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What is PCOS?

PCOS stands for polycystic ovarian syndrome. PCOS is a really interesting condition, principally because it is not static, but very dynamic. Women affected by PCOS experience differences in their symptoms at different stages of life, at different body weights, with different lifestyle choices.

PCOS is not entirely genetic and it’s not entirely conditioned by diet and lifestyle. It is a bit of both.

The official definition of PCOS (as defined by the ESHRE (European Society of Human Reproduction and Embryology) Rotterdam criteria) is:

Having at least 2/3 of the below criteria, as a diagnosis of exclusion (meaning other causes of a similar medical presentation have been thoroughly investigated and ruled out):

  1. Irregular menstrual cycles (Normal regular menstrual cycles can be slightly different cycle to cycle and woman to woman. That’s ok. Your menstrual cycle is considered regular and normal if cycles are about the same length every month with an inter-menstrual interval of between 21 and 35 days, and with bleeding lasting between two to seven days. If your cycle doesn’t fit within this picture, it is considered irregular)
  2. A polycystic looking ovary on ultrasound (ultrasound criteria for PCOS have changed as digital ultrasound imagery became more sophisticated, giving better views of the ovaries. We now define >25 visible follicles per ovary as “polycystic”. When ultrasound images weren’t as clear, > 12 follicles were considered polycystic. Those kind of findings today would be considered normal, just because imaging techniques can now see follicles that weren’t recognised and reported using older ultrasound technology)
  3. Hyperandrogenism: this refers to either a clinical or biochemical demonstration of the overreaching effects of testosterone. Examples might include a high level of testosterone for a female demonstrated on a blood test, or alternatively end organ effects of testosterone in the female body like acne, excess body hair growth, facial hair growth, so called “male pattern” hair loss, or excess body odour.

Irregular menstrual cycles are associated with irregular ovulation (release of an egg). This can be incredibly frustrating for women with PCOS who are trying to conceive, as if you don’t release an egg and have sex around the same time, you can’t possibly get pregnant naturally.

For women with PCOS, egg quality can be normal. Fertility treatments such as ovulation induction therapy can very successfully assist natural conception and are considered first line therapy to help women with PCOS get pregnant. Oral medications such as letrozole and clomiphene can successfully be used, integrated with ultrasound monitoring to ensure an effective regimen has been designed and that ovulation will be achieved. Injectable gonadotrophin hormones (FSH (follicle stimulating hormone), LH (luteinising hormone), HCG (human chorionic gonadotropin)) can also be used to induce ovulation in resistant cases where a woman has not successfully ovulated using oral therapies. CREI RANZCOG (Certification in Reproductive Endocrinology and Infertility, Royal Australia and New Zealand College of Obstetrics and Gynaecology) certified reproductive endocrinologists and fertility specialists are fully and optimally qualified to assist women with PCOS to conceive, regardless of the methods needed to help them.

IVF (In vitro fertilisation) can sometime be required to assist women with PCOS. This can be for a number of reasons, but usually would be recommended where a couple present with more than just a simple problem of irregular ovulation. Male infertility may be experienced by a woman’s partner, presenting with sperm problems needing IVF and ICSI (Intracytoplasmic sperm injection - a laboratory technique to help poorer quality sperm effectively fertilise an egg to form an embryo). Additionally, there are many female conditions that can make getting pregnant much harder for a woman with PCOS, for example advanced maternal age with associated poorer egg quality, genetic concerns such as chromosomal rearrangements, endometriosis (an inflammatory condition affecting one in 10 women which can cause period pain and infertility),or blocked or missing fallopian tubes following an ectopic pregnancy of previous sexually transmitted infection like chlamydia, gonorrhoea, syphilis or tuberculosis.

Regular periods are important for endometrial health (the health of the uterine lining, where a baby implants). Women with PCOS can be at a higher risk of conditions including endometrial hyperplasia (pre-cancer like overgrowth) or even endometrial cancer, due to failure of the endometrium to shed with regular periods.

When not trying to conceive, various contraceptive options can be useful to protect a woman’s uterus and endometrium from hormonal effects in PCOS that predispose to endometrial problems.

The best Lovers choices for women with PCOS depends on a woman’s stage of life, pleasure needs and personal preferences, and are not limited by the fact that she has PCOS.

For more information on PCOS, visit Women’s Health Melbourne and Knocked Up Podcast.