Written by: Dr. Janet Choi, a board certified reproductive endocrinologist and medical director CCRM Fertility of New York
You’ve skipped a period or two and have been breaking out like a teenager on a chocolate binge. It’s easy to dismiss it as stress or lack of sleep, but these symptoms may indicate that you have polycystic ovarian syndrome (PCOS), and may need to seek PCOS treatment. Though the exact causes remain unknown, PCOS is a common disorder associated with hormonal imbalances and insulin resistance, which doctors think is caused by genetics. This condition affects 5-10% of reproductive aged women, but millions of women remain undiagnosed.
In honor of PCOS awareness month, we want to shed light on the condition and help you understand how it may affect your fertility. Here are five things you should know about PCOS.
To diagnose PCOS, doctors look for at least two of these three specific signs.
The symptoms of PCOS can vary dramatically from person to person, which can make it tough to diagnose. That said, there are three symptoms that seem to be consistent across the board.
– Absent or irregular periods. “Irregular” meaning, you can’t ever predict when you’re period’s going to show. It’s quite common for women to have “regular” cycles that fluctuate by a few days each month (i.e. 26-28 days or every 30-35 days). “Irregular periods” are those that occur with much more variation like every 1 to 3 months or every 6 months.
– Acne and/or hair growth on the upper lip, chin, nipple area or lower abdomen. Androgens, like testosterone, circulate in both men and women, but men have higher levels. Excess androgens in women can lead to pimples as well as facial and abdominal hair growth. Other women with PCOS may not have these manifestations but might have elevated androgen levels on blood testing.
– Polycystic-appearing ovaries. If a woman has PCOS, the ultrasound may show multiple “cysts” in the ovaries. These cysts aren’t abnormal per se — they represent “follicles,” the tiny individual sacs in the ovaries which contain hibernating eggs. A polycystic ovary usually has 20 or more visible follicles. Many women who don’t have PCOS and have regular cycles can still have “polycystic-appearing” ovaries.
PCOS can mimic other medical conditions and can also affect other areas of your health.
PCOS is one of the most common causes of irregular periods/acne/unwanted hair growth, but it’s not the only medical condition that can affect your cycles. Diseases affecting other hormone-producing sites in the body — like your thyroid, pituitary or adrenal gland — can lead to signs that imitate PCOS. So it’s worth talking with your doctor to rule out these problems.
Women with PCOS are at higher risk of developing diabetes, heart disease and uterine cancer. Work with your doctor to help you manage the condition and to learn how to decrease the chance of these diseases affecting your health down the road.
Birth Control can help regulate your menstrual cycles.
Birth control helps smooth out the natural hormonal fluctuations that occur in PCOS leading to more regular cycles as well as less acne and unwanted hair growth. An added benefit of birth control (besides contraception) is that it helps lower the risk of developing pre-cancerous changes in the uterus. If you don’t like the idea of popping a pill every day but want to protect your uterus against cancer, the Nuva-Ring or progestin-IUD are two other good hormonal contraceptive options.
If you are trying to get pregnant and have PCOS, you don’t necessarily need to take fertility drugs.
While women with PCOS may not ovulate regularly, ovulation can still occasionally occur in a very unpredictable fashion. So, if you’re trying to get pregnant, don’t get hung up on all the different ovulation predictor tests: basal body temperature charting and urine ovulation tests don’t work as well for women who have PCOS. The key is to have frequent intercourse (2-3 times a week). Since an egg can be fertilized for 12 to 24 hours after being released and sperm can survive for up to 5 days, having unprotected sex regularly is your best bet for trying to get pregnant naturally.
If you are overweight, shedding some pounds can sometimes help correct the hormonal imbalances associated with PCOS, leading to more regular, ovulatory cycles.
If you can’t seem to get pregnant naturally after several of months of trying, you should see your gynecologist or fertility specialist. These doctors can prescribe fertility medications to help you ovulate. In certain instances, your doctor might prescribe a medicine called metformin to help with ovulation.
Even though you don’t ovulate regularly, your egg supply continues to decrease at a normal rate.
Females are born with 1-2 million eggs, and by the time a girl has her first menstrual period, whether it’s at 10 or 16, her egg supply is down to about 300,000-500,000. This egg disappearing act continues whether or not a woman has regular cycles (just like we shed skin and hair cells every day of our life). So, even if you’re not having regular cycles — whether it’s because you have PCOS or you’re on the Pill or you’re pregnant — the egg supply in your ovaries is decreasing. With that said, there is some medical research suggesting that women with PCOS may be more likely to hit menopause at a slightly later age than the average of 51. Whether this translates to a longer time frame to try and conceive remains to be seen.
To learn more about PCOS symptoms, diagnosis and treatment, check out this in-depth video with CCRM New York Practice Director Dr. Brian Levine.