Polycystic ovary syndrome

Dear Reader 1 and worried, 

Thank you for your insights and questions! Increasing knowledge about this condition can help you ask informed questions about your health and advocate for yourself as a patient. Polycystic ovary syndrome, also known as PCOS or Stein-Leventhal syndrome, occurs when certain hormone levels are produced at imbalanced levels. In general, too much androgen—hormones found in people of all genders that are influential in reproductive health—and too little estrogen are produced, which prevents the ovaries from ovulating and causes small cysts to form where an egg would have normally been released. That said, having PCOS may influence your ability to become pregnant. Reader 1, you’re correct that PCOS can cause missed periods and that it’s wise to know more about the condition. It affects around five to ten percent of people with ovaries. The good news, Worried, is that there are medications that may help relieve PCOS symptoms and encourage ovulation so as to increase your chances of conceiving. Additionally, a combination of medication and lifestyle changes may also help manage the other concerns associated with PCOS as well. Read on for more about PCOS and how to address the concerns you’ve both mentioned. 

To begin, the exact cause of PCOS is still unknown, but certain factors may play a significant role: 

• Excess insulin: Too much insulin may cause an increase in androgen production, which may interrupt the ovulation process. 
• Low-grade inflammation: When the white blood cells in the body produce substances to guard against infection or injury, it’s considered low-grade inflammation. In people with PCOS, a similar, long-term inflammation may cause polycystic ovaries to produce androgens. 
• Heredity: A family history of this condition may increase an individual’s risk. 

List adapted from Mayo Clinic 

Additionally, PCOS is associated with certain characteristics. A diagnosis may be pursued when a person has at least two or more of the following:

• Irregular or absent menstrual periods (often indicative of a lack of ovulation). 
• High levels of androgen. This can present physically as atypical hair growth on the face and body, acne that isn’t responsive to typical treatments, and hair loss from the head. 
• Having larger ovaries or a significant number of ovarian follicles. 

If any combination of these characteristics is observed, a health care provider may investigate further via physical and pelvic exams. Furthermore, a blood test may be utilized to measure androgen hormone levels, cholesterol, and blood sugar. An ultrasound may also be recommended to look at the ovaries and uterus for cysts and tissue buildup in the uterine lining. It’s wise to be evaluated if PCOS is suspected because people with this condition may also be at an increased risk for sleep apnea, type 2 diabetes, metabolic syndrome, obesity, heart disease, hypertension, mood disorders (e.g., depression and anxiety), and endometrial cancer (which may be associated with a build-up of uterine tissue rather than scar tissue). 

Because there is no cure as of yet, treatment is often geared towards management. Treatment recommendations are specific to each individual and often based on their symptoms, current or additional health concerns, and whether they’re interested in becoming pregnant both now and in the future. Some of these treatment options may include: 

• A change in lifestyle habits: You may first try some lifestyle habits, such as maintaining a healthy weight, getting regular physical activity, and eating a variety of fresh and whole foods—all of which can be done in tandem with other treatment options. 
• Menstrual regulation: A health care provider might recommend options to help regulate menstrual periods. These may include combination birth control methods (such as oral birth control pills, the contraceptive patch, or the vaginal ring that all contain estrogen and progestin) or progestin therapy. An alternative approach is the use of metformin. This is a medication that may be used to help regulate periods, improve insulin levels and resistance, as well as help with ovulation. 
• Help with achieving conception: Though using oral contraceptives may hinder the ability to conceive, several medications can help with achieving conception for someone with PCOS. One option is clomiphene, an oral anti-estrogen medication taken at the beginning of a menstrual cycle. Metformin may also help with ovulation when used in conjunction with clomiphene if clomiphene doesn’t work on its own. If the use of clomiphene and metformin don’t help with ovulation, another possible option is the injection of gonadotropin hormones. 
• Addressing excess hair growth: To address excess hair growth there are both medications to block the effect of androgen (which discourages hair growth) and prescription creams that slow the growth of unwanted facial hair. Oral contraceptives may also be helpful in this pursuit. 

Worried, it may be beneficial to speak with your health care provider to determine what course of treatment is best to address your concerns. In addition to working with your provider, it may also be helpful to join a support group or search for PCOS specific pages on various social media sites. Speaking with others and sharing experiences might help you to get real time advice and feel more supported in the process.