Polycystic ovary syndrome (PCOS) isn’t that bad – if you’re a woman who’s a fan of fertility problems, irregular or absent periods, acne, and sporting excess facial hair. But if, like most women, you’d rather have your cycle under control and regular, PCOS can put a real damper on your life. Just ask the women who struggle with it, a staggering estimate of 5-10% of the female population.
As with any syndrome, not every sufferer has the same symptoms. There are even some you can’t see without medical intervention, such as small, fluid-filled cysts on your ovaries. But of all the possible PCOS symptoms, one of its most prevalent (and most painful) is infertility.
“PCOS is the most common anovulatory cause of infertility; it represents about 70-80% of cases,” says Rachel A. McConnell, M.D., Assistant Professor of Obstetrics and Gynecology at Columbia University Medical Center. But, she adds, there’s hope: With treatment, the chances of getting pregnant are very good.
So what are those treatment options? Well, it depends on what kind of havoc PCOS is wreaking in your life; treatment will vary according to your individual symptoms and ultimate goals.
First of all, no matter how PCOS is making you suffer, your doctor will likely start by recommending lifestyle changes that can make a big difference. Many women with PCOS experience some level of resistance to insulin, a hormone produced by the pancreas that enables your body to use sugar for energy. In those with insulin resistance, the body doesn’t use its insulin efficiently, causing a domino effect of symptoms that can ultimately lead to infertility. The best way to combat insulin resistance is exercise and (brace yourself) avoid refined carbs like sugar, white rice, white flour, and potatoes. I KNOW.
It might sound challenging, especially if you’re not all that into the idea of exercising and eating clean, but don’t see this as a depressing series of un-fun changes – baby steps will make it much more tolerable. Start out by just incorporating more movement into your daily routine – taking the stairs, parking at the back of the grocery store parking lot – and make dietary tweaks like swapping out white bread for whole grain, drinking water instead of juice, and the like. Once you’re accustomed to those small changes, it won’t seem like such a leap to make bigger ones.
According to the American College of Obstetrics and Gynecology, even a 10-15 pound weight loss can regulate periods, and a 2016 study by Penn State University found that women who lost weight before attempting fertility treatments were more likely to have a baby. Of course, weight does not always correlate with health, and women of all weights and sizes can go on to have healthy pregnancies. And if your doctor is looking solely to weight loss to address the problem, then you might want to find a new doctor.
If pregnancy is, in fact, your goal, your doctor’s next step will probably be a prescription. Dr. McConnell advises women with PCOS to undergo a fertility evaluation after six months of trying unsuccessfully to get pregnant. “Medications to help with ovulation may include the use of pills taken orally, Clomiphene Citrate (Clomid) or Letrozole (Femara). When oral medications fail to make the patient ovulate or become pregnant, injectable medications called gonadotropins can be used,” she says.
Your response to these medications will be closely monitored via frequent hormone testing and ultrasounds (side note: in many cases these are transvaginal ultrasounds – not exactly a picnic, but typically easier than a pap smear). Continuous monitoring is important, not only because your doctor needs to see if the treatment is working, but because these meds stimulate the ovaries so there’s a raised risk of multiple births, especially with the use of gonadotropins. If insulin resistance is still a problem, despite lifestyle changes, an additional medication called Metformin may also be prescribed.
If you’re not trying to get pregnant at the moment, but are still over this whole “suffering from PCOS” thing, your doctor may prescribe birth control pills. Seems weird, sure, but they can help in a couple of ways. First, they regulate your menstrual cycle. And second, they decrease the production of androgens, the male hormones that cause excess hair growth and acne (all women produce androgens, for the record – it’s just that PCOS sufferers produce more than necessary).
But there are non-birth control options as well. “Another treatment to reduce excessive hair growth includes the use of Spironolactone, which will block the effects of androgen at the level of the skin,” says Dr. McConnell. She also suggests electrolysis, a drug-free option wherein hair follicles are “zapped” with a mild electric current, which destroys unwanted hair follicles.
PCOS is a common syndrome, which sucks because it means that far too many of us have to deal with it, but there are options. And for those grappling with its unpleasant symptoms — especially the heartbreak of infertility — the solution could (hopefully) be as close as a phone call to your doctor.