of androgens in women with PCOS result from hormonal signals from the brain and are further propagated by elevated blood levels of insulin.
Patients who have PCOS may have enlarged ovaries containing many cystic follicles.
HOW IS PCOS DIAGNOSED?
Dr. Green: If patients have 2 out of 3 factors listed above, they meet the diagnostic criteria for PCOS. A simple blood test will determine hormone levels, and an ultrasound is used to detect polycystic ovaries.
WHAT CAUSES PCOS?
Dr. Green: There are both environmental and genetic features in play. Most of the characteristics of PCOS result from a complex interaction between irregular ovulation and an abnormal endocrine environment. Insulin resistance is a key feature of PCOS and may play a role in the development of the condition as well.
ARE THERE OTHER RISKS TO WOMEN WITH PCOS?
Dr. Green: Metabolic syndrome is common in patients with PCOS, which consists of high blood pressure, abnormal lipid profiles, glucose intolerance, and increased waist circumference. There is also a higher risk of heart disease in women with PCOS. Patients with PCOS are also at risk of developing overt hypertension and diabetes.
Another risk factor is endometrial cancer. Because women with PCOS often don’t have regular menstrual cycles, they have higher levels of estrogen, which causes a thickening of the uterine lining. When the uterine lining is thicker than normal, pre-cancerous and cancerous cells may develop. Depression is also more common in women with PCOS, and it is important for patients and providers to identify any changes in mood so that these women may get the appropriate treatment.
HOW DO YOU TREAT PCOS?
Dr. Green: It depends on the patient’s goals. It’s important to address their immediate concerns, but also think about long-term health.
Weight loss can be extremely beneficial and is considered the first-line treatment in PCOS. Even a small amount of weight loss can resolve some of the metabolic and endocrine symptoms and decrease the likelihood of the patient developing high blood pressure or diabetes.
If a patient is trying to get pregnant, medications can be used to regulate ovulation so that intercourse can be appropriately timed. There are also medications that can be used to manage insulin resistance, if needed. If a patient is not currently interested in pregnancy, birth control pills can be used to decrease androgen levels and regulate menstrual cycles. This significantly decreases the risk of endometrial cancer.
DOES PCOS AFFECT FERTILITY?
Dr. Green: Yes, patients with PCOS are at an increased risk for infertility. When a woman isn’t ovulating regularly, it makes it more difficult to become pregnant. However, this is often easily treated with medications that cause patients to ovulate more predictably.
Infertility treatment options like In Vitro Fertilization (IVF) are also available if patients do not have success with ovulation induction.
It’s important to note that not everyone with PCOS will have all the same symptoms. If you have one or more of these symptoms, please let your doctor know.