Polycystic Ovary Syndrome (PCOS) Symptoms and How It Can Affect Fertility

For some women, an irregular period is the first sign to talk to a doctor.

“Women should consider their menstrual cycles an important signal from their bodies. If they are irregular, consider visiting with a physician to find out why that’s happening,” said Heather Hipp, MD, OBGYN and reproductive endocrinologist. “You want to understand what’s happening with your body. It’s not just about pregnancy; it’s about overall health.”

Many factors can cause irregular periods, including hormone changes, excessive physical stress, medication, and medical conditions. Polycystic ovary syndrome (PCOS) is just one of the causes of irregular periods. And it’s pretty common: about one in 10 women have PCOS.

PCOS causes hormone imbalances. Because of these imbalances, a woman with PCOS doesn’t have a typical ovulatory cycle, and her ovaries may not release eggs every month. PCOS can also affect your metabolism and overall health. So it’s important to speak with your OBGYN if you have any symptoms.

Physicians still don’t fully understand what causes PCOS. Genetics may play a role. Women with PCOS tend to have higher levels of insulin, which can lead to insulin resistance. They also have higher-than-usual androgen levels. Though androgens are often considered male hormones, women also make them. Too much can cause hormonal imbalances that lead to some common PCOS symptoms.

Some of the most common symptoms of PCOS include:

• Acne
• Extra hair on the face, chin, or other body parts
• Irregular periods
• Skin tags
• Thinning hair
• Weight gain or difficulty losing weight

You don’t need to have all these symptoms to be diagnosed with PCOS.

If you’re concerned you may have PCOS, share your symptoms with your OBGYN.

Since many other conditions look like PCOS, physicians often rule out other health issues first. For example, Dr. Hipp does a work-up to rule out thyroid disease, hyperprolactinemia (high levels of the hormone prolactin), and unrelated struggles with obesity.

To be diagnosed with PCOS, a patient must have two of these symptoms:

1. Irregular periods: A regular period comes every 25 – 35 days. If your cycles are shorter or longer, they’re considered irregular.
2. High levels of androgens: Signs include extra hair growth, acne, thinning head hair, and blood test results.
3. Polycystic ovaries: Multiple fluid-filled sacs in ovaries identified via ultrasound.

To reach a diagnosis, your doctor may do a pelvic exam, blood tests, and an ultrasound. During the ultrasound, a wand-like device is inserted in your vagina to create images of your uterus and ovaries.

Treatments can improve some of the symptoms of PCOS. Your treatment path depends on your personal goals.

“I always start by figuring out what my patients want to do,” said Dr. Hipp. She outlines two main treatment paths for people with PCOS: those who want to get pregnant and those who are most concerned about their symptoms.

Of course, there is overlap. Even women who hope to have children soon want to manage their PCOS symptoms. But the treatment may differ.

Dr. Hipp generally encourages all her PCOS patients to make positive lifestyle choices. These choices include getting regular exercise and eating well. Some research supports the Mediterranean diet to help manage PCOS symptoms. This diet focuses on eating whole grains, fruits, vegetables, beans, nuts and olive oil. It also includes fish, dairy, eggs and poultry in moderation.

Many (but not all) women with PCOS struggle with their weight. Patients may also see a nutritionist or medical endocrinologist for added support and expertise.

Some medications can also help manage symptoms. For women who do not want to get pregnant, hormonal birth control can protect the uterus and ensure regular menstrual bleeding for those who prefer this method. It can also improve symptoms like acne and extra body hair. Medications like spironolactone can also help reduce androgen levels.

Another medication, metformin, can lower insulin levels for patients with high insulin resistance. And lower insulin levels can help with weight loss and treat symptoms of prediabetes.

PCOS affects your overall health, not just your ovaries. Women with PCOS have a higher rate of insulin resistance, diabetes, heart disease, and high cholesterol. Your OBGYN may guide you to prevent these conditions and monitor your health over time.

“Some people with PCOS have heard they can never get pregnant, but that’s not true,” said Dr. Hipp. “Many people with PCOS have babies.”

As a fertility physician, Dr. Hipp knows there are many ways to help women with PCOS conceive. But, as a start, she wants her patients to optimize their health.

For patients with irregular periods, ovulating (releasing an egg) can be unpredictable. Some data shows that when women with PCOS lose some weight, they may start to ovulate again. There are also pills like Letrozole and Clomid to help patients ovulate.

“If a patient hasn’t gotten pregnant after trying for six to 12 months and they’ve noticed three to six months of irregular cycles, I recommend they seek specialized fertility care,” said Dr. Hipp.

Emory Reproductive Center offers the next step for patients needing more fertility care.

The fertility specialists at Emory Reproductive Center are trained OBGYNs. They have completed fellowships in reproductive endocrinology, which means they specialize in fertility care.

You can see these fertility specialists for pre-pregnancy planning, genetic screening, and help conceiving. They treat patients trying to get pregnant and care for them through the first eight weeks of pregnancy before transitioning care to a general OBGYN for prenatal care.

Talk to an OBGYN

If you have irregular periods or any symptoms of PCOS, talking to an OBGYN is the first step. Because PCOS affects more than your ovaries, having a relationship with an OBGYN can improve your long-term health. Your OBGYN can help you with your symptoms now and keep an eye on your health in the future.