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  • Writer's pictureDr. Roisin O'Loughlin

Polycystic Ovarian Syndrome (PCOS)

This syndrome affects 4-20% of women worldwide and is the leading cause of infertility.

The official criteria for diagnosing PCOS is the Rotterdam Criteria;

Clinical hyperandrogenism (symptoms such as acne, excessive hair growth) or biochemical hyperandrogenism (elevated testosterone) PLUS either of

Oligomenorrhoea or oligo-ovulation (less than 6-9 periods/year)

Polycystic ovaries on ultrasound (12 or more follicles or cysts in one or both of the ovaries, which can look like a string of pearls)

What causes PCOS?

The exact cause of PCOS is unknown. There may be some women who are genetically predisposed to developing PCOS. Studies have demonstrated a link between being overweight and having PCOS. One study in particular found that PCOS occurs in roughly 8-10% of women with a normal weight, compared to 10-12.5% of women who are overweight or obese.

Approximately, 60% of women with PCOS are overweight and women with the condition tend to gain weight more easily and find it hard to lose weight. This happens because many patients with PCOS have problems with insulin sensitivity.

In a healthy body, insulin plays two primary roles. It regulates our blood sugar, making it readily available for the body to use, and it contributes to how this is stored in body fat and muscle tissue for later use. Too much insulin (for a variety of reasons) can shift this balance towards more storage in body cells and therefore, more body weight. This is further complicated by the fact that being overweight can result in less insulin sensitivity.

At the same time, because of hormonal imbalances, your body starts producing more testosterone than usual. In fat tissue, testosterone is then converted into oestrogen. This can cause even more fat accumulation and also increases your body weight.

How does PCOS affect my fertility?

Too much natural oestrogen in your body acts as a natural contraceptive and therefore reduces your risk of getting pregnant. Also, due to irregular periods, it can be hard to track when you are ovulating and hence your fertile window.

How can I treat my PCOS?

Not all women with PCOS are overweight or obese but if this is the case, first steps are to lose weight. Many women can return to a normal cycle with weight reduction interventions. Adhering to a healthy diet, exercise, getting adequate sleep and stress reduction are all helpful in aiding weight loss.

What other hormones can be tested that indicate an underlying PCOS diagnosis?

LH is the hormone that takes care of ovulation. High levels of oestrogen in PCOS will stop your body from ovulating, and as a result you will start to produce even higher levels of LH. 75% of women with PCOS show an increased LH in blood tests.

Progesterone is usually also involved in balancing LH release, but high testosterone levels stop this from happening. If ovulation doesn’t occur, progesterone levels will decrease.

AMH is produced by your egg follicles. In PCOS over-maturing egg cells produce more AMH than usual, falsely increasing the test result. Therefore, predicting egg stores in women with PCOS using AMH levels is not possible.

Are there other health implications of PCOS?

  • Women with PCOS have a twofold increased risk of developing Diabetes and also Gestational Diabetes.

  • They are almost 3 times as likely to have a transient ischemic attack (TIA) or stroke.

  • They are also more likely to develop endometrial cancer (cancer of the lining of the uterus).

What actions do I need to take if I am concerned about possible PCOS?

  • PCOS is associated with an increased risk of miscarriage, preterm delivery, gestational diabetes, pregnancy induced hypertension and pre-eclampsia. Therefore, it is important to have an awareness of the condition pre-conceptually to optimise management.

  • Take The FertilityHQ test – It may give you some useful information regarding hormones that are implicated in PCOS.

  • Track your menstrual cycle using a menstrual cycle tracking app.

  • Speak with your GP if you are concerned you may have PCOS. They may decide to refer for a pelvic ultrasound to confirm the diagnosis.

  • Lifestyle is Key

  • Adherence to a healthy, balanced diet, exercise, sleep hygiene and stress management are all helpful in the management of PCOS.

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