As September ushers in the annual observance of Polycystic Ovarian Syndrome Awareness Month, more commonly known as PCOS, it's the perfect time to bust some myths and shed light on a topic that often perplexes those dealing with this condition: Ovulation.
PCOS is a hormonal disorder that affects 1 in 10 women of childbearing age, and it's marked by a range of symptoms including (but not limited to) irregular periods, weight gain, and hormonal imbalances. Among the most frequently asked questions about PCOS, one in particular stands out — especially for those who are trying to conceive: Can you still ovulate with PCOS?
The answer is, it's complicated. Now let's dive in to find out why.
What is PCOS, exactly?
Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder that affects each individual differently. According to the Rotterdam criteria, a diagnosis of PCOS requires the presence of at least two of the following three features: irregular menstrual cycles (or the absence of ovulation); physical signs of hyperandrogenism (such as excessive hair growth or acne) or elevated levels of androgens in blood tests; and polycystic ovaries seen on transvaginal ultrasound.
If you suspect you have PCOS, be sure to consult with your healthcare provider to discuss testing and treatment options — especially if you've gone longer than three months without a period or are hoping to conceive.
PCOS and irregular periods: What's the connection?
Speaking of TTC, we know that ovulation, the process by which a mature egg is released from the ovary, is a critical component of the menstrual cycle and necessary for conception. However, in individuals with PCOS, ovulation can be irregular, erratic, or even completely absent, making pregnancy less likely.
"The hormone imbalance of PCOS (male hormones higher than female hormones) throws off the delicate hormonal communication between the pituitary gland, ovaries, and uterine lining such that ovulation becomes less predictable," explains Lora Shahine, MD, FACOG at Pacific NW Fertility in Seattle, WA.
Can you still ovulate with PCOS?
The truth is, PCOS exists on a spectrum: Some women with PCOS may ovulate more consistently (or even every month), while others may go several months without a period. The irregular hormone levels associated with PCOS often lead to unpredictable ovulation patterns, making cycle-tracking more difficult and in some cases, even causing infertility.
"Yes, you can still ovulate with PCOS, but it may be less predictable, less often than monthly, and take longer to conceive," says Dr. Shahine.
However, while research suggests that ovulation may be less frequent in individuals with PCOS than those without the condition, it's not impossible. In fact, one study found that women with irregular menstrual cycles and PCOS-related hormonal imbalances can have occasional ovulatory processes.
Basically, PCOS is complex, and no two cases are the same. Fun, right?
Navigating PCOS-related fertility challenges
"If you know you have PCOS or are having unpredictable, irregular periods and trying to conceive, do not wait to see your doctor," advises Dr. Shahine. "Ask about WHY your periods may be irregular and what options you have to treat to conceive. Too many patients feel they must wait and try for a year or more before getting an evaluation, and many wish they had seen a fertility doctor sooner."
For women with PCOS, lifestyle modifications such as maintaining a healthy weight, remaining physically active, and maintaining proper blood sugar balance can help improve insulin sensitivity and regulate hormone levels. These changes also may have a downstream effect on more regular ovulation patterns.
In cases where lifestyle changes aren't helpful, medical interventions are often the next best option. Clomiphene citrate, a common fertility medication known as Clomid, is often prescribed by OB/GYNs and fertility specialists to stimulate ovulation in individuals with PCOS. Another option is Letrozole, which has also shown promise in promoting ovulation in those with PCOS.
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As always, it's important to work closely with a healthcare provider to determine the appropriate treatment plan based on your individual circumstances, but making an appointment is a good first step!
The role of PCOS awareness month
Jennifer “Jay” Palumbo is a writer, public speaker, infertility advocate, author of the blog “The 2 Week Wait,” and a proud IVF mom of 2 boys.