What we'll cover

⚡️In a nutshell

  • PCOS (Polycystic Ovary Syndrome) is a hormonal imbalance involving excess androgens (male hormones), typically resulting in irregular ovulation.
  • PCOS is not a life-long fertility sentence, it can be managed. Many women with PCOS go on to have healthy pregnancies and babies.
  • In Australia, 1 in 10 women are affected by PCOS, but 70% of women who have PCOS are either misdiagnosed or undiagnosed. And it's often they find out only after actively trying to get pregnant.
  • To be diagnosed with PCOS, you need to show two of three symptoms: irregular ovulation, increased androgens (i.e male hormones like testosterone) and/or showing signs of immature follicles (known as cysts) on your ovaries.
  • PCOS symptoms in women can vary significantly but the most common include irregular periods, hair loss, excessive hair growth, weight gain, acne, anxiety and depression. Symptoms can typically be managed with some lifestyle changes and (if applicable) prescribed treatments or medications.

☝🏼1 in 10

We don't often talk about our ovaries. But when you consider that 1 in 10 women are affected by Polycycstic Ovary Syndrome (PCOS), we need to!

Just like 1 in 10 people are left-handed, or 1 in 12 have asthma - are we not talking about PCOS because we're not immediately affected by it? Maybe. But how do you know you're not?

Many women don’t find out that they have PCOS until they are actively trying to get pregnant, have trouble and then look to get their fertility hormones tested.

In fact, research estimates that about 70% of women with PCOS are either misdiagnosed or undiagnosed.

We deserve this information, and we deserve it much earlier in life!

🙇🏼‍♀️ Let’s chat PCOS  

PCOS is a condition where your reproductive hormones, more specifically, androgens (male sex hormones; like testosterone and DHEA) are out of balance. This imbalance encourages the ovaries to produce way more androgens than they should.

What causes PCOS?

Studies have not been conclusive about how some women get PCOS and others don't. But researchers believe there are two things that can play a role:

🧬Genetics: Women with relatives with PCOS are more likely to have PCOS.

😈Insulin Resistance: When insulin is not working effectively, the body produces more insulin. When there’s more insulin hanging out in the blood, this can increase the production of androgens such as testosterone, causing an imbalance of hormones.

How do I know if I have it?

In Australia, the most widely-accepted criteria for diagnosing PCOS is known as the Rotterdam Criteria 2003.

If you show two of three of the following symptoms, it is grounds for a diagnosis:

  • Irregular ovulation: Does your period sometimes come more than 35 days apart? Does it sometimes come less than 21 days apart?
  • Increased androgens (male hormones, like testosterone): Usually shown by excess hair growth (hirsutism), acne or raised testosterone levels in blood tests.
  • Many immature follicles (known as cysts): These would be found on your ovaries in an ultrasound. These are known as Polycystic Ovaries.  

What? Cysts on my ovaries?

For women who want to fall pregnant, getting told you have PCOS can feel like you've just been passed a fertility bomb.

Despite its damning name, you can still have PCOS and not have cysts on your ovaries. But if you do, this is what’s happening.

Your ovaries are filled with immature follicles. Each month, a small group of these follicles are told by your reproductive hormones that they need to start growing.

If you ovulate, one of those follicles emerges as the dominant one - larger than the others - and basically tells the other follicles to take a hike.

However, if you don’t ovulate (which is sometimes what happens with PCOS), then you will not form a dominant follicle and suppress the other follicles.

Instead, the other follicles will keep on growing just a lil' bit.  The problem with this is that you end up with many small, undeveloped follicles. These undeveloped follicles are officially called 'cysts.' This is what shows up in your ultrasound.

Normal Ovaries

PCOS Ovaries

🤒 What are the symptoms?

Symptoms for PCOS can be different for every woman. You could experience one or a combination of the following:

Bear in mind, if you're currently using hormonal contraceptives - these symptoms can be masked. In other words, as soon as you come off hormonal contraception, you might start noticing them again.

Also, if you had any of these symptoms before you went on hormonal contraception, they may still persist once you come off it.

As we mentioned earlier, PCOS is a commonly misdiagnosed or undiagnosed condition. This becomes a bigger problem beyond your fertility if it's not managed properly.

Poorly managed PCOS can sometimes lead to lifelong increased health risks - such as type 2 diabetes, heart disease, endometrial cancer and high blood pressure.

It's important that if you have PCOS, or suspect you may have the syndrome, you build relationships with doctors who are experienced and well-versed in PCOS. You may be referred to a gynaecologist as well.

😓 How does PCOS impact my fertility?

Women with PCOS have irregular ovulation. This makes it hard to predict the timing of ovulation, if ovulation happens at all. Why does this matter? Well, in order to get pregnant you need 4 things:

  1. An egg to release (ovulate)
  2. At least one open, healthy fallopian tube
  3. Sperm to fertilise the egg
  4. A receptive uterus

Most women with PCOS will take longer to get pregnant because they might only release an egg every couple of months or perhaps not at all. But, there are options you can take to kickstart or regulate ovulation (more on this later!).

It's not a life-long fertility sentence - many women with PCOS go on to have healthy pregnancies and deliver healthy babies.

✊🏼 Showing PCOS who's boss

If you have PCOS and are struggling with any of the these symptoms, the first thing you need to do is make some lifestyle changes.  

Get movin'

Studies have shown that weight loss of 5-10% can make a big difference in:

  • reducing insulin resistance
  • regulating your menstrual cycles
  • restoring ovulation
  • reducing testosterone (and improving hair and acne)
  • Improving your emotional and physical health

Come on, even the most anti-gym goer can admit - that is a lot in return for a max of 40 minutes of moderate exercise everyday.

Experts typically look at this based on your BMI, which is the number calculated by considering your weight to height ratio. You can use an online BMI calculator to check yours.

Generally speaking, the goal is to get your BMI to a healthy range, between 20-25.

If your goal is to maintain your BMI, aim for around 20 minutes a day at moderate intensity.

If your goal is to reduce your BMI, aim for around 40 minutes a day at moderate intensity.

If you’re new to exercising, start small! Remember, every bit of physical activity helps, even a brisk walk around the block counts.

Check out the Sweat app. We love it because it's designed for all women, regardless of what fitness and exercise level you are.  It will help you stay accountable. It offers a lot of variety -  jiu jitsu, pilates and boxing to name just a few that caught my eye. If you do love variety, then try out Class Pass which has been designed specifically to help you try a range of new exercise regimes. 😍

There's actually no right or wrong way to approach an exercise regime for PCOS. It's about finding what you enjoy, so you stick to it.

Change to a PCOS friendly diet

We don't like the word diet either. But research has found that what women eat can significantly help manage PCOS symptoms like acne, weight gain and fertility.

Generally speaking, women with PCOS have elevated insulin levels or insulin resistance. Being able to adjust your diet to keep these levels stable is key to reducing the impact of PCOS symptoms.  

In fact, studies have shown that a low-GI diet can help your insulin levels behave.

Quick note on GI (short for Glycemic index): It measures how quickly a particular food raises blood sugar levels. A low-GI diet consists of eating foods that raise blood sugar levels slowly - like steel-cut oats - which help prevent insulin spikes and improves insulin resistance. You might want to introduce some anti-inflammatory foods too. They can assist with fatigue.

We've broken down this into your own cheat guide. Pretty simple really, and there is nothing revolutionary. Just a whole lot of natural whole foods and not a huge deal of processed and packaged foods we're afraid.

But, just imagine how good you'll feel! 🤩

In addition to a healthy exercise and eating regime: Metformin

If you’re struggling with these changes and may need some help with early weight loss, Metformin may be something you discuss with your doctor, as studies have shown that Metformin helps to improve insulin sensitivity in women with PCOS.

🙏🏼Your fertility treatment options

Ovulation Induction

Not ovulating regularly? If your BMI is below 35, there are safe medications that can be prescribed to help you release eggs more regularly.

It's a treatment either taken orally or can be injected at the beginning of your menstrual cycle. They work by stimulating the ovary to start or regulate your ovulation. The medication is typically called Clomid tablets or gonadotrophin injections.

Your doctor will monitor this treatment carefully by ultrasound and blood tests so they can tell you when you are due to ovulate. This will help you work out when it's the best time to schedule baby-making sex.

IVF

In Vitro Fertilisation (known as IVF) can be an option for some women. It's the most effective fertility treatment available. Yet, it's still not guaranteed to work and can be expensive.

The process of IVF starts with injecting fertility drugs to help stimulate your ovaries to start maturing as many eggs as possible. As many eggs as possible are then retrieved from the ovaries with a simple procedure, and combined with sperm in the clinic to fertilise them - with the hope that some embryos will form. If successful, one of these embryos are then transferred and implanted into the uterus.

Before you go jumping down the IVF path, there are a number of things you should consider to decide whether IVF is right for you. We'll cover that off in an IVF guide (watch this space!).

🙁 Minimising pregnancy complications

Once pregnant, can PCOS complicate my pregnancy?

Unfortunately, it can. It does increase your risk of some pregnancy complications such as gestational diabetes, high blood pressure and miscarriage.

Which is why obstetricians will screen women with PCOS for diabetes when they become pregnant, and check in again later down the track (between 24 and 28 weeks).

What if I'm diagnosed with gestational diabetes?

If you are diagnosed, most pregnant women can maintain good blood sugar levels with diet and exercise.

Also, 1 in 7 women with PCOS will need to take insulin shots during the last part of their pregnancy.

Have a chat with your GP or obstetrician who can help you manage or reduce the risk of these complications by monitoring your blood sugar levels and other tell-tale symptoms.

Now, let's talk weight for a second. A touchy subject we know but when you're pregnant with PCOS, you need to be strict about a weight gain goal.

The best way to keep the weight off? Walking. Even if it's just a light 30 minute walk each day.

🙅🏼 Managing Other PCOS Symptoms

Hormonal contraceptives for acne and hair growth

Hormonal contraceptives can help you balance out the reproductive hormones (in particular, reducing androgens) in your body. This helps manage PCOS symptoms like acne and unwanted hair growth.

Hormonal contraceptives include the pill, patch, ring, the Depo Provera shot, implants (like Implanon) and hormonal IUD. Not all of them will be suitable for you, so you've got to discuss that with your Doctor so you find the right fit.

Mental health awareness and professional help

If you're getting into a tough headspace due to your PCOS symptoms, just know that you've got this. It's frustrating as hell, but it's also in your control.

We believe there is strength in knowledge. By knowing what is happening in your body and what you can do about it can be used to your advantage.

Keep reminding yourself that you’re not alone in this (remember, 1 in 10!). Getting support from your friends, family or health professionals early can help ease the very real emotions you’re experiencing.

LYSN is a great online platform that puts you in touch with psychologists without having to leave the house.

But if you want to see someone in-person, in Australia, there’s a Mental Health Care Plan that you may be able to access if you have Medicare. Talk to your doctor about it - they'll find out if you're eligible. If you are, you’ll be entitled to access 6-10 sessions with a psychologist per year.

💪🏼You're not alone. Let’s do this.

No doubt, PCOS can be a confusing and overwhelming diagnosis to receive. But as you can see, there is plenty you can do to help you take back control.

There is even a community that has been created by people with PCOS to share their experiences and support eachother. They call themselves "cysters" (um, amazing). Cysters often find each other online, through websites like Soul Cysters, in Facebook groups and awareness raising organizations. Get amongst it!

At the very least, find a doctor, endocrinologist or fertility specialist who you trust to help you manage and understand PCOS.

You've got this.

📕 References

  1. Deeks, A., et al. Is having polycystic ovary syndrome (PCOS) a predictor of poor psychological function including anxiety and depression? Human Reproduction, 2011
  2. Deeks, A., et al. Anxiety and depression in polycystic ovary syndrome: a comprehensive investigation. Fertility and Sterility, 2010
  3. Dokras, A. Cardiovascular disease risk in women with PCOS. Steroids, 2013
  4. Ehrmann, D., et al. Prevalence and predictors of the metabolic syndrome in women with polycystic ovary syndrome. The Journal of Clinical Endocrinology and Metabolism, 2006
  5. Fauser, B., et al. Consensus on women’s health aspects of polycystic ovary syndrome (PCOS): the Amsterdam ESHRE/ASRM-Sponsored 2rd PCOS consensus workshop group. Fertility and Sterility, 2012
  6. Gambineri, A., et al. Polycystic ovary syndrome is a risk factor for type 2 diabetes: results from a long-term prospective study. Diabetes Journal, 2012
  7. Goodman, NF., et al. American Association of Clinical Endocrinologists, American College of Endocrinology, and Androgen Excess and PCOS Society Disease State clinical review: Guide to the best practices in the evaluation and treatment of polycystic ovary syndrome. Part 1.Endocrine Practice, 2015
  8. March, WA., et al. The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction, 2010
  9. McCartney, CR. and Marshall, JC. Polycystic Ovary Syndrome. The New England Journal of Medicine, 2016
  10. Mena, GP., et al. The effect of physical activity on reproductive health outcomes in young women: a systematic review and meta-analysis. Human Reproduction, 2019
  11. Meyer, C., et al. Overweight women with polycystic ovary syndrome have evidence of subclinical cardiovascular disease. The Journal of Clinical Endocrinology and Metabolism, 2005
  12. Moran, LJ., et al. Dietary composition in the treatment of polycystic ovary syndrome: a systematic review to inform evidence-based guidelines. Journal of the Academy of Nutrition and Dietetics, 2013
  13. Moran, LJ., et al. Lifestyle changes in women with polycystic ovary syndrome.Cochrane Review, 2011
  14. Moran, LJ., et al. Treatment of obesity in polycystic ovary syndrome: a position statement of the Androgen Excess and Polycystic Ovary Syndrome society. Fertility and Sterility, 2009
  15. Pasquali, R., et al. The impact of obesity on reproduction in women with polycystic ovary syndrome. International Journal of Obstetrics & Gynaecology, 2006
  16. Roe, AH. and Dokras, A. The diagnosis of Polycystic Ovary Syndrome in adolescents. Reviews in Obstetrics and Gynecology, 2011
  17. Rosenfield, RL., The pathogenesis of Polycystic Ovary Syndrome (PCOS): The hypothesis of PCOS as functional ovarian hyperandrogenism revisited. Endocrine Review, 2016
  18. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 2004
  19. Teede, HJ., et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertility and Sterility, 2018
  20. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Ovarian stimulation in assisted reproduction. 2014
  21. Whitaker, SB., et al. Androgen receptor status of the oral sebaceous glands. The American Journal of Dermatopathology, 1997

🧠 Contributors

  • ✏️ Words
    Courtney Goudswaard

  • 🧪 Science
    Dr. Vamsee Thalluri

  • 🎨 Illustrations
    Amelia Hanigan