PCOS or Polycystic Ovarian Syndrome is a wide and complex condition with a general set of accepted symptoms, which are also individual to each woman. This can make it difficult to diagnose. It is also one of the most common reproductive conditions to affect women, so if you have been diagnosed or suspect that you have PCOS then you are far from alone. Studies show that somewhere between 10% and 20% of all women have PCOS. In the UK it is thought that 1 in 5 women have PCOS.
In an Australian study of women (aged 28-38) diagnosed with PCOS, the time to diagnosis was between 1 and 17 years. Most had self-diagnosed by researching their symptoms using the Internet. This in itself can be distressing, so being given a formal diagnosis can be a relief, but also a cause for distress. It does allow for effective planning in terms of managing symptoms and exploring what treatment options are available. This means that patients can have meaningful and constructive discussions with their Gynaecologists, Fertility Consultants and Complementary Therapists for improving fertility naturally and also what forms of assisted reproduction or ovulation induction techniques would be most beneficial.
Before we move on to symptoms and relevant diagnostic testing, I would just like to mention that I do see many women who have episodes of PCO (Polycystic Ovaries) which can be related to stress which causes very irregular menstrual cycles and disrupts ovulation and can, therefore, cause periods to stop altogether. The ovaries can appear to be cystic when scanned.
However, with treatment and stress management, the cycle can fairly quickly return to normal.
PCOS symptoms may include…
Irregular periods and this may mean very long cycles, followed by a shorter cycle i.e. 85 days and then 30 days. It could also mean just having 2-3 periods a year, or sometimes none at all for very long periods of time.
Polycystic Ovaries – ovaries that are enlarged, and contain many follicles (the fluid filled sacs that contain eggs) Although these are called ‘cysts’ they are technically just normally occurring follicles, which don’t develop beyond 8mm in size and therefore do not rupture to release an ovum.
Excess Androgens – higher than normal levels of Testosterone and reduced levels of SHBG (Sex hormone Binding Globulin) which is a carrier for reproductive hormones.
Excessive hair growth – Hirsutism, particularly on face, chest, buttocks and back.
Difficulties managing weight – this can be particularly distressing as weight gain in itself can then impact further on the menstrual cycle and ability to conceive. However, not ALL women have difficulties with managing weight.
Skin Problems, in particular Acne and Acanthosis Nigricans (brown patches)
Hair loss – or thinning hair
Increased skin tags
Fatigue – due to fluctuating hormone levels
Insulin Resistance – Insulin resistance involves the body’s inability to lower blood sugar levels correctly. Blood sugar levels can become too high, which causes yet more insulin production. Too much insulin also increases testosterone production, which, in turn, leads to further disruption of the menstrual cycle.
An increased risk of miscarriage – as if the symptoms of PCOS and difficulties trying to conceive are not enough on their own, there is sadly, an increased risk of early miscarriage and pregnancy related conditions. This includes pregnancy related hypertension, gestational diabetes, pre-term birth and pre-eclampsia.
Diagnosis is usually confirmed if patients experience two or more of the main symptoms, which include lowered SHBG and increased Testosterone, an irregular menstrual cycle and observed polycystic ovaries.
What Causes PCOS?
- A family history, particularly if your mother or sister have already been diagnosed.
- An Increase in visceral fat around the abdomen and obesity.
- Elevated Insulin levels.
Why does it Impact upon Fertility? One of the main reasons that PCOS affects fertility is due to infrequent or complete lack of ovulation (anovulation). If ovulation is sporadic, this can make it very difficult to identify when ovulation is actually taking place and this then makes it difficult to ensure that you are having sex at ‘the right time’.
Weight gain associated to PCOS tends to be around the middle and is known as visceral fat. This in turn can secrete its own kind of oestrogen which can then further disrupt the ability to ovulate.
Can I Improve my Symptoms and Chances of Conceiving? The good news is that there is much that can be done to improve your chances of both getting pregnant and maintaining your pregnancy, and also managing some of your symptoms.
Regulate your menstrual cycle
The most common medical approaches are to use drugs such as
Metformin – to stabilize insulin and which may then restore ovulation
and or Clomiphene Citrate or Leterazole to increase the likelihood of ovulation occurring.
Additionally, Ovarian Drilling, a laparoscopic procedure has been found to be of benefit. This is a surgical procedure which uses heat or laser treatment to destroy tissue in the ovaries and has been found to lower testosterone, Luteinising hormone and raise Follicle Stimulating Hormone.
However, there are many more natural approaches to regulating your cycle, that have fewer or no side effects. Both Acupuncture and Reflexology have reported excellent results in restoring ovulation and a more regular menstrual cycle, with research and data collection studies to support this. Some herbal remedies, including Agnus Castus have also proven to be of benefit.
Reproductive Reflexology, in particular, uses structured protocols including ‘homework’ on the hand reflexology points, alongside monitoring of your menstrual cycle to measure progress.
You could also consult a Fertility Nurse who specializes in supporting women with PCOS, this can be particularly helpful in guiding you to understand your own menstrual cycle.
The most important factor is to try and establish a regular cycle, even if it is long, this will help in making sure that you are able to take advantage of your fertile window. When a menstrual cycle is irregular, it is in the main due to fluctuating ovulation.
Understand when you ovulate – This is key to helping you to optimize your chances of conceiving when you have a PCOS diagnosis. Charting your Basal Body Temperature (BBT) or using an ovulation monitoring device like Ovusense means that you are likely to have a much better understanding of your cycle and when you are most likely to be fertile. The fertile window in the cycle is short, usually around 2-5 days, so ensuring that you are able to identify this will increase your chances of conception.
There are websites which can help with plotting BBT graphs, and noting your ovulation signs. I usually recommend a free website www.fertilityfriend.com which provides a wealth of knowledge and support, including sample PCOS charts so that you are able to identify what you are looking for.
Once you have started to chart your cycle, you will also be able to add in your own individual ovulation signs. These may include…
Changes in Cervical Mucous – CM that becomes more profuse, watery, clear, stretchy or can be likened to egg white.
- An increase in libido
- An increase in energy levels
- A dip and then sustained rise in your BBT
- One- sided abdominal pain – a slight twinge, that relates to the rise in temperature on your BBT chart
- Spotting – which is minimal and also relates to a rise in your BBT
- Breast tenderness – some women experience this for 2/3 days around the time of ovulation
You may have other symptoms that indicate ovulation which are individual to you and BBT charting will help you to identify these.
The more knowledge you have about your own menstrual cycle, the more empowered you are, and the greater your chances of conceiving without further intervention.
I usually then recommend having sex 3 times in the week leading up to ovulation, so that sperm are in situ before ovulation occurs.
Manage Weight – I have purposely left addressing the issue of weight until last as I know that it can be so upsetting for women. It is the one thing we know that can make a real difference. Even losing 5% of your body weight can help to re-introduce a regular cycle. However, for women with PCOS it can be one of the hardest things to do. In fact, it can be incredibly distressing. If you are struggling please do seek the advice of a nutritionist who will be able to provide an individual approach.
Changing eating patterns to include one of the following can make it easier to lose weight and maintain it.
Low glycemic index diets
5:2 fasting diets (or other forms of this)
These can help to regulate insulin levels and make it easier for you to lose weight. Don’t forget to include some exercise, even a good brisk walk each day will help to keep you active and make it easier to manage weight, and improve sleep and energy levels.