Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts. The name describes the numerous small cysts (fluid-filled sacs) that are formed in the ovaries. Polycystic ovaries contain a large number of harmless follicles that are up to 8mm in size. Those follicles are underdeveloped sacs in which eggs develop. In PCOS, those sacs are often unable to release an egg, which means ovulation does not take place. Ovulation occurs when a mature egg is released from an ovary, while that egg needs to be fertilized by a male sperm. If the egg is not fertilized, it is sent out of the body during the woman’s period, and that creates infertility issues.
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The cause of the syndrome is yet not clear. Many women who suffer from PCOS are insulin resistant, meaning that the body can’t use insulin well and insulin levels build up in the body and may cause higher androgen levels. Obesity also increases insulin levels so it maximizes the chances of PCOS. There is also a chance of being inherited through the family, mothers that have it can usually inherit it to their daughters too.
More serious complications are diabetes, high blood pressure, heart problems, uterine cancer and infertility.
If you experience some of the above symptoms, you should consult with your doctor in order for them to examine you thoroughly. Testing usually includes a pelvic exam, an ultrasound and blood tests.
There are several ways to treat PCOS, depending on your age, the severity of the symptoms and if you want to conceive or not. If you want to conceive, the most important thing you should do is to maintain a healthy lifestyle, meaning eat well and exercise. A healthy lifestyle can help your body use insulin more efficiently, lower blood glucose levels, and ovulate. There are also medications that can help you to ovulate, but they are prescribed with certain risks. They can increase the chance for a multiple birth (twins or more), and they can cause ovarian hyperstimulation. This is when the ovaries release too many hormones, and it causes symptoms such as abdominal bloating and pelvic pain. It is very important not to take any pills on your own, only if you have consulted your fertility specialist.
If you do not plan on getting pregnant, you can take birth control pills that help control the menstrual cycle or diabetes medication that is often used to lower insulin resistance in PCOS. It may also help reduce androgen levels, and slow hair growth.
According to PubMed, PCOS represents 80% of anovulatory infertility cases. According to the American Society for Reproductive Medicine, the evaluation of infertility in women with the syndrome or other causes of subfertility should start after six months of attempting pregnancy without success if the couple has regular sexual intercourse (2 to 3 times/week) without using contraceptive methods. For infertility caused by PCOS, treatment involves correcting any ovulation issues and tackling metabolic problems, such as insulin resistance. What you can do on your own, besides leading a healthier life, is to start tracking your periods. There are several online calendars and fertility apps that can help you find which days you are ovulating the most. Medication, surgery or fertility treatments are the usual solutions of any fertility issue that may arise because of the syndrome.
Medication:
Letrozole (Femara) is an aromatase inhibitor. It’s used to treat breast cancer and for jump-starting ovulation in people with PCOS. This medication blocks estrogen production and increases the release of follicle-stimulating hormone (FSH) to stimulate ovulation.
Clomiphene citrate is an ovulatory stimulant that works by blocking estrogen feedback to the brain. This oral medication is taken once a day for 5 days at the beginning of your menstrual cycle. It is quite effective in helping women with PCOS to ovulate, however, about 15 percent of women with PCOS don’t respond to the maximum dose.
Metformin is used to treat type 2 diabetes. It boosts the body’s ability to effectively use insulin. This isn’t a first-line treatment for PCOS, but can be used to encourage regular periods and ovulation. It may not be as effective as letrozole and clomiphene, but it can encourage ovulation, so women taking metformin who do not want to become pregnant should use birth control, as they may start ovulating.
Gonadotropins
Gonadotropins are injectable hormones that can help you ovulate. This treatment may require frequent doctor’s visits to see how your body is responding to them.
Laparoscopic Ovarian Drilling
If you aren’t responding to medication, there is still the possibility of surgery. Laparoscopic ovarian drilling is used when PCOS causes the ovaries not to ovulate. The surgeon makes several tiny incisions, and through one incision, a laparoscope will be used to view the internal organs. Then, a laser or fine needle will be inserted to make a few holes on the surface of the ovary. This generally restores ovulation for 6 to 8 months.
IVF is one of the most common treatments for women with PCOS who wish to have children. Those who attempt to conceive using IVF have up to a 70% chance of becoming pregnant. Once pregnant, these women also have up to a 60% chance of a successful live birth. Greece just recently raised the IVF age limit to 54 years old -the previous was at 52 years old- and has some top-notch clinics and highly experienced doctors who perform the treatment. Also, prices are low in comparison with the USA and United Kingdom and the legislation is pretty solid for everyone who wishes to undergo the treatment.
Having PCOS and at the same time struggling with fertility issues may cause an emotional roller coaster to you, so it is extremely important to have people to talk to. Your mental health plays a very important role during this journey and you should be able to reduce stress and negative feelings to the minimum. Apart for your loved ones that are always there for you there are several communities you can join so as to get informed and encouraged. Resolve.org and PCOS Awareness Association for example.
The fertility journey is not something you should do alone. We are here for you!
This September let’s all raise awareness for this common syndrome that troubles women but thankfully in most cases is treatable! #pcosawarenessmonth
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