What Is PCOS?
Polycystic Ovarian Syndrome is the most common endocrine disorder of reproductive age women and the most frequent cause of anovulatory infertility. This means women have difficulty conceiving because they don't ovulate. Prevalence ranges from 9-18%, but the etiology remains unknown.
It's specifically a syndrome with a collection of signs and symptoms rather than a well-defined disorder. Because of this, there can be variable clinical presentations.
Many women become diagnosed with PCOS after seeking help for irregular or absent menstrual periods, or difficulties with conception. Unfortunately, it’s not a cut-and-dry diagnosis process. There’s no definitive blood test. Rather, practitioners use criteria called the Rotterdam criteria, which requires two of the following three symptoms to diagnose a female with PCOS:
- oligoovulation (irregular periods, cycles less than 25 days or more than 35 days apart)
- clinical and/or biochemical signs of hyperandrogenism (excess amount of androgens)
- polycystic ovaries detected by ultrasound
Aside from fertility concerns, detecting PCOS is crucial because it is linked to other health conditions such as diabetes, obesity, heart disease, and uterine cancer.
That's why it's so important for practitioners to identify these metabolic abnormalities to mediate any future health risks that a patient may have.
Ways to Address PCOS Symptoms
Women can take steps to ease their PCOS symptoms. Lifestyle interventions include weight loss or prevention of weight gain through dietary modifications and regular exercise. A body weight reduction of 5-10% has been shown to exert a significant benefit on psychological, reproductive, and metabolic outcomes.
In addition, BMI is a clear factor associated with reduced pregnancy rates among obese patients compared to normal weight patients. Consulting with a nutritionist and maintaining regular exercise for at least 30 minutes a day can reduce cardiovascular risks that are associated with PCOS. This also assists women in their efforts to achieve pregnancy. However, women who have a “normal” BMI also struggle with PCOS and fertility.
There is a special subset of patients who have what we call lean PCOS. This is where they have a normal BMI, but they have greater insulin resistance compared to weight match controls. They also manifest various metabolic abnormalities such as dyslipidemia, which involves high cholesterol and triglycerides, prothrombotic tendencies [blood clotting issues], and increased inflammatory markers. Unfortunately, their diagnosis is often delayed or missed altogether because they don't exhibit the typical PCOS symptoms.
Medications are also an option, particularly for women who are hoping to conceive. I urge women to seek out help from either an obstetric professional or someone who specializes in both IVF and PCOS.
I want these women to know we're here for them. We would love to help them achieve pregnancy. And if there's any questions that they may have, they can also discuss things with their regular OB/GYN provider as well.