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.
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:
- Irregular menstrual cycles, or 35 or more days from the start of one cycle to the next.
- Hyperandrogenism (too much male-type hormones like testosterone, either on blood tests or with symptoms like acne, or unwanted hair growth, or oily skin).
- 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.
PCOS FAQs
There are a few conditions that can cause unwanted hair growth in women (hirsuitism). Polycystic Ovarian Syndrome (PCOS) is the most common, affecting 8-10% of women. Hair growth in the midline of the body (such as the upper lip, chin, lower stomach, or your back) can be due to PCOS. Weight gain can make PCOS symptoms worse. We diagnose PCOS with blood tests and a sonogram, and treatments can reduce the hair growth. Other conditions that can cause unwanted hair growth include adrenal gland disorders.
If you’re trying to conceive see a Reproductive Endocrinology and Infertility (REI) specialist for testing, and treatment options. We can also see women with PCOS issues who are not trying to conceive. PCOS is diagnosed with 2 out of 3 of: 1. Irregular periods 2. Clinical signs like acne, unwanted hair growth and/or blood tests showing too much male-type hormones (androgens) 3. Ultrasound appearance of polycystic ovaries: high ovarian volumes or antral follicle counts. We also rule out other causes of PCOS-like symptoms such as thyroid, prolactin, or adrenal gland issues. Treatment is different depending on whether or not you’re trying to conceive.
Many women with PCOS gain weight or find it hard to lose. Moderately low carb diets (South Beach or Weight Watchers), and complex carbs instead of simple cards are good: brown rice, whole wheat bread/pasta, less sugars, and more protein. Portion control is also important, paying attention to serving sizes. Exercise is recommended: do weights and cardio at least three times a week: weights increase muscle mass, which burns more calories. Some women lose weight on metformin treatment, too.
Most women with PCOS don’t ovulate (release an egg) regularly, with infrequent periods like cycles over 35-40 days or skipping whole months, or even no periods at all. Not ovulating can also cause frequent irregular bleeding as the lining of the uterus can become thick and bleed unpredictably. You should be checked for thick lining, fibroids or polyps inside your uterus; very thick lining needs an endometrial biopsy test to rule out precancerous changes.
Polycystic ovaries (PCO) refers to one or both ovaries being bigger than normal and/or having a high number of small egg-containing ‘antral follicles. This is determined with an ultrasound scan of the ovaries. PCOS or Polycystic Ovarian Syndrome needs 2 out of 3 of: 1. Irregular cycles 2. Clinical or blood test signs of too much male hormones – acne, unwanted hair growth or oily skin and 3. PCO. Up to 20% of women have PCO, about 8-10% have PCOS.
Yes, some women with Polycystic Ovarian Syndrome (PCOS) get pregnant easily without any help, some need only insulin-sensitizing medications like metformin. Others need tablets like Clomid or letrozole to induce ovulation, rarely fertility shots or IVF (In Vitro Fertilization). About 8-10% of women have PCOS. Your age also affects your chances. See a Reproductive Endocrinology and Infertility (REI) specialist if trying to conceive for an individualized treatment plan
A Reproductive Endocrinology and Infertility (REI) specialist confirms the diagnosis of PCOS and checks for hormone problems or low egg supply. Semen analysis and a Hysterosalpingogram (HSG) to check for blocked tubes are good tests to do as well. Treatment may start with metformin (insulin sensitizers) with or without ovulation inducing tablets like Clomid or letrozole. Some women need IVF (In Vitro Fertilization) if simpler treatments aren’t working, or rarely low-dose shots to induce ovulation.
With PCOS the ovaries produce excess male-type hormones (androgens) like testosterone, which cause unwanted hair growth (especially in the midline of the body like the face or lower stomach) and sometimes male-pattern hair loss. If not trying to conceive birth control pills are often used to lower androgens, sometimes with anti-androgens like spironolactone as well to decrease hair growth more than birth control pills alone. Vaniqa cream may help for excess hair growth on the face only.
It depends on if you’re trying to conceive or not? If not trying to conceive birth control pills are often used, sometimes with anti-androgens like spironolactone as well to decrease acne/hair growth more than birth control 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 (In Vitro Fertilization) is needed. Surgery for PCOS is no longer a good option.
Most women with PCOS have one or more of: irregular periods or no cycles, acne, oily skin, unwanted hair growth especially on the face or lower stomach, infertility or subfertility (difficulty getting pregnant). Some women with PCOS have little or no symptoms – we look at symptoms, blood tests and an ultrasound of the ovaries to make the diagnosis. Not all women with PCOS have fertility issues.
PCOS has a genetic component; we don’t know all the genes yet – and is influenced by environmental factors and lifestyle including obesity and activity levels. Insulin resistance / ‘pre-diabetes’ may be the first thing that ‘goes wrong’ in PCOS. The closest we have to treating the cause is losing weight, with a moderately low-carbohydrate diet (Weight Watchers and South Beach are good) plus regular exercise (cardio and weights) and using insulin-sensitizing drugs like metformin. Surgery is no longer a recommended option.
