PCOS - Polycystic Ovary Syndrome

What is Polycystic Ovarian Syndrome?

Polycystic Ovary Syndrome (PCOS) is a hormonal disorder, and a complex one.  In essence, it is a number of different conditions all caused by much the same thing – but it can present with different symptoms in each person.

The Rotterdam criteria is the technical definition we now use to define Polycystic Ovarian Syndrome.  A patient needs to meet the following criteria for a diagnosis of PCOS.

• The first criteria is the woman probably will have polycystic ovaries. However, they don’t have to definitively have polycystic ovaries to have the syndrome.
• The second criteria of PCOS are symptoms showing increased levels of male hormones or androgens. Androgens are also called ‘male’ hormones, and the main one is testosterone.  All women produce small amounts of androgens in the ovaries and adrenal glands, but high levels of androgens can lead to excessive hair growth – or even some loss of hair right on the scalp, acne or when a blood test sees increased levels of androgens for no other reason.
• The third criteria and the classic one that I see in my role of fertility management, is that of abnormal periods, either the lack of periods or periods being so irregular that women have difficulty getting pregnant.

Polycystic Ovarian Syndrome is seen to be two out of the three of those criteria. While that’s technically the definition, clinically, there are some other ways that Polycystic Ovarian Syndrome is often found such as when an AMH test is seen to be very elevated.

Weight and Body Mass Index is associated with PCOS.  I’m often asked “Is it because we’re Polycystic Ovary Syndrome that I’m overweight, or does the weight make PCOS? The answer is that everything is very much is intertwined.

The good news is a loss of 5 to 10% of your current weight, through diet and exercise makes a significant increase in spontaneous ovulation,

There are also cases where we have to ask women to put on a little bit of weight. Ovaries have a very specific wave range where they work well and both underweight and overweight women are associated with not ovulating

Who gets PCOS?

To a large extent there is a genetic factor involved in polycystic ovary syndrome, but it’s also a really common disorder with about one in five women in Australia having some type of effect of polycystic ovaries.

Predominately, PCOS is a combination of insulin resistance and increased androgens.  In simple terms, the elevated insulin associated with insulin resistance both stimulates androgens, or secondly the increased insulin stimulates ovarian follicles, increasing the oestrogen and decreasing ovulation.

The effect of insulin resistance and the androgens makes the ovary not ovulate. If the ovary is not ovulating, this leads to menstrual disturbances, which then leads to fertility problems.

Will I be able to fall pregnant with PCOS?

When I see women with PCOS and they’re not ovulating, I can see immediately they feel down. They feel stressed because they don’t think they’re ever going to get pregnant because they’re not having periods – and you must have periods to get pregnant.

When I talk with these patients, I feel the opposite. I know that every one of those follicles has an egg in it, and I’m confirmed by that test called AMH where they will have high ovarian reserve.

There are medications and assisted fertility treatment options to assist with ovulation and conception that have high success rates.

So, I feel really quite confident that I can help a woman with PCOS in their journey of obtaining pregnancy and a family.