Debunking PCOS myths

Polycystic ovarian syndrome (PCOS) is common, affecting about 10% of women. Despite this, there are many myths about the condition, particularly around the issue of fertility. It’s a topic that needs to be discussed appropriately with patients, who may not realize that infertility related to PCOS is usually treatable.“I see patients in my practice who have been diagnosed with PCOS many years ago and they’ve been told they’ll never be able to conceive,” said Dr. Olexandra (Alex) Koshkina, staff endocrinologist at Women’s College Hospital and an assistant professor in the faculty of medicine at the University of Toronto (U of T). “They’ve gone for years with this thought weighing down on them that they’ll never be able to have kids and this has never been dispelled and they’ve never been given more information about it.”Educate about misconceptionsThe majority of people with PCOS who want to get pregnant can get pregnant. While most couples take a year to conceive, people with PCOS may take two years on average, explained Dr. Shirin Dason, a fellow in the department of obstetrics and gynecology also at U of T. Drs. Dason and Koshkina were lead authors on a 2024 Canadian Medical Association Journal paper about the diagnosis and management of PCOS.Much of the difficulty surrounding fertility in PCOS patients is due to infrequent ovulation. Some people with PCOS may have no or infrequent periods, but others may have regular periods. “PCOS is a real spectrum,” said Dr. Bryden Magee, an assistant professor at the University of Ottawa and an associate physician at the Ottawa Fertility Centre.Encourage patients with PCOS and irregular cycles to seek help with conception early. “Essentially, by six months, if pregnancy or fertility is not achieved, that’s when I would refer the patient, and that’s what I would recommend other doctors to do,” Dr. Koshkina said.Provide weight loss supportThe first-line recommendation to help patients conceive is to encourage weight loss (if needed). Keep in mind that people with PCOS often have higher rates of depression and body image problems, Dr. Dason said. In any conversation about weight loss, physicians should ensure they are, “framing that in a way that is going to be supportive for the patient.”The 2023 international guidelines for the assessment and management of PCOS provide recommendations for supporting weight loss in PCOS patients, which may include pharmaceutical treatment.Along with advising weight loss and healthy lifestyle habits, physicians can work with patients to promote ovulation. Fertility specialists may prescribe letrozole to stimulate ovulation. Patients initially take a standard dose for five days and then have ultrasound and blood tests to determine if they ovulated. If so, treatment can continue to see if the patient becomes pregnant. If not, physicians and patients can consider increasing the dose.“Letrozole is successful in inducing ovulation in up to 85% of people with PCOS. It’s rare that it’s not successful, but if not, there are other options,” Dr. Magee said.Other options include adding insulin sensitizers or other treatments outlined in the 2023 international guidelines. Fertility experts may recommend in vitro fertilization. “IVF is a very common and very safe fertility treatment that is sometimes needed for people with PCOS as well,” Dr. Magee said.Common symptoms of PCOS include acne and unwanted hair (hirsutism). For those who don’t want to conceive, a combined hormonal oral contraceptive pill provides regular periods and treats excess androgen or testosterone imbalance symptoms.Young people are often keen to get regular periods, and go on an oral contraceptive pill to achieve this, Dr. Dason said. It’s important to find out why they want regular periods, whether it is for contraception, to prevent endometrial cancer or for ovulation. People with PCOS may achieve regular menstruation with the pill, but still may not ovulate regularly. “It’s not actually to get regular ovulatory cycles back. That’s a misconception I often counsel around,” Dr. Dason said.Other patients with heavier periods and fewer skin-related PCOS symptoms may benefit from an IUD with progestin, Dr. Koshkina said.Screen for other conditionsNormal conditions in puberty overlap with the symptoms of PCOS (i.e., acne, oily skin, irregular cycles). Patients might start on oral contraceptive pills to control the symptoms. It’s an appropriate treatment, but it should be paired with counselling so that when they go off it and if their cycles are still irregular, they shouldn’t delay in getting tested for PCOS and seeking help for conception.Dr. Magee said she regularly sees people in their mid-20s or early 30s with symptoms who have never been given a clear diagnosis of PCOS.As soon as the diagnosis is made, it’s important to screen patients for conditions associated with PCOS, including hypertension, diabetes, sleep apnea and endometrial cancer, Dr. Magee said. Anxiety and depression are also common.Like other topics, there’s a lot of misinformation about PCOS online. Suggest patients get the AskPCOS app, which includes accurate information about the condition.

Debunking PCOS myths

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