September is Polycystic Ovary Syndrome (PCOS) awareness month. For this reason, I believe it is important to help educate women and improve awareness of this important condition that impacts the lives of so many. As sub-specialists, we see many women with difficulty conceiving, however, it is important to understand that this condition influences overall health as well as fertility. Most importantly, it is treatable, and making the correct choices and managing it early on will make a tremendous difference for future pregnancies and long-term health.
The available literature quotes a prevalence between 8% and 13%. It is the most common hormone-related condition affecting reproductive-aged women. Many women suffer from this condition and don’t even know they have it. That is why awareness and education are so crucial.
What is it? How is it diagnosed? How is it treated? What does it mean for me if I don’t want a family right now? What if I do want a family? These are very logical questions that frequently come up during a consultation. The answers will enlighten one and potentially significantly influence one’s health now and in the future.
The majority of sub-specialists support the Rotterdam diagnostic criteria for adult women. This guideline states that women must have two out of three factors. These include irregular menstrual cycles, complaints of hyperandrogenic symptoms (related to higher amounts of “male hormones”) including unwanted hair growth, acne or oily skin or elevated levels of male hormone in the blood; and ultrasound evidence of polycystic ovaries. It is really important to understand that these cysts are very small and do not need to be excised with a surgical procedure. Ultrasound evaluation can also be normal in the setting of PCOS and some women with polycystic appearing ovaries don’t have the condition, according to the accepted diagnostic criteria. Blood work is needed to rule out other issues that may mimic the condition and are treated differently.
PCOS has health, psychological, and fertility implications. The condition is typically associated with insulin resistance. Insulin resistance is associated with an increased risk of Diabetes and Heart disease and early diagnosis may help prevent these negative consequences. Increased insulin levels related to resistance are also related to increases in male hormone released from the ovary and adrenal gland which may result in irregular cycles, unwanted hair growth, and acne for some women. Endometrial or uterine cancer risk is also elevated.
PCOS is associated with sub-fertility and increases in pregnancy complications. Subfertility is due to a disorder of ovulation (release of the egg). The condition also results in increases in pregnancy-induced hypertension and gestational diabetes to mention two.
The good news, however, is that this is a very treatable condition in all of the above situations. The main goal is to reduce the impact of hyperinsulinemia on the body. Nutrition is key to reducing the insulin surge and negative stimulus. A ketogenic approach is essential, and medication is also utilized to reduce the impact of the elevated male hormone, whether to reduce symptoms, improve overall health, or influence fertility in a very positive way. From a fertility standpoint, ovulation medication may be utilized to assist in correcting the timing of ovulation so couples may achieve a pregnancy. As a matter of fact, we have found that by far the majority of women with PCOS can achieve a pregnancy without using advanced fertility therapies. If the metabolic changes of high insulin are addressed aggressively, most women will conceive without the use of in vitro fertilization (IVF).
In conclusion, PCOS is a very common condition that impacts multiple facets of a woman’s life. Whether fertility is desired or not, the condition should be treated to prevent the long-term sequelae of insulin resistance. You have the ability to be your own advocate and if you feel that you may have this condition, it is important to address. We have answers and treatments to treat all the aspects of this condition. We are here to help!
Christopher W. Lipari, M.D.
Reproductive Endocrinology and Infertility
Jacksonville Center for Reproductive Medicine
Advanced Reproductive Specialists
Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 3rd PCOS Consensus Workshop Group. Fertil Steril 2012; 97:28-38.
Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Available at https://doi.org/10.1016/j.fertnstert.2018.05.004