PCOS – Polycystic Ovary Syndrome


What is PCOS?

Polycystic ovary syndrome, or PCOS, is a condition where a woman’s sex hormones are unbalanced. PCOS is primarily linked to abnormal levels of three hormones: estrogen, progesterone, and androgen. This imbalance can result in a wide range of symptoms, including menstrual cycle changes and/or irregularities, ovarian cysts, trouble getting pregnant, weight gain, increased facial hair and other health changes.

picture of pcos ovary

The difference between a normal ovary and a PCOS ovary. Image courtesy of http://womenshealth.gov

Causes of PCOS

It is not totally understood what causes PCOS but our knowledge is increasing every year. We know that PCOS has a genetic component, and is influenced by environmental factors and lifestyle including body weight and, activity levels. Insulin resistance/ ‘pre-diabetes’ may be the first thing that ‘goes wrong’ in PCOS.

Symptoms of PCOS

Most women with PCOS have one or more of: irregular periods, with 31+ days between cycles or no cycles, acne, oily skin, unwanted hair growth especially on the face or lower stomach, infertility or sub-fertility (difficulty getting pregnant). Some women with PCOS have little or no symptoms, and may even have regular cycles.

PCOS can make it harder to get pregnant, and it can cause insulin resistance (pre-diabetes), and an increased risk of diabetes. Some women are at increased risk of endometrial cancer (cancer of the lining of the uterus) especially if you go a long time with very irregular cycles such as 3-4 months between periods. PCOS can also be associated with abnormal blood cholesterol.

PCOS and Fertility

Some women with Polycystic Ovarian Syndrome (PCOS) don’t have difficulty getting pregnant, but if you have irregular periods you’re not ovulating (releasing an egg) on a regular basis. Treatment of PCOS should help you to get pregnant faster. If you suspect you might have PCOS and want help, contact us for an appointment.

Diagnosis of PCOS

We look at symptoms, blood tests and an ultrasound of the ovaries to make the diagnosis. Not all women with PCOS have fertility issues. To make a diagnosis of PCOS we need two out of three of:

  1. Irregular menstrual cycles, or 35 or more days from the start of one cycle to the next.
  2. Hyperandrogenism (too much male-type hormones like testosterone, either on blood tests or with symptoms like acne, or unwanted hair growth, or oily skin).
  3. Sonogram showing one or more enlarged ovaries or a high number of small follicles in the ovary (elevated antral follicle count).

The sonogram is not really looking for ‘cysts’ on the ovaries – really we are looking at small antral follicles which are fluid-filled egg-containing structures that all women have. Women with PCOS often have above-average numbers of these follicles on one or both ovaries and/or bigger ovaries than normal. The name “polycystic ovarian syndrome” is not a very good one, but we’re stuck with it.

Treatment of PCOS

Treatment of PCOS varies depending on whether you are trying to conceive or not.  If not trying to conceive birth control pills are often used, sometimes with antiandrogens like spironolactone as well, to decrease acne/hair growth more than BC pills alone. If trying to conceive we use insulin sensitizers like metformin, plus ovulation-inducing tablets – most commonly Clomid or letrozole – sometimes low-dose shots or IVF if needed. Surgery for PCOS is not recommended as it is an outdated treatment method.

Lifestyle changes, including regular exercise and weight loss, are also a good idea. Some women with PCOS do better on a moderately low-carb diet such as Weight Watchers or South Beach.

If you are planning to conceive in the future and have had some signs of PCOS including irregular cycles and excess body hair, we recommend setting up an appointment for testing and to make a treatment plan that fits your individual situation. If you aren’t yet trying to conceive we can still see you to optimize your PCOS treatment.

Got a question about PCOS? Check out our frequently asked questions page on PCOS.