What is PCOS?

PCOS is polycystic ovary syndrome. About one in ten women may be affected by PCOS, making it the most common endocrine condition.

PCOS is actually not the best name to describe the condition, but it has been around for a long time, and it seems to have stuck. Women with PCOS don’t really have cysts…they have lots of follicles in their ovaries which lead to higher amounts of hormones. Those hormones cause the signs and symptoms of PCOS. (Ovarian cysts are classically larger structures that can rupture and cause pain. The small follicles of PCOS do not cause pain.)

What are the signs of PCOS?

The diagnosis of PCOS is made when a woman has two out of three of these conditions:

  1. Irregular or absent menstrual cycles
  2. Signs of elevated testosterone such as excess face or body hair, acne, or scalp hair thinning
  3. The appearance of polycystic ovaries by ultrasound. Ovaries are enlarged and appear to have multiple small cysts, or follicles. Follicles, or cysts, are fluid-filled sacs, each containing an egg.

Many women diagnose themselves with PCOS if they have the first two signs.

Does PCOS require treatment?

Women with PCOS frequently have insulin resistance, which makes it easier to gain weight and harder to lose it. Weight gain and insulin resistance sometimes lead to pre-diabetes or diabetes. Women with PCOS may also have elevated cholesterol and some have pre-hypertension or hypertension.
Other symptoms common for women with PCOS include infertility, mood changes, disordered eating, sexual dysfunction, and sleep disturbances. Staying ahead of these symptoms can help women with PCOS live healthier and avoid complications down the road.

Why do women with PCOS have trouble getting pregnant?

Because women with PCOS have irregular or absent menstrual cycles, they are rarely releasing an egg, or ovulating. Women with PCOS have more than the usual amount of eggs, and each egg is contained in its own follicle. These follicles are paused at an immature stage. All of the small follicles produce estrogen. The high amount of estrogen can inhibit the brain’s ability to stimulate egg production, because it thinks the estrogen is coming from a single large, growing follicle. The brain can’t tell whether the estrogen is coming from multiple small follicles, or one big follicle that has grown to maturity and is getting ready to release its egg, so the ovulation process is irregular.

What are the best fertility treatment options for women with PCOS?

If a woman with PCOS is trying to get pregnant, there are both simple and long-term treatments available. Ovulation medications lower or block the action of estrogen, so the brain can start doing what it is supposed to do: recruit an egg. For women with PCOS who are trying to become pregnant, medications such as letrozole or clomiphene are used to help jumpstart ovulation. PCOS is one of the easiest infertility problems to treat. Many women will become pregnant within six months if they are able to ovulate with medications and lifestyle changes.

How do they work?

Letrozole reduces estrogen levels and allows the pituitary gland in the brain to get back to secreting FSH to allow a single follicle to grow and eventually release an egg. Clomiphene blocks estrogen receptors. Since estrogen is a hormone that works as a lock and key, if you block the lock, the key cannot get in. If the clomiphene blocks the estrogen receptor, the pituitary thinks there is no estrogen around. It starts secreting FSH to allow a single follicle to grow and release an egg. Changes in diet and exercise, as well as medications such as metformin, can lower insulin resistance and allow some women to ovulate on their own, or make the ovulation medications work better at a lower dose.


What if the ovulation induction medications don’t work?

If the medications do not result in regular ovulation, some women go on to try synthetic FSH hormone injections under the supervision of a Reproductive Endocrinologist. These medications require close monitoring because there is a higher risk of having multiple follicles grow at once, and that increases the probability of a multiple gestation occurring, such as twins or triplets.
If pregnancy has not occurred after multiple months of normal ovulation, many women consider high tech therapy such as in vitro fertilization (IVF). IVF greatly increases the chance of pregnancy when other methods have not worked.

What are the best treatments for women with PCOS who are not trying to conceive?

For most women who are not trying to become pregnant, oral contraceptive pills are frequently used to regulate the abnormal menstrual periods and protect the uterine lining from forming abnormal cellular changes.

How do women treat the other common symptoms of PCOS?

Women focus on which symptoms they would like to address. Many seek out a team of health care providers who specialize in PCOS. This group frequently includes nutritionists, counselors, health coaches, primary care providers, women’s health providers, reproductive endocrinologists, and sleep specialists.