PCOS can influence your fertility as a woman. If you are diagnosed with this metabolic condition, it is important to see a gynaecologist to manage your treatment. This will involve not just your fertility journey but also the associated lifelong risks of vascular disease.
What is PCOS?
So what to look out for, if you believe you may have PCOS? The typical symptoms are:
- irregular periods,
- absent periods,
- difficulties conceiving,
- unwanted or excessive hair growth.
In older women or very severe cases ‘male-pattern hair loss’ can be one of the symptoms. This is very rare in young women.
Another aspect of PCOS in cases with irregular ovulation, is the chance of changes in your endometrium (the lining of the uterus). That then creates an increased risk of endometrial cancer, but the good news is that simple treatments can prevent this.
You might be in a situation where different doctors have told you different things. Some may have told you that you have PCOS, others may have told you that you don’t. When you then receive a diagnosis, it can be reassuring because it creates clarity, or it can be distressing if you feel you now have a ‘disease’. While women with PCOS can struggle to conceive, good treatments are available to help safely and it is reassuring to remember that on average, women with PCOS have as many babies as women without PCOS(*).
“It is possible to have a milder form of PCOS with a regular period and no clinical signs of raised androgens. In that case the diagnosis of PCOS is made on blood test results and the ultrasound appearance of your ovaries.”
What causes PCOS?
When you hear that you may have a condition, you want clear answers. And at my practice, it is my intention to aim for the highest level of clarity. However, sometimes the answers are not simple. There is not one single cause of PCOS.
It tends to run through families in a pattern similar to autosomal dominant genetic conditions, where there is a 50% chance the offspring of an affected person will develop the disease. There is however no single gene associated with PCOS. Carrying extra weight will often exacerbate the symptoms of PCOS.
PCOS diagnosis and treatment
- high levels of androgens, either clinically (acne, hirsutism, male pattern hair loss) or biochemically (on blood tests),
- irregular or absent periods,
- polycystic ovaries on ultrasound.
There are a number of other metabolic conditions which can mimic PCOS and we need to exclude those conditions.
Diagnosis can be difficult in adolescents, where acne and irregular periods are common. There are some adolescents who meet some but not all the diagnostic criteria. They are in an “at risk” group and a definitive diagnosis may not always be possible until up to 8 years after periods start.
When you are trying to conceive and are diagnosed with PCOS, Ovulation Induction treatment is the first line treatment for PCOS, where various medications are used to stimulate your ovaries to produce the perfect menstrual cycle. We aim for just one egg being released at ovulation and for this egg being supported by good robust hormone levels and a normal endometrium.
Fertility specialist and gynaecologist Perth
PCOS and fertility treatment
In case you are having difficulties conceiving, Ovulation Induction (OI) treatment is commonly used for women with PCOS and effectively treats ovulatory disturbance. A number of medications can be used including Clomiphene, Letrozole and Recombinant FSH (Gonal-F or Puregon). I most frequently use recombinant FSH as this allows a graduated increase in the level of stimulation until the ovaries respond as we want them to.
It is important that any Ovulation Induction treatment cycle is carefully monitored to minimise the risks of multiple pregnancy, remembering that the best way to get a perfect baby is having them one at a time. Often Metformin is used, a medication commonly used in type 2 diabetes, which reduces the risk of over responding to ovarian stimulation with too many eggs. Unmonitored OI can result in twins (often tricky but good when things go well), triplets (very often a disaster for mums and babies) or worse!
IVF is not first line treatment for the ovulation problems associated with PCOS because in an IVF cycle the embryo transfer needs to happen in the correct part of your cycle, 5 days after ovulation, so with an irregular cycle, “ovulation induction” type treatment is needed before transfer. Women with PCOS are at higher risk of Ovarian Hyperstimulation Syndrome, one of the most common and severe complications of IVF.
Will PCOS go away at menopause?
Why Dr Richard Murphy as your gynaecologist?
Whether you are looking to get pregnant sooner, later or not at all PCOS will need managing. If pregnancy is planned soon and your cycles are irregular or absent, then please come to see me.
The success rates for Ovulation Induction are very good. If you are looking at conceiving in the future, then planning early and perhaps making some adjustments beforehand can often make things much easier.