Selected Podcast
Fertility: What is PCOS
What does a PCOS diagnosis mean for a patient and will it impact her chances to conceive? Dr. Laura Eisman discusses PCOS and its ramifications.
Featuring:
Dr. Eisman is an author of over 25 research publications, abstracts and presentations. She is a junior fellow of the American College of Obstetrics & Gynecology and a member of the American Society for Reproductive Medicine. Her special interests include uterine factor infertility and fertility preservation.
When Dr. Eisman isn’t at the clinic, she enjoys baking, running and spending time with her husband and two daughters.
Laura Eisman, MD, RE
Dr. Laura Eisman received her doctor of medicine from Jefferson Medical College in Philadelphia before completing her residency in obstetrics and gynecology at Abington Hospital-Jefferson Health in Abington, PA. She rounded out her education at Cedars-Sinai Medical Center in Los Angeles where she completed her fellowship in reproductive endocrinology & infertility. Dr. Eisman earned many honors and awards throughout her educational career including Resident Research Award, cum laude, Dean’s List and Benjamin Franklin Scholars Honors Program.Dr. Eisman is an author of over 25 research publications, abstracts and presentations. She is a junior fellow of the American College of Obstetrics & Gynecology and a member of the American Society for Reproductive Medicine. Her special interests include uterine factor infertility and fertility preservation.
When Dr. Eisman isn’t at the clinic, she enjoys baking, running and spending time with her husband and two daughters.
Transcription:
Deborah Howell: So maybe you've had a friend who's been diagnosed with PCOS. What does this mean for her and could it affect her chances to conceive? Let's learn more with Dr. Laura Eisman about PCOS and its ramifications. Laura is a physician at Reproductive Science Center of San Francisco Bay.
This is Fertile Edge, a podcast by Reproductive Science Center of the San Francisco Bay Area. I'm Deborah Howell. Dr. Eisman, can you explain to us what PCOS is?
Laura Eisman: Sure. So PCOS or polycystic ovary syndrome isn't a specific disease with a specific cause. It's a syndrome. So it's a collection of signs and symptoms. It's actually the most common endocrine disorder or hormonal disorder in women. The main components of polycystic ovary syndrome are hyperandrogenism, meaning having elevated testosterone and other related hormones; ovulatory dysfunction, meaning not obviating regularly or at all; and polycystic-appearing ovaries or ovaries that have many small follicles or large volume.
Deborah Howell: And how do you diagnose it?
Laura Eisman: There've been several different efforts to establish the diagnostic criteria for PCOS. The criteria that are most frequently used require that a patient have at least two of three of the following: so oligo or anovulation meaning infrequent or no ovulation; androgen excess and polycystic ovarian morphology.
Oligo or anovulation manifests as irregular menstrual cycles. So women with PCOS often present with irregular periods. Androgen excess can be based on either elevated levels of testosterone in the blood or clinical signs, such as excess hair growth, acne or male pattern hair loss. And ovarian morphology is assessed by ultrasound and at least one ovary must have at least 12 small follicles or fluid-filled egg sacs or a volume over 10 milliliters. Making the diagnosis of PCOS also requires that you exclude other disorders that have similar presentation, for example, thyroid disorder, which can also cause irregular periods.
Deborah Howell: No, I understand. It's sometimes difficult to diagnose PCOS in adolescents. How has that done?
Laura Eisman: Yes. Diagnosing PCOS in adolescents is especially difficult because many menstrual cycles are not ovulatory in the first few years after menarche or the first period. And so to make the diagnosis of PCOS, irregular periods should be present for at least two years after menarche. Also, acne is common in adolescents. So in order to make a diagnosis, there should be elevated androgens in the blood and not just signs of elevated androgens on exam.
And another complicating factor is that young women are likely to have multiple follicles on their ovaries because of good ovarian reserve. And so using ovarian volume is often recommended. And also in order to be more confident diagnosing adolescents, all three criteria should be present in teenagers in order to make the diagnosis of PCOS.
Deborah Howell: Okay, so you've got to have all three. And why is it so important to know if one has PCOS?
Laura Eisman: Women with PCOS are at increased risk for infertility because they often aren't obviating regularly. And anovulation can also lead to abnormal bleeding and also increases the risk of endometrial cancer or cancer of the lining of the uterus because of the absence of progesterone, which opposes the overgrowth of the lining.
PCOS is also associated with obesity, type 2 diabetes, elevated cholesterol, high blood pressure and cardiovascular disease. And so we often initiate screening for these things earlier than we otherwise would. And another implication is for female children of women with PCOS. They are also at increased risk for the syndrome.
Deborah Howell: Understandable. What should women with PCOS do if they want to get pregnant?
Laura Eisman: So women with PCOS who aren't having regular periods should see their OB-GYN or an infertility doctor, even if they haven't been trying for very long. If they aren't ovulating, there's no need to wait to have an evaluation and treatment. There are multiple fertility medications that we can use in these circumstances to induce ovulation.
If women with PCOS do have regular periods, they could always check an ovulation test to be sure they're ovulating. One thing to note is that the test should only be positive for one or two days. If it's persistently positive for several days in a row, it could be because of persistently elevated LH or luteinizing hormone, which we can see in women with PCOS. In these cases, the ovulation kit won't work and so it's best to just see an OB-GYN or seek fertility care.
Something else to keep in mind for women with PCOS, who would like to conceive if they're overweight, small amounts of weight loss, even 5% to 10% of their body weight, can potentially restore ovulatory cycles. So they may also want to discuss diet and weight loss strategies with their doctor.
Deborah Howell: Sure. Now for women with PCOS who are not trying to conceive, is there anything important for them to know?
Laura Eisman: Sure. So I can expand on what I mentioned earlier about the risk of endometrial cancer due to the absence of progesterone. For women with PCOs, who aren't having regular menstrual cycles, it's important for them to have progestin exposure. And this can be in the form of either birth control pills, intermittent progestin therapy, or an IUD that has a progestin. Combined oral contraceptive pills are often a good choice, especially for women with excess hair growth or acne, because they can also improve those symptoms.
And then the other goal for all women with PCOS is to manage the metabolic abnormalities and reduce risk factors for type 2 diabetes and cardiovascular disease. So lifestyle changes with diet and exercise are important for women with PCOS who are overweight or obese and, of course, managing any specific existing disorders such as diabetes or elevated cholesterol is of course important.
Deborah Howell: Okay, Dr. Eisman. Is there anything else you'd like to leave us with today?
Laura Eisman: That's it. Thank you so much for having me.
Deborah Howell: Well, you've given us some very important considerations. Thanks so much for being with us today. It's been a pleasure to talk to you.
Laura Eisman: You as well. Thank you.
Deborah Howell: To get in touch with a provider such as Dr. Eisman and to learn more, please visit RSCBayArea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics that interest you.
This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I'm Deborah Howell. Thanks for listening and have yourself a terrific day.
Deborah Howell: So maybe you've had a friend who's been diagnosed with PCOS. What does this mean for her and could it affect her chances to conceive? Let's learn more with Dr. Laura Eisman about PCOS and its ramifications. Laura is a physician at Reproductive Science Center of San Francisco Bay.
This is Fertile Edge, a podcast by Reproductive Science Center of the San Francisco Bay Area. I'm Deborah Howell. Dr. Eisman, can you explain to us what PCOS is?
Laura Eisman: Sure. So PCOS or polycystic ovary syndrome isn't a specific disease with a specific cause. It's a syndrome. So it's a collection of signs and symptoms. It's actually the most common endocrine disorder or hormonal disorder in women. The main components of polycystic ovary syndrome are hyperandrogenism, meaning having elevated testosterone and other related hormones; ovulatory dysfunction, meaning not obviating regularly or at all; and polycystic-appearing ovaries or ovaries that have many small follicles or large volume.
Deborah Howell: And how do you diagnose it?
Laura Eisman: There've been several different efforts to establish the diagnostic criteria for PCOS. The criteria that are most frequently used require that a patient have at least two of three of the following: so oligo or anovulation meaning infrequent or no ovulation; androgen excess and polycystic ovarian morphology.
Oligo or anovulation manifests as irregular menstrual cycles. So women with PCOS often present with irregular periods. Androgen excess can be based on either elevated levels of testosterone in the blood or clinical signs, such as excess hair growth, acne or male pattern hair loss. And ovarian morphology is assessed by ultrasound and at least one ovary must have at least 12 small follicles or fluid-filled egg sacs or a volume over 10 milliliters. Making the diagnosis of PCOS also requires that you exclude other disorders that have similar presentation, for example, thyroid disorder, which can also cause irregular periods.
Deborah Howell: No, I understand. It's sometimes difficult to diagnose PCOS in adolescents. How has that done?
Laura Eisman: Yes. Diagnosing PCOS in adolescents is especially difficult because many menstrual cycles are not ovulatory in the first few years after menarche or the first period. And so to make the diagnosis of PCOS, irregular periods should be present for at least two years after menarche. Also, acne is common in adolescents. So in order to make a diagnosis, there should be elevated androgens in the blood and not just signs of elevated androgens on exam.
And another complicating factor is that young women are likely to have multiple follicles on their ovaries because of good ovarian reserve. And so using ovarian volume is often recommended. And also in order to be more confident diagnosing adolescents, all three criteria should be present in teenagers in order to make the diagnosis of PCOS.
Deborah Howell: Okay, so you've got to have all three. And why is it so important to know if one has PCOS?
Laura Eisman: Women with PCOS are at increased risk for infertility because they often aren't obviating regularly. And anovulation can also lead to abnormal bleeding and also increases the risk of endometrial cancer or cancer of the lining of the uterus because of the absence of progesterone, which opposes the overgrowth of the lining.
PCOS is also associated with obesity, type 2 diabetes, elevated cholesterol, high blood pressure and cardiovascular disease. And so we often initiate screening for these things earlier than we otherwise would. And another implication is for female children of women with PCOS. They are also at increased risk for the syndrome.
Deborah Howell: Understandable. What should women with PCOS do if they want to get pregnant?
Laura Eisman: So women with PCOS who aren't having regular periods should see their OB-GYN or an infertility doctor, even if they haven't been trying for very long. If they aren't ovulating, there's no need to wait to have an evaluation and treatment. There are multiple fertility medications that we can use in these circumstances to induce ovulation.
If women with PCOS do have regular periods, they could always check an ovulation test to be sure they're ovulating. One thing to note is that the test should only be positive for one or two days. If it's persistently positive for several days in a row, it could be because of persistently elevated LH or luteinizing hormone, which we can see in women with PCOS. In these cases, the ovulation kit won't work and so it's best to just see an OB-GYN or seek fertility care.
Something else to keep in mind for women with PCOS, who would like to conceive if they're overweight, small amounts of weight loss, even 5% to 10% of their body weight, can potentially restore ovulatory cycles. So they may also want to discuss diet and weight loss strategies with their doctor.
Deborah Howell: Sure. Now for women with PCOS who are not trying to conceive, is there anything important for them to know?
Laura Eisman: Sure. So I can expand on what I mentioned earlier about the risk of endometrial cancer due to the absence of progesterone. For women with PCOs, who aren't having regular menstrual cycles, it's important for them to have progestin exposure. And this can be in the form of either birth control pills, intermittent progestin therapy, or an IUD that has a progestin. Combined oral contraceptive pills are often a good choice, especially for women with excess hair growth or acne, because they can also improve those symptoms.
And then the other goal for all women with PCOS is to manage the metabolic abnormalities and reduce risk factors for type 2 diabetes and cardiovascular disease. So lifestyle changes with diet and exercise are important for women with PCOS who are overweight or obese and, of course, managing any specific existing disorders such as diabetes or elevated cholesterol is of course important.
Deborah Howell: Okay, Dr. Eisman. Is there anything else you'd like to leave us with today?
Laura Eisman: That's it. Thank you so much for having me.
Deborah Howell: Well, you've given us some very important considerations. Thanks so much for being with us today. It's been a pleasure to talk to you.
Laura Eisman: You as well. Thank you.
Deborah Howell: To get in touch with a provider such as Dr. Eisman and to learn more, please visit RSCBayArea.com. And if you found this podcast helpful, please share it on your social channels and check out our entire podcast library for topics that interest you.
This is Fertile Edge, a podcast by Reproductive Science Center of San Francisco Bay. I'm Deborah Howell. Thanks for listening and have yourself a terrific day.