What is PCOS?

September: the month when the world focuses its attention on Polycystic ovary syndrome, also known as PCOS. Why? To raise awareness about this hormonal imbalance among the general public, women, girls and healthcare professionals. And to help diagnose and treat it and, ultimately, improve the quality of life of women and girls with PCOS.

PCOS is a genetic, metabolic, hormonal and reproductive disorder which affects up to 1 in 5 women in the UK. It is one of the most common causes of infertility, and it also carries risks of obesity, type 2 diabetes, cardiovascular disease and endometrial cancer.

How do I know if I have got PCOS?

PCOS symptoms can start as early as puberty, and they can vary from woman to woman. Of the two most common symptoms the first is menstrual disturbance, for example, irregular periods, or having periods every few months or not having a period at all. The second is having unwanted hair growth in a male pattern, especially on the face, neck, chest, lower back, thighs, and below the belly button. Other symptoms are persistent facial or body acne, and hair loss, also in a male pattern known as androgenetic alopecia. Body weight can also be higher in women with PCOS, as they are more likely to gain weight and can find it harder to lose weight. All these symptoms can get worse in overweight or obese women.

How do doctors diagnose PCOS?

PCOS is diagnosed when two of the following are present, and other aetiologies are excluded:

• Oligo-or anovulation: You do not ovulate each month.
• Clinical and/or biochemical signs of hyperandrogenism: your body produces higher than normal levels of the male hormone testosterone.
• Polycystic ovary morphology on ultrasound (PCO): the presence of little follicles (cysts) in your ovaries.

It is important to highlight that someone whose ultrasound shows polycystic ovaries, but has regular periods and no signs of hyperandrogenism, does not have PCOS. Around 20-25% of women have ovaries with PCO morphology, but they do not have the syndrome.

What causes polycystic ovarian syndrome?

This is not clear, and it seems that many factors are involved in the genesis of the disease, for example.

• Insulin resistance: This happens when your body cells do not respond well to insulin and cannot keep your blood sugar at a normal level. Your pancreas produces more insulin, and this high level causes your ovaries to make more testosterone. An increase in both insulin and testosterone can lead to a lack of ovulation and fertility problems.
• Luteinising hormone (LH): This hormone is released by the pituitary gland and stimulates the ovaries to ovulate. It is also involved in testosterone production. Slightly high levels of LH can be found in around 40% of PCOS women.
• Hereditary factors: It seems that PCOS has a genetic factor, so it often runs in families (mother, aunts, sisters)
• Weight: An increased Body Mass Index (BMI) is not a cause of PCOS, but it is known that being overweight or obese can make symptoms worse.

What does it mean for my fertility?

Irregular menstrual cycles are the most common symptom in PCOS so, women with this pathology tend to have fewer periods, therefore, less ovulations. This lack of regular ovulation is caused by the hormonal imbalance, which interferes with the growth and release of eggs. If the egg is not released, there is no way you can get pregnant. This does not mean that PCOS women cannot conceive naturally. It means that the fertile window is hard to predict, and there may be months without ovulation.

Do I still ovulate?

Yes, having PCOS does not mean you cannot get pregnant, but ovulation might not happen regularly, that is why it takes more time to conceive. If you have been trying for 6 to 12 months, an infertility evaluation is recommended to optimise your chances.

How is PCOS treated?

PCOS is considered a chronic disease. This means that there is no cure for it, but symptoms can be managed. The management is different depending on the needs of every woman. Losing weight by eating healthily and doing regular physical activity is key. This helps lower the blood glucose levels, improves the action of insulin, and regulates the hormonal imbalance, all of which will help recover monthly ovulation and regular periods.

In short:

• PCOS is a chronic disease, but symptoms can be managed.
• Having a PCOS morphology does not mean you have the syndrome.
• You can conceive naturally with PCOS, but it might take more time.
• Losing weight by maintaining a healthy lifestyle is key to treatment.