As part of an ongoing series to provide information on the various facets of infertility and related conditions I want to talk a little about PCOS or polycystic ovary syndrome. Awareness of PCOS is increasing with the obesity prevalence among women of childbearing age in the United States. Since a link exists between obesity and PCOS, a corresponding increase in fertility problems and inability to conceive a pregnancy may occur. According to data from the National Health and Nutrition Examination Surveys of 2009-2010 presented by the Centers for Disease Control, 39.1% of women between 20-39 years old in the United States were obese. PCOS occurs in women on normal weight, as well. It is an endocrine abnormality that causes cysts to form in the ovaries and produce abnormally high levels of androgens, along with irregular periods and systemic hormonal imbalances.
Long considered as a hereditary condition, there is still no known cure. The website of the National Women’s Health Network includes an article in the Women’s Health Activist Newsletter (November/December 2007) by Kiesha McCurtis that describes the broad range of problems associated with PCOS.
The symptoms of PCOS will vary from woman to woman and include:
- Infertility (not able to get pregnant) In fact, PCOS is the most common cause of female infertility.
- Infrequent, absent, and/or irregular menstrual periods (root cause of infertility)
- Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
- Pelvic pain
- Cysts on the ovaries
- Acne, oily skin, or dandruff
- Weight gain or obesity, usually with extra weight around the waist
- Thick patches of dark brown or black skin on the neck, arms, breasts, or thighs
- Skin tags — excess flaps of skin in the armpits or neck area
- Male-pattern baldness or thinning hair
- Anxiety or depression
- Sleep apnea — when breathing stops for short periods of time while asleep
How common is PCOS
In 2005, Azziz stated in the Journal of Clinical Endocrinology and Metabolism that approximately 6.6% of women in the United States have PCOS. It is estimated that as many as 5 million woman in the US may suffer from PCOS. Due to the strong correlation between obesity and the incidence of PCOS and the rising prevalence of obesity in the US I would expect that percentage to be even higher now.
Health insurance companies that cover in vitro fertilization may not cover it for women with PCOS due to the possible health risks. In that case, women with PCOS who choose IVF may need to bear the entire cost themselves. For a woman with PCOS who wants a baby, adoption—even international adoption—may be a preferable option.
Treatment of PCOS
The primary means of treating PCOS will vary depending if you are trying to concieve or not. If you are not trying for a baby then the most common recommendations are lifesytle modifications, including: exercise, healthy eating, and weight loss (if overweight); or birth control pills to help regulate your hormonal levels.
For women with PCOS seeking to become pregnant, Clomiphene Citrate is the fertility drug frequently prescribed. While in vitro fertilization has been performed on young women with polycystic ovary syndrome, the risks may outweigh the benefits. Pregnant women with PCOS are at increased risk of gestational diabetes (which is a predisposing factor for later development of Type 2 Diabetes), as well as miscarriage and pre-eclampsia.
Another pregnancy risk for a women with PCOS is the higher association of premature birth. Additionally, because of the hormonal imbalances associated with PCOS, lactation may also be a problem.
Preventing PCOS
Although, we do not yet have a clear picture of how to prevent PCOS, weight loss in young women of childbearing age needs to be emphasized as a way to prevent potential development of PCOS. Since PCOS has been linked to insulin resistance, avoiding overly sugary foods and regular exercise (both of which are proven to help with insulin resistance) may be beneficial.For those obese women who want to have children, prevention of PCOS may provide a better goal for them to reduce their body mass index (BMI) than other health-related reasons. Because of the array of health risks associated with PCOS—including infertility—addressing the increase in prevalence of obesity in adolescents in the United States is important in reducing the overall incidence of PCOS. (sidebar: I have found a paleo-based diet, comprised of mostly whole foods with lots of meat and vegetables, to be quite effective in regulating my weight and would be happy to discuss that with anyone if they were interested.
The relationship of obesity to PCOS is yet another reason for obesity to be a primary public health focus. Infertility prevention is less costly to the health system as a whole than infertility treatment.
References
U.S. Centers for Disease Control. NCHS Data Brief 82; January 2012.
McCurtis K. Women’s Health Activist Newsletter (November/December 2007). National Women’s Health Network.
Azziz R, Marin C, Hoq L, et al. (2005). Health care-related economic burden of the polycystic ovary syndrome during the reproductive life span. J Clin Endocrinol Metab 90(8): 4650-4658.