Polycystic ovarian syndrome better known as PCOS, affects nearly a third of women who seek infertility treatment in Colorado and across the U.S. September is PCOS Awareness Month. According to PCOS Challenge.org, the aim of PCOS Awareness Month is to help improve the lives of those affected by PCOS and to help them to overcome their symptoms as well as prevent and reduce their risks for life-threatening related conditions. We sat down with Jasmine Chiang MD, FACOG from Conceptions Reproductive Associates of Colorado to talk more about PCOS and getting pregnant.
What percent of your patient population has been diagnosed with PCOS?
Dr. Chiang: Among infertility patients, it’s relatively high. Probably about a third, sometimes it feels higher. Out of reproductive-aged women, we know it affects 10% of the general population, but amongst infertility patients, I’d say probably at least a third of my patients have a PCOS diagnosis contributing to issues getting or staying pregnant.
We know that changes in diet and medications like metformin can help, but what are some of the other things you do with PCOS patients in the early stages?
First thing I do is kind of preconception counseling, which talk about lifestyle modification, PCOS, dietary changes, exercise, and counseling, so it’s actually been shown in studies that obese women with PCOS, even if they lose as little as 5% of their body weight, it regulates their cycles and improves their pregnancy rates.
I always start with that, and it’s hard because a lot of women already know that and have been trying to lose weight and modify their lifestyle, as much as they can, obviously many of them are busy working, they’re busy as moms, but I always try to remember that piece of education in preconception counseling. Then I screen them for diabetes and stuff like that. We check to make sure they don’t have associated complications with diabetes.
Even just a little change in body weight can have a positive impact, right?
Absolutely and even if they start running or walking 4-5 times a week, I’ve seen that have a positive impact, even if they don’t lose any weight. It’s like just making an attempt is really helpful.
We often associate PCOS with a higher BMI, but isn’t it true that PCOS can present itself in a patient that may not fit the mold?
Correct. There can be this atypical PCOS or lean PCOS- interestingly, those patients, just because of their hormonal profile, are still at risk of all these other things. I recently saw a patient who has run a few marathons and an athlete and sometimes too much exercise can be a bad thing when it comes to trying to get pregnant.
Do PCOS patients present themselves differently emotionally? Often it seems like they understand what’s going on, right? Do you deal with them emotionally differently?
Good question. There’s definitely a wide variety of PCOS patients. Some are very educated about their diagnosis, they’ve got this and they really know what they need, and they feel really motivated. And others, they’re kind of shrouded in mystery about their diagnosis. I mean, someone just looked at them and told them they have PCOS, and now they’re very frightened by this diagnosis that hasn’t been really clarified. I always talk to my patients about how I diagnose PCOS, like how we treat it, how we manage it, and what exactly is it. How is it going to affect you? And so there’s a lot of education around it, and even for the patients that know or who are educated, there’s a lot of education surrounding what options you have with PCOS and fertility treatment.
So from a clinical diagnosis standpoint, are we talking about hormones alone? What do you typically look for?
So there are very specific diagnostic criteria for PCOS. I use something called the Rotterdam criteria, and you basically need two out of three findings to meet the criteria. One is hyper-androganism, just basically you have evidence of hair growth or you have a blood draw that shows higher levels of testosterone.
The second thing is irregular periods, so patients usually ask what makes a period irregular, it’s outside of the 28-35 day cycle. Or, a cycle that varies greater than 7-9 days per month. And we have to clarify these things for patients.
How do you help a patient that thinks they may have PCOS?
First of all, it’s going to require treatment, so I say go to your OBGYN. The OBGYN is a really great place to start, and kind of figure out if the person is meeting the criteria for something like fertility pills or if are they not even trying to get pregnant and they just need contraceptive management.
The other thing the OB-GYN can do is rule out other problems because there are other things that cause irregular periods. Things like thyroid disease, other hormones, and low egg count, may manifest themselves like PCOS, but need to be ruled out. Start with the OB-GYN, and state your goals clearly – is it for hair growth, fertility, alopecia, things like that. I think there are different ways to manage PCOS depending on what the patient’s goals are.
So you meet the criteria, you come in, what are the options open to patients from a family-building standpoint?
So a lot of my counseling is for patients who are trying to conceive and have PCOS. So first, I offer them a comprehensive fertility workup, because sometimes it’s just PCOS, and their only problem is that they’re not ovulating. That’s it. But you don’t wanna miss something- it could be a male-factor, maybe we need a semen analysis. They’re going to get an ultrasound, and we can study their uterus and tubes to make sure everything is open and normal. So completing a basic fertility evaluation to make sure PCOS is the only problem contributing to infertility.
How often do you see PCOS with other conditions?
Quite often. Usually, it’s PCOS with some degree of male factor. It’s incredibly common. PCOS is incredibly treatable and there’s usually a lot of options with fertility treatment.
Any last words of advice for people with PCOS?
I always like to mention to patients that are considering fertility treatment but may not be there yet- the other thing about PCOS is that you have to pay attention to irregular periods. You can’t ignore it. Think of menstrual cycles as one of their vital signs, if the cycle is not regular, that is a sign that something needs to be evaluated.
PCOS is sometimes associated with a slightly higher risk of uterine pre-cancer and cancer. One of the ways we prevent that is cycle regulation, even in patients that are not trying to get pregnant. That is called endometrial protection. You can do that with birth control pills, IUDs, protecting your general health. My patient’s total health -mind and body comes first.