What Is PCOS?
Polycystic ovary syndrome, or PCOS, is a hormonal condition that can happen during childbearing years. It can affect your ability to have a child (your doctor will call it your fertility). It can also:
- Stop your periods or make them hard to predict
- Cause acne and unwanted body and facial hair
- Raise your risk of other health problems, including diabetes and high blood pressure
You can get treatments for the symptoms. And you could be able to get pregnant, although you may need to take medicines to improve your fertility.
Some people with PCOS have cysts on their ovaries. That’s why it’s called “polycystic.” But the name is misleading because many people with PCOS don’t have cysts.
What Do Hormones Have to Do With PCOS?
When you have PCOS, your reproductive hormones are out of balance. This can lead to problems with your ovaries, such as not having your period on time or not getting it at all.
Your body makes hormones to make different things happen. Some affect your menstrual cycle and are tied to your ability to have a baby. The hormones that play a role in PCOS include:
- Androgens. They’re often called male hormones, but women have them, too. Women with PCOS tend to have higher levels.
- Insulin. This hormone manages your blood sugar. If you have PCOS, your body might not react to insulin the way it should.
- Progesterone. With PCOS, your body may not have enough of this hormone. You might miss your periods for a long time or have trouble predicting when they’ll come.
What Are the Symptoms of PCOS?
The most common PCOS symptoms are missed, irregular, infrequent, or prolonged periods. Other symptoms include:
- Hair loss or hair in places you don’t want it (like on your face) from excess androgens
- Darkened skin or excess skin (skin tags) on the neck or in the armpits
- Mood changes
- Pelvic pain
- Weight gain around your middle
What Are the Causes and Risk Factors of PCOS?
Doctors don’t know all of the reasons why some people get PCOS.
You might be more likely to have PCOS if your sister or mother also has it. It could also be related to problems that make your body produce too much insulin, which can affect your ovaries and their ability to ovulate (or release eggs). Long-term low-grade inflammation may also play a role. White blood cells produce substances to fight infection, and that can cause the ovaries to produce androgens. Most people with PCOS have high levels of androgens.
Transgender men (also known as female-to-male transsexual people, or FTMs) are highly prone to getting PCOS. Hormone therapy may or may not be a factor in that. That’s because so many other things – including insulin resistance, metabolic syndrome, and high levels of androgens – come into play with PCOS. In fact, some studies have shown that while hormone therapy can cause changes to the ovaries in transgender men, it doesn’t necessarily cause PCOS.
What Are the Complications of PCOS?
If you have PCOS and your androgen levels are too high, you have higher odds for a number of complications. These can differ from person to person and include:
Trouble getting pregnant. Cysts in the ovaries can interfere with ovulation. That’s when one of your ovaries releases an egg each month. If a healthy egg isn’t available to be fertilized by a sperm, you can’t get pregnant. You may still be able to get pregnant if you have PCOS. But you might have to take medicine and work with a fertility specialist to make it happen.
Insulin issues and diabetes.Insulin resistance may cause your body to make too many androgens. If you have insulin resistance, the cells in your muscles, organs, and other tissues don’t absorb blood sugar very well. As a result, you can have too much sugar moving through your bloodstream. This is called diabetes, and it can cause problems with your cardiovascular and nervous systems. PCOS can also cause gestational diabetes (diabetes when you’re pregnant).
Metabolic syndrome. This group of symptoms raises the risk of cardiovascular disease. The symptoms include high triglyceride and low HDL (“good”) cholesterol levels, high blood pressure, and high blood sugar levels.
Other common complications of PCOS include:
- Miscarriage or premature birth
- Bleeding from the uterus and a higher risk of uterine cancer
- Sleep problems, including sleep apnea
- Inflammation of the liver
How Is PCOS Diagnosed?
No single test can diagnose PCOS. Your doctor will start by asking about your symptoms and medical history and by doing a physical exam, and possibly a pelvic exam.
They might give you blood tests to measure your hormone levels, blood sugar, and cholesterol. An ultrasound can check your ovaries for cysts, look for tumors, and measure the lining of your uterus.
How Is PCOS Treated?
If you aren’t planning to get pregnant, your doctor might prescribe hormonal birth control, like the skin patch or the pill. These medications can help lower your risk of endometrial cancer, get your periods on track, clear up acne, and lessen extra body hair. If you do want to get pregnant, fertility medications can help your ovaries release eggs.
Ask your doctor about medications to treat body hair and acne.
You should also see your doctor if you’re having:
- Irregular periods
- Mood changes
- Unexplained weight gain
- Changes in your hair or skin
These symptoms might not be caused by PCOS but could signal other serious health issues.
PCOS and Pregnancy
PCOS causes a woman’s body to produce higher-than-normal levels of androgens. These are hormones that are usually thought of as male hormones, because men have much higher levels of androgens than women.
Androgens are important in the development of male sex organs and other male traits.
In women, androgens are usually converted into the hormone estrogen.
High levels of androgens get in the way of the development of your eggs and the regular release of your eggs. This process is called ovulation.
If a healthy egg isn’t released, sperm can’t fertilize it, meaning you can’t get pregnant. PCOS can cause you to miss your menstrual period or have irregular periods. This can be one of the first signs that you may have a problem such as PCOS.
Regulating your period
Your doctor may prescribe birth control pills that contain lab-made versions of the hormones estrogen and progestin. These pills can help regulate your menstrual cycle by reducing androgen production.
If you cannot tolerate a combination birth control pill, your doctor might recommend a progestin-only pill.
You take this pill for about 2 weeks a month, for about 1-2 months. It’s also designed to help regulate your period.
Medicines to help you ovulate
You won’t be able to get pregnant while you’re taking birth control pills for PCOS. But if you need help ovulating so that you can become pregnant, certain medicines may help:
- Clomiphene (Clomid, Serophene) is an anti-estrogen drug that you take at the beginning of your cycle.
- If clomiphene doesn’t help with ovulation, you may be prescribed the diabetes drug metformin.
- If clomiphene and metformin don’t work, your doctor may prescribe a medication containing a follicle-stimulating hormone (FSH) and a luteinizing hormone (LH). You get this medicine in a shot.
- One other drug that helps with ovulation is letrozole (Femara). It’s sometimes used when other medications don’t work.
Diet and Lifestyle Changes for PCOS and Fertility
In general, living a healthier lifestyle with a better diet, regular exercise, no smoking, less stress, and control of diabetes and other medical conditions should improve your fertility odds.
Not all people who have PCOS are overweight, but many are. For some women, gaining a lot of weight can affect their hormones. In turn, losing weight, if you’re obese or overweight, may help get your hormones back to normal levels. Losing 10% of your body weight may help your menstrual cycle become more predictable. This should help you get pregnant.
Your doctor may recommend a diet that’s lower in calories and fat and watching the size of your portions. But losing weight is not easy for everyone. A nutritionist or dietitian may be able to help. Also, keeping a journal of your meals and snacks or using an app to help track your food can make things easier.
Managing blood sugar
Many people with PCOS also have insulin resistance. That’s when your body doesn’t use insulin the way it should. Insulin keeps your blood sugar levels steady.
To manage your blood sugar, your doctor may suggest eating foods that are lower in sugar and certain carbohydrates (carbs). Some carbs are good for you, like vegetables and fruit. But you should avoid others, which are found in processed food, white flour, rice, potatoes, and sugar. Eating other healthy foods – poultry and other lean meats, fish, and whole grains – can help with your blood sugar levels, too.
Regular exercise can help burn calories and increase your muscle mass. This can help decrease insulin resistance, which can lower the androgens in your body. That, in turn, can help with your PCOS.