To understand what PCOS is and how it affects a woman, it's helpful to learn a little about how the ovaries work.
Every month in women of childbearing age, tiny fluid-filled cysts called follicles develop on the surface of the ovary. One of the follicles will produce a mature egg, which is released from the ovary. Female sex hormones including estrogen cause the egg to mature and break through the follicle.
In women who have polycystic ovary syndrome, there is an imbalance in female sex hormones. The imbalance may prevent mature eggs from developing and being released. Without a mature egg, ovulation does not occur, which leads to infertility.
The imbalance may also include an abnormal increase in testosterone, which is mainly a male sex hormone. Although women also produce testosterone, it is usually in small amounts.
Causes of polycystic ovary syndrome
The imbalance in female hormones may prevent ovulation, leading to infertility.
According to the Mayo Clinic, the cause of PCOS is not fully known. There does appear to be a genetic connection. If a woman's mother or sister has the condition, she also has an increased risk.
Along with a genetic link, excess insulin in the body also increases a woman's risk of developing PCOS. Insulin is a hormone produced by the pancreas that is needed to change sugar from food into energy.
Women with PCOS often have insulin resistance. Insulin resistance involves the body's inability to lower blood sugar levels effectively. Blood sugar levels can become too high, which causes even more insulin to be produced.
Too much insulin also increases testosterone production, which causes some of the symptoms related to PCOS.
Symptoms of polycystic ovary syndrome
Not all women with PCOS have the same signs or symptoms. Symptoms can also change over time. Some of the most common symptoms of PCOS include the following:
- Abnormal hair growth on the face, chest, or back
- Weight gain
- Male-pattern baldness
- Irregular periods
- Ovarian cysts
PCOS can lead to a variety of complications. Infertility is often one of the main complications, but it's not the only one. Several conditions are linked with PCOS, including increased cholesterol levels and high blood pressure.
Diabetes is also associated with PCOS. In fact, about half of all women with PCOS develop either prediabetes or diabetes before the age of 40. There is also an increased risk of being overweight and having sleep apnea. The risk of endometrial cancer may also be increased in women with PCOS.
Physical problems are not the only complications. Depression, anxiety, and poor body image also sometimes occur in women with PCOS.
When to see a doctor
If showing any symptoms of PCOS, it is wise to see a doctor in order to prevent further complications.
Anytime a woman has symptoms of PCOS, she should see her doctor. Even women who are not trying to get pregnant should consider getting symptoms of PCOS under control. Treating symptoms may prevent complications.
Although there are many other causes of infertility, it's helpful to rule out PCOS. Finding the specific cause of infertility can help target treatment to improve a woman's chances of becoming pregnant.
It's also essential for a woman to know if she has PCOS in case she becomes pregnant. Women with PCOS have a higher risk of pregnancy complications including gestational diabetes, premature delivery, and high blood pressure during pregnancy.
There is no specific test to diagnose PCOS. A doctor makes a diagnosis based on several factors. Tests will include a physical exam, medical history, and blood tests to measure hormone and blood sugar levels. An ultrasound scan may also be used.
Effects on fertility
PCOS can affect fertility in different ways. Ovulation problems are usually the main cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or because follicles do not mature.
Even if ovulation occurs, an imbalance in hormones may prevent the lining of the uterus from developing properly to allow for implantation.
Due to unbalanced hormones, ovulation and menstruation can be irregular. Unpredictable menstrual cycles can also make it difficult to get pregnant.
Treatment for infertility
Currently, there is no cure for PCOS. Symptoms can be managed, however, and fertility can be improved if desired.
Symptoms and associated health problems can vary, so treatments need to be tailored to each person. Treatment also depends on whether a woman wants to become pregnant or not.
Unless a woman is trying to get pregnant, birth control pills may be used to correct the hormonal imbalance.
Treatment may include birth control pills to correct hormonal imbalances. Of course, if a woman is trying to get pregnant, birth control pills may not be the best option.
Additional treatment may include medication to control diabetes and blood sugar levels. Lifestyle factors, such as exercise and eating healthy can decrease symptoms. Maintaining a healthy weight can help reduce insulin and testosterone levels, which often improves symptoms.
Women who are trying to get pregnant may also want to consider treatments for infertility. Medications may be prescribed that regulate menstrual periods and encourage ovulation.
In cases where medication does not improve fertility, surgery may be an option. A procedure called laparoscopic ovarian drilling may be performed.
The surgery is done by making small cuts in the abdomen and inserting a needle with an electrical current. The electrical current is used to destroy a small amount of tissue on the ovary where testosterone is produced. A decrease in testosterone levels may allow regular ovulation to occur.
Tips for increasing fertility
For women who are overweight, losing weight is one way to increase fertility. Losing weight may improve hormonal imbalances and increase the chance of ovulation.
In some cases, losing weight may be enough to restore normal ovulation. According to the National Institute of Health, even a 5 percent weight loss may help.
Finding healthy ways to manage stress can also give fertility a boost. Long-term stress can affect hormones. For example, ongoing stress can increase cortisol production, which may trigger an increase in insulin production. High insulin levels can lead to an imbalance in female sex hormones and infertility.
Women with PCOS may also find that a low glycemic diet may reduce symptoms and improve fertility. A low glycemic diet involves eating fewer foods that cause a spike in blood sugar levels.
A low glycemic diet may make blood sugar levels more stable. This lowers insulin levels and may decrease testosterone production.
Other factors that affect fertility
It's important to understand that PCOS is only one cause of female infertility. There are many issues that may lead to problems getting pregnant. Ovulation problems can occur for reasons other than PCOS and prevent pregnancy.
Endometriosis, which involves an abnormal growth of uterine tissue, can also lead to infertility. Problems with the fallopian tubes can also make getting pregnant difficult. Fibroids, which are noncancerous tumors in the uterus, can cause fertility problems by preventing implantation.
The good news is that most women with fertility problems - including PCOS - can be successfully treated and achieve pregnancy. The first step is seeing a doctor and getting an accurate diagnosis and appropriate treatment.