Polycystic Ovary Syndrome: What to Expect From PCOS

You’re 16 years old and still haven’t had your first men­stru­al peri­od. Or, you’re in your 30s, and strug­gling to get preg­nant. Or maybe, you’re near­ing menopause and your peri­ods are sud­den­ly becom­ing reg­u­lar, despite hav­ing been irreg­u­lar most of your adult life. 

In any of these sce­nar­ios, poly­cys­tic ovary syn­drome may be to blame. 

Poly­cys­tic ovary syn­drome (PCOS) is a con­di­tion that occurs when a woman’s body pro­duces more male hor­mones than they are sup­posed to, cre­at­ing an imbal­ance in her repro­duc­tive hor­mones. PCOS caus­es flu­id-filled sacs called cysts to grow on the ovaries (the part of the body that pro­duces the egg released each month dur­ing a woman’s men­stru­al peri­od). The hor­mon­al imbal­ance also leads to prob­lems in the ovaries like irreg­u­lar peri­ods, infer­til­i­ty, or exces­sive body hair. 

Even though most women with PCOS find out they have it in their 20s and 30s, PCOS can affect women and girls of all ages dur­ing their repro­duc­tive years (ages 15 – 44) — and which phase of life you are in can play a role in how PCOS affects you. 

Here is what you can expect at dif­fer­ent ages when you have PCOS when you are … 

… A Teenager 

Dur­ing ovu­la­tion, your ovary releas­es an egg so that it can be fer­til­ized by sperm. If you have PCOS, the egg might not have devel­oped cor­rect­ly or might not be released. This inter­feres with the men­stru­al cycle, caus­ing missed or irreg­u­lar peri­ods. 

Men­stru­al irreg­u­lar­i­ties from PCOS can hap­pen at any age, but there is some­thing unique to the ado­les­cent and teenage years: get­ting your first period. 

When a woman does not start men­stru­at­ing by age 15, it is called pri­ma­ry amen­or­rhea. Since PCOS is among the lead­ing caus­es of pri­ma­ry amen­or­rhea, get­ting your first peri­od after age 15 may be one of the first clues that you have PCOS. 

… A Young Adult 

Many women do not learn that they have PCOS until they see a provider because they are hav­ing trou­ble get­ting preg­nant. This is a fair­ly com­mon sce­nario — PCOS is the num­ber one cause of infer­til­i­ty in the US. 

For­tu­nate­ly, it’s also a treat­able cause of infer­til­i­ty in most cases. 

For most women with PCOS who are strug­gling with infer­til­i­ty, the cause is anovu­la­tion (not ovu­lat­ing). Some­times, mak­ing cer­tain lifestyle changes can increase your like­li­hood of get­ting preg­nant. For exam­ple, research has found that among women with PCOS who are obese, los­ing even a small amount of weight can trig­ger changes in their bod­ies and their men­stru­al func­tion — changes that may help restore ovu­la­tion and improve the chances of get­ting pregnant. 

Your provider may also pre­scribe med­ica­tion, like letro­zole or met­formin, to increase ovulation. 

If these meth­ods don’t work, your provider may rec­om­mend in vit­ro fer­til­iza­tion (IVF) — a pro­ce­dure where an egg is fer­til­ized out­side of the body and then placed into the uterus. 

… Preg­nant 

Hav­ing PCOS doesn’t mean that you can’t have a healthy preg­nan­cy. How­ev­er, it does mean that you’re at a high­er risk for cer­tain com­pli­ca­tions. Com­pared to women with­out PCOS, those with PCOS expe­ri­ence high­er rates of:

• Mis­car­riage
• Preeclamp­sia (high blood pres­sure, as well as signs of kid­ney or liv­er dam­age after 20 weeks of pregnancy) 
• Ges­ta­tion­al dia­betes (dia­betes that is only present dur­ing pregnancy) 
• Deliv­ery via Cesare­an sec­tion (C‑section)
• Preterm birth (birth before 37 weeks of pregnancy)

Also, babies of women with PCOS have a high­er risk of being heavy or of need­ing to stay in the neona­tal inten­sive care unit (NICU). 

Your health­care providers can help you devel­op a plan for nutri­tion, exer­cise, weight man­age­ment, blood sug­ar con­trol, and vit­a­min intake to keep you and your baby healthy dur­ing pregnancy. 

If you are con­cerned that you may have PCOS, or want to talk to a provider about liv­ing health­ily with PCOS, make an appoint­ment with a Duly Health and Care women’s health provider or endocri­nol­o­gist. 

… Approach­ing Menopause

Menopause is when it has been 12 months since your last men­stru­al peri­od. The time lead­ing up to that, when your month­ly cycle changes and you start hav­ing those dread­ed hot flash­es, is called perimenopause. 

Many women with PCOS enter menopause lat­er in life — typ­i­cal­ly, around 2 years lat­er than women with­out PCOS. As they approach menopause, some women with PCOS start to have more reg­u­lar periods. 

After menopause, some women find that their symp­toms improve, but oth­ers con­tin­ue to have symp­toms. Also, some of the health risks that come with hav­ing PCOS do remain and con­tin­ue to increase with age. 

… Any Age

At any age, hav­ing PCOS means you may be at risk for hav­ing addi­tion­al health con­cerns. PCOS has been asso­ci­at­ed with: 

• Dia­betes. Many women with PCOS are insulin-resis­tant, mean­ing their bod­ies pro­duce enough insulin but don’t use it cor­rect­ly. This increas­es the risk for type 2 diabetes. 
• High blood pres­sure and high ​“bad” cho­les­terol. Both of these increase the risk for heart attack and stroke. 
• Sleep apnea. This dis­or­der caus­es momen­tary paus­es in breath­ing while sleep­ing, and increas­es your risk for type 2 dia­betes and heart dis­ease.
• Endome­tri­al can­cer. The risk of devel­op­ing can­cer in the endometri­um (the lin­ing of the womb or uterus) is high­er in women who have obe­si­ty, insulin resis­tance, dia­betes, and ovu­la­tion prob­lems — all of which are com­mon in women with PCOS. 
• Depres­sion and anxiety.

More than half of women with Poly­cys­tic Ovary Syn­drome devel­op type 2 dia­betes or pre­di­a­betes by their 40^th birthday. 

It’s still unclear whether PCOS itself leads to these con­di­tions or if there’s an under­ly­ing issue that is caus­ing both PCOS and oth­er con­di­tions. But since there is a clear asso­ci­a­tion, it is essen­tial for women with PCOS to be aware of their ele­vat­ed risks, and work with their providers to decrease these risks as much as possible. 

What’s Next? 

If you have PCOS, check with your women’s health provider about treat­ment options. While there isn’t a cure, there are ways to man­age symp­toms so that PCOS doesn’t need to stand in your way.