Understanding PCOS

A woman may experience infertility for many reasons. One of the most common is a condition known as polycystic ovary syndrome, or PCOS. PCOS affects roughly 10 percent of women and, along with infertility, includes symptoms such as increased growth of body and facial hair, acne, weight gain, baldness, irregular periods, depression, and more.

The root cause of PCOS is still unknown, but a number of theories link the condition to insulin resistance and higher levels of certain hormones, including testosterone. As scientists and doctors work to understand the causes for this condition and how to effectively combat it, it helps to understand how our views on PCOS have evolved over the last several decades.

Changes in Diagnosis

PCOS was first identified in 1935. But for many years ,there weren't many significant attempts by the global medical community to understand more about the condition—or to even understand how to properly diagnose it. With so many different symptoms, no two cases of PCOS are exactly alike.

In 1990, a medical convention attempted to create a universal system of diagnosis, mainly based around the idea that ovarian cysts are a very common problem for PCOS sufferers. At that time, it was possible to use ultrasound technology to identify ovarian cysts. However, the available ultrasound technology was also very limited, which meant that it was hard to get a detailed look at the ovaries.

As technology advanced, so did the approach to diagnosis. "What was proposed in 2003 was that if there were more than 12 visible follicles on the ovary, or an ovary larger that 10 cubic centimeters, it meant the patient had PCOS," said Erica Johnstone, MD, gynecologist and endocrinologist at University of Utah Health. "The problem is that 12 follicles is actually a very common and normal finding."

In other words, women were getting diagnosed with PCOS even though they didn't have it, based on an arbitrary system. In 2018, the criteria for diagnosis was upped to 20 visible follicles. But again, doctors like Johnstone argue that it's the symptoms that matter—and a true diagnosis means finding evidence of cysts in combination with some of the other symptoms.

Multiple Treatment Options

For the most part, treatment for PCOS has involved different kinds of infertility treatments. For example, in some countries, women are given gonadotropins, which increase ovulation. The problem with this treatment is that it significantly increases the rate at which multiple births—like twins and triplets—appear.

Another pharmaceutical hormone, progestin, is also a popular treatment. Usually found in birth control implants, progestin does help with irregular periods, but it does little for acne or excess hair growth. Many patients who use this method will use additional treatments for facial hair and other PCOS symptoms.

Regular birth control pills are a good option, as they treat irregular periods and also help with hair growth and acne. In fact, for many doctors, birth control pills are the first option for their patients. However, birth control pills can cause blood clots and raise blood pressure, so women with a history of those problems should not take them to treat PCOS.

A number of other treatments focus on the risk of diabetes while some tackle other symptoms, such as weight gain. What should be understood from learning about all of these treatments is that the problem of PCOS has no single solution. Individual symptoms can be addressed, but most doctors tend to focus on those that reduce the risk of diabetes and heart disease.

"I think it really is something best combated with education," Johnstone says. "The more we know, starting in the teen years, the better we will be able to address the difficulties that come with PCOS."