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Condition

Your guide to polycystic ovary syndrome (PCOS)

Affecting around one in 10 women, polycystic ovary syndrome (PCOS), recently renamed polyendocrine metabolic ovarian syndrome (PMOS), is the most common cause of fertility problems. Recognising the symptoms early is important, especially if you plan to have children in the future.

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In this guide:

PMOS is a major factor that can impact your fertility. Whether you've been aware of your PMOS for a while or have recently received a diagnosis, we are here to support you on your fertility journey.

In this guide, we cover:

- What PMOS is and its causes

- Why was the name changed from PCOS to PMOS

- Common signs and symptoms to look out for

- How the condition affects your fertility

What is PCOS?

Polycystic ovary syndrome (PCOS), recently renamed polycystic metabolic ovarian syndrome (PMOS) is a hormonal condition that affects how the ovaries function. Women can develop PMOS at any age after puberty, but it is most commonly diagnosed in their twenties or thirties.

PMOS may lead to irregular menstrual periods, cause increased levels of androgens (male hormones), which can lead to excessive facial and body hair. Enlarged ovaries can also be a result of PMOS, which contains multiple harmless fluid-filled sacs, known as follicles, that surround the eggs. The exact cause of PMOS is unclear and not everyone with the condition will experience symptoms.

What does the PMOS rename mean?

The term PCOS (polycystic ovary syndrome) has been deemed misleading, as it suggests that the condition specifically leads to cysts on the ovaries, which is not always true. It is believed that the term "polycystic" has contributed to delays in diagnosis and inadequate medical care for those affected.

The name PMOS (polycystic metabolic ovarian syndrome) is proposed to better reflect the complexity of the condition, which affects not only the reproductive system but also metabolism and increases the risk of diabetes and cardiovascular disease.

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Couple receiving emotional support and fertility counseling

What causes PCOS?

While the exact cause of PCOS remains unclear, several factors can influence its development, including genetics. If a biological family member has PCOS, your risk of developing it may be higher. Additionally, individuals with insulin resistance must produce extra insulin to compensate. This excess insulin can lead the ovaries to produce too much testosterone, disrupting follicle development and ovulation, which can contribute to PCOS (now also referred to as PMOS).

Furthermore, PMOS is often associated with hormonal imbalances, including elevated levels of androgens like testosterone, as well as high levels of luteinising hormone (LH), which promotes ovulation. However, if LH levels are excessively high, it can interfere with ovulation.

Condition

What are the symptoms of PCOS?

Some individuals may first notice symptoms of PCOS or PMOS in their early twenties or thirties. Not everyone will exhibit signs of the condition, and symptoms can vary in intensity. It's essential to be aware of the symptoms and contact your doctor if you have any concerns.

Common signs of PCOS

Most women who experience this condition may display various symptoms, including irregular or absent menstrual periods, difficulty conceiving, bloating, weight gain, oily skin, acne, thinning hair, hair loss from the head or excessive hair growth on the face, chest, back or buttocks.

Less common signs of PCOS

In more severe cases, you may experience an increased chance of developing high blood pressure and high cholesterol, type 2 diabetes, mood changes and anxiety. Overweight women may also develop sleep apnoea.

Although rare, individuals with a history of absent or very irregular periods have a higher-than-average risk of developing endometrial cancer.

When to see a doctor

PMOS can impact individuals in different ways, especially for those who are trying to start a family.

If you're concerned about any symptoms you are experiencing, contact your doctor for advice and guidance.

How does PCOS affect fertility?

PCOS, now referred to as PMOS, impacts fertility in several ways. It disrupts ovarian function, which can hinder ovulation and the release of eggs. This is mainly due to hormonal imbalances, particularly elevated levels of androgens, often referred to as male hormones. This can also impact egg quality, reducing the chances of successful fertilisation and implantation.

It's important to acknowledge that other factors, such as age, lifestyle, and underlying medical conditions, can also influence fertility.

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The difference between PCOS and polycystic ovaries

Polycystic ovaries (PCO) and PCOS, also known as PMOS, are related, but they are not the same. PCO refers to the presence of multiple small cysts, or follicles, in the ovaries and is considered a physical characteristic. In contrast, PCOS is a hormonal disorder that affects women of reproductive age, leading to imbalances in hormone levels.

It is important to understand that not everyone with polycystic ovaries necessarily has PCOS, and having PCO alone isn't sufficient for a diagnosis. If you have any concerns, it's essential to consult your doctor.

Treatment

Fertility treatment options

Fertility drugs

Your consultant may offer medicines to induce ovulation like Clomifene or Letrozole. Metformin is another option that can encourage regular monthly ovulation and reduce insulin resistance to help improve fertility.

IVF - In Vitro Fertilisation treatment cell

In vitro fertilisation (IVF)

During IVF, eggs are retrieved from the ovaries following a period of stimulation and then mixed with sperm in a lab. The resulting embryo/s are left to develop over a 5-6 day period before being transferred to the birth parent or frozen.

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Intrauterine insemination (IUI)

IUI is a less invasive procedure than IVF which involves injecting healthy sperm directly into the uterus. This is usually recommended for same-sex female couples using a sperm donor.

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Intracytoplasmic sperm injection (ICSI)

ICSI is an additional step during the IVF process that is recommended for patients with male factor infertility or that are using frozen eggs. It involves injecting a single healthy sperm directly into the egg.

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Egg freezing

Egg freezing is a way of preserving an individual's fertility, giving you the flexibility to have children when you're ready. This treatment involves a partial IVF cycle, which includes a course of hormone medication, followed by an egg collection procedure.

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Donation

For some people, their journey to parenthood is only possible with the help of a donor. This is often recommended for same sex couples, solo parents and those not producing viable eggs or sperm. Finding the right donor can be overwhelming but we'll offer guidance to support you.

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