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Polycystic ovary syndrome and fertility

Polycystic ovary syndrome (PCOS) is a group of symptoms, or “syndrome”, that affects the ovaries and ovulation. It is common in women of reproductive age. Women with PCOS produce higher-than-normal levels of androgens (male hormones). This hormone imbalance disturbs the menstrual cycle—infrequent or prolonged periods; and the ovaries may develop numerous follicles (small sacs of fluid that produce hormones and influence fertility) and fail to release eggs regularly, which makes it difficult to get pregnant. An accurate and early diagnosis makes it easier to get the proper treatment to manage symptoms.

At puberty, a woman has approximately 400,000 primordial or dormant follicles, each with the potential to release an egg for fertilization. In women with PCOS, the eggs are unable to mature and trigger ovulation. Instead, immature follicles accumulate in the ovaries. American gynaecologists Irving F. Stein, Sr., and Michael L. Leventhal, who described this syndrome in 1935 (PCOS is also called the Stein-Leventhal syndrome), mistook the many follicles in the ovaries for cysts.  The word “polycystic” in polycystic ovary syndrome means “many cysts”. Although this health problem was identified many years ago, the cause of PCOS is still unknown.

How to recognize PCOS?

Many women have PCOS but are not aware of it. As one study showed, up to 70% of women with PCOS were undiagnosed. Symptoms of PCOS often develop during puberty, but moderate cases are usually diagnosed around the age of 25–30.

The symptoms include:

  • irregular menstrual cycles
  • excessive bleeding during menstruation
  • hairiness (pilosity or hirsutism) on the face and body
  • acne on the face, chest, and upper back
  • thinning hair or hair loss on the scalp; male-pattern baldness
  • weight gain or difficulty losing weight
  • darkening of skin, particularly along neck creases, in the groin, and beneath the breasts
  • skin tags—small excess flaps of skin in the armpits or neck area

In the absence of another disease (such as an adrenal genetic disease or ovarian or adrenal tumours), the presence of at least two of these symptoms suggests a diagnosis of PCOS.


Studies show that PCOS is hereditary. It is likely that multiple genes—not just one—contribute to this condition.

Although more than twenty genes linked to the syndrome have been identified, they explain fewer than 10% of PCOS cases. However, there is a 30% chance of developing PCOS if it has been diagnosed within the family. Currently, heredity is the most predictable risk factor. Environmental factors such as endocrine disruptors (chemicals that can interfere with endocrine / hormonal systems) are also believed to play a role in the onset of the disease.


A multifactorial disease

Scientists and doctors have not yet identified what causes PCOS. It is thought that women with PCOS have multiple interrelated factors that contribute to the syndrome.


About 1 in 10 women suffer from PCOS, making it one of the leading causes of infertility in the world.

High level male hormones: There is evidence that high levels of male hormones (hyperandrogenism) prevent the ovaries from producing hormones and eggs normally. When a woman is fertile, several tiny ovarian follicles begin to grow at each menstrual cycle. Eventually, one of these follicles becomes dominant and releases an egg for fertilization. The other follicles wither away and are reabsorbed into the body. In severe cases of PCOS excess androgens make the follicles resistant to this process and they accumulate in the ovary instead of following through with the maturation process.

Insulin resistance: Up to 70 percent of women with PCOS also suffer from insulin resistance, which means their cells cannot use insulin properly. Insulin is a hormone produced by the pancreas to help the body metabolise sugar, the body’s primary energy supply. When cells cannot use the insulin correctly, the body’s demand for insulin increases. The pancreas produces additional insulin to compensate. Excess insulin causes the ovaries to produce more androgens. Obesity is a major factor in insulin resistance.

Inflammation: Women with PCOS often have increased levels of inflammation in their bodies. Being overweight can contribute to inflammation. Studies have also linked excess inflammation to higher androgen levels.

Obesity: Obesity has now been recognised as a common feature of PCOS. In addition to its significant effect on reproductive capability, PCOS also has metabolic characteristics. Between 40–80% of women with PCOS are reported to be overweight or obese, which substantially increases the risk for glucose intolerance and type 2 diabetes. Environmental factors such as a high-caloric diet and reduced exercise also play a role in the high rate of obesity in women with PCOS. To date, the genes responsible for PCOS have not been clearly identified.


Signs and symptoms of PCOS are typically more severe if a woman is obese.

Complications

PCOS can cause a number of complications. The most common (and treatable) complication is infertility. As mentioned above, PCOS causes an imbalance in female sex hormones that may prevent the development and release of mature eggs. Without a mature egg, neither ovulation nor pregnancy can occur.

In addition to fertility problems, PCOS can cause other long-term complications.

Up to 80 percent of women with PCOS are overweight or obese. Both obesity and PCOS increase the risk of high blood sugar, high blood pressure, and abnormal cholesterol. Together, these factors are considered a metabolic syndrome that increases the risk for heart disease, diabetes, various cardiovascular diseases (stroke, myocardial infarction), and endometrial cancer.

Sleep apnoea, another PCOS complication, is a potentially serious sleep disorder in which breathing repeatedly stops and starts. If you snore loudly and feel tired, even after a full night’s sleep, you may have sleep apnoea.

Other complications from PCOS include:

  • abnormal uterine bleeding
  • depression
  • anxiety
  • eating disorders

How is PCOS diagnosed?

To help diagnose PCOS and rule out other causes for symptoms you may be experiencing, your doctor will likely ask about your medical history, perform a physical exam, and do some tests.

A physical exam will likely include measuring blood pressure, determining body mass index and waist size, looking for excess hair on the face, chest, or back, and for acne or skin discoloration. Your doctor may look for signs of hair loss and other health conditions (such as an enlarged thyroid gland).

Your doctor may do a pelvic exam to look for signs of excess male hormones (such as an enlarged clitoris) and check to see if your ovaries are enlarged or swollen.

A pelvic ultrasound (or sonogram) uses sound waves to examine the ovaries for cysts and to check the condition of the endometrium (the uterine lining).

A blood test can be performed to determine the levels of androgen hormones and other hormones related to common health problems that can be mistaken for PCOS, such as thyroid disease. Your doctor may also test your cholesterol levels and test you for diabetes.

There is no one precise test to diagnose PCOS. Once other conditions are ruled out, doctors usually diagnose the condition by determining the presence of at least two of these three symptoms: high androgen levels, irregular menstruation, and cysts in the ovaries.

Keeping track of your menstrual cycle and any irregularities that may come up. Other symptoms such as weight gain, acne, or excessive hair growth can also be factored in when making a diagnosis.


How is PCOS treated?

While there is no cure for PCOS, the symptoms can be managed. Your doctor can work with you to develop a personalised treatment plan based on your symptoms, your desire to have children, and your risk of long-term health problems such as diabetes or heart disease. Many women will need a combination of treatments to manage their symptoms effectively.

Hormonal birth control can help relieve the symptoms of PCOS, including the pill, patch, shot, vaginal ring, and hormone intrauterine device (IUD).

For women who don’t want to get pregnant, hormonal birth control can:

  • regulate the menstrual cycle
  • lower the risk of endometrial cancer
  • improve acne and reduce extra hair on the face and body (ask your doctor about using birth control that contains both oestrogen and progesterone).

What can I do on my own?

Although PCOS is a complex disease, there is a lot you can do to improve your own health, for example, eating a healthy diet and avoiding certain harmful ingredients can markedly reduce the symptoms.

A nutritious diet helps regulate hormones and the menstrual cycle, while eating processed foods can contribute to inflammation and insulin resistance.

Steps you can take steps at home to reduce the symptoms of PCOS include:

  • Losing weight. Healthy eating habits and regular physical activity can help you lose weight, which in turn can lower your blood glucose levels, improve the way your body uses insulin, and help normalise your hormones levels.
  • Removing hair. Facial hair removal creams (available at most drug stores), laser hair removal, or electrolysis can be used to remove excess hair.
  • Slowing hair growth. A prescription skin treatment (eflornithine HCl cream) can help slow the rate of new hair growth in unwanted places.


Foods that are high in sugar, hormones, and preservatives are not recommended.

While researchers continue to search for new ways to treat PCOS, we can all focus on living a healthy lifestyle and keep track of any changes in the menstrual cycle.

You can track your period using WomanLog. Download WomanLog now:

Download on the App Store

Get it on Google Play

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