The term “polycystic ovaries” refers to the number of follicles a woman has. Follicles are tiny fluid filled structures that have eggs in them, and women of reproductive age should have many of these follicles.
There is often some confusion around polycystic ovaries as the name implies that a woman has cysts in her ovaries. However, the condition is actually referring to when the ovaries are slightly larger than normal. Due to this confusion many doctors are now referring to the condition as “multi-follicular ovaries”. Multi-follicular ovaries are very common and can occur in about 20-40% of women. Most women who have multi-follicular ovaries have no symptoms such as pain and are completely healthy and fertile.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome or PCOS is a syndrome. It is a hormonal condition that can impact both your physical and emotional health. PCOS can affect your fertility as well as your body metabolically and also your emotional wellbeing.
The most common symptom of PCOS is irregular bleeding with some women experiencing no menstrual period at all. Other symptoms include acne, hirsutism (excess body or facial hair), alopecia (loss of scalp hair), emotional distress, and reduced fertility. A number of women will also be overweight and often experience sleep apnoea and depression.
PCOS can also have significant longer-term complications that can be quite serious for some women including type 2 diabetes. It may also lead to gestational diabetes that occurs during pregnancy.
There can also be a greater risk of heart disease and this can be related to women having higher cholesterol. In addition, when a woman is not having regular periods, the endometrium can overgrow and can develop into a hyperplasia and then an endometrial cancer.
The psychological affects of PCOS include increased anxiety and depression. Many women with PCOS can benefit greatly from psychological support and I will always strongly encourage my patients to establish a support network that works for them.
The affects of PCOS on fertility include hyperandrogenism, which is characterised by excessive levels of androgens in the body and leads to acne as well as hirsutism, problems ovulating and infertility.
Often women with PCOS will struggle with their weight and therefore having a healthy diet and lifestyle will help reduce the risks of PCOS including developing diabetes.
From the above you can see that PCOS is very complex and although learning about it can be overwhelming and daunting around 60% of women with PCOS are still fertile and fall pregnant naturally without any problems.
Although there is no cure for PCOS, it can be managed very well. If you’re diagnosed with PCOS we will spend time developing the best approach to ensure you can manage it successfully throughout your life.
PCOS and Fertility Treatments
Treatments relating to fertility include lifestyle changes. Research has shown that women who are overweight or obese have a lower chance of conceiving, regardless of if they are undergoing fertility treatment or trying naturally.
Medical management of PCOS can result in a woman ovulating and subsequently achieving pregnancy. Other options include an injection of hormones such as gonadatrophins.
There will be some patients who unfortunately don’t become pregnant with these treatments and will require IVF, and this is more common if the male partner has significant male factor infertility or the woman also has problems with her fallopian tubes. In these cases, IVF is going to be the most effective treatment for you to achieve a successful pregnancy.
Regulation of your Menstrual Cycle
For women who are not currently looking to become pregnant, or who have had children, regulation of your cycle is important. This will ensure you prevent any overgrowth of the endometrium that can lead to the development of endometrial cancer.
There are a three options for protecting the lining of the uterus:
- Oral Contraceptive Pill – women who are on the pill regardless of if they have a regular period or not, just need to be on the pill for 12 months and the risk of endometrial cancer reduces by 50%. The oral contraceptive pill can also assist in the regulation of hormones which can alleviate the symptoms of acne and facial hair.
- Mirena IUD – a contraceptive device that causes the lining in uterus (endometrium) to become very thin and inactive and therefore prevents any overgrowth in the lining.
- The other option for regulating cycles or preventing an overgrowth in the lining is to take regular progestogen. These drugs will cause a regular shedding of the lining, however are not a form of contraception.