Celebrating PCOS Awareness Month – What is PCOS? 

Polycystic ovary syndrome (PCOS) is a hormonal imbalance that occurs when your ovaries (the organ that produces and releases eggs) create excess hormones called androgens.

If you have PCOS, your ovaries produce unusually high levels of these androgens. This causes your reproductive hormones to become imbalanced. As a result, people with PCOS often have irregular menstrual cycles, missed periods, and unpredictable ovulation.

Small follicle cysts (fluid-filled sacs with immature eggs) may be visible on your ovaries on ultrasound due to lack of ovulation (anovulation).

However, despite the name “polycystic,” you dont need to have cysts on your ovaries to have PCOS. 

Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women. Up to 70% of affected women remain undiagnosed worldwide.

PCOS is the most common cause of anovulation and a leading cause of infertility.

PCOS is one of the most common causes of infertility in women and people assigned female at birth. September is a month of creating awareness, and bringing attention to the condition. The world will shine teal throughout the month of September.

Back to Basics – What is Hormonal Imbalance and How Does it Affect The Reproductive System?

Regulation of the reproductive system is a process that requires the action and reaction of hormones from the hypothalamus, the pituitary gland, and the gonads (ovaries and testicles), with constant communication between the hormone-producing organs (glands) and their target cells so that the levels of all the important hormones do not go too high or too low (“balanced” hormone levels).

This is necessary so that the whole reproductive system works adequately.

An imbalance in the levels of certain hormones will therefore disrupt the normal sequence of events in the menstrual cycle, which then results in either delayed development of eggs in the ovaries, no development at all (female), or reduced sperm production (male).

Hormonal imbalances are the leading cause of infertility in women.

PCOS Diagnosis Criteria:

There are a number of criteria to consider in the diagnosis of PCOS: 

  1. Biochemical Hyperandrogenism 

Biochemical hyperandrogenism or hyperandrogenemia is defined as an elevating serum level of one or more androgens, that is, total testosterone (TT), free testosterone (FT), dehydroepiandrosterone sulfate (DHEAS), and androstenedione (ADD).

  1. Clinical Hyperandrogenism

The clinical manifestations of elevated androgen levels in women include hirsutism, acne and female pattern hair loss. Hirsutism, excessive terminal hair growth in a male pattern distribution, is common in patients with PCOS, affecting 60–70% of people.

Female pattern hair loss and acne are common complaints among patients with PCOS. While both have been associated with biochemical hyperandrogenism, only one-third of women with female pattern hair loss have elevated androgen levels.

  1. Oligo-anovulation

Oligoovulation is a condition that causes irregular or infrequent periods. While women with an average menstrual cycle typically have periods every 28 to 32 days, women experiencing oligo ovulation generally have eight or fewer periods each year.

  1. Polycystic ovarian morphology

Polycystic ovarian morphology is an ultrasonographic finding that can be present in women with ovulatory disorder and oligomenorrhea due to hypothalamic, pituitary, and ovarian dysfunction.

Possible Symptoms of PCOS, Caused by Excess Androgens – When to make an appointment with your Fertility Specialist 

If you are suffering from any of the following symptoms, it may be a good idea to make an appointment with one of our Fertility Specialists.

PCOS is a metabolic condition, and excess Androgens (male sex hormones) may result in the following:

Possible symptoms include:

  • heavy, long, intermittent, unpredictable or absent periods
  • infertility
  • acne or oily skin
  • excessive hair on the face or body
  • male-pattern baldness or hair thinning
  • weight gain, especially around the belly

It is important to remember that symptoms of polycystic ovary syndrome can differ from person to person. Symptoms may change over time and often occur without a clear trigger.

Methods for treating PCOS – For Women Wanting to Conceive

If you are struggling with PCOS-related fertility issues, then one of our Fertility Specialists will be able to guide you on the right course of action.

Treatment options for PCOS include:

  1. Drugs to induce ovulation (releasing an egg): A successful pregnancy begins with ovulation. Certain drugs have been proven to induce ovulation in people with PCOS.
  2. Ovarian drilling: Consists of making numerous perforations on the surface of the ovary in order to decrease its size and make it easier to select an ovulating follicle and release the ova.It improves ovarian responsiveness to successive ovulation induction agents.This surgery is not commonly used.
  3. In vitro fertilization (IVF): This is an option for people with PCOS when medication doesn’t help with ovulation. Your provider fertilizes your egg with your partner’s sperm in a lab before transferring it to your uterus.
  4. Lifestyle Changes: As a first step weight loss through a low-calorie diet combined with moderate exercise activities can restore ovulation which will result in a normal menstrual cycle. Even a modest reduction of 5-10 percent of body weight might already improve the condition dramatically.

Lifestyle-Related Treatment Options for PCOS

Research shows that at least 50% of women with PCOS are obese class I (BMI > 30) or obese class II (BMI > 35). 

As a first step, women suffering from PCOS, weight loss through a low-calorie diet combined with moderate exercise activities can restore ovulation, resulting in a normal menstrual cycle. 

Even a modest reduction of 5-10 percent of body weight might already improve the condition dramatically. 

Set up a consultation with our dietician, Sonia Malczyk if you feel that this is something that you are struggling with.

Stir Health – @stirhealth.nutrition

PCOS in Younger Women: 

Polycystic ovary syndrome treatment generally focuses on the management of each individual’s main concerns, such as infertility, hirsutism, acne, or obesity. 

In younger girls with PCOS who are not looking to fall pregnant, usually, the only request is to re-establish regular menstruation, which can easily be done with the combined oral contraceptive pill. 

This is a safe and simple solution to treat the symptoms of PCOS. 

Additional Health Condition Affecting Women with PCOS:

Patients with PCOS are more likely to have other health conditions including:

  • type 2 diabetes
  • hypertension (high blood pressure)
  • high cholesterol
  • heart disease
  • endometrial cancer (cancer of the inner lining of the uterus). 

PCOS can also cause anxiety, depression and a negative body image. Some symptoms such as infertility, obesity and unwanted hair growth can lead to social stigma. This can affect other life areas such as family, relationships, work and involvement in the community.

Other Possible Causes of Anovulation:

A very rare cause of anovulation is hypothalamic dysfunction. 

Hypothalamic dysfunction can be due to surgery, tumors, radiation, brain injury and genetic conditions.

But it can also be caused by recent and severe weight loss or gain, excess physical and emotional stress, nutritional deficiencies, and a high or very low body weight. This can be seen in athletes who went through an extreme training program, or in young adults with excessive weight loss (anorexia).

As stated before, this discussion of hormonal imbalances related to infertility is not complete, but has addressed the more common disorders related to the reproductive system and the reproductive hormones.

Hormonal Functions in Male Fertility:

Let’s look at the effect of hormonal imbalance in males, and how this can affect fertility.

But first, we have to establish the exact roles that hormones play in the male reproductive system.

In males, the hypothalamus produces gonadotropin-releasing hormone (GnRH), which stimulates the production and release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland.

These hormones regulate the gonads (testes in males), and therefore they are called gonadotropins.

The FSH stimulates the production of the reproductive cells (sperm) and LH stimulates the production of sex hormones (Testosterone) by the gonads.

Each process has its own very unique and specific function, and therefore it is vital for all of the hormones to be kept ‘in balance’ for the full reproductive system to work smoothly.

Male Infertility and Hormones Imbalance

Hormonal Imbalance in men could also be a cause for concern linked to fertility.

Separate signals from the pituitary gland are sent for these two functions inside the testicles: FSH stimulates sperm production, and LH stimulates testosterone production.

The failure of the pituitary gland to secrete follicle-stimulating hormone (FSH) and luteinizing hormone (LH) results in disruption of testicular function and infertility. 

However, in men diagnosed with infertility, gonadotropin deficiency is extremely rare and only accounts for less than 0.5% of the causative factors of male infertility.

Other Causes of Hormone Imbalance in Men

Another well-known cause of hormone imbalance in men is the long-term abuse of androgens or androgen-like hormonal treatment, often used in bodybuilding programs.

This can completely suppress sperm production for a very long time, with often very slow recovery after the drugs have been stopped.

Medication that May Harm Sperm Production – Due to Hormonal Changes

Hormone imbalance in men can be caused by multiple factors. In some cases, you may not even be aware that a medication that you are taking may affect your hormonal balance.

The following medications could potentially be the cause of male hormonal changes:

  • Finasteride, frequently prescribed in managing male pattern hair loss, is a strong anti-androgen found in Propecia. This hormone antagonist can interfere with sperm production.
  • Certain anti-hypertensive medications (verapamil, alpha methyldopa) can cause raised prolactin, which can interfere with sperm production.
  • Phenytoin (anti-epileptic) probably via hypothalamus

Coping with Fertility Issues linked to PCOS or Hormonal Imbalance

If you feel that you are experiencing any of the symptoms mentioned above, or you are concerned about the effects of your hormonal imbalance on your fertility, contact us to set up a consultation with one of our Fertility Specialists. We will be able to determine whether you are suffering from PCOS or hormonal dysfunction, and we will be able to suggest a course of action. We’re here to help!