“PCOS affects 8-10% of women of reproductive age and is considered one of the leading causes of infertility.”
Dr. Caitlin Huckell is an associate director of obstetrics and gynecology and the co-director of the OBGYN clerkship at Weill Cornell Medicine-Qatar (WCM-Q). She is also a senior attending physician in obstetrics and gynecology at Sidra Medicine and a fellow of the Royal College of Physicians and Surgeons of Canada. With over 18 years of experience as a private consultant in obstetrics and gynecology and a subspecialty interest in pediatric and adolescent gynecology, Dr. Huckell established the Pediatric and Adolescent Clinic at Sidra Medicine in 2018. Dr. Huckell was a national program presenter and human papillomavirus (HPV) vaccine campaign educator during the introduction of routine HPV immunization for Canadian children in 2011. In addition, Dr. Huckell was a keynote speaker at CME conferences for contraception, Mirena use, and polycystic ovarian syndrome. She has also designed and implemented an annual lecture series for family practice physicians focusing on the nonsurgical management of women’s health concerns, including polycystic ovarian syndrome, dysfunctional uterine bleeding, and fibroids. Dr. Huckell spoke with “Hospitals” magazine about the importance of early diagnosis and treatment of Polycystic Ovary Syndrome.
Can you briefly describe Polycystic Ovary Syndrome (PCOS)?
Polycystic Ovary Syndrome, or PCOS for short, is a common but often undiagnosed endocrine and metabolic condition in which certain hormones are out of balance. These imbalances typically show up as irregular menstrual cycles, a higher level of androgens (a type of hormone, including testosterone) in the body, and small cysts in the ovaries.
That said, not everyone with PCOS has ovarian cysts, and polycystic ovaries on their own don’t meet the criteria for diagnosis. Multiple medical groups have therefore called for the condition to be renamed because the current name seems quite misleading.
Who is impacted by PCOS?
PCOS typically affects women once they start their menstrual cycles or reach the age of puberty.
Worldwide, PCOS affects 8-10% of women of reproductive age and is considered one of the leading causes of infertility. It is estimated that 70-80% of women with PCOS may struggle with infertility, and approximately 7 in 10 women who suffer from the condition, go undiagnosed.
Can you explain how PCOS impacts fertility and pregnancy?
Not all women who are diagnosed with PCOS are infertile. However, since women with PCOS do not ovulate regularly, the condition can lead to difficulties getting pregnant, and many women may need assistance with ovulation. Therefore, it is essential that any patient who has been unsuccessfully trying to get pregnant or has irregular cycles seek guidance from a medical provider to review and discuss the options that could help increase a patient’s chances of getting pregnant.
In addition, women with PCOS are more prone to miscarriages, and this secondary PCOS issue can limit a woman’s ability to achieve a desired term pregnancy. The risks associated with a PCOS pregnancy include miscarriage; gestational diabetes; preeclampsia; high blood pressure; and preterm birth.
What are the symptoms of PCOS?
The symptoms of the condition vary. Some women experience severe symptoms, while others may experience mild ones.
Symptoms can include irregular menstrual cycles or no periods at all; difficulty becoming pregnant; irregular ovulation or no ovulation at all; depression or mood changes; oily skin; acne; unwanted facial or body hair (hirsutism); thinning hair or hair loss (alopecia); multiple small cysts on the ovaries; and weight problems—being overweight, gaining weight rapidly, or difficulty losing weight.
Would you consider PCOS a serious condition?
PCOS can be a serious condition. Women who go multiple months at a time without a menstrual cycle can be impacted by a thickening in the lining of their uterine cavity. Over the years, this can increase the risk of uterine cancer. Additionally, women with PCOS have an increased risk of cardiovascular diseases like diabetes, coronary artery disease, or hyperlipidemia. Lastly, PCOS can increase the risk of infertility. So, women who want to get pregnant may require medication to promote ovulation and increase their chances of getting pregnant.
What treatments are available for the condition?
Although PCOS cannot be cured, the condition can be managed with the appropriate treatment. The treatment options for PCOS vary and are based on whether or not a woman is actively trying to get pregnant.
Women seeking to get pregnant may need assistance with medication to help them ovulate and get pregnant. On the other hand, the primary treatment for women not seeking to get pregnant is a combination of hormones, found most commonly in the form of oral contraceptive pills. Other than medicine, diet, exercise, and lifestyle changes can have a significant impact on preventing and managing the condition.
Limiting simple carbohydrates and sugars in the diet can help keep insulin balanced and may prevent inflammation. Not smoking, or ceasing smoking, is also important, as nicotine may increase androgenic activity, and smokers tend to have higher testosterone levels. Smoking is associated with increased free testosterone and fasting insulin levels in women with PCOS, resulting in elevated insulin resistance.
How important is it to get diagnosed and treated for the condition?
PCOS is often unfortunately underdiagnosed because symptoms can be mild or seem unrelated. Since the condition is underdiagnosed, it is also undertreated, which can lead to a wide range of more serious health conditions, causing significant distress. Unmanaged PCOS is associated with type 2 diabetes, infertility, cardiovascular disease, obesity, sleep apnea, fatty liver disease, and depression. Early diagnosis and treatment of the condition can significantly help reduce these risks. Therefore, diagnosing and managing the condition as early as possible is extremely important.