Polycystic Ovary Syndrome is a hormonal disorder that affects between 1 and 6 and 1 and 20 women of reproductive age. It’s a leading cause of infertility — 40% of women with PCOS experience problems with fertility — and women often learn they have PCOS when they encounter difficulty getting pregnant.
But despite how common PCOS is today, it’s not well understood, and awareness is still on the rise. As you can see in the chart below, searches for PCOS-related on Zocdoc have increased significantly over the past few years. Over the last 12 months, among women between 20 to 34 years old, Zocdoc has seen a 16% month-over-month growth for these searches. Between May and July 2017, we saw more than 100% growth versus 2016.
PCOS Searches Per 1 Million Searches on Zocdoc
The recent surge in awareness is partially because PCOS is a complex syndrome that can be hard to diagnose. Connecting the dots between some of its more visible symptoms, such as irregular periods, and some of its more hidden symptoms, like high cholesterol, can make PCOS challenging to understand and treat.
September is PCOS Awareness Month, so we spoke with Dr. Carolyn Alexander, an LA-based OB-GYN and reproductive endocrinologist and fertility specialist at the Southern California Reproductive Center, to help provide straightforward answers to common–and complicated–questions asked by many women who may be affected by this syndrome.
Polycystic Ovary Syndrome
Starting with the basics
PCOS is named for one of the syndrome’s main symptoms—the presence of multiple, small cysts on the ovaries. But PCOS affects more than just that. It involves several factors related to hormone levels in your body and how they interact.
In PCOS, higher than normal levels of male hormones, called androgens, can interfere with the way your ovaries make and release eggs. These increased hormone levels can also cause excess hair growth on your face, chest, abdomen or upper thighs, as well as cause thinning hair, oily skin, and cystic acne.
Researchers don’t know exactly what causes PCOS, but according to Dr. Alexander, the current medical and scientific thinking is that PCOS is caused by a “combination of genetic, endocrine, metabolic and environmental factors.” There’s no cure for PCOS, but there are ways to treat the symptoms.
Why does PCOS affect your period?
Because hormonal imbalances directly affect your reproductive system
In PCOS, hormone imbalances interfere with the way your ovaries produces eggs. When eggs don’t develop as they should, or the ovaries don’t release them, this leads to irregular menstrual cycles and/or the development of ovarian cysts.
If you have PCOS you might not get your period, or your periods could be infrequent or too frequent. And when you do get your period it could be heavy or unpredictable.
So PCOS is a reproductive disorder?
Yes, but it’s more than that too.
The hormone imbalances that are part of PCOS affect the entire female reproductive system — your ovaries are affected and so is your uterus.
But PCOS affects a woman’s entire body. PCOS involves multiple parts of your endocrine system (the system that regulates hormone production throughout your body). This puts women with PCOS at increased risk for several serious health conditions. Women diagnosed with PCOS, Alexander says, “are at risk for irregular menstrual cycles, pre-diabetes, cardiovascular disease, and sleep apnea.”
The other hormonal factor involved in PCOS is insulin, which can affect a woman’s metabolism.
Insulin? As in diabetes?
Yes. Insulin plays a significant role in PCOS.
Insulin regulates the levels of glucose in your bloodstream. High levels of insulin can also increase your appetite and lead to weight gain. But if you’re insulin resistant, your body doesn’t respond to the effects of insulin, so it makes more of it than usual. This can lead to pre-diabetes or type 2 diabetes.
Up to 80% of women with PCOS are obese or overweight, and obesity is associated with insulin resistance. But even lean women with PCOS can be insulin resistant.
In PCOS there’s a connection between insulin resistance and the excess androgens that interfere with ovulation. That’s why you might hear your doctor describe PCOS as metabolic disorder.
Another symptom of insulin resistance in some women with PCOS is patches of dark, velvety skin, called acanthosis nigricans, which is a physical sign of high insulin levels.
Depending on your symptoms, taking diabetes medicines that lower insulin levels might be part of treating PCOS.
If I have irregular periods, do I have PCOS?
This is a good question to ask your doctor.
What’s going on with your period gives your doctor important information about how your body is functioning. Dr. Alexander calls your period “the fifth vital sign. It’s really vital to have your period unless you’re on birth control pills,” she says.
PCOS is diagnosed through a complete medical history, a physical examination, a pelvic ultrasound, and blood tests. And yes, your doctor will ask you a lot of questions about your menstrual history.
Do I need to worry about PCOS if I don’t want to get pregnant?
It’s still important to regulate your menstrual cycle even if you don’t want to be pregnant any time soon.
Alexander boils it down to this: “Don’t skip your period.” Even if you don’t want to be pregnant now, she says, it’s important “to take the proper steps to protect your future fertility.”
That’s because skipping periods isn’t good for your endometrium, otherwise known as the lining of your uterus. “When you skip your period, the lining of your uterus can thicken,” Alexander explains. The medical term for that thickening is hyperplasia, and it can lead to precancerous cell growth.
Birth control pills containing a combination of estrogen and progestin can be used as a long-term treatment for PCOS. Taking birth control pills will help control the hormonal symptoms of “high testosterone and skipped periods,” Alexander says. Birth control pills will also regulate your menstrual cycle and lessen your risks of endometrial cancer. They can also decrease the acne and hair growth often associated with PCOS by helping reduce the high hormone levels associated with PCOS.
What if I’m trying to conceive?
Each woman’s situation is different. Your doctor can discuss possible approaches with you.
It’s all about ovulation. In general, you and your doctor are going to be focused on ways to encourage healthy and regular ovulation. A more regular menstrual cycle means that you’re ovulating more regularly. The healthier your ovulation, the greater your chances of conceiving.
Why did my doctor tell me to lose weight? It seems unrelated.
It’s more complicated than that.
Researchers have found that weight loss can help a woman ovulate more regularly. Alexander told us that for women with PCOS who are overweight, “losing just 5 percent of their body weight could improve their chances of conceiving spontaneously.”
That’s because fat cells play a role in hormone production, she explains. The hormones produced by fat cells can contribute to hormone imbalances that interfere with ovulation.
Paying attention to nutrition and exercising regularly can also help lower cholesterol and insulin levels. There are also medications that can help you ovulate.
What kinds of doctors diagnose and treat PCOS?
PCOS is a complex syndrome and can be difficult to diagnose
First, talk to your primary care doctor or OB-GYN if you have irregular periods, or if your mother, sister, or an aunt has PCOS. If you are having trouble getting pregnant, your OB-GYN might suggest you consult a specialist in reproductive endocrinology and infertility. Alexander says she often sees patients who tell her, “I might have PCOS, but I’m not really sure.”
There’s no single, definitive test for PCOS. Usually a diagnosis is made if you have two of three symptoms: irregular periods, high androgen levels, and polycystic ovaries. But you don’t have to have all the symptoms to have PCOS.
The symptoms of PCOS can vary a lot among women. Not all women who have PCOS are overweight. Not all women who have PCOS have every single symptom. That’s why doctors and scientists are currently debating the best criteria to use for diagnosing PCOS, especially in adolescents.
If you are diagnosed with PCOS, your doctor will work with you to develop a treatment plan that is right for your lifestyle and your unique symptoms.
What kind of research is on the horizon?
Learning more about the genetics and biology of PCOS will help improve diagnosis and treatment
Researchers want to know more about the specific genetic basis of PCOS and are working on identifying the genes that cause it. Advances in genetic analysis could help doctors diagnose PCOS more definitively.
Learning more about the how exactly the different biological aspects of PCOS, especially hormones, interact has the potential to help medical researchers create new treatments for PCOS.
Studies are underway that test drug and non-drug treatments for PCOS.
Another line of research is investigating precursors to PCOS and looking for ways to predict PCOS among adolescent girls. This could help scientists develop early treatments to slow or manage the development of PCOS.