The Basics

Polycystic Ovary Syndrome (PCOS) is the most common ovulatory disorder in women. It affects the menstrual cycle and is characterized by the formation of fluid-filled cysts in the ovaries. These cysts are not harmful but can lead to hormone imbalances that may affect fertility.

How Does PCOS Affect Ovulation?

In a typical menstrual cycle, multiple small follicles grow in the ovaries, and one egg is released during ovulation. In PCOS, ovulation is disrupted, leading to fluid-filled follicles that turn into cysts. Elevated insulin levels may stimulate excess testosterone production, further disrupting hormone balance and ovulation.

PCOS Symptoms

The symptoms associated with PCOS vary from patient to patient, but many of these symptoms are rooted in the presence of excess male hormone (androgen) production. Some common symptoms that occur in women include:

• Irregular, infrequent, or absent menstrual periods

• Excess facial and body hair

• Infertility or recurrent miscarriage

• Thinning hair on the scalp

• Weight gain or obesity

• Insulin resistance or type 2 diabetes

• Acne

PCOS & Hormone Imbalances

Hormonal imbalances are central to the symptoms of PCOS. Women with PCOS often have irregular levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH), leading to limited egg development and increased levels of testosterone and other androgens.

Blood tests are essential for diagnosing PCOS, as they measure these hormone levels. Additionally, abnormal insulin metabolism in PCOS can increase androgen levels, contributing to obesity and exacerbating anovulation (lack of ovulation).

PCOS & Insulin Resistance

In most people, insulin effectively regulates blood sugar levels. However, in cases of insulin resistance, cells become less responsive to insulin, prompting the pancreas to produce extra insulin to maintain normal blood sugar levels. This excess insulin can contribute to the hormonal imbalances characteristic of PCOS.

PCOS & Obesity

Obesity can exacerbate insulin resistance, and excess abdominal fat further intensifies this issue. Research indicates that even a modest weight loss of about 10% can significantly improve a woman's chances of conceiving by normalizing sex hormone levels.

PCOS Testing and Treatment

The first step in addressing PCOS is to schedule an appointment with a Care Fertility physician. During this consultation, the physician will conduct a thorough assessment focusing on hormonal and metabolic abnormalities.

Based on the initial evaluation, a comprehensive treatment plan will be developed. Additional testing may be recommended depending on the patient's symptoms and needs.

PCOS Testing

There is no single test for diagnosing PCOS. Instead, a diagnosis is often based on a combination of factors, including:

• Medical History and Physical Exam: A thorough review of your medical history and a pelvic exam are essential.

• Blood Tests: Elevated levels of male hormones (androgens) and other hormonal imbalances are assessed through blood tests. Key hormones checked include FSH, LH, estrogen (estradiol), and androgens.

• Ultrasound: An ultrasound may reveal cysts on the ovaries, a common feature of PCOS.

• Endometrial Biopsy: In some cases, a biopsy of the endometrial tissue may be performed to investigate the cause of irregular periods.

Many women are diagnosed with PCOS after being evaluated for infertility or recurrent miscarriages.

PCOS Treatments

PCOS treatment plans are tailored to meet each individual's unique needs.

While diet and exercise can help manage some general PCOS symptoms, improving fertility often requires medical intervention. Ovulation induction medications like clomiphene citrate or gonadotropins, along with metformin, are commonly used to promote ovulation and increase the chances of pregnancy.

Your clinical team will work closely with you to create a personalized treatment plan. Possible treatments include:

• Fertility medications like clomiphene citrate to stimulate ovulation.

• Diabetes medications such as metformin to improve insulin sensitivity and regulate ovulation.

• IVF, which provides the highest chance of pregnancy per cycle.