Polycystic Ovary Syndrome (PCOS)

A quick look at polycystic ovary syndrome

Polycystic ovary syndrome, often referred to as PCOS, is a condition where women have an overabundance of eggs as a result of hormonal shifts, including testosterone. Though women with PCOS often worry they have “cysts” on their ovaries, these are technically not cysts, but antral follicles that reflect the normal fluid surrounding eggs.

PCOS is also marked by infertility, painful, irregular or absent menstrual periods, excess hair growth, severe acne and oily skin.

There is no single cause of PCOS. But much of it relates to shifts in hormones such as LH (luteinizing hormone from the brain), testosterone (from the ovary and fat), DHEA, or dehydroepiandrosterone, (from the adrenals), and the interplay of insulin and body fat.

PCOS is estimated to affect as many as 1 in 10 women.

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Understanding polycystic ovary syndrome

Polycystic ovary syndrome (PCOS) is a relatively common health condition in women of reproductive age. PCOS is thought to have two driving factors: excess production of testosterone and insulin resistance. It is the cause of an estimated 80 percent of infertility cases due to anovulation, which is the lack of releasing a mature egg at each menstrual cycle (ovulation).

PCOS is characterized by increased levels of the androgen testosterone (often thought of as a male sex hormone) and insulin resistance in women. Women naturally produce androgens such as testosterone. But in addition to infertility mentioned above, elevated levels can lead to menstrual abnormalities and other common symptoms of PCOS such as acne, unwanted hair or even hair loss.

Insulin is a hormone that allows the body to absorb glucose (blood sugar). Insulin resistance, another contributing factor to PCOS, occurs when the body does not respond to insulin. This can lead to elevated blood glucose levels, cause the body to produce excess insulin, and result in the overproduction of testosterone.

PCOS symptoms

Women with PCOS can experience a number of often frustrating symptoms starting as early as their teenage years, including:

• Irregular or absent periods.
• Ovarian cysts (polycystic ovaries).
• Resistance to insulin.
• Weight gain, obesity, difficulty losing weight.
• Infertility.
• Enlarged ovaries.
• Excess hair on the face, chest, stomach or upper thigh area.
• Male pattern baldness and thinning hair on the scalp.
• Severe acne, excessively oily skin.
• Dark skin pigmentation.

Women with PCOS are not only at an increased risk of infertility, but they are also at a higher risk of health complications such as diabetes, hypertension, heart disease and endometrial (uterine) cancer.

The effects of PCOS on the female body & fertility

Polycystic ovary syndrome is often over-simplified as a condition that causes cysts to grow on or in the ovaries, but this is just one aspect of a rather complex condition. Ovarian cysts are fluid-filled sacs that develop in or on the surface of an ovary. It’s thought that most women will have an ovarian cyst at some point during their lifetime without knowing. However, some women experience extreme discomfort and pain, particularly if a cyst has ruptured.

Women with PCOS truly have an overabundance of antral follicles instead of cysts. Cysts frequently linger and are greater than 20 mm, while antral follicles are the fluid surrounding an egg and measure 2-10 mm. Counting antral follicles is a good measure of ovarian age, where it may be normal to see 10 per ovary at age 30, seven per ovary at 35, and four per ovary at 40. One of the core findings for PCOS is to see 12 or more follicles in at least one ovary. Though PCOS patients can develop cysts, because most women with PCOS don’t have cysts, the condition needs a better name.

PCOS poses significant challenges to women trying to get pregnant. The increased androgen levels can also disrupt ovulation. This means that the ovaries rarely or irregularly release an egg. Unpredictable or absent ovulation hinders the female reproductive cell (the egg) from being fertilized by male sperm, making it difficult to become pregnant naturally.

Diagnosing polycystic ovary syndrome

Many women experience the symptoms of polycystic ovary syndrome for years before they are diagnosed – and its impact on fertility often leads women to seek help long after they’ve begun experiencing symptoms. In many cases, a comprehensive medical history can help doctors identify potential symptoms or related conditions.

Doctors can often identify with a simple blood test whether the ovaries are functioning properly and if the body is producing excess testosterone. An ultrasound can also identify if the ovary has a polycystic appearance.

With Parryscope® fertility testing women can better understand their natural gynecologic anatomy, including whether they have PCOS. The more follicles seen, the more likely a woman has PCOS.

A woman is diagnosed with PCOS if she has two of these three issues: high testosterone levels, irregular/absent cycles, and polycystic ovaries (≥12 antral follicles on at least one ovary).

PCOS treatment

There is not a cure for PCOS, but we can treat its symptoms – even infertility. Lifestyle changes such as altering diet and/or activity levels have proven helpful in symptom reduction and can also lower the risk of diabetes. Medications can be used to assist in the reduction of insulin levels in women who are considered overweight or obese.

Treatment for PCOS can be tailored to personal lifestyle and goals. Women who are not immediately concerned about fertility or becoming pregnant can be prescribed hormone medications to treat some of their symptoms, and oral contraceptive pills to reduce symptoms like acne. Women who are not immediately concerned with becoming pregnant often see their OB/GYN for treatment.

Treating infertility from PCOS

Some women with PCOS can increase their likelihood of becoming pregnant by changing their exercise and dietary habits. Research shows that weight loss can help promote pregnancy and improve the efficacy of infertility treatment.

Related reading: When to see a fertility specialist

Oral medications can also promote ovulation and improve the chances of pregnancy. If oral medication alone does not prove effective, a fertility specialist may recommend adding intrauterine insemination (IUI) or in vitro fertilization (IVF). In some cases, a reproductive endocrinologist may prescribe injectable fertility medicines called gonadotropins. Gonadotropins stimulate egg growth and can increase the likelihood of success.

Next Steps: Find a solution for your symptoms

Dr. Parry works with his Positive Steps patients to develop personalized treatment plans to help address the root of the issue.