1 in 10 women will be diagnosed with polycystic ovarian syndrome (PCOS) at some point in their life. PCOS is very common, but is so often misunderstood and misdiagnosed. Here we discuss symptoms and potential treatments of the condition. We’ll also explain what PCOS means for your fertility, and your long-term mental and physical health.
What are polycystic ovaries?
‘Polycystic ovaries’ (or PCO) is simply a way of describing what your ovaries look like on an ultrasound scan. Ovaries have little cysts (collections of fluid, also referred to as ‘follicles’) on them – from which eggs are released. Ovaries appearing ‘polycystic’ have more of these little cysts (and are therefore usually a little larger) than is average.
About a third of women have ovaries that are polycystic, but the appearance of your ovaries can change over time. Therefore, you shouldn’t be surprised if one sonographer says they are polycystic and another says they are not. Some contraceptives also make your ovaries look polycystic, but this is normal and nothing to worry about.
What is PCOS?
This is where it gets a little complicated.
Many women who have polycystic ovaries (PCO) do not have polycystic ovarian syndrome (PCOS).
To be diagnosed with PCOS, you will have a combination of symptoms. A group of experts got together a few years ago to agree some criteria for PCOS. This is called the ‘Rotterdam criteria’. Someone with PCOS would have at least two out of three of the following:
- Polycystic ovaries on a scan.
- Infrequent or absent ovulation – which usually means irregular periods (if you are not on the pill).
- Signs of high testosterone, or high levels of testosterone on blood tests.
Although the diagnosis above is quite strict, the truth is that everyone is on a spectrum. Someone developing the condition may only have one of the symptoms – and may still benefit from medical advice. Of people who do officially have PCOS, it ranges from those who hardly notice it, to those who find it affects almost every area of their lives.
Can you have PCOS without cysts on the ovaries?
Because you only need to meet two out of the three Rotterdam criteria, confusingly, this means that you can technically be diagnosed with PCOS even if you don’t have polycystic ovaries!
What is the main cause of PCOS?
Doctors don’t really know exactly what causes PCOS, although there is evidence to support the theory that it could be linked to our genes. The biological cause of PCOS is an imbalance of fertility hormones in your brain and ovaries. PCOS usually occurs when levels of the hormone LH or insulin are too high. This can cause the ovaries to make extra testosterone.
What are the first signs of PCOS?
Some of the key symptoms of PCOS include:
- Irregular periods
- Weight Gain or difficulty losing weight
- Acne or skin issues
- Hair growth – particularly on the face or back
- Hair loss from the head
- Difficulties conceiving
Often the first sign of PCOS is not having regular periods, which reflects the fact that you are not ovulating regularly. Of course, while you are on the contraceptive pill, this will be masked – so it is very common not to know your periods are irregular until you come off the pill.
Young women may show symptoms such as acne, and excess hair growth on their faces or other parts of their body (breasts and belly most commonly). These symptoms often indicate high testosterone levels, which is a key element of PCOS.
During puberty, most teenage girl’s weight will fluctuate as their hormones are running wild. However, for young girls with PCOS they may notice excess weight gain especially in the abdominal area, due to higher levels of insulin.
Whilst these symptoms may affect some people with PCOS, it’s important to remember that for some they will show no signs at all, and may not even realise they are living with the condition until they are older. Many women discover they have PCOS once they try to conceive.
Can polycystic ovaries be cured
At present there is no cure for PCOS. However, recent research indicates there may be a way of using the IVF drug cetrorelix to reverse the effects and cure PCOS. Whilst this research is currently at early stages, it does offer hope to women with PCOS.
Until a cure is found, you can speak to your GP about ways to decrease and alleviate symptoms of the condition.
How do doctors treat PCOS?
Whilst doctors may not be able to cure PCOS, there are some treatments and medications they can prescribe to help with the symptoms of the condition.
If your PCOS is causing fertility issues they can prescribe a medication to stimulate ovulation, such as Clomifene. Some doctors also prescribe a medication called Metformin, alone or in combination with clomifene. Metformin is generally used to treat type 2 diabetes, but it can often help women with PCOS by lowering insulin and blood sugar levels.
Can I manage my PCOS symptoms naturally?
Whilst some people find medication helpful, it’s important to remember that diet and lifestyle can play a huge role in the severity of your PCOS symptoms and your hormonal balance.
Diet advice for women with PCOS
Nutritionist, Katie Darymple has some great advice on diet for people who have PCOS:
Women with PCOS are known to have higher than normal insulin levels. One way to lower insulin levels is to change and modify your diet.
Insulin is produced by our pancreas in response to glucose in our blood which comes from the sugar in our diet. The low glycaemic index (GI) diet helps to control blood glucose levels, as foods with a low GI do not cause spikes or high levels of blood glucose. The sugars from low GI foods are released slowly into our blood and therefore do not result in high levels on insulin.
Low GI foods include wholegrains which are high in fibre, such as oats and wholegrain pastas and breads. Beans, nuts and pulses are also low GI foods.
If you are considering a low-GI diet focus on:
- Eating 3-4 different vegetables per day.
- Switching white bread, pasta and rice for wholegrain alternatives.
- Incorporate beans and pulses into your meals.
- Stay away from processed or refined foods which are high in sugars, such as crisps, sweets and chips.
Does PCOS affect pregnancy?
One of the features of PCOS is not ovulating regularly, meaning it can take longer to get pregnant. Having an irregular menstrual cycle can make it harder to pinpoint ovulation, which is helpful when trying to conceive.
The good news is, many women with PCOS are able to conceive naturally. However, if your periods are very infrequent, or you are above the age of 35, then you might want to consider discussing it further with your GP as part of your preconception planning.
Whilst the general advice is to investigate fertility treatment after trying for a year, if you have PCOS it may be advisable to seek medical advice earlier in your fertility journey.
If you’re having mostly regular periods and/or you’re happy to accept that it may take a little longer, then there’s no reason to be concerned or take action. Often a healthy lifestyle, with a good diet and regular exercise, and maintaining a healthy weight, will improve your fertility.
How can doctors help me get pregnant if I have PCOS?
If you are having difficulty there are ways your doctor can help you improve your fertility and chances of conceiving.
Fertility services (once they have done a thorough check to confirm that this is the only reason why you are not conceiving – i.e. a check of your womb and fallopian tubes, and also your partner’s sperm count) can prescribe medications to help you ovulate regularly (they usually start with a medication called clomifene). While you are on this, you need to have regular checks to make sure it is working and you are on the right dose. It does increase your risk of a twin pregnancy.
If this doesn’t work, sometimes a procedure called ‘laparoscopic ovarian drilling’ is considered – in which a keyhole procedure is performed while you are asleep, and small holes are made in the ovary (it’s not known exactly how or why this works – but there is good evidence for it!). IVF may also be appropriate.
Can PCOS affect a pregnancy test?
PCOS should not really affect the results of your pregnancy test.
False negative test results are usually caused by low levels of human chorionic gonadotropin (HCG). If the levels of this are too low sometimes a test won’t detect a pregnancy. This can happen if you take the test too early.
For women who have PCOS it can be hard to pinpoint ovulation and irregular periods might mean you have missed a period when it is simply late. If your period does not come when expected, and the test is negative, you should repeat it again in a week’s time if your period does not come.
How do I know if I’m ovulating with PCOS?
Having regular periods is the best indication that you are ovulating. However there are a few other ways of helping you to determine when you are ovulating. Understanding these fertile signs can be helpful when you are trying to conceive – especially if you have PCOS.
Your Cervical Mucus. Your cervical mucus will be different at different stages of your cycle. Familiarising yourself with these changes can help you work out when, and if, you are ovulating. At the start of your cycle is will be dry, whilst during ovulation it will be wet and sticky – a bit like egg whites.
Your Cervical Position. Similarly to your mucus, your cervical position changes slightly throughout the month. If you reach inside your vagina and can easily feel your cervix, you’re probably not ovulating. During ovulation your cervix may be higher in your body and therefore harder to reach.
Basal Body Temperature. Right before ovulation, a woman’s body temperature will spike. You can use a simple thermometer to record your temperature every morning throughout a month. When you notice an increase in your basal temperature, there’s a good chance you are ovulating.
Ovulation Prediction Kits. There are many at home kits on the market that work similarly to pregnancy tests. These tests look for elevated levels of LH. However, women with PCOS tend to have high levels of LH, so these tests may not always be accurate, and are not generally recommended.
Does PCOS increase risks in pregnancy?
Women with PCOS may be more likely to develop diabetes in pregnancy known as gestational diabetes. Some doctors will advise that all women with a past diagnosis of PCOS have a test called a ‘glucose tolerance test’ in pregnancy. This will usually take place about 6 months into the pregnancy.
If you have gestational diabetes, it is important to control your blood sugar by changing your diet and using medication as advised by your doctor. Without good control of your blood sugar, you have a higher risk of having a very large baby, which can lead to complications with labour, and may result in a higher chance of a caesarean section, and the risk of a tricky delivery. If you have a large baby on board, or it has been difficult to control your blood sugars, you may be recommended to be induced earlier than your due date, or soon after, because of a slightly higher risk of stillbirth.
PCOS also seems to be associated with a slightly higher risk of early miscarriage. This can be due to increased testosterone levels and a thinner womb lining. Some studies have shown that of women who have suffered with recrurent miscarriage, 40-80% of them have PCOS.
If you want to find out more information or get more support around miscarriage you can read our blogs “missed miscarriage” and “Are sperm health and miscarriage linked?”.
What if PCOS is left untreated?
If left untreated, women with PCOS are more likely to develop diabetes in later life. Keeping a healthy weight significantly reduces this risk. Some research also shows that women with PCOS are more at risk of cardiovascular disease (including heart attacks and strokes) – so it’s important to keep a close eye on your lifestyle and blood pressure to reduce this risk.
In PCOS, the lining of the womb (the endometrium) may be thickening under the influence of high levels of the hormone oestrogen, but, because of a lack of regular ovulation, is not being shed. A very thick endometrium is more prone to develop abnormalities in its cells, which can, if untreated, lead to endometrial cancer in later life.
Having PCOS also seems to be associated with a higher risk of anxiety and depression. Some of this may be a reaction to the symptoms themselves, which can be understandably upsetting. Research has shown that mindfulness, yoga and meditation are helpful for low mood and anxiety. Parla has a daily meditation for fertility programme that you can try. Regular exercise for fertility has also been shown to be helpful.
You can learn more about yoga in our blog post “Yoga for mental health” and find a sequence of asanas in “Yoga poses for fertility”.
Reviewed by our experts.
We hope you have found this article useful. If you want to learn more about PCOS and pregnancy or have some questions for our experts you can join our next PCOS Masterclass!
