Polycystic ovary syndrome (PCOS), also called Stein-Leventhal syndrome, can cause fertility problems. We take stock of the causes, symptoms, and possible treatments of this disorder.
Polycystic ovary syndrome results in an unusual increase in the number of androgens (male hormones) in the ovaries, which disrupts egg production. Instead of being released at the time of ovulation, these turn into cysts – small pockets filled with fluid – which accumulate in the ovaries and sometimes increase in size.
A distinction must be made between polycystic ovaries and polycystic ovary syndrome. “If all women of childbearing age were given an ultrasound, 20% of them would have polycystic-looking ovaries, but not all of them would have other symptoms related to PCOS,” explains Dr Louise Lapensée, obstetrician and gynecologist specializing in fertility at the CHUM assisted procreation clinic and at the OVO clinic in Montreal. To be diagnosed with PCOS, two of the following three symptoms must be observed:
- presence of ovarian cysts on ultrasound;
- irregular menstrual cycles (less than eight cycles per year)
- signs of high levels of male hormones: acne, excessive hair growth, including on the face (hirsutism).
Causes and Symptoms
The causes of PCOS are not known for sure, but the results of the studies carried out so far would lean towards the genetic factor. “We haven’t done prenatal screening, because no gene has yet been identified, but the research tends to point to a genetic anomaly of insulin resistance,” says Dr. Lapensée. 6 to 8% of women are affected by this disorder.
PCOS is characterized by several symptoms, the number, and intensity of which can vary between women. Here are ten of them:
- long and irregular menstrual cycles (oligomenorrhea);
- absence of menstruation (amenorrhea);
- overweight and difficulty losing weight;
- excessive hairiness;
- hair loss;
- excess cholesterol and triglycerides;
Symptoms can appear as early as adolescence, but the diagnosis is usually made after the woman stops taking birth control pills (whether she is trying to get pregnant or not), as these masks the symptoms of PCOS.
Although PCOS does not necessarily cause fertility problems, it decreases a woman’s chances of becoming pregnant, since it is associated with irregular menstrual cycles. It is therefore common for specialists in fertility clinics, who see couples struggling to conceive, to diagnose PCOS. “We see cases of PCOS every day, attests Dr. Lapensée, they represent 15% of the causes of infertility.
Unfortunately, PCOS has no cure. However, the symptoms can be controlled. If one of the observed symptoms is overweight, the first step is weight loss. According to Dr. Lapensée, by establishing healthy lifestyle habits (exercise, diet), possibly with the help of a nutritionist and an endocrinologist, one-third of affected women succeed in becoming pregnant.
Weight loss can significantly reduce hyperandrogenism (acne, hairiness) and the risk of suffering from type 2 diabetes. Women who do not wish to become pregnant can, for their part, take an oral contraceptive to regulate their cycle.
In the case of women who wish to have a child and who suffer from metabolic disorders resulting from PCOS (diabetes, hypertension), it is important to consult an endocrinologist in order to follow a treatment. Indeed, these pathologies can have harmful consequences on the health of the fetus and even cause a miscarriage.
If after weight loss there are still no signs of pregnancy, medications that stimulate ovulation may be considered. Dr. Lapensée wants to be reassuring: “You shouldn’t worry, because polycystic ovary syndrome remains a common fertility problem that can be treated well.”
Finally, the specialist mentions that having less than four periods a year is dangerous since it increases the risk of endometrial cancer. Dr. Lapensée, therefore, invites the women concerned to consult a gynecologist.