Dear Future Mom:
Polycystic ovarian syndrome, or PCOS, is an extremely common hormonal disorder and it’s something that OB/GYNs know how to treat. The good news is that most of my patients with PCOS are able to get pregnant.
When you have this condition, for unknown reasons, you have an excess of male hormones, or androgens, circulating throughout your body. All women have both female and male hormones, but when you have PCOS, there’s an imbalance, and your androgen levels are too high. This is what causes all of those troublesome symptoms you mentioned, as well as acne and thinning hair on your head.
In addition, PCOS can also cause problems with insulin resistance, which increases your risk for type 2 diabetes as well as heart disease.
The name polycystic ovarian syndrome causes confusion among many women because they think they have huge ovarian cysts that require surgery, and that’s what causes their infertility. But that’s not true. The cysts associated with PCOS do not usually require surgical intervention. The reason that it can be difficult to get pregnant with PCOS is because you’re not ovulating regularly and it’s not uncommon to only get your period every two to three months. And when you do menstruate, your flow can be extremely heavy.
When you’re not ovulating regularly, this can also lead to other hormonal imbalances that may increase your risk of uterine cancer. So to help protect yourself against this cancer, we often advise women with PCOS to either take birth control pills or to get an IUD that contains progesterone. These forms of contraception will help balance your hormones and protect you from precancer of the uterus as well as cancer of the uterus.
When you do decide to try to get pregnant, one option that works for many women is taking the diabetes drug Metformin. Studies have shown that by regulating insulin levels, the drug helps women with PCOS to ovulate more consistently so that they can conceive. If this doesn’t work on its own, we often combine it with another medication that induces ovulation.
Another way to try to ovulate more regularly is to lose excess weight. Unfortunately, as you know, that can be especially difficult to do when you have PCOS. But it’s important not only for conception but also for a healthy pregnancy, since we know that obesity during pregnancy increases your risk for several problems, including preterm birth, stillbirth and increased rates of early pregnancy loss.
The highest probability of conception occurs when you have intercourse one to two days prior to ovulation. Several ways to predict ovulation is through a menstrual calendar, tracking your basal body temperature, and using ovulation prediction kits—and then having intercourse accordingly. Increase in volume of discharge, as well as change in consistency of discharge, are also good indicators of ovulation.