Understanding PCOS

Expert Q&A: Dr Marcus Faesen

PCOS is a severe genetic, hormonal, metabolic, and reproductive disorder that affects women of all ages. It is a cause of female infertility, which can lead to other severe conditions including obesity, type 2 diabetes, cardiovascular disease, and endometrial cancer.

 

It is PCOS (Polycystic Ovary Syndrome) Awareness Month, so we sat down with our expert Fertility Specialist, Dr. Marc Faesen of HART Fertility Clinic, to ask a bit more about this debilitating disorder:

 

What are the symptoms of PCOS? 

 

Women with PCOS have infrequent menstruation because they do not ovulate. Most women with this condition only menstruate 3 or 4 times a year. They often have oily skin, sometimes mild, but sometimes worse in the form of acne. They may also have excessive hair growth, all due to the increase in male hormones. 

 

The ovaries would commonly be enlarged, with an unusually large amount of small follicles (eggs in the making) on the ovaries, usually aligned around the ovary’s periphery under a thickened ovarian capsule. 

 

These follicles have stopped normal development, and the cells inside and around the follicles have changed hormone production, tipping the balance to an increase in male hormone production.

 

What causes PCOS? 

 

The exact cause of PCOS is not known. There is usually an abnormality in the production of steroid hormones, resulting in increased male hormones production, often associated with insulin resistance. 

 

The imbalance between female and male hormones and the insulin levels all interfere with the eggs’ growth and maturation on the ovary.

 

Can PCOS be prevented? 

 

Because the exact cause of PCOS is unknown, it is difficult to determine if it can be prevented. However, many of the features of PCOS can be treated. 

 

We know that some lifestyle factors play a significant role in symptoms. Women with PCOS who are overweight or obese may see a dramatic improvement in the condition by reducing their body mass index (BMI).

 

However, many patients tell us that they have been trying for a very long time to lose weight and are failing to achieve that. However, by putting them in contact with our supportive and knowledgeable dieticians, they have the opportunity to change their lifestyle and can then most certainly achieve their goals.

 

Can PCOS be cured or only managed? 

 

We do not have a single “cure” for PCOS, but we can treat many of the symptoms.

 

How can you treat PCOS? 

 

Treatment depends entirely on what a woman with PCOS wants to achieve. Some women want to see menstruation, so if that is the case, we use the contraceptive pill to menstruate every month. Other women are desperate to fall pregnant but are not ovulating (and therefore not menstruating). For these patients, we need to look at re-activating the follicles’ growth and maturation on their ovaries so that they start ovulating again. We call that Ovulation Induction. 

 

There are several ways to do that, using medication such as fertility pills, alongside injections.

 

What can happen if you do not treat PCOS? 

 

Long-term health risks are cardiovascular disease and diabetes, mainly due to wrong lifestyle factors, raised male hormones, and insulin resistance. If the patients with PCOS do not menstruate for many years, the endometrium (lining of the uterus) is also at risk of developing abnormalities, sometimes atypical or even cancerous.

Can one rid themselves of PCOS for good? 

 

Yes, If simple lifestyle changes can bring all the abnormal hormone and insulin levels back to normal. However, some patients with PCOS will need lifelong monitoring to make sure that long-term risks are addressed.

 

How common is PCOS? 

 

There have been many attempts to determine how common PCOS is in the general population. 

 

Polycystic “looking” ovaries on ultrasound is much more common than the confirmed and diagnosed PCO Syndrome. About 20-25% of women in the reproductive age groups have polycystic “looking” ovaries on ultrasound, which is a subjective assessment by the Ultra-Sonographer. 

 

How does PCOS affect fertility? 

 

Women with typical PCOS do not ovulate and do not menstruate. They will, therefore, not fall pregnant unless they get help. Treatment will only work correctly if the contributing factors are addressed. Those women who are overweight need to help in their treatment by reducing their body weight. In those cases, medication alone will not restore fertility.

 

Is PCOS considered as the leading cause of infertility for women? 

 

Apart from PCOS, there are, as you may imagine, many other causes of infertility in both females and males.  At HART Fertility clinic, these can all be appropriately investigated and possibly treated.  It is important to reiterate that PCOS is not the MAIN cause of infertility. Still, it is by far the most common diagnosis in the subgroup of infertile women who do not ovulate properly.

 

Does PCOS affect African Women disproportionality or not?

 

There isn’t much information in the medical literature that focuses on racial differences amongst PCOS patients. From my point of view, It seems that there are no real differences in prevalence among the different racial groups.

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