Polycystic Ovary Syndrome (PCOS): Could this be the cause of my infertility and weight issues?
- Ashlyn Smith
- Sep 1
- 5 min read
By Ashlyn Smith, MMS, PA-C, DFAAPA
ELM Endocrinology & Lifestyle Medicine
PCOS is a relatively common hormonal and metabolic disorder that can affect menstrual cycles/ovulation, weight management, metabolic health, androgen symptoms.
The syndrome is named after ovaries that have multiple fluid-filled areas called “cysts.” These cysts are created as a normal part of the egg development during the menstrual cycle. Then during ovulation, the cyst bursts open, releasing the egg. However, in PCOS the egg is not always released which means these cysts are retained. Without the egg’s release, we are not able to have a regular menstrual cycle and thus may struggle with infertility.
It is important to know that not everyone with PCOS will have cysts! The diagnosis of PCOS is made based on two out of three positive signs:
o Irregular or absent menstrual cycles—a side effect of irregular or absent ovulation
o Excess androgen symptoms—some examples are acne, facial hair, increased body hair, or high measured testosterone levels
o Polycystic appearance of ovaries on imaging
What can PCOS look like?
· PCOS can present differently in different women and can be mistaken for several other medical conditions, such as isolated insulin resistance/prediabetes, thyroid disorders, or perimenopause.
· Common symptoms include:
o Irregular or absent menstrual cycles causing infertility. This symptom is caused by infrequent or absent ovulation and may also look like someone who is unsuccessful attempting pregnancy or perhaps someone who has avoided pregnancy for many years without contraception.
o Increased weight, particularly around the abdomen. Another sign could be darker velvety patches on the skin around the neck, armpits, and groin known as acanthosis nigricans. These metabolic signs indicate high insulin levels or “insulin resistance,” a hormonal condition that promotes weight gain and inhibits ovulation. Together, these signs may signify underlying metabolic disorders such as insulin resistance, prediabetes, type 2 diabetes, high cholesterol, or fatty liver.
o High androgen symptoms such as facial or body acne, facial hair, excessive body hair, and hair loss on the head—traditionally in a “male pattern baldness” distribution. It is important to note that there is quite a bit of subjectivity related to facial and body hair distribution so this symptom alone does not indicate PCOS without at least one of the other symptoms above.
Why does PCOS matter?
In addition to fertility concerns, untreated PCOS increases the risk of endometrial cancer over time. Throughout the first portion of the menstrual cycle, the endometrial lining in the uterus builds up. Following ovulation if there is no fertilization, the endometrial lining sheds which causes menstrual bleeding. However, in PCOS ovulation is not consistent and without ovulation the endometrial lining remains in place and builds again the next cycle. Over time, this endometrial thickening can cause atypical changes and potentially endometrial cancer.
Women with PCOS have a significantly increased risk of metabolic complications, even if they are not overweight. These metabolic complications can include:
Overweight and obesity
Insulin resistance and type 2 diabetes
High cholesterol
Fatty liver disease
High blood pressure
Increased cardiovascular disease (CVD) risk
How I can help support you with PCOS
Overall, the two main goals of treatment are restoration of regular menstrual cycles to reduce the risk of endometrial cancer and metabolic conditions. Treatment goals are tailored to your specific symptoms, metabolic parameters, and fertility preferences.
Assess your metabolic and hormonal health. Knowledge is power! Knowing your individualized hormonal and metabolic profiles helps to target your body’s specific needs. This includes may include lab tests, body measurement evaluations, blood pressure testing, imaging, and others depending on your particular case. Tracking these measurements over time empowers us to tailor our plan to your individual needs!
Lifestyle intervention is the foundation of treatment regardless of medication use. You may be thinking, “Yeah I’ve heard that before” or perhaps you have tried in the past without success. Well, I have good news! Most importantly, you are not alone. We will discuss together what small, incremental changes make sense with where you are in your life right now. These changes could range from walking a few minutes each day to reducing carb portions to increasing water intake. Small changes make a difference! In fact, only 5-10% weight loss can significantly improve regular ovulation and metabolic risk factors.
Medications may or may not be right for you. For some women, lifestyle intervention and modest weight loss are enough to restore ovulation and improve metabolic help. Others may find medication helpful depending on their specific needs. Some medication options include:
Medications to lower weight and/or insulin resistance, which help reduce insulin levels, restore ovulation, and decrease overweight and obesity. Importantly, these medications can also restore fertility so if pregnancy is not in your plans it is important to use contraception!
For women with acne, excessive hair, or hair loss, anti-androgen treatment may be helpful. It is important to note that these medications may cause birth defects so should not be taken without contraception.
Notably, anti-androgen treatment only addresses new hair growth, so cosmetic solutions such as laser hair treatment and electrolysis may be needed for existing facial or body hair. For some women, cosmetic treatment for acne may be beneficial as well.
If pregnancy is desired and medications for weight and/or insulin resistance are not sufficient in restoring fertility, fertility treatments can be considered.
Conversely, hormonal contraception such as birth control pills can restore regular menstrual cycle and reduce androgen symptoms.
Medications to treat specific metabolic conditions, such as medications for high cholesterol, high blood pressure, or diabetes
Regular menstrual cycles can be achieved through hormonal contraception or lifestyle plus medication based on your fertility preference.
Take home messages:
PCOS is a common and complex syndrome affecting hormonal, metabolic, and reproductive health. Diagnosing PCOS depends on identifying at least two out of the three of irregular or absent ovulation, androgen symptoms, and multiple cysts found on ovaries. The syndrome can cause symptoms such as irregular or absent menstrual cycles, weight gain, acne, hair loss, excessive facial or body hair, and darkening of the skin at the neck, armpits, and groin. In addition to infertility, common metabolic conditions can be caused by PCOS including insulin resistance, type 2 diabetes, overweight or obesity, high cholesterol, high blood pressure, and fatty liver. Though there is no known cure, treatment helps manage the symptoms to improve weight, restore fertility, mitigate androgen symptoms, and reduce the risk of long-term metabolic complications. Treatment is individualized to each patient’s specific symptoms, metabolic profile, and preferences to incorporate endocrinology, gynecology, and lifestyle medicine. Proactive partnership with a skilled clinician team dedicated to your overall well-being is the key to optimizing your your whole health.
Have more questions about PCOS? I am here to help—let’s connect on a free educational consultation to discuss further!
Access ELM's free PCOS handout for more information:
Disclaimer: |
The content on this blog is for informational purposes only and is not intended to provide medical diagnosis, treatment, or replace professional medical advice, diagnosis, or care. Always consult a qualified healthcare provider with any questions regarding a medical condition or treatment. |
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