Understanding PCOS through 11 key questions

Women who have spent years agonizing over irregular periods and extra weight may be frustrated when they finally learn that the root of their problem is polycystic ovary syndrome (PCOS). This hormonal disorder can cause ovarian cysts and challenges with fertility and metabolism. PCOS affects up to 13% of women of reproductive age and is usually diagnosed when women are in their when women are in 20s and 30s.

Unfortunately, there’s no cure for it yet.

“There’s no perfect drug or treatment for PCOS, either,” said Dr. Pooja Raghavan, an endocrinologist with Novant Health who works with patients dealing with PCOS and Type 2 diabetes. “It’s a complex syndrome, but there are options to help manage and improve symptoms.”

Here, Raghavan answers common questions about PCOS.

Is there a way to prevent PCOS?

No, but there are risk factors, which include a family history of PCOS, obesity, Type 2 diabetes and a history of irregular menstrual cycles. Both Type 2 diabetes and obesity can be addressed, and this may help reduce the risk or severity of PCOS.

Both conditions are linked to insulin resistance. That’s when your body has a harder time using the hormone insulin, so sugar stays in your blood instead of going into your cells to give you energy. Insulin resistance is a key element to how PCOS develops and progresses.

What are the symptoms of PCOS?

The roots of PCOS are grounded in hormonal imbalance, and symptoms can range from irregular menstrual periods, infertility and ovarian cysts to weight gain, pelvic pain, increased hair growth, acne, male pattern baldness, anxiety, depression and sleep apnea.

Why is PCOS diagnosed so late?

Many women start getting irregular menstrual cycles as teenagers, but they may be in the care of pediatricians who may not be as adept at diagnosing PCOS. While there are pediatric endocrinologists who specialize in hormone-related conditions, people often don’t start seeing endocrinologists until they are age 18 or older, so hormonal concerns may not yet be on the radar. This can delay diagnosis. In large part, a woman’s experience with PCOS involves navigating the uncertainty of whether she has it, then managing symptoms and trying to prevent related risks.

How is PCOS diagnosed?

Diagnosis can include a full family history, a physical exam, blood samples and a pelvic exam or ultrasound to check the ovaries. A woman who satisfies two of the following three conditions may be diagnosed with PCOS:

Long-term absence of ovulation that leads to menstrual irregularities such as infrequent, absent or heavy periods.

High levels of androgens – a group of hormones often called “male hormones” – that don’t result from other conditions, such as adrenal, thyroid or pituitary gland dysfunction.

At least 12 follicles of a specific size and volume on one or both ovaries, as detected by an ultrasound. Ovarian follicles are small sacs in the ovaries that hold eggs during the menstrual cycle.

Why is it harder for women with PCOS to lose weight?

PCOS affects how the body processes blood sugar. When your body has trouble using sugar for energy, it stores more of it as fat.

Why does PCOS cause infertility? How does it impact a woman’s chances of conceiving?

About 70% of women with PCOS can have difficulty getting pregnant. The main reason is that they don’t ovulate, or release eggs, regularly. This happens because of hormone imbalances that affect how eggs grow and when they’re released. Irregular periods make it hard to know when ovulation might happen. Additionally, even if an egg is released, hormone problems can keep the uterus from being ready for pregnancy.

How can someone with PCOS approach conception?

Women with PCOS under the age of 35 who are trying to conceive are recommended to try for a year without any fertility assistance. Women with obesity can work on weight loss to improve ovulatory cycles. After that year, the fertility drug clomiphene citrate (sold under the brand name Clomid or Serophene) are usually used as the first line of defense before trying more extensive fertility measures.

For women with PCOS over the age of 35 who don’t want to lose a year to trying to conceive naturally and/or to lose weight, ovulation induction is an option. Medication can help release an egg to improve chances of conceiving.

If you do conceive with PCOS, is your pregnancy higher risk? Could you pass this to a female child?

Women with PCOS have a higher rate of miscarriage in the first trimester. This can occur in 30% to 50% of women with PCOS, compared with 10% to 15% of women without PCOS. Women with PCOS also have a higher risk for high blood pressure, gestational diabetes and premature delivery.

Studies have shown that there is a genetic component to PCOS. Women are more likely to develop PCOS if their mothers or sisters have the condition. Up to 70% of girls whose mothers have PCOS may develop the condition.

What other health challenges are women at risk for if they have PCOS?

PCOS puts women at higher risk for insulin resistance, heart disease, high blood pressure, Type 2 diabetes, obesity and endometrial cancer (a type of cancer that starts in the lining of the uterus).

What treatments can you consider for PCOS?

For women who don’t want to get pregnant, birth control can help control menstrual cycles, reduce male hormone levels and clear acne.

Whether women are trying to conceive or not, Metaformin (a medicine that helps lower blood sugar) is a common option to help with insulin resistance, and this could potentially help with ovulatory cycles.

What lifestyle changes can help with PCOS?

Lifestyle changes work better than medication alone to reduce PCOS symptoms and your risk for other related health conditions down the line. You can improve your diet by limiting simple carbohydrates, processed food and sugar, and by focusing on eating whole grains, lean meats, vegetables and fruit. Diet improvements in addition to regular exercise are an important component in preventing complications related to PCOS.