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Polycystic Ovary Syndrome Is a Fertility and Metabolic Problem
Polycystic ovary syndrome, or PCOS, is a hormone disorder that has been misunderstood, underdiagnosed and undertreated for many years. It is estimated that approximately one out of ten women in the United States may suffer from the condition, but even when diagnosed, many women do not receive the full breadth of appropriate counseling, testing and treatment. If their symptoms become intrusive or they experience a delay to conception, they may get only targeted treatment without a full explanation of what PCOS means. But, the good news is that as awareness of PCOS has becomes more widespread, appropriate care is being provided at an earlier age and its most challenging aspects are beginning to be addressed.
In the most inclusive definition of PCOS, women experience a combination of not ovulating regularly, having high levels of male hormones (androgens), and/or having ovaries with a classic “polycystic” appearance on ultrasound. In women who do not ovulate regularly, the follicles that contain eggs do not develop and mature properly, preventing the monthly release of eggs and resulting in irregular periods. Indeed, many women are diagnosed with PCOS as a result of their menstruation failing to settle into a regular pattern even as they enter adulthood. The high androgen levels can result in excess hair growth and cystic acne, and women may also experience pelvic pain due to ovarian cysts, mood disorders, or pre-malignant or malignant changes of the uterine lining. However, some women remain mostly asymptomatic and are not diagnosed until they seek help getting pregnant.
Importantly, we now know that PCOS is not only a fertility concern, but also a metabolic disorder. It is believed that resistance to insulin, the hormone that manages our sugar intake, is a fundamental characteristic of PCOS, disrupting normal hormone patterns and triggering ovulatory dysfunction. This insulin resistance also means that women with PCOS have not only a higher rate of pregnancy complications such as gestational diabetes and abnormal birthweights, but also a higher risk of pre-diabetes or diabetes, obesity, heart disease, fatty liver disease, and other manifestations of poor metabolic health. Unfortunately, with the childhood obesity epidemic in our country, we are seeing some of these metabolic complications at earlier and earlier ages.
Therefore, though the condition is still not fully understood, the good news is that we do have enough knowledge to adequately counsel, test and treat women for both the reproductive and metabolic complications of PCOS, and guidelines to help us do so, starting in adolescence. Girls and women who have these symptoms or carry a PCOS diagnosis should talk to their doctor and be sure that they understand all the steps they can take to maximize their health and fertility potential. Despite the high infertility rate in women with PCOS compared to the general population, the prognosis for fertility treatments is generally quite good. Reproductive endocrinologists are able to use a variety of protocols to induce ovulation, including oral medications such as letrozole or clomiphene citrate, or injectable gonadotropins, particularly for women pursuing in vitro fertilization. A strong partnership between a woman and her doctor, resulting in good lifestyle choices and appropriate counseling and care, can prevent PCOS from standing between a patient and her goals of achieving successful pregnancies and ongoing good health!