After 15 years on hormonal birth control, I went off the pill at 29 expecting to get pregnant with ease. That’s what happens to everyone else on your social media feed, right? Instead, my hormones went haywire, I gained weight, and my period disappeared for seven months at a time. It wasn’t until I had received a PCOS diagnosis that symptoms began to make sense and I could begin the journey to healing.
As I worked hard to understand and balance my hormones, waves of anger rolled in. “Why hadn’t anyone caught this before I went on birth control? Why didn’t I even know what PCOS is? Have I been treating my body kindly, knowing it has certain predispositions?”
I am not alone in my diagnosis. PCOS, or polycystic ovary syndrome, is one of the most common causes of female infertility, affecting 6 percent to 12 percent (as many as 5 million) of US women of reproductive age.1 Understanding PCOS is about more than fertility. This lifelong condition can affect everything from insulin resistance to cholesterol levels. To give us the full PCOS rundown, we caught up with Dr. Banafsheh Bayati, M.D., a board-certified OB/GYN in Los Angeles, California.
To start, what is PCOS?
“PCOS is a syndrome characterized clinically by oligomenorrhea (less frequent cycles) and hyperandrogenism (excess male hormones), as well as the frequent presence of associated risk factors for cardiovascular disease, including obesity, glucose intolerance, dyslipidemia, fatty liver, and obstructive sleep apnea along with increased risk of mood disorders,” Dr. Bayati explains.
How common is it?
“Women from every race and ethnicity can have PCOS and in the US the prevalence is around 10 percent and increasing.”
Does PCOS often go undiagnosed?
“It can be undiagnosed in adolescents when the lack of cycles is not perceived as an issue, thus the adolescent may not feel the need to present for evaluation. It can also be undiagnosed if a patient is simply placed on medication to regulate the cycles without a clear etiology for the irregularity and underlying cause. It can also be undiagnosed if different physicians are treating different symptoms and not connecting the dots. For example, a dermatologist treating the patient for acne while the general physician is treating the patient for weight management and the gynecologist is managing irregular cycles and no one is doing a deeper dive into the patient’s global presentation of symptoms.”
“In general if you have irregular periods or suffer from a lack of periods caused by a lack of ovulation, higher than normal levels of male hormones and polycystic ovaries on ultrasound, then the diagnosis of PCOS needs to be considered,” Dr. Bayati says.
What are classic symptoms? Is it possible to have just some of these symptoms and still have PCOS?
“It is a syndrome and thus an individual can have some but not all of the symptoms. The two most common symptoms that are needed for diagnosis are irregular and infrequent cycles along with excess androgen production,” Dr. Bayati continues.
What exactly is the “string of pearls” you hear about with PCOS?
“The classic polycystic ovary is a high volume ovary with an increased number of follicles bilaterally that do not mature or ovulate and thus lead to a lack in regular cycles. Cyst is a generic term for a fluid filled structure. Ovarian follicles are dynamic, functional cysts,” Dr. Bayati says.
How do you suggest women with PCOS manage and heal symptoms?
“First the diagnosis needs to be clearly made at the right time. For example, an adolescent who has just started menstruating and thus may be irregular in the first few years or a woman just off birth control pills may need more time before a diagnosis can be clearly made.”
“Once the diagnosis is made, it’s important to have a clear understanding of the pathophysiology of this syndrome. It’s important to look at an individual’s predisposition, family history and start with diet and exercise. But at the same time, many may need to start with medication as well. Given it is a syndrome, it is even more important to tailor the treatment for each individual,” Dr. Bayati says.
Can women with PCOS still get pregnant?
“Absolutely! In fact those high volume ovaries often mean a high ovarian reserve. However, PCOS can be a cause of infertility given lack of regular ovulation. To start, diet and exercise changes can bring about an improvement in ovulatory cycles and allow for spontaneous pregnancy. At times, oral medication can be used to improve ovulation or induce ovulation. Rarely, IVF is needed,” Dr. Bayati explains.
What do women with PCOS need to be aware of in terms of a predisposition to other health imbalances?
“All your systems in your body are connected to and affected by each other. Blood sugar regulation is key for PCOS management. Women with PCOS are often insulin resistant which increases the risk for type 2 diabetes.”
“They may have high lipid levels increasing risk of heart disease as well as strokes. Higher weight levels can increase risk for high blood pressure as well as sleep apnea. PCOS has also been linked to increased rates of depression and anxiety. Thus, it’s important to manage PCOS and its effects on your entire body and not just focus on cycle resumption. However, note that diet and exercise changes can bring about metabolic shifts that can lower risks and bring about regular cycles at the same time,” Dr. Bayati says.
Are there any resources that you recommend for women with PCOS?
“I would say first start with a thorough exam by a physician. Look for a gynecologist as they usually have the most experience working with PCOS patients. Look for someone who has the time to provide you a clear and coherent education. The internet is a good secondary source. Including endocrinologists, acupuncturists, nutritionists, exercise physiologists and therapists can also provide a multi-disciplined approach,” Dr. Bayati concludes.
This article is for informational purposes only. It is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and we recommend that you always consult with your healthcare provider. To the extent that this article features the advice of physicians or medical practitioners, the views expressed are the views of the cited expert and do not necessarily represent the views of Perelel.
Written by Jessica Lopez. Jessica Lopez is a freelance writer, digital content creator, and new mother. She has covered all lifestyle topics ranging from bridal to beauty for publications including Brides Magazine, Byrdie, THE/THIRTY, and more. Walking wide-eyed into motherhood has inspired her to connect with other parents through her writing and shared experience. You can follow more of her journey @Jessica.H.Lopez.