PCOS affects about 5 to 10 percent of women of reproductive age, and related symptoms and even a diagnosis can be confusing. Fertility Authority talked with Dr. Deborah Wachs, a reproductive endocrinologist with Reproductive Science Center of the Bay Area, to answer fertility patients’ frequently asked questions about PCOS.
Q: Why do some doctors tell me that I have PCOS but others tell me that I don’t?
A: There are differing opinions on the features that should be present in order for someone to be diagnosed with PCOS. So depending on your physician’s methodology, you may or may not be considered to have PCOS. For example, most physicians believe that if you have irregular menstrual periods and excess hair growth on your body, you most likely have PCOS. Other physicians may tell you that you have PCOS if your ovaries have many follicles on an ultrasound exam and if certain lab results are elevated. Because there are different criteria included in making the diagnosis, it can sometimes vary as to which patients physicians will officially diagnose with PCOS.
The ultrasound findings of PCOS are important to talk about in more detail. An ovary that has more than 10 follicles is considered to be a “polycystic ovary.” Approximately 25 to 30% of all women will have ovaries that meet this definition. But 25 to 30% of all women DO NOT have PCOS. In order to have PCOS, a woman needs to have another finding such as irregular periods or excess hair growth or a high testosterone level. So some women will have a diagnosis of polycystic ovaries, without having Polycystic Ovary Syndrome. This can be confusing and I see a lot of patients who are unsure of their diagnosis because they were told that their ovaries were polycystic.
Q: What does insulin have to do with PCOS and why is my doctor talking to me about diabetes?
A. In addition to symptoms such as irregular menstrual periods, excess hair growth, and weight gain, another feature of PCOS is resistance to insulin. Up to 70% of women with PCOS are found to have insulin resistance. Insulin resistance occurs when the cells in a woman’s body stop responding to the insulin that is released. The body makes insulin as it should, but the cells in the body no longer use it effectively. The result of this is high glucose levels (high blood sugar levels). When sugar levels are high, a woman is at a higher risk of developing diabetes. Approximately 20-30% of women with PCOS will develop Type II Diabetes in their lifetime. Being overweight is another factor that can increase a woman’s chances of developing diabetes. Since so many women with PCOS struggle with their weight and have resistance to insulin, the development of diabetes is a very common problem.
Q: What is Metformin and should I be taking it?
A: Metformin (also called glucophage) is a medication that helps control blood sugar levels. It is a common treatment for Type II Diabetes. Since women with PCOS may have early features of diabetes even before they fully develop Type II Diabetes, many women with PCOS are good candidates for Metformin use. If you have PCOS, your doctor will likely want to check your insulin and blood sugar levels. They will sometimes ask you to do a test called an Oral Glucose Tolerance Test. With this test, you have your blood checked in a fasting state and then you drink a cola with a high sugar content. Blood tests are checked one or two hours later to see how your body responded to the high sugar load. Based on your results, your doctor will let you know if Metformin is recommended or not.
Some women may begin to have more regular cycles once they start taking Metformin. If this is the case for you and you are trying to conceive, you may want to talk with your doctor about starting Clomid or Femara (letrozole) as you continue to take the Metformin. A great study was published by Dr. Richard Legro and several other authors that compared taking Metformin alone versus taking Clomid alone versus taking a combination of Metformin plus Clomid. Pregnancy rates were significantly higher in the groups taking Clomid and the combination of Metformin and Clomid over women simply taking Metformin alone.