How Polycystic Ovary Syndrome (PCOS) Affects Fertility
Polycystic ovary syndrome (PCOS) is a condition that affects women of reproductive age and is characterized by a hormone imbalance. It can impact many areas of a woman’s health, including menstrual cycles, fertility, insulin levels, and risk of cardiovascular disease.
Symptoms of PCOS can be treated through a combination of medications and lifestyle changes. Here’s what to know about the condition’s causes, symptoms, and treatment options.
What is polycystic ovary syndrome?
Polycystic ovary syndrome has three defining symptoms: high levels of male hormones, irregular menstrual cycles, and the development of cysts in the ovaries. These features overlap.
Many women with PCOS have higher levels of androgen hormones, which are responsible for the development of certain male characteristics. For those with PCOS, overproduction of androgens leads to irregular menstrual cycles, hair loss, extra growth of hair on the face and body, and acne.
The cysts that develop in the ovaries are small follicles containing an immature egg. Since these eggs do not reach maturity, ovulation — the release of a mature egg from the ovaries — does not occur. The absence of ovulation leads to further imbalance of hormones, as progesterone decreases.
Causes and risk factors
Polycystic ovary syndrome can develop at any age after puberty. It is estimated that 5-10% of women between the ages of 15-44 have the condition.
The specific causes of PCOS have not been identified, but the medical community believes that condition is the result of several intersecting factors: insulin resistance, higher levels of androgens, higher levels of inflammation, and an irregular menstrual cycle.
Some evidence suggests that PCOS may have a genetic component. You may have a higher risk of developing PCOS if you have a mother, sister, or aunt with the condition. Obesity is also a risk factor.
Common symptoms of polycystic ovary syndrome include:
- Irregular, absent, or abnormally short (i.e., less than 21 days) menstrual periods
- Excess hair on the face, chin, chest, abdomen, or upper thighs, also referred to as hirsutism
- Weight gain or difficulty maintaining a healthy weight
- Thinning hair or hair loss on the scalp
- Patches of darkened skin, particularly on the neck, in the groin, and beneath the breasts
- Small flaps of excess skin near the neck or armpits, sometimes referred to as skin tags
- Infertility, defined as the inability to get pregnant after twelve months or more of unprotected sex
How PCOS affects your health
The hormone imbalances that characterize PCOS can affect many areas of a woman’s health, including the following.
Infertility is a common symptom of PCOS, as hormone levels interfere with ovulation, an important step in reproduction. However, PCOS is a highly treatable cause of infertility. Many individuals and couples affected by PCOS do become pregnant after fertility treatment.
During pregnancy, women with PCOS may face a greater risk for miscarriage, high blood pressure, and gestational diabetes. They are also more likely to deliver prematurely. If you have PCOS, you can set yourself up for a healthy pregnancy by maintaining a healthy weight and blood sugar levels before trying to conceive and during pregnancy.
Type 2 diabetes
Insulin is a hormone naturally produced in the pancreas. It helps convert sugar, or glucose, into energy. Type 2 diabetes occurs when blood sugar levels rise due to issues with the body’s production or use of insulin. Since insulin resistance is often a symptom of PCOS, many individuals with the condition have a greater risk for type 2 diabetes.
Individuals with PCOS are also more likely to develop metabolic syndrome, a group of conditions associated with a higher risk for diabetes and heart disease, including:
- High blood pressure
- High blood sugar
- Excess body fat around the waist
- Abnormal cholesterol or triglyceride levels
Endometrial hyperplasia, a condition in which the lining of the uterus becomes too thick, is also associated with PCOS. It can increase a woman’s risk for endometrial cancer.
Diagnosing polycystic ovary syndrome
The process for diagnosing PCOS includes a conversation about your health history, a physical exam, and several tests that can rule out other causes of PCOS symptoms.
During the physical exam, a healthcare provider typically measures blood pressure, body mass index (BMI), and waist size. They will also check your skin for extra hair, acne, or discoloration.
Your doctor will likely conduct a pelvic exam to check for signs of high androgen levels and abnormalities with your ovaries. Then, a pelvic ultrasound, or sonogram, will check the ovaries for cysts and scan the uterine lining.
Blood tests may be used to measure levels of androgens as well as hormones linked to other health conditions with similar symptoms as PCOS. You may also be tested for high cholesterol and diabetes.
If other health conditions have been ruled out, you must have at least two of the following symptoms to be diagnosed with PCOS:
- Irregular, absent, or abnormally short menstrual periods
- Signs of high androgen levels such as hirsutism, acne, or thinning of hair on the scalp
- High blood levels of androgens
- Multiple cysts on one or both ovaries
PCOS and related medical conditions can be managed through a variety of treatments including medications and lifestyle changes. Treatment is tailored to an individual’s health history, PCOS symptoms, and reproductive goals. Here’s how different treatment options target various symptoms of PCOS.
Hormonal birth control
Hormonal birth control, which may contain both estrogen and progestin, is often used to regulate a woman’s menstrual cycle. It can also reduce hirsutism and acne and lower the risk of endometrial cancer. Many women who do not have plans to get pregnant use hormonal birth control as a long-term treatment for PCOS.
Metformin, an oral medication most commonly used to treat type 2 diabetes, is sometimes used off-label to treat PCOS. It improves the body’s response to insulin and can lower blood sugar and androgen levels. In some cases, it may be effective at restoring ovulation, though it typically does not treat hirsutism or acne.
Anti-androgen medications such as spironolactone (CaroSpir® and Aldactone®) block the effects of androgens and treat hirsutism. They are often used in combination with birth control and should not be used during pregnancy or when trying to conceive.
Maintaining a healthy weight can help regulate menstrual cycles. It may also improve insulin levels and treat excess hair growth and acne. Additionally, following a heart-healthy diet and staying physically active is especially important for those with PCOS.
In many cases, metformin or lifestyle changes can help address ovulation issues associated with PCOS. There are additional treatments that restore ovulation in women with PCOS, including oral medications used to treat infertility such as Clomid® and Femara® and injectable fertility medications including gonadotropins.
A procedure called laparoscopic ovarian drilling is a fertility treatment typically reserved for cases when medication is not effective.
A partner in your care
PCOS treatment looks different for each individual, and our team has the expertise to support your personal health journey. Whether you are getting started with hormonal birth control, metformin, or fertility treatment, we’re here to simplify medication management and keep you supported.
We offer free, same-day delivery seven days a week, with temperature controlled packaging that ensures fertility medications always arrive in the right condition. And we’ll work with your doctor, your insurance (if applicable), and any third party savings programs that you may qualify for to ensure your medications are as affordable as possible.
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This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.
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