Today we're walking through one of the most common hormonal disorders women face: PCOS. We'll dive into what it is, how it's diagnosed, and what you need to know about your treatment options.
What is PCOS?
Polycystic Ovary Syndrome, or PCOS, is a hormonal disorder common among women between the ages of 15 to 44. It’s thought to be the most common hormonal disorder for women in their childbearing years; NIH estimates that between 2.2 and 26.7 percent of women this age have PCOS. (We know, this is a big range. That’s because research on PCOS often uses different diagnosis criteria, so different studies show different rates of prevalence). All this to say, if you are struggling with PCOS you are definitely not alone.
Symptoms of PCOS
PCOS is characterized by abnormally high levels of androgen, a male hormone normally produced in small amounts by the ovaries during ovulation. As a result, symptoms of PCOS usually involve issues with ovulation. The most common include:
Infrequent or prolonged menstrual periods
This includes having fewer than 9 periods a year, going more than 35 days between periods, or having abnormally heavy periods.
Cysts on your ovaries
Cysts are small fluid-filled sacs that grow inside your ovaries. These are actually follicles that contain eggs, but the eggs never mature enough to trigger ovulation. Your ovaries might also be enlarged as a result of these follicles.
Excess male hormone levels
That excess androgen circulating in your body can lead to other symptoms like excess facial or body hair, severe acne, or baldness.
Since your ovaries are having a hard time releasing eggs properly, infertility can also be a sign of PCOS.
How do I know if I have PCOS?
This condition usually develops around the time of your first menstrual period, but sometimes develops later. Often, when symptoms of PCOS develop during puberty, hormonal birth control is prescribed as a treatment to manage heavy periods. This can mean that people don’t know they have PCOS until much later in life, when they stop taking their birth control pills and start trying to get pregnant. PCOS can also develop later in life in response to major changes in your body, such as big weight gain.
If you are experiencing symptoms of PCOS, it’s a good idea to check in with your doctor. They will likely be the best resource for any questions about PCOS and your treatment options. Your doctor will perform a pelvic exam to check your ovaries and can order a blood test to monitor hormone levels. For more on hormone testing and PCOS, click here. A diagnosis typically comes when you have at least 2 of the 3 main symptoms: high androgen levels, irregular periods, and ovarian cysts.
What causes PCOS?
Long story short, the jury is still out. Researchers suspect that the elevated levels of androgen prevent your ovaries from producing hormones and making eggs normally. This could be a result of a number of possible factors:
1. Genetic Factors
Research shows that PCOS does tend to run in families and that there are a number of genes that could be responsible.
2. Too Much Insulin
Insulin is the hormone that helps your cells process sugar to make energy. If your body can’t process insulin properly, your body makes more to compensate. Extra insulin triggers the ovaries to produce more androgen. This is called insulin resistance, and the biggest cause for this is obesity. Obesity and insulin resistance can both also increase your risk for type 2 diabetes.
Women with PCOS typically have higher levels of inflammation in their body. This means their white blood cells are overactive, producing substances to fight infection. This can also stimulate polycystic ovaries to produce androgen.
PCOS & Your Fertility
This condition can make it harder for women to get pregnant. According to NIH, between 70 and 80 percent of women with PCOS also have fertility problems. It can also increase your risk for pregnancy complications: women with PCOS are more likely to deliver preamturely, and are at greater risk for miscarriage, high blood pressure, and gestational diabetes.
Don’t let this discourage you: with treatment, women with PCOS can still get pregnant and have healthy pregnancies. Fertility treatments aimed at improving ovulation can help. So can lowering your blood sugar levels through a healthy diet and losing weight.
Treatment for PCOS
Typically, the first treatment doctors recommend for PCOS involves managing your weight, improving diet, and exercising regularly. If you are overweight, research shows that losing just 5 to 10 percent of your body weight can help regulate your menstrual cycle and manage your symptoms. Maintaining a healthy weight has the added benefits of improving cholesterol levels and reducing your risk of heart disease and diabetes.
Along with managing your weight, research indicates that pursuing a low glycemic index diet, aka low in carbohydrates can also help lower insulin levels. Researchers recommend getting most of your carbohydrates from fruits, vegetables, and whole grains.
Lastly, we can’t forget regular exercise. More research has found that getting at least 30 minutes of moderate-intensity exercise at least three times a week can help women with PCOS manage their weight and their symptoms.
For more on natural ways to treat your PCOS, click here.
Taking an antioxidant like N-Acetyl cysteine (NAC) or Vitamin D can be really helpful for managing the inflammation that is common in women with PCOS. NAC helps improve insulin levels, regulate hormones, and regulate your menstrual cycle. For more on NAC at PCOS, click here. We love NAC here at Binto. If you want to add NAC to your Binto pack, just shoot us a message in the chat!
Daily estrogen and progestin is a common treatment used to help manage your hormone balance, regulate ovulation, and help with excess hair growth and difficult period symptoms. If you are trying to get pregnant, this obviously is not an ideal solution for you, but for women who are not TTC, the pill, patch, or vaginal ring can be a great option. To learn more about how hormonal birth control works, click here.
Your doctor may recommend that you take Metformin, a drug used to treat type 2 diabetes which can help improve your insulin levels. One study found that women who took Metformin in addition to making lifestyle changes lowered their blood sugar and restored their menstrual cycle more effectively than just diet and exercise changes alone. Long term, metformin can also help lower your cholesterol levels and reduce your risk of heart disease.
The most common medication for women with PCOS who are trying to get pregnant is a medicine called Clomifene, which encourages regular release of eggs from your ovaries. It can increase your risk of a multiple pregnancy, aka twins!
Sometimes Clomifene and Metformin are used together to help encourage regular periods and improve fertility in women with PCOS. If this doesn’t help, your doctor might recommend that you discuss other options like IVF.
Another option is a surgical treatment called laparascopic ovarian drilling. While this sounds scary, it basically boils down to the use of lasers or a heated needle to poke holes in your ovary and encourage regular ovulation. It essentially clears a path within your ovary, which may be full of cysts, to allow regular ovulation to take place. This is usually used as a last resort if you still aren’t ovulating after adopting lifestyle changes and trying fertility medication. About 50% of women who do not respond to medication for their PCOS may still become pregnant after this procedure.
When Should I See A Doctor?
If you suffer from very long and heavy periods, or you have less than 9 periods a year, you should reach out to your doctor. If you’re experiencing other physical symptoms of PCOS like hair growth on your face and body, it’s also a good idea to check in. On the fertility side, if you have been trying to get pregnant unsuccessfully for 12 months or more, call your provider.
PCOS can be really disruptive for a woman’s menstrual cycle, and stressful to deal with if you’re trying to get pregnant. Just remember, you are not alone and you have options. If you have any questions or concerns about PCOS, you can reach our certified healthcare professionals anytime through our chat or by scheduling a telehealth consultation here. We’ve got your back!