Polycystic Ovarian Syndrome (PCOS)

Dr. Suruchi Thakore

Reviewed by Dr. Suruchi Thakore on Aug 22, 2022

Polycystic Ovarian Syndrome (PCOS) is a leading cause of female infertility; in fact, PCOS is the most common cause of chronic anovulation (when a woman’s ovary does not release an egg). It is estimated that about one in five women in the UK have polycystic ovaries1.

  • PCOS is a condition caused by hormone imbalance and miscommunication between the brain and ovary resulting in irregular periods. One in five women in the UK have polycystic ovaries1
  • • See your doctor if you suspect PCOS; blood tests and possibly an ultrasound scan of your ovaries will be used to help diagnose the condition. Symptoms can include irregular periods, weight gain, excess hair growth, acne, as well as problems trying to conceive due to a lack of ovulation.
  • With treatment, most women with PCOS are able to become pregnant1
  • Because of the hormone imbalance associated with PCOS, ovulation tests may give a misleading result.

What is Polycystic Ovarian Syndrome (PCOS)?

PCOS is a condition of hormone imbalance associated with elevated androgens (like testosterone), irregular periods and possibly increased number of normal follicles within the ovaries (small ovarian cysts containing eggs). The exact cause of PCOS is unknown but it is thought to be caused by a hormone imbalance, resulting in women with PCOS having elevated levels of LH, estrogen and testosterone throughout their cycle. PCOS can be associated with “polycystic ovaries” which are ovaries that carry an overabundance of eggs in a specific pattern seen on pelvic ultrasound.

It is estimated that more than half of women with polycystic ovaries have no symptoms at all1 and some women only discover they have PCOS when they have difficulty conceiving. If present, symptoms can vary from mild to severe, and may include irregular periods or no periods at all (amenorrhea), excess body hair, oily skin, acne, weight gain and depression.

To diagnose PCOS a healthcare practitioner takes a detailed medical history, to rule out other potential causes of the symptoms and blood tests are often also used to establish hormone levels; an ultrasound may be used to detect polycystic ovaries.

PCOS cannot be cured, but for many women their symptoms can be effectively managed. For women who are overweight, the initial recommended course of action is usually to lose their excess weight, exercise regularly and have a healthy balanced diet; this can greatly improve many symptoms. Studies2 have shown that loosing just 10% of your body weight can “reset” the system, regulate menstrual cycles and ovulation, and improve pregnancy rates.

Management of PCOS has 2 paths. If you are not attempting pregnancy, oral contraception pills may be prescribed to help induce regular periods and improve symptoms associated with PCOS. However, if you are attempting pregnancy, these medications would not be recommended.

Infertility due to PCOS can be treated with fertility drugs such as letrozole or clomiphene which causes a hormone called FSH to rise, enabling ovulation. There are also other treatments options if these oral medications are unable to induce ovulation.

Rest assured, with treatment, most women with PCOS are able to become pregnant1

Bill Ledger
Professor Bill Ledger,
Fertility Specialist

I have been diagnosed with polycystic ovarian syndrome, will this make getting pregnant difficult and why?

Women with polycystic ovarian syndrome often don’t ovulate, or at least not regularly. This group of women will have irregular or infrequent periods. If you are not ovulating then the egg is not released from the ovary to pass into the Fallopian tube in order to be fertilised and implant in the uterus. There are several treatments for anovulation (a cycle when no egg is released) with polycystic ovarian syndrome. These include clomiphene tablets (Clomid), letrozole tablets (Femara), and injections of fertility drugs. Your doctor will be able to advise on this and refer you to a specialist clinic for help.

Can I use an ovulation test or fertility monitor if I have PCOS?

The short answer is no, as they are likely to give misleading results, ovulation tests and fertility monitors are not designed for women with ongoing anovulation due to an underlying hormonal disorder such as PCOS.

Clearblue Ovulation Tests identify the onset of ovulation by detecting a surge of LH above a baseline level. Women with PCOS may have a high baseline level of LH, and so there may not be a sufficient change in LH for the test to detect a surge, so ovulation may not be indicated. Or the baseline may be so high that it appears the surge is already underway, and the test will indicate ovulation on the first day of testing, a “false positive”.

The Clearblue Advanced Digital Ovulation Test and Clearblue Advanced Fertility Monitor measure estrogen as well as LH, to identify more fertile days than is possible with LH alone. Women with PCOS may also have a high baseline level of estrogen. Women with PCOS may therefore see more ‘high fertility’ days than expected, or an incorrect result due to high background levels of LH.

If you are using ovulation tests or a fertility monitor, you may see unexpected results, and we recommend that you seek advice from your healthcare provider.

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