A PCOS (polycystic ovarian syndrome) diagnosis can be scary at any age, even if you aren't yet sure you want a family. Let's break down what the diagnosis could mean for you.
Do I even have PCOS?
PCOS or Polycystic ovarian syndrome is associated with the following symptoms:
Symptoms:
Dark facial hair growth
Hair loss from the scalp
Acne on the face or body
Weight gain
Irregular cycles - longer than 35 days
Infertility
High cholesterol
Before we get into the ins and outs of PCOS, first, let’s see if the diagnosis fits you.
According to the Rotterdam criteria PCOS can be diagnosed if any two of the following are present:
- Clinical or biochemical hyperandrogenism - high androgens on a blood test or physical signs of high androgens (dark facial hair growth, hair loss, acne)
- Evidence of oligo-anovulation - lack of ovulation or irregular ovulation (cycles longer than 35 days)
- Polycystic appearing-ovarian morphology on ultrasound (note: you can have polycystic ovaries on an ultrasound WITHOUT having PCOS the condition)
There also needs to be no other causes for the symptoms, all other disorders are ruled out.
Newer thinking focuses on the androgen excess aspect of the syndrome, and believe for a true PCOS diagnosis that androgen excess must be present physically or on a blood test. A change of name of the syndrome has been suggested for better clarity, from PCOS to Androgen Excess Syndrome. This would leave other factors causing irregular ovulation to be classified as their own syndrome/issue.
It is important to keep in mind that PCOS shouldn’t be diagnosed until 2-3 years after menstruation starts as it takes time for the body to regulate hormones and maintain a regular cycle. While PCOS can start in someone aged 18 years and younger, I am hesitant to rely on a diagnosis made this young as cycles often regulate and change after a few years. Stress, lifestyle and diet play a massive role in the development of hormonal disorders and often the diet and lifestyle of teens and early 20-year-olds isn’t conducive to great hormonal health. Fitting the criteria for PCOS during this time doesn’t always mean you will still fit the criteria later in life.
Types of PCOS
Insulin Resistant - most common cause (70% of cases). High insulin triggers the ovaries to produce more testosterone which drives PCOS. Insulin resistance is driven by diet and genetic factors, simple blood testing can help you determine if you are insulin resistant (test fasting glucose and insulin, HbA1c is not sufficient).
Adrenal - high-stress levels can cause the adrenal glands to make an excess of an androgen hormone called DHEA-s which drives PCOS symptoms.
Inflammation - long-term inflammation can cause the ovaries to produce more testosterone than needed. Gut infections, autoimmune diseases and other illnesses can drive this sub-type of PCOS.
Post Pill - as the name suggests this can occur after stopping hormonal birth control. Most birth control suppresses androgen production, so when the medication is taken away the body can go a bit overboard on androgen production which can lead to PCOS. This type will often resolve on its own, or be accompanied by another type of PCOS. Typically if you went on hormonal birth control to manage acne, dark hair growth or irregular cycles then there will be another driver at play.
It is possible to have more than one driver of PCOS, and as you can see the causes are different therefore the treatment needs to be too.
Will having PCOS make it harder to conceive?
Maybe, but not always! The key factor with PCOS is that ovulation isn’t regular, but for most with PCOS it does still happen every so often. Even with irregular ovulation, conception is possible, it’s just harder to time and track.
PCOS is associated with other conditions which can make conditions for conception less than ideal. High insulin, blood sugar, inflammation and stress levels can all affect your health and chances of conception.
Tests to run to get the full picture:
These blood tests will help diagnose PCOS and rule out other causes of the same symptoms. Your GP can order these for you, or a qualified natural health practitioner. Book here for more support with this.
- Follicle-stimulating hormone (FSH) (Day 2-3 of cycle)
- Luteinising hormone (LH) (Day 2-3 of cycle)
- Anti-Müllerian hormone (AMH) (Day 2-3 of cycle)
- Estrogen (E2) (Day 2-3 of cycle)
- 17OH Progesterone (17OHP4) (Day 2-3 of cycle)
- Prolactin (Day 2-3 of cycle)
- Total testosterone (T)
- Free androgen index (FAI)
- Sex hormone binding globulin (SHBG)
- Androstenedione
- Dehydroepiandrosterone-sulphate (DHEA-S)
- Full thyroid panel: TSH, T3, T4, Thyroid antibodies
- Fasting glucose and insulin
- HbA1c
- CRP
The good news?
PCOS can be managed through diet, nutrients, herbs and medication. Fertility can be supported. Please don’t write yourself off as infertile if you have been given a PCOS diagnosis. Often when I work with PCOS patients going through infertility it goes one of two ways:
- Ovulation is irregular making timing conception hard. After treatment with herbs, diet and/or ovulation induction drugs ovulation becomes regular and conception happens easily.
- We find other causes for infertility other than irregular ovulation (commonly: uterine structural issues, sperm issues, nutrient deficiencies, inflammation, vaginal or uterine infections, or thyroid issues).
Trying to conceive (TTC) with PCOS
Here are some things to consider:
- Start prep early: start working on blood sugar management, stress or inflammation 12+ months out from TTC (know YOUR PCOS driver and what you are trying to treat)
- Start tracking your cycle and learning about the signs of ovulation so you have more chance of timing conception correctly - Learn how to track ovulation here.
- Get your bloods done so you know what you are working with - test, don’t guess
- Make diet changes early, especially for insulin-resistant PCOS types - you are playing the long game here!
- Know that any improvements you make will benefit egg quality and your future offspring.
- Ask for help early! PCOS and infertility can be tough to navigate on your own. Reach out to me for support if needed.
