September is PCOS Awareness Month. Here’s What You Need to Know About PCOS and Fertility.
September is PCOS Awareness Month. PCOS, which affects 1 in 6 women in the U.S., is often misunderstood. Although there’s some confusion about the condition, much is known about PCOS. Unfortunately, misinformation, often spread by those with ulterior motives, has clouded the truth.
I am passionate about clearing this confusion so that women can see the hope that lies ahead. With PCOS, while there are challenges, it’s still possible to live a full and happy life.
What is PCOS?
PCOS stands for polycystic ovary syndrome, and despite the name, women with PCOS do not have cysts on their ovaries. When PCOS was first named, we didn’t have as good of an understanding of ovarian anatomy and physiology as we do today. What was once believed to be cysts are actually follicles: fluid filled sacs in the ovary, each of which contains an egg.
Since women with PCOS ovulate less frequently, they may be less likely to develop ovarian cysts than those who ovulate regularly.
How is PCOS Diagnosed?
PCOS is diagnosed using the Rotterdam criteria. You must meet two of the following three criteria:
1. Irregular or absent periods.
2. More than 20 follicles on one or both ovaries on an ultrasound, known as polycystic appearing ovaries.
3. High testosterone levels or symptoms of high testosterone, such as unwanted male-pattern hair growth, severe acne, or hair loss.
Additionally, your doctor will rule out other conditions that may cause similar symptoms.
You’ve Been Diagnosed with PCOS, Now What?
Following a PCOS diagnosis, it's essential to screen for related health issues such as diabetes, high blood pressure, and high cholesterol. A pelvic ultrasound is also crucial to assess the uterine lining, as women with irregular periods due to PCOS are at higher risk for endometrial cancer.
What Are Common Symptoms of PCOS?
Irregular and heavy periods are the most common symptoms, along with infertility, hair loss, and unwanted hair growth. PCOS is also linked to an increased risk of pre-diabetes, diabetes, high cholesterol, and heart disease. Insulin resistance plays a significant role. Insulin is the hormone that helps our bodies breakdown sugar and insulin resistance is when our bodies need larger amounts of insulin than average to breakdown a given amount of sugar/glucose/carbohydrates in our food. This is why lifestyle changes such as optimal nutrition with low glycemic index foods and exercise are vital.
It’s also important to note that while PCOS is associated with an increased risk of obesity, not all women with PCOS are overweight. This misconception can lead to delayed diagnoses. Similarly, obesity alone can cause irregular periods in the absence of PCOS, so accurate diagnosis using the Rotterdam criteria is key.
How Does PCOS Affect Fertility?
PCOS causes infertility by preventing regular ovulation. Ovulation is when a mature egg is released from the ovary. This is the egg is that is then fertilized by sperm and results in a pregnancy. Therefore if no egg is released, there is nothing to fertilize and pregnancy cannot occur.
While lifestyle changes and supplements like Myoinositol can help some women resume regular periods, others may need medical treatment to induce ovulation, or additional fertility treatment procedures such as intrauterine insemination (IUI) or in vitro fertilization (IVF).
When Should You See a Fertility Specialist?
If you're under 35 and lifestyle changes aren’t helping to regulate your periods, starting fertility treatment with your OBGYN is a good first step. For women 35 or older, it’s wise to see a fertility specialist once you’re ready to start your journey. Depending on your situation, treatments like ovulation induction with timed intercourse, IUI or IVF may be recommended.
Conclusion
PCOS can feel overwhelming, but it is important to know you’re not alone. This is a very common condition and there are many success stories to take inspiration from. Many of my patients with PCOS have gone on to conceived with lifestyle changes, ovulation induction with timed intercourse, IUI and IVF respectively.
With the right knowledge and support, PCOS manageable. Remember, you’re not alone on this journey, and there’s hope every step of the way. As always, sending you love.