Polycystic Ovarian Syndrome (PCOS)

Polycystic ovarian syndrome (PCOS) is a condition in which a woman produces a high level of insulin or of luteinizing hormone, leading to hormone imbalance, excess secretion of androgens (male hormones) and a lack of progesterone.

This imbalance interferes with egg development and ovulation and leaves women with a proliferation of immature ovarian follicles. The lack of ovulation and progesterone can lead to irregular or absent menses and to difficulty conceiving.

PCOS is a common cause of infertility, especially in the Jewish community. It can also lead to other medical problems such as elevated blood pressure, elevated cholesterol, metabolic syndrome, and type 2 diabetes.

Diagnosis

Diagnosis typically begins with a physical exam. Symptoms of PCOS can include any of the following, though not all women with PCOS exhibit symptoms: a history of irregular periods, increased hair growth in a male pattern (on the face, hands and torso), male pattern baldness or thinning, weight gain (particularly around the waist), or acne.

A physician will often confirm the diagnosis through pelvic exam and ultrasound, to reveal enlarged cystic ovaries, and conduct blood tests to check hormone levels. Blood pressure, glucose levels, and cholesterol levels are measured as well.

Treatment

A number of treatments are available for PCOS. Because the condition involves the metabolic system, dietary changes and weight loss, when indicated, are a first-line treatment. Even a 10% weight loss can improve menstrual irregularities in women with PCOS who carry extra weight, and can also be beneficial to cholesterol, blood pressure, and metabolic issues.

Other treatment options include Metformin, which regulates insulin, or hormonal contraception to regulate the cycle. It is important for women with PCOS to shed their uterine lining at least four times a year in order to lower the cancer risk that results from an overly thick uterine lining. Some women have also reported success with complementary medicine.

Fertility Treatment

Women with PCOS who have difficulty conceiving often receive hormonal medication to induce ovulation. In some cases, in vitro fertilization (IVF) is recommended to control the chance of having triplets or more, which is higher for women with PCOS.

Halacha

Women with irregular bleeding or spotting from PCOS can usually benefit from reviewing the laws of stains and from consulting a halachic authority when questions arise, to ensure that they spend no more time in niddah than necessary.

When medically indicated for treatment of PCOS, hormonal contraceptives are halachically permitted without specific halachic consultation.

Halachic Resources

Yoatzot Halacha help women with PCOS address any complications that arise with observing taharat hamishpacha.

Yoatzot Halacha Fertility Counselors offer free, personal consultations to women with PCOS seeking halachic guidance for their fertility journeys.

Other Resources

Click here for additional fertility resources.

Learn more about PCOS through any of the following organizations:

• American Association of Clinical Endocrinologists (AACE): http://www.aace.com
• American Society for Reproductive Medicine (ASRM): http://www.asrm.org
• The Hormone Foundation: http://www.hormone.org
• International Council on Infertility Information Dissemination, Inc. (INCIID): http://www.inciid.org
• National Institute of Child Health and Human Development (NICHD): https://www.nichd.nih.gov/health/topics/pcos
• The National Women’s Health Information Center (NWHIC): https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
• PCOS Awareness Association: http://www.pcosaa.org