PCOS: An Infertility Issue That Is Little Understood

A Gynecology Specialists note: A New York Times column by Jane E. Brody took a close look at polycystic ovarian syndrome (PCOS), a condition our gynecologists diagnose and treat regularly. Here is a summary of her reporting, along with our perspective.

What the article covered

PCOS affects as many as 10 percent of women of childbearing age and often impairs fertility — yet, as Brody reported, the name itself can mislead. Not all women with PCOS have polycystic ovaries, which can result in misdiagnosis; the cysts are just one manifestation of a complex hormonal condition first described in 1935. Under the widely used Rotterdam criteria, a woman with any two of the following may have the condition: symptoms of elevated androgens (acne, excessive hairiness, sometimes male-pattern hair loss); irregular menses with prolonged periods between cycles; or twelve or more follicular cysts on the ovaries seen on ultrasound.

Experts quoted in the piece discussed insulin resistance as a possible underlying factor — excess insulin promotes fat storage and can stimulate the ovaries to produce androgens — while noting that some women with PCOS are thin, and that the condition tends to run in families. The article also noted that women with PCOS produce high levels of estradiol but low progesterone, resulting in a thickened uterine lining and, over time, an increased risk of endometrial cancer if untreated.

On treatment, the reporting matched what we tell our own patients: there is no cure, and the best approach is individualized. Hormonal contraceptives can regulate the menstrual cycle and suppress androgen production; spironolactone can help with acne or excess hair; and for women trying to conceive, ovulation-inducing medications are commonly prescribed — with most women with PCOS who undergo ovulation induction going on to conceive and bear children. Weight reduction can be the most challenging but powerful therapy: losing 10 percent of body weight can restore more regular cycles and reduce testosterone levels, with a lower-carbohydrate eating pattern, smaller and more frequent meals, and regular exercise recommended.

Our takeaway for patients

If you have irregular cycles, difficulty conceiving, acne, or unwanted hair growth, don’t assume you have to live with it — and don’t assume an ultrasound alone settles the question. A proper PCOS workup looks at your history, hormones, and metabolic health together, and treatment can be tailored to your goals, whether that’s pregnancy, regular cycles, or symptom relief.

If you have questions about PCOS, ovarian cysts, infertility, or irregular menstrual cycles, please contact our Gynecology Clinic at (757) 312-8221. Our gynecologists can help you.