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PCOS symptoms and treatment

PCOS in pregnancy

Polycystic ovary syndrome (PCOS) is a hormonal condition of the ovaries, and affects around one in five women in the UK. PCOS makes ovulation rare or irregular, and can make it harder to get pregnant. The good news is that, with treatment, most women with PCOS do eventually conceive.

What is PCOS?

What causes PCOS is unknown – but there are a few factors thought to have an effect:

  • Genetics: If your mum, sister or another female family member suffers from PCOS you might be at greater risk.
  • Hormones: Lots of women diagnosed with PCOS are found to have a hormonal imbalance – raised levels of testosterone (the 'male' hormone), prolactin (the hormone that causes the breasts to produce milk) or luteinising hormone (which usually stimulates ovulation but can cause problems with PCOS). It's not yet known exactly why these changes to hormone levels take place.
  • Insulin resistance: High levels of insulin cause the ovaries to produce too much testosterone. This in turn can cause weight gain, which again triggers the body to produce more insulin.

Do you know when you're ovulating?

Try our ovulation calculator

What are the symptoms of PCOS?

I was diagnosed with PCOS about eight years ago. I had the classic symptoms – overweight, spots etc but my cycle was fairly regular. I had strong insulin resistance and really struggled to lose any weight.

PCOS symptoms can come and go, but you'll usually first experience them in your late teens or early twenties. PCOS symptoms can become apparent later on, though, and many women don't realise they have PCOS until they have trouble trying to conceive.

Not all women wit PCOS will experience all the possible symptoms, and each symptom can vary from mild to severe.

These are some of the symptoms you might experience:

  • Disruption to your menstrual cycle – resulting in absent or irregular periods.
  • Infertility (because ovulation isn’t occurring).
  • A tendency to excess hair growth, particularly on the tummy, face and nipples. This is caused by extra testosterone, which may also make the hair on your head a bit thinner.
  • Loss or thinning of the hair on your head
  • Spots and oily skin.
  • Weight gain, which can itself exacerbate the syndrome by raising insulin levels in the blood and stimulating testosterone production.
  • Pelvic pain
  • Dark patches of skin in your groin, neck and armpits (acanthosis nigricans)
  • Depression
  • Mood swings

These symptoms (particularly depression) may be caused by other issues, so if you're struggling with any of them, do see your GP.

How is PCOS diagnosed?

To make a diagnosis of PCOS two of the three following factors need to be present:

  • Polycystic ovaries (you can have these, without having the full syndrome – and confusingly, you may have the syndrome even if your ovaries aren’t polycystic)
  • Anovulation (no egg released)
  • Raised testosterone levels

A diagnosis is normally made after a vaginal ultrasound scan to look at the ovaries and see if they are polycystic, in combination with blood tests to check testosterone levels.

If you're diagnosed with PCOS, your GP will discuss the lifestyle changes you can make to help keep the condition under control, as well as start you on medication if you need it. You may also be referred to an endocrinologist or gynaecologist, depending on your treatment needs.

PCOS treatment options

Although PCOS can’t be cured, the symptoms can be treated, enabling most women who are trying to conceive to get pregnant.

The treatment recommended may include:

  • Drugs such as Clomifene to stimulate ovulation.
  • Medication like Metformin which lowers insulin. It’s a drug usually given for type 2 diabetes but can be used ‘off label’ to treat this particular symptom of PCOS.
  • Gonadotrophin injections to stimulate the ovaries (there is the risk of overstimulation, causing multiple pregnancies, however).
  • Laparoscopic ovarian drilling – this isn’t nearly as horrific as it sounds! Under general anaesthetic, a tiny microscope is inserted into the lower abdomen to look at the ovaries and then the tissue that’s producing the male hormones is lasered off.

If you haven't conceived within six months to a year of treatment, assisted conception such as IUI or IVF might be considered.

How can I improve my chances of getting pregnant with PCOS?

There are lots you can do to help reduce the effects of PCOS and boost your fertility.

I had suggestive PCOS. It took us two years to conceive our daughter naturally, falling pregnant after initial fertility tests.

If you're overweight, try to lose some of it to help break the cycle of raised insulin levels that in turn increase the amount of testosterone produced. NHS Choices says even a 5% weight loss could make a big difference to the syndrome’s effect on your fertility as well as reducing your risk of developing long-term problems associated with PCOS including diabetes, high blood pressure, heart disease and endometrial cancer.

Having a balanced diet and taking regular exercise are the easiest ways you can help limit the effects of the syndrome. Try to avoid sugary foods, alcohol and caffeine as these can all affect insulin resistance.

You should also aim to:

  • Eat less meat – reduce your intake of meat and when you do eat it, try to eat good quality, organic meat. Too much meat can worsen any imbalance in your estrogen levels
  • Eat more plant-based protein – try to up your intake of beans, nuts, legumes and other non-meat sources of protein
  • Include Omega 3 fats in your diet- they have been shown to lower testosterone levels in women with PCOS
  • Eat a little bit of full-fat dairy – although you should avoid consuming too much dairy, a small amount of full-fat, good quality dairy can actually be benefitial
  • Take supplements – a lack of certain vitamins and minerals can negatively affect your ability to conceive. Your doctor can advise you which supplements you may need to take

Talk to other Mumsnetters about getting pregnant with PCOS.

How will PCOS affect me in pregnancy?

Having PCOS while pregnant will put you at greater risk of weight-related complications such as gestational diabetes, high blood pressure and preeclampsia. You can lower your risk of developing these by losing weight before you conceive.

Unfortunately, PCOS does also increase your risk of having an early miscarriage.

Being diagnosed prior to getting pregnant will give you time to make as many changes to your lifestyle as possible and your GP will be able to discuss options for keeping symptoms under control during pregnancy and beyond.

PCOS and the risks later in life

Having PCOS can increase your risk of developing other health problems later on in life. For example, if you have PCOS you have an increased risk of developing:

  • Type 2 diabetes, a condition that causes blood sugar levels to become too high
  • Depression and mood swings, because the symptoms of PCOS can affect your confidence, self-esteem and general sense of wellbeing
  • High blood pressure and high cholesterol, which can lead to heart disease and stroke
  • Sleep apnoea, a condition that causes interrupted breathing during sleep