Polycystic ovary syndrome (PCOS) is a hormonal condition that impacts 1 in 10 women of reproductive age. While there are PCOS symptoms, such as excess androgens (often called male hormones), multiple immature follicles in the ovaries, excess hair growth (aka hirsutism), unexplained weight gain, and infrequent or absent ovulation, it can be complicated to diagnose.
"PCOS is not one well-defined condition," says Dr. Sharon Briggs, PhD, Modern Fertility's head of clinical product and research. "That means that what PCOS looks like can be very individual, which can lead to the condition being undiagnosed or misdiagnosed."
Because of this, we hosted a digital meetup to tackle the must-knows about PCOS and answer the biggest questions people have about the condition. Here, we recap the PCOS Digital Meetup with Dr. Briggs.
After you’re done reading the recap (and watching the video at the end if you want even more knowledge), you’ll have the answers to these Q’s:
- What is ovulation and how is it impacted by PCOS?
- How does PCOS diagnosis happen?
- Do you need to see a specialist for PCOS, or can your primary care physician treat it?
- Why do some people get PCOS and others don't?
- Is there a connection between thyroid issues and PCOS?
- Does age impact PCOS?
- What can you do to get proactive about your reproductive health if you’re thinking about trying to conceive in the future?
What is ovulation and how is it impacted by PCOS?
Ovulation is a phase of the menstrual cycle that comes after a surge of luteinizing hormone (LH) — causing a mature egg follicle to burst and release an egg into the fallopian tube. In order for fertilization to happen, sperm needs to arrive on the scene within 12-24 hours. Ovulation typically happens 14 days before the start of your period.
One of the symptoms of PCOS is high androgen levels. This hormonal imbalance interferes with ovulation, resulting in irregular or absent periods, which make it difficult to ascertain if and when ovulation has occurred. "The infrequent and unpredictable nature of ovulation in women with PCOS is one of the challenges when trying to get pregnant," says Briggs.
Curious to find out if you're ovulating? "Ovulation predictor kits are one way to check," says Dr. Briggs. "Checking your basal body temperature is another way, and some women track their cervical mucus and look for changes that can signal ovulation."
If you're on birth control pills to treat symptoms of PCOS, you might experience what's known as withdrawal bleeding, which is what happens when you take the inactive, or placebo, pills. It's not your period, and it doesn’t mean ovulation took place. "It's not an absolute requirement that women have a period every month," says Dr. Briggs. "However, it can become a problem if the uterine lining continues to grow, which can put women with PCOS at increased risk for endometrial cancer."
You can be on certain forms of birth control and still ovulate, clarifies Briggs. "Women using the copper IUD do ovulate because it doesn't contain hormones. Some women on progesterone-only birth control also ovulate." If you're not on birth control and you get a regular period, that's a good indication that you've ovulated.
But if you’re not ovulating… do you “save” your eggs? "Every month, 500-1,000 eggs disintegrate from the ovarian reserve pool,” says Dr. Briggs. “And that’s true whether you’re ovulating or not."
How does PCOS diagnosis happen?
PCOS is diagnosed via the Rotterdam criteria, which looks for the presence of two out of three symptoms: hyperandrogenism (high levels of "male" hormones like testosterone), ovulatory dysfunction (aka irregular periods), and polycystic ovaries (enlarged, with many immature follicles surrounding the eggs). Although, it’s not as cut and dry as you might expect — "You can have a blood test that comes back normal for testosterone and still have the symptoms of androgen excess," says Dr. Briggs.
There are other signs and symptoms that may also suggest PCOS but aren’t part of the Rotterdam criteria. The first is high anti-mullerian hormone (AMH), which is often at higher levels among those with PCOS. Two others are high blood sugar and insulin resistance. Dr. Briggs explains that data suggests a relationship between these conditions and PCOS, but not all people diagnosed with PCOS have them.
That said: If you have PCOS but not insulin resistance, you are at increased risk for developing it in the future. (Metformin, a medication for type 2 diabetes which lowers insulin levels and improves insulin resistance, is safe for women trying to get pregnant.) Those with PCOS are six times more likely to develop type 2 diabetes than those without PCOS.
Do you need to see a specialist for PCOS, or can your primary care physician treat it?
"Not all primary care physicians and OB-GYNS are prepared to address and recognize the symptoms of PCOS," says Dr Briggs. That being said, if you have a good relationship with your primary care physician, she advises starting there. But: "Reproductive endocrinologists are prepared to talk about PCOS — they deal with hormone imbalances as part of their day to day."
Why do some people get PCOS and others don’t?
The medical community is still a little fuzzy on the exact causes of PCOS. "We still don't know the exact combination of lifestyle factors, genetics, and unknown [risk factors] that lead to PCOS," says Dr. Briggs. "There hasn't been a trend of PCOS becoming more prevalent, but it's possible that we'll see it becoming more common in the future."
Is there any correlation between thyroid issues and PCOS?
According to a 2015 study, there is evidence that women with PCOS are likely to have subclinical hypothyroidism (underactive thyroid), which means levels of thyroid-stimulating hormone (TSH) are slightly out of the normal range, and therefore can have an impact on the ovaries and other bodily functions.
Does age impact PCOS?
1 in 10 women between ages 15 and 44 have PCOS, and while many are often diagnosed as teenagers, it's not always so clear cut. PCOS has variations in its characteristics, so it doesn't look the same in everyone, and therefore, diagnosis can be delayed.
PCOS does change with age (high body-fat percentage and insulin resistance are more predominant as one gets older), but it doesn’t go away. Says Dr. Briggs: "It's not necessary to check in to see if you [still] have it. It’s not going to change. If you're concerned about your symptoms, or if you feel like your symptoms are consistent with PCOS and not being addressed, check in with your doctor.”
What can you do to get proactive about your reproductive health if you’re thinking about trying to conceive in the future?
Staying on top of how your reproductive system is functioning (if you're not on birth control, are you getting your period regularly?) is a good place to start, as well as exercising, eating well, and definitely not smoking nicotine. "Not smoking is the number one thing you can do for your reproductive health even if you're not thinking of conceiving," says Dr. Briggs.
Listen to the entire convo with Dr. Briggs below — and keep your eye out for more digital info sessions and meetups with Modern Fertility!