The ins and outs: PCOS
Why should you care about PCOS and how can it impact your life? PCOS, or Polycystic Ovarian Syndrome, is a hormonal imbalance that impairs ovulation often results in irregular cycles (ref. 1).
Poly = Much
Cystic = Vesicle filled with fluid
Ovarian = Ovaries
Two to 20% of women suffer from PCOS (ref. 2). This disorder is one of the most common disorders amongst women of reproductive age (ref. 3).
It is also the most common cause of infertility, mainly due to lack of ovulation or irregular ovulation (ref. 4). Furthermore, women with PCOS have a higher risk to suffer from insulin resistance, diabetes and high cholesterol in later life (ref. 5). So, as you can see PCOS is a pretty common disorder among women and chances are that it might affect women in your social circle as well. Stay educated and read up on this post!
What is PCOS and how is it characterized?
So, PCOS is an imbalance of your hormones that is characterized by ovaries that are lined with many vesicles (small follicles) filled with fluid. Normally, a follicle would grow and mature, and eventually burst to release an egg - this is known as ovulation. But with PCOS, there are many follicles that are less sensitive to the hormones LH and FSH and therefore mature less quickly. As a result, you have irregular and longer cycles because it takes longer for a follicle to reach the mature stage. The duration of your cycles can vary from anything between 38 days to only having one or two periods a year.
Besides having an irregular period, other common symptoms of having PCOS can include acne, weight gain and irregular hair growth (typically more hair growth on the chin, chest and lower abdomen and typically less hair growth at your temples and crown). These symptoms are largely caused by an increase in testosterone (ref. 2 and 4).
Is there a test to diagnose PCOS? Unfortunately, no. As the name says, PCOS is a syndrome and syndromes differ in how they present from person to person. Therefore, there won’t be a single test that can diagnose everyone at the same time. Currently the diagnosis of PCOS is based on the Rotterdam-criteria (ref. 6). This is basically just a checklist used by doctors.
To be diagnosed with PCOS, 2 out of 3 criteria need to be present. This means that women with polycystic ovaries on an ultrasound, but regular cycles and normal testosterone are not diagnosed with PCOS. Also, women without cysts on their ovaries, but irregular cycles and elevated testosterone can be diagnosed with PCOS (ref. 6).
How does AMH relate to PCOS?
In PCOS, it is believed that the follicles, which would normally develop to an egg cell, stop development at a certain stage. These follicles are stuck in this stage. The surrounding cells of these follicles are known to produce AMH. Thus when more follicles fail to develop fully, more AMH is produced (ref. 7).
How does PCOS affect fertility?
The biggest restrictions of PCOS in terms of fertility are irregular ovulation and cycles. As you already have read above, one of the common symptoms of PCOS is an irregular cycle. This means that often the ovaries won’t release an egg every month, therefore there may not be an egg to fertilize every month. Less ovulations in one year = less chances to get pregnant in a year.
How do I manage PCOS?
Unfortunately PCOS is a chronic syndrome and will therefore never fully go away. Currently there is no absolute cure for PCOS, but there are some treatment options and lifestyle changes that might help decrease the effect of PCOS on your fertility. As for treatment options, birth control pills may help with improving the regularity of period. Metformin and clomiphene are also hopeful in improving your fertility if you suffer from PCOS. As for lifestyle changes, the most important one is weight loss (ref. 7 and 8) When you get older, the symptoms tend to get milder (as you will have less follicles)
What can we do for you at Grip?
Luckily, AMH and testosterone are just as easy to test as cholesterol. At Grip, we can help you get more insight in your hormonal levels to give you an indication of your risk at PCOS.
Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med. 2010;8(1). doi:10.1186/1741-7015-8-41
Pal L. Polycystic Ovary Syndrome. New York, NY: Springer New York; 2014:7.
Polycystic Ovary Syndrome (PCOS): Condition Information. National Institute of Child Health and Human Development. https://www.nichd.nih.gov/health/topics/pcos/conditioninfo. Published 2020. Accessed July 14, 2020.