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What Is PCOS And How Does It Affect My Fertility?

In this latest series, I am exploring everything to do with fertility. So far we have looked at how to improve your fertility, the importance of folic acid and male fertility. If you have missed any of these articles you can read the following:

This week I want to explore polycystic ovarian syndrome (or PCOS), a common endocrine disorder that affects many women. PCOS is caused by cysts on the ovaries that secrete increased levels of testosterone (also called androgens) and estrogen which causes a hormonal imbalance. The cysts themselves are not dangerous but the hormone imbalance can prevent ovulation.

What Is Ovulation?

Ovulation is when the ovary releases a mature egg (follicle) full of DNA and ready to meet a sperm for fertilization. Ovulation is controlled by a hormonal feedback loop from the pituitary gland in the brain to the ovary. Circulating levels of estrogen and progesterone regulate this feedback loop and tell the pituitary gland to increase follicle stimulating hormone (or FSH) for follicle development and increase luteinizing hormone (LH) to eject the follicle from the ovary. If estrogen and progesterone levels are out of balance then this affects the feedback loop and ovulation does not occur. If ovulation has not occurred then a women will not get her period (which would normally happen 10 days to 2 weeks post-ovulation) – this is called an irregular menstrual cycle.

If we don’t ovulate then we don’t release a follicle in order to get pregnant. In addition to playing a role in ovulation the hormone imbalance caused by PCOS can affect weight, mood, hair growth, can cause acne and increase risk factors for diabetes and heart disease.

What Causes PCOS?

There are a number of factors that can contribute to the development of PCOS:

Research has shown that women with PCOS have low-grade inflammation which occurs when the body’s white blood cells produce substances to fight infection. This type of low-grade inflammation stimulates polycystic ovaries to produce androgens (testosterone and estrogen).

Signs and Symptoms of PCOS

Signs and symptoms of PCOS often begin soon after a woman first begins having her periods although, in some cases, it can develop later on in the reproductive years.

As a primary care physician I find this condition is often overlooked as a diagnosis in women. Many doctors will dismiss the diagnosis if the ovaries don’t have a significant number of cysts on them, however, PCOS is a spectrum and women may have mild, moderate or severe PCOS depending on where they are on that spectrum. Here is a list of the signs and symptoms that women with PCOS can experience:

Diagnosing PCOS

If a woman has fewer than eight menstrual cycles per year, there is an 80% potential chance she has PCOS. If you are experiencing any of the above symptoms, your doctor may want to investigate further to see whether you have PCOS. These investigations will include bloodwork and an ultrasound. The following labs are what I use when I am screening for PCOS or suspect a patient has it.

A positive ultrasound in addition to elevated testosterone levels and absence of period are considered evidence of PCOS. However, PCOS is a progressive condition and, in the early stages, you may not observe as many signs and symptoms so, just because someone does not have all the criteria for PCOS it does not mean they may not go on to develop those markers over the next few years. That is why, when I suspect PCOS, I always educate my patients on it and suggest diet and lifestyle changes that can help prevent any further progression of the condition.

How to Treat PCOS

PCOS is fairly common and many women with PCOS go on to have healthy babies, the key is getting the treatment right to ensure a good hormonal balance.

And, even if you don’t have an official diagnosis the following courses of action can improve your hormonal balance and increase your chances of getting pregnant.

You can increase your intake of Omega 3 fats and balance the estrogen and progesterone stages of your menstrual cycle by following my simple nut and seed oil rotation.

Closing Thoughts

Polycystic ovarian disease is very common and many women go undiagnosed for years. If you have a history of irregular cycles, acne, facial hair growth and weight concerns then ask your doctor about being tested for PCOS.

Aside from improving your fertility, early detection of PCOS can also help prevent the long-term development of diabetes and heart disease that can occur over the years.

Please schedule an appointment to discuss your health concerns or to find out about my fertility treatment options. Treating fertility really does mean addressing the whole body and PCOS is an example of how hormones are interconnected throughout the body. Join me next week when I will discuss the role that thyroid hormone plays in fertility.

Dr. Maura Scanlan

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