Why PCOS matters to your fertility

You’ve skipped a period or two and have been breaking out like a teenager. It’s easy to dismiss these factors as a result of increased stress or lack of sleep, but these symptoms could indicate an underlying issue, such as polycystic ovary syndrome (PCOS).

PCOS can impair or hinder your fertility. The condition is also associated with an increased risk of insulin resistance, metabolic syndrome, high cholesterol and high blood pressure.

Though the exact causes remain unknown, PCOS is a common disorder associated with hormonal imbalances and insulin resistance, which doctors think is related to genetics or an autoimmune disorder, as well as lifestyle risk factors. This condition affects 6% to 12% of reproductive-aged women, but millions of women remain undiagnosed.

We’re shedding light on the condition to help you understand how PCOS affects fertility.

Here are 5 things you should know about PCOS

1. To diagnose PCOS, doctors are looking for three specific signs. 

The symptoms of PCOS can vary dramatically from person to person, which can make it tough to diagnose. That said, three symptoms seem to be consistent across the board.

Absent or irregular periods: This means having missed periods, for a total of fewer than 8 cycles a year. You can also still have a regular menstrual cycle and have PCOS. A lot of women will have “regular” cycles that are longer or shorter than the traditional 28-day cycle. This is quite common and is still considered a regular cycle.

Acne and hair growth on the upper lip, chin, nipple area or lower abdomen: Though androgens are male hormones, both men and women have them. But men have higher levels, and excess androgens in women can lead to pimples and facial and abdominal hair growth. Others with PCOS may see elevated testosterone levels on blood testing.

Polycystic-appearing ovaries: If a woman has PCOS, the ultrasound may show multiple cysts on the ovaries, often described as looking like pearls. These cysts aren’t abnormal per se—they represent follicles, the tiny individual sacs in the ovaries which contain hibernating eggs. A polycystic ovary usually has 20 or more visible follicles. Many women who don’t have PCOS and have regular cycles can still have polycystic-appearing ovaries, and many women diagnosed with PCOS don’t have polycystic ovaries. Diagnosing PCOS can be difficult for these reasons.

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2. PCOS can resemble other medical conditions and can also affect other areas of your health. 

Even though PCOS is the most common cause of irregular periods, there are other treatable medical conditions that can cause irregular cycles. Diseases affecting other hormone-producing sites in the body, like your thyroid, pituitary or adrenal gland, can lead to signs that imitate PCOS. So it’s worth talking with your doctor to rule out other conditions.

Women with PCOS are also at higher risk of developing diabetes, heart disease and uterine cancer. Your doctor can help you manage the condition and ultimately decrease the chance of these diseases affecting your health down the road.

3. You can’t cure PCOS, but you can manage it. 

Birth control pills are typically the first-line treatment after diagnosis with PCOS, as they can help smooth out the natural hormonal fluctuations that occur in PCOS and thus lead to more regular menstrual cycles. The pill can also help treat the acne and hair growth associated with the condition. It can also lower the risk of developing pre-cancerous changes in the uterus.

Additionally, taking metformin, a medication used for insulin regulation, can work to regulate insulin sensitivity and restore ovulation given the disease’s link to blood sugar imbalance. Other lifestyle changes such as regular exercise and increasing your intake of vegetables, lean proteins and plant-based fats can help regulate insulin.

4. If you are trying to get pregnant and have PCOS, you don’t necessarily need to take fertility drugs. 

Women with PCOS may not ovulate regularly, but they may still ovulate naturally, if unpredictably. So if you’re trying to get pregnant, the key is to have regular intercourse 2 to 3 times a week. Since an egg can be fertilized for 12 to 24 hours after being released and sperm can survive for up to 5 days, having unprotected sex regularly is your best bet. Don’t get hung up on all the different ovulation predictor tests: Basal body temperature charting and urine ovulation tests may not work as well for women who have PCOS.

If you can’t seem to get pregnant naturally, then you should seek help from your gynecologist or fertility specialist. These doctors can prescribe fertility pills such as clomiphene citrate (Clomid) or letrozole (Femara) to help you ovulate. In certain instances, your doctor might prescribe a medicine called metformin to help with ovulation.

5. Even though you don’t ovulate regularly, your egg supply continues to decrease at a normal rate. 

Females are born with 1 to 2 million eggs, and by the time a girl has her first menstrual period, whether it’s at 10 or 16, her egg supply is down to about 300,000 to 500,000. This egg disappearing act continues whether or not a woman has regular cycles (just as we shed skin cells and hair strands every day of our life). So even if you’re not having regular cycles—whether it’s because you have PCOS or you’re on the pill or you’re pregnant—the egg supply in your ovaries is decreasing. With that said, there is some research suggesting that women with PCOS may be more likely to hit menopause at a slightly later age than the average of 51. Whether this translates to a longer timeframe to try and conceive remains to be seen.

A version of this post was originally published on Sept. 26, 2016. It has been updated.

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