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Infertility and PCOS


Women with polycystic ovary syndrome (PCOS) have a number of seemingly unrelated symptoms, many of which manifest themselves as cosmetic annoyances which vary from nominal to extreme.

Regardless of the severity of your cosmetic problems, the underlying cause is the same for nearly all of us: a significant hormonal imbalance which often appears to have its root in problems with insulin metabolism. That hormonal imbalance can manifest itself in many different ways, affecting each woman’s body differently. Remember, PCOS is a syndrome and each person has a different set of symptoms.


The most common symptom of PCOS is infrequent or even absent menstrual cycles. Infrequent cycles, medically referred to as oligomenorrhea, is defined as having 8 or fewer periods per year. Other women with PCOS have amenorrhea, or no cycle at all. Women with amenorrhea rarely have a regular cycle without the aid of medication. Longstanding amenorrhea can put some women at risk for changes in the uterine lining that may lead to endometrial cancer. A simple scan can rule out this rare but potentially life-threatening problem.

While some women have few or no cycles at all, other women experience the opposite: polymenorrhea or excessive bleeding. This is a condition in which bleeding occurs too often. A period will start and then stop a few days later only to reappear in a week or two. Heavy, abnormal bleeding can be caused by PCOS but it can be caused by other problems as well. See your doctor to rule out problems such as uterine fibroids, polyps, or tumors.


PCOS may account for as many as half of all cases of infertility. Because women with PCOS generally do not ovulate regularly, it affects their ability to conceive. However, many women with PCOS are able to get pregnant, especially with the help of a fertility specialist, and to carry successful pregnancies to term. There are a number of possible treatments, ranging from simple and fairly inexpensive medications which induce ovulation to costly high-tech treatments such as in vitro fertilization. Some of the most exciting new options being used to regulate cycles and enhance fertility are medications known as “insulin sensitizers”. Insulin sensitizing medications (Cmetformin) address the underlying endocrine problem present in many women with PCOS and can restore natural ovulatory function.


Hirsutism, or excess hair, is one of the more difficult aspects of living with PCOS. Hair that was previously light in color and texture can be stimulated by free androgens in the system which are present because of the hormone imbalance. For most women, this manifests itself as a darkening and coarsening of hair in the mustache and beard areas as well as the breasts. Many women with PCOS also experience a masculinization of hair on their arms and legs and an extension of pubic hairs on the abdomen and thighs. Those who deal with this particular aspect of PCOS frequently find it to be a major source of aggravation and embarrassment.

There are several physical methods of hair removal, including bleaching, waxing, tweezing, shaving, depilatory creams, electrolysis and laser therapy. Most hair removal professionals advise women to shave or bleach rather than to pluck or use depilatories in order to avoid problems with ingrown hairs and skin irritation.

On the pharmaceutical front, new hair growth can be prevented and existing hair may be lessened by taking an anti-androgen medication. Anti-androgens such as cyproterone, spironolactone and finasteride counteract the male hormone responsible. In many cases the hair growth slows down and the hairs become thinner and less noticeable. It can take between six months and a year to notice a difference, and most medicines should be continued for several years.


In adolescence and beyond, acne can be another particularly annoying problem for women with PCOS. Found mostly on the face, chest and back, it can be treated with some success by over-the-counter medications. Several prescription medications have proven helpful including the anti-androgen medications mentioned above. Anti-
androgens work because acne is caused by the same hormone imbalance that causes hirsutism.


Many, but not all women with PCOS struggle with their weight. PCOS weight gain is typically exemplified by the “apple-shape” as opposed to the “pear-shape”. A high hip to waist ratio is commonly seen in PCOS and is associated with impaired glucose and insulin metabolism. Weight loss can be a helpful tool to decrease PCOS symptoms but many women find it difficult to achieve. Anecdotal evidence seems to indicate that women with PCOS do not have as much success with the standard low-fat diet as women who aren’t affected. Women with PCOS typically find more success by both reducing total carbohydrate consumption and by choosing to eat different types of carbohydrates. Replacing refined carbohydrates with whole grains, fruits and vegetables not only helps reduce insulin response, it also increases the daily intake of essential micronutrients such as anti-oxidants.

Choosing the right carbohydrates and assuring adequate protein intake at each meal can go a long way toward helping control the hypoglycemic/low blood sugar episodes that many women experience as well as potentially regulating insulin response and modifying the hormone imbalance. Exercise can also play a key role in helping the body use insulin more effectively and should not be overlooked. Dietary modifications and regular exercise are a successful first step for many women as they try and take control of their PCOS.



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