Polycystic Ovarian Syndrome (PCOS) is something mentioned a lot here on Your Fertility Journey. The international guidelines for PCOS were released in 2018 and are currently the most up-to-date information available. This article features part of a previous conversation had on the Fertility Podcast with Professor Adam Balen, a full-time consultant and fertility specialist, and highlights some of the key aspects of the guidelines.

What is Polycystic Ovarian Syndrome?

Polycystic Ovarian Syndrome (PCOS) is very common and affects approximately 15% of women. The condition itself comes in many forms, and the term ‘syndrome’ relates to a collection of signs and symptoms. The key symptom is irregular or absent periods (however there are other symptoms too). For some women, this means unpredictable periods or maybe no periods at all. If you are not having periods, then you won’t be having regular ovulations.

When you have PCOS, your ovaries contain many more of the tiny, normally occurring cystic structures which contain the eggs. These are often referred to as follicles and in normal cycles, you have several follicles at the beginning of the cycle, but only one will grow and ovulate. When you have PCOS, you tend to have an imbalance of hormonal signals within the ovaries and the signals which are important for the follicle to grow in a coordinated way. The ovary stacks up with lots of these tiny cystic follicles, which are visible on an ultrasound scan.

PCOS and lifestyle

Weight can affect PCOS. Often people who are overweight tend to suffer more with PCOS, and they can benefit from lifestyle changes, weight loss, and careful nutrition assessment to improve prospects of ovulating naturally and ovulating in responses to any treatments which may be necessary. These aspects are all covered in the international guidelines.

There is not one set diet for PCOS but trying to keep carbohydrate levels low is a good plan. However, you need to have an appropriate balance of the right protein and fats. Seeing an expert in reproductive nutrition can be a good idea.

Making healthy lifestyle changes is a first action step to take. It is important to get your partner involved too. Going through a fertility journey is often a shared experience, so improving both of your lifestyles and health will increase the prospects of having a healthy home, household, and hopefully pregnancy.

Ovulation induction treatment

Unfortunately, even with lifestyle changes, many women will still experience irregular periods.

For many years, Clomifene, or Clomid, has been used as a treatment for increasing ovulation, and this works well, with many successful pregnancies and births as a result.

More recently, Letrozole, which is in a different class of drugs, has been used as a treatment and works within the ovary itself to influence the relative balance of the main ovarian hormones, which are testosterone and oestrogen. These are the main hormones that the growing follicles make. Testosterone is required to produce oestrogen, which is the main hormone associated with reproductive health. Women with PCOS, however, often have elevated levels of testosterone, which can lead to other side effects such as unwanted hair growth, and sometimes acne and hair thinning.

Letrozole works by correcting the hormone imbalance and allows the follicles to grow in an orderly manner. Clomifene, on the other hand, leads to higher levels of the hormones which stimulate the follicles outside the ovary. The evidence is showing that Letrozole is going to give you a better chance of conceiving due to its work within the ovary.

Current prescriptions and the need to change mindsets

Overall, we are still seeing a mix of the treatments being prescribed, with many people still receiving Clomifene, or Clomid, despite the guidelines regarding Letrozole being there. However, if you are on Clomid and are not responding after two rounds, it is worth going back to your doctor and ask if you can go back and try Letrozole because it could be that you are more likely to respond to Letrozole if you haven’t done so with Clomid.

Letrozole also carries a lesser risk of Ovarian Hyperstimulation Syndrome (OHSS) and multiple pregnancies due to the way it works and overall seems to have less side effects and risks.

IVF, ovarian drilling and your ability to conceive with PCOS

Many women are still being told that they won’t get pregnant with PCOS – which is not the case. As long as you get referred to the right specialists, there is every reason to feel optimistic about conceiving when you have PCOS. It may take longer to get pregnant, but it doesn’t mean it won’t happen. The same goes for weight loss and leading a healthier lifestyle. With the right support, even a small decrease in weight can improve your fertility chances.

A common belief is that women with PCOS need to have IVF, but this is not always the case. Ovulation induction treatments are very effective. Of course, it is also important to ensure all other aspects of your fertility are healthy.

An ovarian diathermy or the more off-putting name of ‘ovarian drilling’, which is a laparoscopic surgical procedure, is a further option. The surgery is designed to cauterise points on the ovary to stimulate ovulation. This offered as frequently these days as medication can be very successful.

Key points to take away

PCOS can’t be cured but it can be controlled through the treatment options available.

From a diet perspective, lowering your refined carbohydrate and sugar intake, and switching to wholegrain products, along with lifestyle changes is where the treatment starts.

Tracking and understanding your cycle is important, along with becoming your own advocate and fighting for the support and treatment you deserve.

I hope you have found this helpful and feel more informed about PCOS and what it involves.

Useful resources and blog posts on PCOS:

It can’t be cured but it can be controlled

Fighting back against PCOS

PCOS journal