PCOS, or Polycystic Ovary Syndrome, is a very common condition that affects approximately six to eight percent of fertile girls and women globally. It’s related to an increase in male hormones, which we call androgens. These androgens cause symptoms including skin issues (oiliness, acne and skin tags) and weight gain. They also cause tiny fluid filled sacs (called cysts) on the ovaries and irregular periods, among other problems.
The cysts are actually follicles that haven’t matured and ovulated. In this instance, PCOS can affect fertility and lead to struggles for women who are trying to conceive a baby.
The exact cause of PCOS remains unclear, however we do know that the condition is linked to insulin resistance and the aforementioned increased male hormones. PCOS can cause fertility struggles when trying for a baby and may even lead to Type 2 Diabetes after menopause. Therefore the earlier the diagnosis, the better, to help maintain a healthy lifestyle, take medication where advised and help manage the PCOS condition.
Despite PCOS being so common, there is much about it that remains a mystery. Here, Fertility Specialist and Gynaecologist, Dr Raewyn Teirney, bust some of the myths and clarify some truths around the condition.
Ovarian Cysts Must Be Present To Be Diagnosed With Polycystic Ovary Syndrome
False: While ovarian cysts may indicate the presence of PCOS, their presence alone is not enough for a positive diagnosis. In fact, many women have it without having ovarian cysts at all. There are a lot more factors involved, and myriad symptoms.
Conducting an ultrasound to look for the presence of ovarian cysts is part of the diagnostic regime, but there also are other factors that determine the condition. These factors include things such as signs of raised androgens with excessive oiliness in the skin, increased facial hair, usually on the upper lip and chin and increased hair growth around the nipples and belly button and more. Being overweight is a factor however you can have PCOS and be slender.
PCOS is caused by being overweight
False: While carrying excess weight is both a symptom and cause of PCOS, it isn’t the only reason you may have it. However, it pays to remember that being overweight can exacerbate hormonal changes. As such, part of our treatment plan with PCOS is to assist patients with healthy eating and exercise and other lifestyle tweaks that will assist them in maintaining a healthy weight.
Thin People Don’t Get It
False: PCOS can affect even very slender women. While the majority of PCOS patients are overweight or even obese, there is a significant proportion PCOS patients who are of completely normal weight (BMI; ≤25 kg/M2). This of course makes diagnosis trickier, but new diagnostic methods, where there must be two out of three symptoms present, help make diagnosis – and treatment – a lot easier for both doctor and patient.
PCOS Is Almost Impossible To Diagnose
False: As stated above, it can be trickier to detect in slender women as being overweight is one of the most obvious symptoms of the condition. Indeed, the classic presentation of PCOS is a young woman who is overweight, has irregular periods that may come every three or four months and when they do come, they are very heavy. She may also experience increased acne on her face and increased hair growth on the chin and upper lip. Other symptoms include hair loss, pigmentation around the neck area, skin tags and difficulty conceiving.
Some women with PCOS may only have severe acne, while others may only have erratic periods. Others may have perfect skin, but experience weight gain. This means we may need to conduct further testing, which could include a blood test to detect increased male hormones and /or an ultrasound to reveal a polycystic appearance of the ovaries.
In 2003, a medical conference held in Rotterdam defined PCOS to give more uniformity and lessen the ambiguity surrounding the condition.
To be diagnosed with PCOS, you must have two of the three below criteria
- Your blood test confirms the presence of increased male hormones we call Androgens, or you show clinical signs of increased male hormones. This means having signs such as acne, or increased hair growth on your face or body called hirsutism.
- You have infrequent or no periods (i.e., menstrual bleeding), this indicates infrequent ovulation (releasing of the egg from your ovary).
- You have a pelvic ultrasound showing at least one ovary to have many small cysts. It must be 20 or greater cysts.
Polycystic Ovary Symptom Can Affect My Mental Health
True: No matter what age you are at, if you have PCOS, there is a risk that some mental health issues like body image, self-esteem, anxiety, and depression may present themselves. This has to do with hormone imbalance, as well as the difficulty PCOS women have in maintaining a healthy weight, as well as physical symptoms such as acne and hirsutism (excess hair). It becomes particularly noticeable if PCOS is hindering fertility. I always ensure that my ladies with PCOS receive holistic care, which includes full attention to physical, mental and emotional health.
PCOS Goes Away Eventually
False: PCOS is a manageable, lifelong condition. Those affected should always follow medical advice. Maintaining healthy lifestyle habits, such as enjoying regular exercise, eating a healthy diet, and avoiding too much alcohol and junk food are important.
PCOS can even begin in utero with what we call Small Baby Syndrome. It can also lead to peri-puberty/early puberty or what we call medically precocious puberty, where girls begin menstruating and a very young age. PCOS can lead to acne in teenage girls as well as women and when trying to start a family, it can cause fertility struggles. Finally, menopausal women with PCOS are at risk of Type 2 Diabetes and as such should check in with their GP regularly to be tested. The good news is that while it is a lifelong condition, PCOS is very manageable, and the worst of the symptoms pass as the number of follicles on the ovaries decline with age.
I’ll Never Be Able To Have A Baby
False: This is completely false. In fact, most women with PCOS can be treated quite easily and go on to have happy healthy babies and women in their 30s with polycystic ovaries may actually be better off than their peers, as they have a better ovarian reserve.
Things To Remember
PCOS may sound a little scary, but it’s important to remember it’s quite common and very manageable. If you have been diagnosed, please keep these four things front of mind, and never hesitate to get in touch, as I can guide and support you in your journey to become a mother.
1.PCOS is common and manageable. It is important to be diagnosed so you know what you are dealing with, and you can seek support from your gynaecologist and any PCOS support groups online.
2.Fertility treatments follow a pathway, which will lead to success for most patients, and we begin with lifestyle modifications, which are a very effective treatment option in PCOS.
3. Some cases do require longterm care, but at all times we will ensure you are holistically cared for and we can help you become a mum, if that is what you wish for.
For more information on PCOS and to find out how you can fall pregnant if you have it, click here.