Polycystic ovarian syndrome (PCOS) is one of the main causes of infertility in women. It affects anywhere from five to ten per cent of women between the ages of 20 and 40, making it the most common reproductive syndrome for women of this age group. However, a further 30% of women may have some of the symptoms associated with PCOS although they won’t be diagnosed with the syndrome.
What Is PCOS?
Women who suffer from PCOS have cysts (fluid-filled sacs) on their ovaries that prevent the ovaries from performing normally. PCOS affects regular reproductive functions, like the menstrual cycle, as well as fertility. Ovaries of PCOS suffers tend to be from 1.5 to 3 times larger than normal ovaries.
Although PCOS has been recognized as a syndrome for more than 75 years, no one is sure exactly what causes it. Some experts speculate that it may be hereditary but others suspect that there might be a link between PCOS and diabetes. Because so many women who have PCOS also have high insulin levels, this link does not seem unreasonable.
A connection has also been made between the seizure medication, valporate, and PCOS. This particular medication may cause or worsen the symptoms of PCOS. However, doctors are not sure if it is actually the epilepsy that affects PCOS or the valporate, but it is usually recommended to switch seizure medication if you’ve been diagnosed with PCOS.
While cysts are the most common symptom of PCOS, some doctors will diagnose a woman with PCOS even when cysts aren’t present. In these instances, the diagnosis is based on the presence of other symptoms and hormonal abnormalities.
Symptoms of PCOS include:
- Amenorrhea (cessation of period) or infrequent periods
- Irregular bleeding
- Infrequent or no ovulation
- Cysts on ovaries
- Increased levels of male hormone, like testosterone
- Chronic pelvic pain for six months or more
- Increase in weight or obesity (most women with PCOS are overweight)
- Diabetes; over production and inefficient use of insulin by the body
- Lipid abnormalities (high or low cholesterol, high triglycerides)
- High blood pressure
- Excess facial and body hair growth
- Male-pattern baldness or thinning hair
- Acne, oily skin, or dandruff
- Dark-colored patches of thick skin on neck, groin, underarms or skin folds
- Skin tags in the armpits or neck.
PCOS is one of the most under-diagnosed reproductive syndromes in women. Because the symptoms often seem unrelated to each other, doctors may try to treat each problem individually rather than evaluating them together. However, during a pelvic exam, your doctor will be able to feel any cysts that might be on your ovaries. Once these have been identified, a vaginal ultrasound will be performed to help the doctor get a better view of the cysts. PCOS cysts are often referred to as a “string of pearls” because of their resemblance to a pearl necklace. Next, a blood test may be ordered to evaluate your hormone levels as well as your insulin and glucose levels. Tests may also be ordered to measure your cholesterol and triglyceride levels.
Unfortunately, there is no standard criterion for diagnosing PCOS. Some doctors may give a diagnosis once a woman shows a minimum of three PCOS symptoms while others may use exclusion of other problems to narrow it down to PCOS. Regardless, it is important to receive a proper diagnosis in order to receive treatment. Left untreated, PCOS can lead to many health problems including endometrial hyperplasia (excess growth of the endometrial lining), endometrial cancer, Type II diabetes, high blood pressure, High cholesterol, and heart disease.
Traditionally, doctors have only been able to treat the symptoms of PCOS. Since the cause of PCOS is unknown, there is currently no cure. The birth control pill is often prescribed to help regulate the menstrual cycle as well as reduce the levels of hormones and minimize the appearance of acne. Other medications can also be prescribed to help with blood pressure, cholesterol, hormone levels or cosmetic problems.
Because so many women with PCOS have high insulin levels or their body does not use insulin efficiently, insulin medications are also commonly prescribed. Normalizing insulin levels has been found helpful in regulating periods and promoting ovulation. Women who prefer a more natural way of easing the symptoms of PCOS are frequently recommended to do so through diet and exercise. Maintaining a healthy weight has been shown to help insulin and glucose levels as well as promote fertility. Since PCOS can worsen over the years (although it should improve as you approach menopause), living a healthy lifestyle is one of the best ways to protect yourself.
Surgery is available for PCOS however it is not recommended as a first line of defense. Ovarian drilling is an outpatient, laparoscopic procedure that uses a small needle to puncture the cyst. An electric current is then employed to destroy part of the cyst. Unfortunately, the surgery has a success rate of less than 50% and the long-term effects are not known. Plus, there is the possibility of scar tissue forming or other damage being done to the ovaries, thereby compromising your fertility even more.
PCOS and Pregnancy?
While it is possible to become pregnant, women with PCOS tend to suffer a much higher rate of miscarriages. Estimates put the rate of miscarriages in women with PCOS at 45% although some believe the figure may be higher. However, experts aren’t sure why exactly this is. Fertility problems experienced by women with PCOS may be related to the elevated hormone, insulin, or glucose levels, all of which can interfere with implantation as well as development of the embryo. Additionally, abnormal insulin levels may also contribute to poor egg quality, making conception more difficult.
Stabilizing hormone levels can help fertility by promoting ovulation. Some doctors may also prescribe ovulation medications, such as Clomid, to encourage ovulation. If you are thinking of conceiving, be sure to discuss the issue with your doctor. Not all of the medications used to help PCOS sufferers are safe to use during pregnancy and may need to be discontinued.
Although getting pregnant can be problematical for women with PCOS, many have found it easier to get pregnant the second time around. Additionally, some women have found that their menstrual cycles regulate themselves after a pregnancy. Following a healthy diet and exercising regularly will also help to promote fertility.
Revision date: June 18, 2011
Last revised: by Andrew G. Epstein, M.D.