Polycystic Ovary Syndrome

Though not everyone with PCOS will experience problems with fertility, PCOS is one of the most common causes of female infertility in the United States. In fact, about 90 to 95 percent of women seeking infertility treatment have PCOS. Many women only realize they have PCOS when they start trying to get pregnant and have trouble conceiving. Fortunately, infertility caused by PCOS is treatable (1, 4, 5).

Think of it this way: your ovaries are in charge of helping your eggs mature and releasing one every month as part of your menstrual cycle. If you have PCOS, an imbalance in your reproductive hormones may create problems in your ovaries that keep them from releasing healthy eggs regularly or at all (6).

Hormonal imbalances in those with PCOS lead to issues with ovulation, which can cause irregular or missed periods. Most women with PCOS have higher-than-average levels of luteinizing hormone (LH), androgens (aka male sex hormones), and insulin. They also tend to have lower-than-average levels of follicle stimulating hormone (FSH). When you’re not ovulating regularly, getting pregnant can be difficult or even impossible (7).

For women who are overweight or obese, it is recommended to speak with your doctor about a healthy weight management plan. Eating mindfully, eating healthy and regular exercise is recommended to improve fertility and may lead to higher ovulation rates and pregnancy success (1, 5, 8).

Yes, you can still get pregnant if you have PCOS, but it may take a little longer. Once you and your doctor determine that your infertility is caused by PCOS, you can start working together towards finding the right solution for your specific situation.

Ovulation is essential for conception, therefore, if you have irregular periods, your goal will be to regulate your menstrual cycles so it’s easier for you to identify your fertile window and time sex appropriately.

To regulate your hormones and improve fertility, you may be advised to adjust your diet and increase physical activity. If you are not ovulating at all, work with your doctor to help you figure out which lifestyle changes and/or medications you need to start ovulating (1).

PCOS is one of the most common causes of infertility in women, but it doesn’t mean that you can’t get pregnant (1). For women dealing with PCOS-related infertility, treatments and lifestyle changes can often help. The focus is getting your ovulation back on track. And there’s good news: you can often do this without having to turn to more advanced fertility treatments (9).

PCOS affects everyone differently, and your treatment options will depend on your specific situation. For example, many women with PCOS experience insulin sensitivity, meaning that their bodies have a hard time absorbing the sugar from the foods they eat. This can lead to above-average blood sugar levels and interfere with ovulation (9).

If you’re experiencing insulin sensitivity, your doctor may refer you to a registered dietitian specializing in PCOS. For some, making dietary changes and adding more physical activity may help lower blood sugar and regulate ovulation. Taking natural supplements, such as inositol, berberine, or cinnamon, may also help with insulin sensitivity (10). Your doctor may choose to prescribe medication, such as Metformin, to help lower blood sugar and androgen levels in the body (1).

Exercise can also be a game-changer if you’re trying to conceive with PCOS. Incorporating movement into your daily and weekly routines may help regulate ovulation and drastically increase your chances of getting pregnant and have a healthy pregnancy. Physicians recommend weight-bearing exercises, such as strength training, jogging, and hiking, for the maximum benefit (11, 12).

As a bonus, exercising may also help improve insulin sensitivity too (14).

We recommend focusing on sticking to healthy habits rather than the number on a scale; this isn’t only found to be more effective for the long term, but is also best for your mental and emotional health (15).  It is more difficult to lose weight with PCOS, but even losing as little as 5%-10% of your body weight may help regulate ovulation and drastically increase your chances of conception (1, 13).

If lifestyle changes aren’t enough, and you’ve already ruled out other causes of infertility, your doctor may suggest trying a prescription medicine, such as clomiphene (Clomid), to help you start ovulating. And, if that doesn’t work, your doctor may recommend assisted reproductive technologies, like in vitro fertilization (IVF), or surgery to help you conceive (1).

Throughout this process, your doctor may also refer you to a specialist, such as an endocrinologist, gynecologist, or reproductive endocrinologist that may be better equipped to treat your specific situation (9).

Yes, PCOS can cause pregnancy complications, but maintaining healthy habits before and during your pregnancy can help decrease the risk of serious problems. This can include sticking to a nutritional diet, exercising, and scheduling early and regular prenatal care visits with your doctor (16, 17, 18). Pregnancy complications associated with PCOS include:

• Miscarriage: A spontaneous loss of fetus that happens in the first 20 weeks of a woman’s pregnancy, usually because the fetus isn’t developing normally (19). Women with PCOS are three times as likely to experience a miscarriage in the early months of pregnancy than women without PCOS (16).
• Preeclampsia: A type of high blood pressure that develops during pregnancy, usually in the third trimester. It interferes with the blood supply to the fetus, which may keep the baby from getting the oxygen and nutrients it needs. Left untreated, preeclampsia can also negatively affect the mother’s kidney, liver, and brain (20, 21, 22).

• Gestational diabetes: A diabetes diagnosis that happens during pregnancy. It’s usually temporary, and typically resolves after delivery. If diagnosed and treated quickly, it doesn’t usually cause any additional issues. If left untreated, it could lead to complications like higher birth weight, premature delivery, and respiratory distress syndrome. Gestational diabetes is usually treated by dietary changes and exercise, monitoring glucose levels, and insulin therapy (23).

Other potential pregnancy complications caused by PCOS include preterm birth and caesarean section (C-section) delivery. Your doctor may suggest lifestyle changes or put you on insulin-sensitizing drugs during your pregnancy to help ensure that you and your baby stay healthy through your delivery and beyond (21).

PCOS can be tricky to diagnose because there is no single test that can definitely confirm whether you have it or not. Instead, doctors look for at least 2 of the following 3 conditions (24, 25):

1. Irregular or missed periods, which are a sign of problems with ovulation
2. High levels of androgens, such as testosterone (called hyperandrogenism)
3. Multiple ovarian cysts that show up on an ultrasound (polycystic ovaries); cysts make ovaries enlarged and could cause problems with ovulation

When trying to determine whether you have PCOS, your doctor may perform blood tests, pelvic exams, and ultrasounds. Before giving a diagnosis, they’ll discuss your symptoms with you and try to rule out other conditions that could be causing them (24). It may be helpful to track your symptoms to provide your doctor with insight and trends about your cycle. They will be able to  better provide you diagnosis and treatment plans

One of the reasons that PCOS is so hard to diagnose is that it looks different for everyone. It’s possible to have PCOS and see all of the symptoms below, or almost none of them. The most common sign that doctors look for is irregular or missed periods. Women with PCOS may have fewer than 9 periods a year, more than 35 days between periods, or abnormally heavy periods (24).

Weight gain, obesity, and trouble losing weight are also common symptoms of PCOS. They can be related to insulin sensitivity, which is associated with the obese type of PCOS. However, you can have a lean body mass and still have PCOS – this is referred to as lean PCOS, which isn’t typically accompanied by insulin sensitivity (26)

Other symptoms of PCOS include (16, 27):

• Acne, especially along the jawline 
• Excess hair growth, especially on the face, chest, stomach, or upper thighs (called hirsutism)
• Darkening of the skin around the armpits, nape of the neck, or other skinfolds 
• Deepened voice
• Decrease in breast size
• Ovarian cysts
• Pelvic pain
• Oily skin
• Infertility

Doctors don’t know exactly what causes PCOS, but they’ve observed that elevated insulin and androgen levels are commonly associated with the syndrome. It’s hard to say whether these hormonal imbalances are responsible for PCOS development or caused by it (1), but the latest research suggests that environmental and genetic factors, such as geographic location, exposure to industrial products, and maternal and paternal links to PCOS, may contribute to it (28, 29).

Insulin is what helps your body convert sugar from the food you eat into energy. When your cells don’t respond well to insulin, your blood sugar levels can rise quickly after you eat, which tells your body that it needs to make even more insulin. That excess insulin can lead to increased androgen production and contribute to PCOS symptoms. This is more common in women with PCOS who are overweight or obese, aren’t getting enough exercise, or have a family history of diabetes (1, 24).

Androgens are typically referred to as “male hormones,”  but they’re important for women too. We just need way less of them than men do. When women have excess androgens, they can start to develop unwanted facial hair, male-pattern baldness, and acne. Elevated androgen levels can also interfere with ovulation and cause tiny cysts to form on the ovaries (1, 30).

Doctors also think genetics may play a role in how likely someone is to develop PCOS, but there isn’t enough evidence to say exactly how or why (1).

Treatment for PCOS largely depends on which symptoms you’re experiencing, as well as whether you’re currently trying to conceive. Many women find they can achieve hormonal balance and regular ovulation by making lifestyle changes (think: healthy dietary changes, weight loss, stress management, and exercise (31)). Natural supplements, such as inositol, berberine, or cinnamon, may also help with insulin sensitivity and hormonal balance (10).

Doctors may also suggest the following medications to help manage PCOS symptoms (1, 16):

• Hormonal birth control: Birth control pills are often prescribed to help “regulate” menstrual cycles for women with PCOS who aren’t trying to get pregnant (32). However, using birth control to mask PCOS symptoms can mean that underlying health issues go unaddressed, which could cause conditions such as diabetes and heart disease to become lifelong problems (33).
• Spironolactone: An androgen blocker that may help balance hormones, restore ovulation, and decrease acne and hair growth 
• Metformin: A diabetes drug that may help lower blood sugar, make it easier to lose weight, and restore ovulation
• Additional topical or oral medications to help with acne and unwanted hair growth

Researchers are still looking for new and better ways to treat PCOS. If you’re interested in checking out current PCOS treatment studies, you can go to ClinicalTrials.gov.

There is no cure for PCOS, symptoms can often be managed by making lifestyle changes, such as dietary changes and exercising. For overweight and obese women, you do not have to lose a lot of weight to heal your body. A minor weight loss of 5-10% of your total weight can lead to a big improvement in PCOS symptoms, help regulate your periods, and even improve your mental health (34, 35, 36).

Losing weight is difficult for anyone, but is especially challenging with PCOS. For long term success and happiness, the focus should be on exercise and healthy eating, rather than weight loss and calorie restriction (37, 38).

Due to a variety of factors, weight loss can be difficult when you have PCOS, but making healthy lifestyle changes benefits you in many more ways than just the number on the scale. You’ll still benefit from eating a nutritious diet and making exercise a regular part of your life, such as improvements in insulin sensitivity and a decrease of visceral fat, a dangerous type of fat that gathers around the organs (39, 40, 41).

Dietary changes can also have a huge impact on PCOS symptoms. Yes, this may mean cutting down on carbs, but things are a little more complicated than that. Athletes or those with lean PCOS may benefit from adding more complex and healthy carbs to their diets, but others who are more sensitive to sugar may need to keep all carbs very low. No matter which type of PCOS you have, it’s a good idea to avoid simple carbs, such as white bread, pasta, donuts, soda, and cereals (42). Some may need to cut dairy from their diet, but others may not be as affected by it (10).

Making appropriate dietary changes is one of the best things you can do to support your ovulation and hormonal health. Everyone is different, so if it is feasible for you, it is best to work with a registered dietician who works especially with PCOS  to determine what approach and foods will best support your reproductive health needs.. Your doctor may also have some free resources readily available. 

Dr. BreAnna Guan says, “a good rule of thumb is to eat at least 4 ounces of protein with every meal and leafy vegetables with 2-3 meals each day.” Also, sticking to organic foods can help you avoid endocrine-disrupting chemicals that may cause PCOS symptoms to get worse (10, 43).

Like all things with PCOS, the answer to this question is complicated. Many women with PCOS actually find that their periods become more regular as they get closer to menopause. However, other PCOS symptoms can continue into menopause or later, especially if there are underlying issues like insulin sensitivity or thyroid problems that aren’t resolved. The risk of health problems related to PCOS (including diabetes, stroke, and heart attack) may increase with age if symptoms aren’t brought under control. Fortunately, the lifestyle changes that we discussed in the last question can help women manage PCOS through menopause and beyond (1, 10).

Type 2 diabetes is more prevalent among PCOS patients; however, being diagnosed with PCOS doesn't necessarily mean you’ll get type 2 diabetes. If you have PCOS, it is important to work with your physician to better understand your insulin sensitivity, as this can be a precursor to diabetes. Women with PCOS are more likely to develop type 2 diabetes at an earlier age than those without PCOS. Whether you have been diagnosed with PCOS or suspect you may have it, prioritizing your health through stress management, joyful movement, and eating well may decrease your risk of developing type 2 diabetes, in addition to helping you regulate your menstrual cycle (44, 45, 46).

With  a major emphasis on weight loss as a treatment for PCOS and diabetes, people with PCOS are more susceptible to eating disorders and binge eating (50).

Experiencing intense cravings for sugar and carbs is a common symptom of PCOS and can lead to a confusing relationship with food. No foods are inherently good or bad, and we do not recommend calorie counting. The number one cause of binge eating is restriction, so instead of denying yourself the foods you crave, opt for an all-inclusive diet that allows you to satisfy your hunger through regular, balanced meals. A balanced meal may include all food groups, such as veggies, fruit, dairy products, protein, and carbs. Dr. BreAnna Guan suggests including around 4 ounces of protein in every meal as a way to ensure you feel satiated throughout the day (47, 48)

Ending binge eating does not mean you cannot satisfy your cravings. It means allowing yourself any and all foods while ensuring you eat regular, balanced meals. Also, many of us eat when we are emotional, so be sure to get in touch with what you’re truly craving: be it a specific food, stress relief, or a hug from a friend (49). 

If you have any concerns regarding your relationship with food or have experienced a binge eating episode before, reach out to an eating disorder professional. Women with PCOS are predisposed to depression, anxiety, and eating disorders, and restoring your cycle requires prioritizing your mental and physical health (50). If you are concerned, the National Eating Disorders Association (NEDA) provides extensive resources and support, including a nation-wide list of providers.