tag:theconversation.com,2011:/fr/topics/pcos-1587/articlesPCOS – The Conversation2023-09-19T11:13:48Ztag:theconversation.com,2011:article/2109332023-09-19T11:13:48Z2023-09-19T11:13:48ZPolycystic ovary syndrome and gut health: what you need to know<p><a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/">Polycystic ovary syndrome</a> (PCOS) affects around <a href="https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome">8% to 13%</a> of women during their reproductive years. <a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Symptoms</a> include irregular menstrual cycles, acne, excessive facial hair growth, voice changes, ovarian cysts and challenges in conception. It can also increase your risk of developing Type 2 diabetes and heart disease.</p>
<p>Despite its prevalence, a significant number – <a href="https://www.who.int/news-room/fact-sheets/detail/polycystic-ovary-syndrome">up to 70%</a> – of PCOS cases worldwide go undiagnosed. This is in part because there isn’t one specific test for diagnosis. </p>
<p>The cause of PCOS remains unclear – it’s a complex condition influenced by both genes and environmental factors. But what we do know is that it can take a huge emotional toll on women, particularly in relation to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6858949/">body image</a> and fertility.</p>
<p><a href="https://www.mdpi.com/2077-0383/12/4/1454">In recent years</a>, scientists have started looking at PCOS and the gut microbiome of sufferers to see if there’s a link. These studies have found that the gut microbiome in women with PCOS is different from those without the condition. </p>
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<img alt="" src="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/542294/original/file-20230811-4652-hn8w80.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>This article is part of <a href="https://theconversation.com/uk/topics/womens-health-matters-143335">Women’s Health Matters</a>, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.</em></p>
<p><em>You may be interested in:</em></p>
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</a></em></p>
<p><em><a href="https://theconversation.com/the-orgasm-gap-and-why-women-climax-less-than-men-208614">The orgasm gap and why women climax less than men</a></em></p>
<p><em><a href="https://theconversation.com/science-experiments-traditionally-only-used-male-mice-heres-why-thats-a-problem-for-womens-health-205963">Science experiments traditionally only used male mice – here’s why that’s a problem for women’s health</a></em></p>
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<p><a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0124599">Women</a> tend to have <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.933110/full">more diverse</a> gut microbiomes, compared to men. But females with PCOS have fewer types of bacteria in their stool and that mix of bacteria is different compared to <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0168390">women without PCOS</a>. </p>
<p>Lower diversity of gut bacteria is linked to <a href="https://www.frontiersin.org/articles/10.3389/fendo.2022.933110/full">higher testosterone levels and excess hair growth</a>. It’s also connected to problems like <a href="https://www.mdpi.com/2079-7737/11/11/1586">abnormal cholesterol levels</a> and being overweight – as well as insulin resistance, which is when cells in your muscles, fat and liver don’t respond well to insulin and can’t easily take up glucose from your blood. All of which are seen with PCOS.</p>
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Read more:
<a href="https://theconversation.com/weight-loss-improves-polycystic-ovary-symptoms-but-dont-wait-until-middle-age-start-now-113449">Weight loss improves polycystic ovary symptoms. But don't wait until middle age – start now</a>
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</em>
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<h2>Gut health and PCOS</h2>
<p>Many things can affect the types of microbes living in our gut – what we eat, sex hormones, our sleep quality, where we live and our weight. But while the gut microbiome was once viewed primarily as a digestion aid, it’s now acknowledged as an intricate player in our overall health. </p>
<p><a href="https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-020-02173-y">Research</a> has found that women with PCOS are more likely to have <a href="https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0127094">unhealthy dietary habits compared to women without PCOS</a>. Women with PCOS are also <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1365-2265.2006.02587.x">more likely</a> to be <a href="https://academic.oup.com/bmb/article/143/1/4/6547855">overweight or obese</a>.</p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0306987712001703?via%3Dihub">One recent theory</a> as to the role that gut microbiome plays with PCOS is that an unhealthy diet can upset the balance of bacteria in our gut. This is known as <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1142041/full">gut dysbiosis</a>. <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-023-02975-8">The theory</a> suggests that <a href="https://www.frontiersin.org/articles/10.3389/fcimb.2023.1142041/full">this imbalance</a> might make the lining of the gut permeable allowing harmful substances from certain bacteria to leak into the bloodstream – also known as leaky gut.</p>
<p>This, in turn, can trigger the immune system and mess with how insulin works, leading to high insulin levels, more male hormones being made in the ovaries and problems with how the ovaries make eggs. </p>
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<img alt="Woman standing in a room in front of a mirror." src="https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/547495/original/file-20230911-20-4fhhf3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Several studies have reported that women with PCOS have a worse body image than those without PCOS.</span>
<span class="attribution"><a class="source" href="https://www.pexels.com/photo/woman-standing-in-front-of-a-mirror-near-a-window-8433395/">Mart Productions/Pexels</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p><a href="https://www.frontiersin.org/articles/10.3389/fendo.2023.1239276/full#:%7E:text=Our%20investigation%20revealed%20that%20within,hyperandrogenism%20in%20PCOS%20(34)">New research</a> has found that there seems to be a link between PCOS and some of the chemicals made when good bacteria in the gut digest fibre from food. These chemicals influence the metabolic and hormonal aspects of PCOS and when their production is increased through fibre intake, it seems to improve PCOS symptoms. </p>
<p><a href="https://www.frontiersin.org/articles/10.3389/fendo.2023.1239276/full">A 2021 study</a> also discovered that specific types of bile acids – which play a role in fat digestion – are present in larger amounts in people with PCOS. In those with PCOS, two types of bile acids are much higher. One of those acids, deoxycholic acid, is linked to how the body stores fat and insulin levels before and after meals and is also affected by testosterone. </p>
<p>So it may be that altered bile acid in people with PCOS negatively affects the gut bacteria. And that these changes weaken the gut walls, contributing to a leaky gut – which then worsens PCOS-related symptoms. But it’s also important to note that the relationship between bile acids, insulin and hormones like testosterone is complex and can vary from person to person.</p>
<h2>Gut help</h2>
<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4918443/">Probiotics</a>, which introduce beneficial microorganisms to the gut, have <a href="https://journals.asm.org/doi/full/10.1128/msystems.00017-19">been shown to be helpful</a> in restoring microbial equilibrium. <a href="https://journals.asm.org/doi/full/10.1128/msystems.00017-19">A 2019 publication</a> found that when women with PCOS took a <a href="https://www.frontiersin.org/articles/10.3389/fmicb.2016.00925/full">specific probiotic</a> called <em>bifidobacterium lactis</em> V9, it led to an improvement in gut health. </p>
<p><a href="https://bmcendocrdisord.biomedcentral.com/articles/10.1186/s12902-023-01294-6">A study that’s currently underway</a> is looking at whether probiotics or metformin (a diabetic medication used in the treatment of PCOS) can lower the levels of a hormone called free testosterone, which is often high in PCOS. The researchers are also checking other things related to PCOS, like metabolism as well as looking at gut bacteria to see if that changes too. </p>
<p>Other things that have been shown to be good for gut health more broadly are <a href="https://www.bbc.co.uk/food/articles/what_should_you_eat_for_a_healthy_gut">eating healthily</a>, getting <a href="https://www.kcl.ac.uk/news/irregular-sleep-patterns-harmful-gut-bacteria#:%7E:text=Sleep%20is%20a%20key%20pillar,unfavourable%20associations%20with%20your%20health.">enough good quality sleep</a>, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5513683/">limiting or avoiding alcohol</a> and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5357536/#:%7E:text=Exercise%20is%20able%20to%20enrich,mucosal%20immunity%20and%20improve%20barrier">exercise</a>. Indeed recent research shows that a <a href="https://academic.oup.com/jes/article/7/10/bvad112/7259972?login=false">keto diet</a> – which involves eating low carb high-fat foods – may also help to reduce testosterone levels in women with PCOS.</p><img src="https://counter.theconversation.com/content/210933/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Goitseone Thamae does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Studies have found that the gut microbiome in women with PCOS differs from those without the condition.Goitseone Thamae, Senior Research Lab Coordinator , School of Clinical Medicine, University of CambridgeLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1995682023-04-27T15:01:40Z2023-04-27T15:01:40ZWhy menstrual leave could be bad for women<figure><img src="https://images.theconversation.com/files/519854/original/file-20230406-18-29woex.jpg?ixlib=rb-1.1.0&rect=0%2C98%2C6000%2C3898&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/bad-period-full-length-view-caucasian-2064704318">NFstock/Shutterstock</a></span></figcaption></figure><p>Spain recently <a href="https://www.euronews.com/next/2023/02/16/spain-set-to-become-the-first-european-country-to-introduce-a-3-day-menstrual-leave-for-wo">adopted a menstrual leave policy</a>, which makes additional (paid or unpaid) days off work available to “<a href="https://doi.org/10.1007/978-3-030-53269-7_9">only and all cisgender women</a>”.</p>
<p>It’s so great that we’re having more public conversations about menstrual and menopausal health, but I’m getting very tired of being told that menstrual leave is the solution.</p>
<p>As someone with a background in policy evaluation and the founder of the world’s first evidence-based <a href="https://www.menstrual-matters.com/">menstrual health website</a>, I am well placed to comment on this topic. When I evaluated existing menstrual leave policies around the world, I found that they were not progressive or beneficial for <a href="https://doi.org/10.1007/978-3-030-53269-7_9">female reproductive health or gender equality</a>. </p>
<p>The thing is, it is really hard to argue against something that sounds good, even if the available evidence suggests otherwise. Humans seem to be bad at going beyond surface thoughts and we may even prefer stories that align with <a href="https://www.tandfonline.com/doi/abs/10.1080/1350178X.2014.939691">rather than challenge gender stereotypes</a>. </p>
<p>So, here is a quick outline of what I think you should know about this policy.</p>
<h2>What is the problem?</h2>
<p>There are <a href="https://doi.org/10.1007/978-3-030-53269-7_9">four main arguments</a> used by those promoting menstrual leave policy:</p>
<ol>
<li><p>It will make the workplace fit for the menstruating female body.</p></li>
<li><p>It will improve menstrual health.</p></li>
<li><p>It will reduce menstrual shame and stigma, and associated discrimination.</p></li>
<li><p>It will improve gender equality in the workplace and beyond. </p></li>
</ol>
<p>However, it has never been made clear exactly how the policy will deliver these outcomes. In fact, based on what we know about existing menstrual leave policies, it might not contribute to any of them.</p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series about issues affecting those of us in our twenties and thirties. From the challenges of beginning a career and taking care of our mental health, to the excitement of starting a family, adopting a pet or just making friends as an adult. The articles in this series explore the questions and bring answers as we navigate this turbulent period of life._</p>
<p><em>You may be interested in:</em></p>
<p><em><a href="https://theconversation.com/five-important-things-you-should-have-learned-in-sex-ed-but-probably-didnt-202177?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Five important things you should have learned in sex ed – but probably didn’t</a></em></p>
<p><em><a href="https://theconversation.com/postpartum-exercise-can-have-many-benefits-heres-how-to-do-it-safely-200388?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Postpartum exercise can have many benefits – here’s how to do it safely</a></em></p>
<p><em><a href="https://theconversation.com/joy-can-help-us-be-better-at-work-heres-how-to-find-it-198260?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Joy can help us be better at work – here’s how to find it</a></em></p>
<hr>
<p>For instance, the policy does not make it easier to manage your period at work because your employer doesn’t have to change a thing. Instead, you are encouraged to stay away from the workplace. </p>
<p>The policy also does nothing to improve menstrual health. The 90% of people who menstruate and <a href="https://abdn.alma.exlibrisgroup.com/discovery/delivery/44ABE_INST:44ABE_VU1/12152380480005941">do not regularly experience severe symptoms</a> do not need to take a whole day off work during their periods. </p>
<p>Meanwhile, the minority who do regularly experience severe symptoms almost always have <a href="https://www.rcog.org.uk/guidance/browse-all-guidance/green-top-guidelines/premenstrual-syndrome-management-green-top-guideline-no-48/">an underlying health issue</a>, such as endometriosis, heavy menstrual bleeding, polycystic ovary syndrome, fibroids, auto-immune disorders, depression or premenstrual dysphoric disorder. Encouraging people to cope with severe symptoms alone at home every month, is not an effective or humane solution.</p>
<p>These health conditions deserve effective and timely medical diagnosis and treatment, sick leave and reasonable workplace adjustments. The same things that apply to all chronic health conditions and are already covered by <a href="https://www.legislation.gov.uk/ukpga/2010/15/contents">EU and UK labour policies</a>. </p>
<p>Menstrual leave also does not help to reduce menstrual shame, stigma or discrimination. It actually encourages the removal of menstruation – and by extension women – from the public realm by hiding it at home.</p>
<p>This sex-based policy conflates healthy periods with debilitating menstrual health conditions, which both pathologises the normal female body and undermines health conditions that mainly affect women. This is partly why women and conditions that mainly affect women are <a href="https://doi.org/10.1155/2018/6358624">more likely to be dismissed by doctors</a>, sometimes taking <a href="https://www.medicalnewstoday.com/articles/gender-bias-in-medical-diagnosis#how-does-it-affect-diagnosis">years to get a formal diagnosis</a>.</p>
<p>Finally, by medicalising the menstrual cycle (that is, positioning it as an illness rather than a healthy process) these policies reinforce sexist beliefs that make it seem like all women are <a href="https://www.ncbi.nlm.nih.gov/books/NBK565629/">biologically inferior (mentally and physically)</a>. This is a major contributing factor in gender discrimination, especially in the workplace, since these ideas are <a href="http://www.beacon.org/Inferior-P1278.aspx">used to undermine</a> the value, contribution and leadership potential of women.</p>
<figure class="align-center ">
<img alt="A woman clutches a hot water bottle to her body." src="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/519858/original/file-20230406-14-tzzphp.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Period leave policies keep menstruation at home where employers don’t have to deal with it.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-cropped-view-unhealthy-30s-woman-2113290665">Fizkes/Shutterstock</a></span>
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<h2>Menstrual leave might even make things worse</h2>
<p>Not only have existing menstrual leave policies failed to address the problems they set out to solve, they have also directly resulted in <a href="https://www.menstrual-matters.com/ml-gender-4/">discrimination against female workers</a>. This is largely due to the gender myths reinforced by the policy. It makes all women seem like more expensive and less consistent and productive employees. It can also lead to a backlash from colleagues and employers <a href="https://books.google.co.uk/books/about/Periodic_Struggles.html?id=F5YvQwAACAAJ&redir_esc=y">against a sex-based benefit</a>.</p>
<p>We already know that shared parental leave (for parents regardless of gender) is a <a href="https://doi.org/10.2307/j.ctvfrxngh">more effective policy than maternity leave</a> (which is female sex-based). It improves the gender pay gap, women’s hiring, promotion and leadership opportunities, child health outcomes, fatherhood experiences and gender equality in wider society.</p>
<p>These improvements occur because the policy avoids the gender-based backlash associated with maternity leave. This backlash is driven by the conscious or unconscious resentment of, and associated discrimination against, working women due to a perceived unfair advantage (paid time off work) and/or biological liability (the female reproductive body). The <a href="https://www.menstrual-matters.com/ml-gender-4/">same issues</a> apply to menstrual and menopausal health workplace policies.</p>
<p>We need to improve workplace (and school, and medical) knowledge of reproductive health and wellbeing. We should all know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">what’s normal</a> or the sign of an underlying health condition. Likewise, it’s shocking that some people do not know <a href="https://www.menstrual-matters.com/learn-homepage/resources/">why we menstruate</a> or how to reduce cyclical changes.</p>
<p>We also need to make <a href="https://www.bloodygoodemployers.com/">workplaces (including schools) fit for those who have periods</a> and to promote more <a href="https://www.menstrual-matters.com/ml-alternatives-5/">flexible and equitable work cultures and practices</a> that benefit all employees. For instance, challenging “presenteeism” if employees feel obliged to work even when feeling unwell, and ditching <a href="https://www.ndtv.com/feature/amazon-staff-in-uk-claims-their-toilet-breaks-were-timed-3727431">“timed” toilet breaks</a>. </p>
<p>While these <a href="https://www.menstrual-matters.com/ml-alternatives-5/">actions</a> are not quite as simple or catchy as “menstrual leave”, they would at least make a positive difference in the lives of millions of workers – without unintentionally worsening gender inequalities.</p><img src="https://counter.theconversation.com/content/199568/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sally King is the founder of Menstrual Matters. Her doctoral research was funded by the ESRC (Economic and Social Research Council). She is affiliated with the Women's Equality Party and a board member of the Society for Menstrual Cycle Research. </span></em></p>Sex-based policies can lead to backlash and further discrimination in the workplace.Sally King, PhD Candidate, Department of Global Health & Social Medicine, King's College LondonLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1876722022-09-26T12:31:12Z2022-09-26T12:31:12ZTransgender men and nonbinary people are asked to stop testosterone therapy during pregnancy – but the evidence for this guidance is still murky<figure><img src="https://images.theconversation.com/files/486337/original/file-20220923-214-dia4h.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C2048%2C1020&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Diane Rodríguez and her husband, Zack Elias, are a trans couple in Ecuador.</span> <span class="attribution"><a class="source" href="https://commons.wikimedia.org/wiki/File:Diane_Rodr%C3%ADguez_abraza_a_su_esposo_embarazado_Zack_Elias_en_Guayaquil_-_alta_resolusi%C3%B3n.jpg">Chichicko/Wikimedia Commons</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>When I talk about our research team’s work on <a href="https://doi.org/10.1080/15532739.2020.1808554">pregnancy in transgender people</a>, people often recall <a href="https://people.com/tv/people-oprah-exclusive-the-pregnant-man-speaks-out/">Thomas Beatie</a>, a pregnant man who appeared on “Oprah” and in People magazine in 2008. The media focus on Beatie and his pregnancy provoked public fascination that tended to overshadow the everyday lived realities of being pregnant as a trans person. </p>
<p>Transgender people, as opposed to cisgender people, have a gender identity that is different from the gender they were assigned at birth. Some may go on hormone therapy to help align their body with their gender identity. Like most trans men, Beatie went off testosterone during his pregnancy because it was medically advised as standard practice. But <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone therapy</a> is often essential to the mental and physical health of many trans men as well as some nonbinary people whose genders don’t fit within the categories of man or woman. What is the experience of pausing treatment like for them? Why do medical guidelines recommend going off testosterone?</p>
<p>As a <a href="https://scholar.google.com/citations?user=JF-zRXYAAAAJ&hl=en">sociologist</a> who studies sex, gender and sexuality, and trans experiences of family, health and well-being, these questions piqued my interest. I work with an <a href="https://transpregnancy.leeds.ac.uk">international team of researchers</a> on a project about trans men and nonbinary people’s experiences of pregnancy. We interviewed 70 trans and nonbinary people who were either currently or intending to become pregnant, as well as 22 health care providers specializing in working with these communities, across seven countries.</p>
<h2>Testosterone therapy</h2>
<p>While testosterone is widely considered a “male hormone,” <a href="https://www.medicalnewstoday.com/articles/323085">all people produce testosterone</a>. Physicians consider a <a href="https://doi.org/10.1210/endocr/bqaa014">wide range</a> of testosterone levels to be “normal.”</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Thomas Beatie holding his two children" src="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=878&fit=crop&dpr=1 600w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=878&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=878&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1103&fit=crop&dpr=1 754w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1103&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/486335/original/file-20220923-13704-j9rjqf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1103&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Thomas Beatie is a trans man who received widespread media attention during his pregnancies.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/thomas-beatie-with-his-daughter-susan-and-son-jensen-enjoy-news-photo/120564551">Christopher Hunt/TB via Getty Images</a></span>
</figcaption>
</figure>
<p>Many transgender and nonbinary people take <a href="https://transcare.ucsf.edu/article/information-testosterone-hormone-therapy">testosterone</a> as part of their mental and physical health care. Testosterone therapy often results in a more masculine appearance through facial hair and muscle growth, fat redistribution and lowered vocal pitch.</p>
<p>In addition to physical changes, many of our study participants spoke of positive mental health improvements while on testosterone therapy, including feeling calmer, balanced and more fully themselves – sometimes for the first times in their lives. This is a <a href="https://theconversation.com/transgender-youth-on-puberty-blockers-and-gender-affirming-hormones-have-lower-rates-of-depression-and-suicidal-thoughts-a-new-study-finds-177812">common finding</a> across research on hormone therapy and trans and nonbinary people. </p>
<p>While there’s no universal dosing protocol for trans or nonbinary people undergoing testosterone therapy, the <a href="https://www.endocrine.org/clinical-practice-guidelines/gender-dysphoria-gender-incongruence">Endocrine Society’s treatment guidelines</a> recommend supplementing testosterone until blood ranges fall within those for cisgender men. By basing clinical standards on cisgender men, these guidelines can <a href="https://doi.org/10.3390%2Fjcm9061609">reproduce sex and gender binaries</a> that may not fit with actual desires of many trans and nonbinary people. Some resist this prescriptive medical model by <a href="https://www.sfaf.org/collections/beta/microdosing-hormones-expands-gender-affirming-care-options-for-non-binary-folks/">microdosing</a> testosterone, with or without health care provider support.</p>
<h2>Testosterone and pregnancy</h2>
<p>When my team and I analyzed our research interviews, we learned that the health care providers in our study typically told their trans patients to stop testosterone therapy either six months before trying to get pregnant or immediately upon becoming aware of pregnancy. They also advised continuing to withhold testosterone therapy until either after birth or stopping chestfeeding (nursing their babies). This could mean a pause in testosterone therapy for up to two years.</p>
<p>Why do doctors tell trans and nonbinary patients to stop testosterone therapy during pregnancy? </p>
<figure>
<iframe src="https://player.vimeo.com/video/691197437" width="500" height="281" frameborder="0" webkitallowfullscreen="" mozallowfullscreen="" allowfullscreen=""></iframe>
<figcaption><span class="caption">Trans artist Chella Man weighed the decision of stopping testosterone therapy during pregnancy in a 2022 performance piece.</span></figcaption>
</figure>
<p>The health care providers we interviewed expressed concerns about patients continuing testosterone while pregnant or chestfeeding. When we asked them what risks they were most concerned about, they often noted that there is either not enough or inconclusive research on using supplemental testosterone during pregnancy. Despite this, nearly all of the providers we interviewed routinely advised patients to pause testosterone therapy without reservation. </p>
<p>Some providers compared continuing testosterone therapy during pregnancy to illicit drug use during pregnancy, perceiving it as a future risk to the child. Others suggested that testosterone use during pregnancy is selfish because it prioritizes the parent’s own health and well-being in the present over the potential health and well-being of their child in the future. Some providers even suggested that trans and nonbinary patients shouldn’t have children if they are unwilling or unable to pause testosterone therapy during pregnancy. </p>
<p>In contrast, the trans men and nonbinary people we interviewed described grappling with difficult and weighty decisions around pausing testosterone during pregnancy. These decisions often involved choosing between their own mental health and well-being against the potential health and well-being of their child. As one participant described their experience going off testosterone during pregnancy:</p>
<blockquote>
<p>“My lows were miserable, depressed, to the point of suicidal. … I knew that going back on testosterone would help. I didn’t really know whether [my doctor] would be happy to re-prescribe me testosterone … and there was a fear there that it would be withheld from me … that they were going to say, ‘Well, sorry, you came off it, you’re not getting it back.’”</p>
</blockquote>
<h2>PCOS and producing ‘normal’ children</h2>
<p>Despite it being fairly standard medical advice, there remains relatively <a href="https://doi.org/10.1080/26895269.2022.2035883">scant empirical evidence</a> guiding the practice of pausing testosterone therapy for trans men and nonbinary people during pregnancy and chestfeeding. There is also currently no published work on microdosing testosterone during pregnancy.</p>
<p>Instead, much of the medical literature on the potential developmental effects of “excess androgen” exposure in the womb focuses on pregnant people with <a href="https://www.verywellfamily.com/what-is-polycystic-ovarian-syndrome-pcos-1959930">polycystic ovary syndrome</a> who have testosterone levels that generally <a href="https://doi.org/10.1210/jc.2010-1123">fall between those for cisgender women and men</a>. These studies center on the likelihood of the baby later developing <a href="https://doi.org/10.1210/en.2016-1801">intersex conditions</a>, or having biological traits that do not fit binary definitions of male or female characteristics; later self-identification as <a href="https://doi.org/10.1093/humupd/dmi013">lesbian</a> or <a href="https://doi.org/10.1093/humrep/del474">trans</a>; <a href="https://doi.org/10.1093/humrep/deab112">metabolic and cardiovascular dysfunction</a>, such as obesity; and <a href="https://doi.org/10.1038/s41398-021-01699-8">neuropsychiatric disorders</a>, such as autism and attention-deficit disorder. Most of these concerns have involved children categorized as female at birth.</p>
<p>People with polycystic ovary syndrome, however, are <a href="https://doi.org/10.1016/s0015-0282(01)02995-8">not routinely placed on testosterone blockers</a> during pregnancy or discouraged from feeding their infants milk they produce.</p>
<figure>
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<figcaption><span class="caption">Pursuing parenthood as a trans person in an anti-LGBTQ environment comes with many challenges.</span></figcaption>
</figure>
<p>In my review of our interviews and the medical literature, I became increasingly concerned that this focus on producing “<a href="https://theconversation.com/how-pregnancy-can-be-made-more-difficult-by-maternity-cares-notions-of-normal-117223">normal</a>” children fails to attend to both natural human diversity in cognitive processing, bodies and identities, and the mental health of trans and nonbinary parents. It may also echo <a href="https://theconversation.com/forced-sterilization-policies-in-the-us-targeted-minorities-and-those-with-disabilities-and-lasted-into-the-21st-century-143144">eugenicist policies</a> that attempt to eliminate human characteristics and communities that society deems inferior or bad. But <a href="https://autisticadvocacy.org/wp-content/uploads/2016/06/whitepaper-Increasing-Neurodiversity-in-Disability-and-Social-Justice-Advocacy-Groups.pdf">people</a> <a href="https://www.thetaskforce.org/">from these</a> <a href="https://naafa.org/">communities</a> have done a great deal of work over the past several decades to ensure they are granted equal rights and protections.</p>
<p>Paradoxically, the desire to protect offspring from testosterone exposure during pregnancy and chestfeeding may become a method to prevent the reproduction of some of the very same characteristics held by trans and nonbinary parents themselves. As one participant noted:</p>
<blockquote>
<p>“There’s a bunch of research around androgen exposure in utero and intersex conditions. … I did have complex feelings around working hard to not have an intersex child. … As someone who is a gender ‘other,’ to work hard to not create a different body that is a gender ‘other’ feels weird. It feels hypocritical.” </p>
</blockquote>
<h2>Moving beyond one-size-fits-all</h2>
<p>While concerns about “androgen excess” during pregnancy for trans men and nonbinary people parallel those for people with polycystic ovary syndrome, doctors treat these cases differently. This discrepancy in clinical approach indicates that there may be other pathways forward that don’t require stopping testosterone therapy completely. </p>
<p>I believe that careful attention to the physical and mental health and well-being of trans and nonbinary people before, during and after pregnancy is long overdue in medicine. Instead of approaching testosterone therapy during pregnancy as a binary yes/no question or a one-size-fits-all standard, investigating how various dosages of testosterone may affect all stages of pregnancy and chestfeeding could lead to better outcomes for both trans parents and their children.</p><img src="https://counter.theconversation.com/content/187672/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Carla A. Pfeffer received funding from the Economic and Social Research Council for her work on the Transgender Pregnancy Project.
The Trans Pregnancy Project team includes: Sally Hines (PI), Ruth Pearce, Carla A. Pfeffer, Damien W. Riggs, Elisabetta Ruspini, and Francis Ray White.</span></em></p>Testosterone therapy is often essential for the health and well-being of transmasculine people. The choice to stop it to pursue pregnancy can be a difficult one.Carla A. Pfeffer, Associate Professor of Social Work, Affiliate Faculty in Sociology and the Center for Gender in Global Context, and Director of the Consortium for Sexual and Gender Minority Health, Michigan State UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1895622022-09-11T08:24:43Z2022-09-11T08:24:43ZOvarian condition that can cause missed menstrual periods and infertility is going undetected in Nigeria<figure><img src="https://images.theconversation.com/files/483220/original/file-20220907-15-1d1rn.jpg?ixlib=rb-1.1.0&rect=50%2C42%2C5615%2C3690&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women with Polycystic Ovarian Syndrome often battle infertility and may not conceive easily. Photo by Florian Plaucheur/AFP via Getty Images.
</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/young-nigerian-girl-who-fled-maiduguri-to-kano-with-78-news-photo/463348590?adppopup=true">from www,gettyimages.com</a></span></figcaption></figure><p><em>Polycystic ovary syndrome is the most common gynaecological endocrine disorder in women of reproductive age. It affects between <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879843/#:%7E:text=Background%3A,women%20of%20reproductive%20age%20worldwide">4% and 20% of women globally</a> and is influenced by genetic and environmental factors. Despite its prevalence, it remains a conundrum amongst clinicians and allied health professionals. The Conversation Africa’s Nigeria based commissioning editor Kofoworola Belo-Osagie asked public health lecturer Ajike Saratu Omagbemi to explain the syndrome and the challenges around how it’s being detected.</em> </p>
<h2>What is polycystic ovarian syndrome?</h2>
<p><a href="https://www.nichd.nih.gov/health/topics/pcos/conditioninfo">The condition</a> refers to the presence of small, benign and painless cysts in the ovaries, which result in a range of symptoms and changes in hormonal levels. </p>
<p>It is characterised by elevated androgen levels. In turn this leads to <a href="https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome">excessive body and facial hair</a> and menstrual irregularities (no period or a long period).</p>
<p>It’s called a <a href="https://www.cancer.gov/publications/dictionaries/cancer-terms/def/syndrome">syndrome</a> because it’s a collection of signs and symptoms which occur consistently together. </p>
<p>Polycystic ovary syndrome <a href="https://academic.oup.com/humrep/article/17/9/2219/563943">can</a> mildly or severely disturb the reproductive, endocrine and metabolic functioning of a woman. </p>
<h2>How big a problem is it in Nigeria?</h2>
<p>Polycystic ovary syndrome affects <a href="https://pubmed.ncbi.nlm.nih.gov/24283091/#:%7E:text=Conclusion%3A%20PCOS%20is%20fairly%20common,are%20the%20commonest%20presenting%20features">one in six</a> infertile women in Nigeria. Local <a href="https://www.itmedicalteam.pl/articles/prevalence-of-polycystic-ovarian-syndrome-pcos-in-women-of-child-bearing-age-within-port-harcourt-metropolis-in-nigeria-.pdf">studies</a> have reported rates of between <a href="https://www.scirp.org/journal/paperinformation.aspx?paperid=87687">13.8%</a> and <a href="https://www.researchgate.net/publication/258956774_Prevalence_presentation_and_management_of_polycystic_ovary_syndrome_in_Enugu_south_east_Nigeria">18.1%</a>, amongst study populations of women in their reproductive age. </p>
<p>Local studies have mostly focused on determining its prevalence, treatment and management techniques. Only a couple of studies have focused on knowledge about the condition; and their findings were mixed. It’s not clear how much people know about polycystic ovarian syndrome in Nigeria. </p>
<p>It’s important to close the knowledge gap on the condition in Nigeria. The country <a href="https://www.researchgate.net/publication/288971582_Double_Burden_Non-Communicable_Diseases_And_Risk_Factors_Evaluation_In_Sub-Saharan_Africa_The_Nigerian_Experience">suffers</a> from a double burden of infectious and non-infectious diseases such as HIV/AIDS, tuberculosis, cardiovascular disease, diabetes and obesity. There is growing <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">evidence</a> that these are linked to polycystic ovarian syndrome.</p>
<h2>What is the impact?</h2>
<p>Polycystic ovary syndrome can greatly affect the health and well-being of girls and women in the short, middle and long term, leading to deterioration of the quality of life. </p>
<p>It can begin as early as the start of puberty. A girl may not understand what she is experiencing or be aware of her risk of ill health. Older women may not seek or receive targeted care early enough. They may have years of <a href="https://journals.lww.com/progprevmed/fulltext/2020/06000/cross_sectional_study_on_the_knowledge_and.1.aspx">unrecognised ill health</a> before getting a diagnosis. </p>
<p>Symptoms are often related to a deterioration in a woman’s self-esteem and self-image and may thus affect her <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3941334/">psychosocial</a> health.</p>
<p>Infertility, a classic symptom of polycystic ovarian syndrome, remains a critical concern in many African societies. There’s a great deal of stigma attached to women in Nigeria if they <a href="https://www.researchgate.net/publication/261903427_The_Social_meaning_of_meaning_of_infertility_in_Southwest_Nigeria">can’t become pregnant</a>. Th psycho-social and other <a href="https://www.ajol.info/index.php/njfp/article/view/157342#:%7E:text=The%20main%20negative%20psychosocial%20effects,confidence%20in%20oneself%20(7.7%25">consequences</a> may include deprivation and neglect, violence, marital problems and mental health issues. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Secondary school students sit in a group outside their classroom" src="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/483218/original/file-20220907-24-8gzz17.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It is often difficult for teenage girls to recognise the symptoms of Polycystic Ovarian Syndrome at puberty.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/public-school-for-girls-in-mainland-area-on-march-17-2016-news-photo/648348944?adppopup=true">from www.gettyimages.com</a></span>
</figcaption>
</figure>
<h2>Why is the syndrome difficult to recognise?</h2>
<p>Polycystic ovary syndrome is most often diagnosed two or three years <a href="http://dx.doi.org/10.1097/GCO.0b013e3282f10e22">after</a> the start of puberty because the menstrual patterning stabilises around that time. There are different manifestations at this stage of development. Some adolescents more frequently experience menstrual irregularity – a good marker of a heightened androgen level. That in turn leads to unwanted developments such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5835258/#:%7E:text=Hyperandrogenemia%20is%20a%20salient%20feature,resistance%20in%20women%20with%20PCOS">male-pattern hair growth on the chest, back and face, male-pattern baldness</a>, and acne. It’s thought that heightened androgen results in the development of polycystic ovary syndrome in adulthood.</p>
<p>The syndrome is not the only cause of missed ovulation in the menstrual cycle, but is strongly associated with menstrual irregularities.</p>
<p>Other manifestations are a skin condition known as <a href="https://www.mayoclinic.org/diseases-conditions/acanthosis-nigricans/symptoms-causes/syc-20368983#:%7E:text=Acanthosis%20nigricans%20is%20a%20skin,the%20armpits%2C%20groin%20and%20neck">acanthosis nigricans</a>, which causes darker skin in the folds of the body, and <a href="https://pubmed.ncbi.nlm.nih.gov/18502254/">premature pubarche</a>, where pubertal changes take place too early – often before eight years of age.</p>
<p>It is easy to miss the condition in adolescents. And in the transition between adolescence and adulthood, normal changes can mimic the syndrome’s characteristics. </p>
<h2>Why are older women not likely to seek treatment early?</h2>
<p>Polycystic ovarian syndrome shows up in multiple ways and so it’s usually treated as different things. Health professionals still struggle with understanding it themselves, so they can’t always give women the information they need. Sometimes women eventually just try to treat their symptoms themselves. </p>
<p>Women who are using contraceptives may not realise that the hormonal changes they are experiencing are actually <a href="https://pubmed.ncbi.nlm.nih.gov/14748678/">symptoms</a> of polycystic ovarian syndrome. Only when they are off the contraceptive and trying to conceive without success do they seek help. </p>
<h2>What social and lifestyle factors may cause the syndrome?</h2>
<p>The exact cause is not known. Factors such as genetics and lifestyle have been linked to the development of polycystic ovarian syndrome. One can inherit the risk. Studies have <a href="https://www.endocrineweb.com/conditions/polycystic-ovary-syndrome-pcos/what-causes-pcos-how-will-it-affect-body">found</a> familial links.</p>
<p>Women with polycystic ovarian syndrome have an imbalance of insulin and androgens. Higher levels of insulin are suggestive of a high caloric diet and sedentary lifestyle. Up to 85% of women with polycystic ovarian syndrome also experience <a href="https://www.monash.edu/medicine/sphpm/mchri/pcos/guideline">insulin resistance</a> – when their body’s cells stop responding normally to insulin, and instead block the entry of glucose into the cell and thus cannot maintain normal glucose levels. Insulin resistance is brought on by certain <a href="https://www.jeanhailes.org.au/health-a-z/pcos/symptoms-causes">lifestyle factors</a> such as poor diet and physical inactivity. Physical activity plays a <a href="https://pubmed.ncbi.nlm.nih.gov/1681160/">role</a> in insulin resistance disorders such as diabetes.</p>
<h2>What needs to be done?</h2>
<p>The big challenge is to fill the knowledge gaps about the condition. Then people can manage the disease better, prevent complications, and be less anxious about fertility. </p>
<p>Women and girls with the condition and those at risk need to be educated about the possibility of <a href="https://academic.oup.com/jcem/article/91/2/492/2843344">metabolic complications</a> so they can make lifestyle changes.</p><img src="https://counter.theconversation.com/content/189562/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ajike Saratu Omagbemi does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Polycystic Ovarian Syndrome is common among women and girls in Nigeria but not many know its impact on their lives and reproductive health.Ajike Saratu Omagbemi, Lecturer, Babcock UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1855492022-06-27T15:35:07Z2022-06-27T15:35:07ZEngland appoints first ever women’s health ambassador – here’s what she should focus on<figure><img src="https://images.theconversation.com/files/470546/original/file-20220623-51658-gj9nrl.jpg?ixlib=rb-1.1.0&rect=14%2C42%2C9475%2C6260&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/applying-contraceptive-hrt-estrogen-birth-control-2032605695">Andrey Popov/Shutterstock</a></span></figcaption></figure><p>The government recently appointed Dame Lesley Regan, professor of obstetrics and gynaecology at Imperial College London, as the <a href="https://www.gov.uk/government/news/dame-lesley-regan-appointed-womens-health-ambassador">first women’s health ambassador</a> for England. The new role has been created to help close the gender health gap. </p>
<p>Women make up <a href="https://www.ethnicity-facts-figures.service.gov.uk/uk-population-by-ethnicity/demographics/male-and-female-populations/latest">51% of the population</a> in England and Wales, yet persistent gender-based inequalities in health, social care, living standards and employment mean women spend more years than men in poor health. And for the first time in a century, their <a href="https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on">life expectancy is declining</a> – and women in deprived areas are the most affected.</p>
<p>Women from underserved and underrepresented racial and ethnic groups face <a href="https://pubmed.ncbi.nlm.nih.gov/34735797/">consistently poor outcomes</a>, even after taking socioeconomic factors into account. Black mothers are <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_Lay_Summary_v10.pdf">four times more likely to die in pregnancy and childbirth</a> than white mothers. </p>
<p>Timely, inclusive and relevant research based on woman-centred care is key to addressing the above problems. Regan has highlighted the immediate need to focus on areas that affect almost all women – such as menopause, menstrual problems, and contraception. She has also highlighted the importance of empowering women to access the healthcare they need across their whole life.</p>
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<h2>Across the lifespan</h2>
<p>Women’s health needs to be viewed across the whole lifespan. For example, conditions such as <a href="https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos/">polycystic ovary syndrome</a> have different symptoms at different stages of a woman’s life. Menstrual irregularities and facial hair are common in adolescence, but other symptoms – such as infertility, diabetes during pregnancy, and even complications such as high blood pressure and type 2 diabetes, stroke, and heart attack – are common in the long term. A single strategy targeting polycystic ovary syndrome across the woman’s life will have a positive effect on her short and long-term health.</p>
<p>Another important area that needs more attention is pregnancy in women with underlying complications, such as epilepsy. Compared with more than 200 randomised trials involving the general population with epilepsy, there is only <a href="https://www.journalslibrary.nihr.ac.uk/hta/hta22230/#/abstract">one trial involving pregnant women</a>. Despite improvements in maternity care, <a href="https://www.npeu.ox.ac.uk/assets/downloads/mbrrace-uk/reports/maternal-report-2021/MBRRACE-UK_Maternal_Report_2021_-_FINAL_-_WEB_VERSION.pdf">maternal deaths are increasing</a> in women with epilepsy, mainly because seizure risks in pregnancy are not being properly identified.</p>
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<strong>
Read more:
<a href="https://theconversation.com/research-into-pregnancy-birth-and-infant-care-is-historically-underfunded-and-women-are-paying-the-price-126629">Research into pregnancy, birth and infant care is historically underfunded – and women are paying the price</a>
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</p>
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<p>Effective communication of the risks, benefits, and treatments during pregnancy is an essential component of woman-centred care. The recent <a href="https://www.immdsreview.org.uk/downloads/IMMDSReview_Web.pdf">Cumberlege review</a> on complications in babies exposed to the drug valproate (an epilepsy drug) in pregnancy highlights the lack of communication with women about the risks. For women to make informed decisions about the treatments they are offered, they need reliable information on the long-term effect of drugs taken during pregnancy. </p>
<p>Pregnancy and breastfeeding should not be reasons for excluding women from drug trials. The recent report <a href="https://www.birminghamhealthpartners.co.uk/wp-content/uploads/2021/01/21560-Policy-Commission-Maternal-Health-Report-AW-accessible.pdf">Safe and Effective Medicines for Use in Pregnancy</a> sets out how research can be managed to mitigate safety concerns and give confidence to women and their doctors.</p>
<h2>Racial and ethnic disparities</h2>
<p>To optimise the health of all women, we need to tackle the disparities in health outcomes arising from <a href="https://pubmed.ncbi.nlm.nih.gov/34735797/">race, ethnicity and socioeconomic factors</a>. The first step is to really understand the burden of the problem facing women across different regions and for specific conditions, and provide targeted funding. We need to identify those women at risk of ill health early, and target interventions to prevent complications. Moreover, complications in pregnancy adversely affect babies in the long-term. This intergenerational impact can further widen race and ethnicity related inequalities. </p>
<p>It will also be important to invest more in research that promotes women’s health. This can be achieved by drawing on academic expertise in the UK, putting more robust financial investment into these areas, building infrastructure within the NHS and providing training opportunities for early career researchers and clinicians. Seamless integration of academic and health services is critical to the successful delivery of the research. </p>
<p>Any effort to improve women’s health can only succeed when women and their families are involved from the start to the end of the research. Women should guide, support, lead and disseminate research. We need dedicated, inclusive, and representative patient and public involvement groups to promote women’s health research. </p>
<p>The appointment of a dedicated women’s health ambassador is the first step toward achieving the ambitious goal of removing gender, race, and income-based health inequalities to benefit all women and future generations.</p><img src="https://counter.theconversation.com/content/185549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Shakila Thangaratinam receives funding from NIHR, MRC, WHO. </span></em></p>Regan, England’s first women’s health tsar, has her work cut out for her.Shakila Thangaratinam, Professor of Maternal and Perinatal health, University of BirminghamLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1795002022-03-23T16:27:49Z2022-03-23T16:27:49ZPeople with endometriosis and PCOS wait years for a diagnosis – attitudes to women’s pain may be to blame<figure><img src="https://images.theconversation.com/files/453829/original/file-20220323-23-19qsxu0.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C5176%2C3453&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Many women are told not to complain about pain.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/sad-unhappy-woman-suffering-pms-menstruation-1357975841">goffkein.pro/ Shutterstock</a></span></figcaption></figure><p>Former Miss Ireland, Chelsea Farrell, <a href="https://www.rsvplive.ie/life/former-miss-ireland-chelsea-farrell-26463906">recently shared the story</a> of how she ended up in the emergency room in severe pain with a twisted ovarian cyst. </p>
<p>After over two-and-a-half years of symptoms, Farrell found out she had endometriosis, polycystic ovary syndrome (PCOS) and an ovarian cyst. She had suffered pain, irregular periods, bloating and pain during sex, but thought this was normal. </p>
<p>Farrell’s story isn’t unique. Many women face difficulties getting diagnoses, care and treatment for such conditions – with some women even reportedly <a href="https://www.bbc.co.uk/news/av/uk-england-tees-60754629">waiting up to 12 years</a> for help. </p>
<p>There are many <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">complex reasons</a> behind why women with these conditions wait so long for proper help and treatment. But part of it comes down to how women’s pain is often normalised and dismissed in <a href="https://journals.sagepub.com/doi/abs/10.1111/j.1748-720X.2001.tb00037.x">healthcare settings</a> – and <a href="https://www.jpain.org/article/S1526-5900(21)00035-3/fulltext">even society</a> more widely. </p>
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<img alt="Quarter life, a series by The Conversation" src="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/451343/original/file-20220310-13-1bj6csd.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Working to make a difference in the world but struggling to save for a home. Trying to live sustainably while dealing with mental health issues. For those of us in our twenties and thirties, these are the kinds of problems we deal with every day. <strong><a href="https://theconversation.com/uk/topics/quarter-life-117947?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">This article is part of Quarter Life</a></strong>, a series that explores those issues and comes up with solutions.</em></p>
<p><em>More articles:</em></p>
<p><em><a href="https://theconversation.com/news-of-war-can-impact-your-mental-health-heres-how-to-cope-178734?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">News of war can impact your mental health — here’s how to cope</a></em></p>
<p><em><a href="https://theconversation.com/news-of-war-can-impact-your-mental-health-heres-how-to-cope-178734?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Body image issues affect close to 40% of men – but many don’t get the support they need</a></em></p>
<p><em><a href="https://theconversation.com/would-you-bring-your-dog-to-a-shop-why-retailers-should-be-more-pet-friendly-178112?utm_source=TCUK&utm_medium=linkback&utm_campaign=UK+YP2022&utm_content=InArticleTop">Would you bring your dog to a shop? Why retailers should be more pet-friendly</a></em></p>
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<p>In 2020, an <a href="https://www.oxfordmail.co.uk/news/18899456.oxford-school-tells-girls-attend-period/">Oxford school</a> caused controversy after suggesting girls should not miss school because of period pain. It reportedly stated: “Learning to deal with a monthly inconvenience is all part of being a woman.” </p>
<p>Not only does this show a lack of understanding of how debilitating menstrual pain can be, but also how girls are taught early on to endure pain rather than to <a href="https://pubmed.ncbi.nlm.nih.gov/33548448/">seek help or medical advice</a>. </p>
<p>This could also mean girls living with possible signs of endometriosis or PCOS won’t seek the help that they need. In fact, many women with PCOS or endometriosis report they felt expected not to to complain and “<a href="https://www.taylorfrancis.com/chapters/edit/10.4324/9781351035620-9/women-experience-endometriosis-elaine-denny-annalise-weckesser">get on with it</a>”, and to accept that “it’s a woman’s lot to suffer.”</p>
<p>This attitude means that women are often <a href="https://blogs.bmj.com/bmj/2021/05/13/placing-womens-voices-at-the-centre-of-their-care/">not involved in their own care</a> and that their complaints are often dismissed as “women’s problems”. This “<a href="https://www.theguardian.com/society/2020/jul/08/denial-of-womens-concerns-contributed-to-medical-scandals-says-inquiry">arrogant culture</a>” of not taking women’s concerns seriously has even led to decades of medical scandals, avoidable patient harm, and needless suffering.</p>
<h2>Unnecessary wait</h2>
<p>For the last decade, the average wait for an endometriosis diagnosis in the UK is <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">eight years</a>. Patients often have up to ten doctor visits before being diagnosed. </p>
<p>For <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6283441/">PCOS</a>, it can often take more than two years and appointments with around three doctors for a diagnosis. Both endometriosis and PCOS are complex conditions with symptoms that may vary widely and also resemble other conditions. So, the <a href="https://bjgp.org/content/71/710/e668#sec-7">diagnostic process is also complex</a>, which explains to some extent why diagnosis is slow. </p>
<p>But complexity around diagnosis is not just about symptoms. The UK government’s recent <a href="https://www.gov.uk/government/consultations/womens-health-strategy-call-for-evidence/outcome/results-of-the-womens-health-lets-talk-about-it-survey">Women’s Health Survey</a> captured how women continue to be dismissed and ignored when seeking care. It can be difficult for them to <a href="https://pubmed.ncbi.nlm.nih.gov/30782020/">put their pain into words</a> and they report not always being believed. </p>
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<img alt="Young woman sitting on a hospital bed waits alone in an examination room." src="https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/453830/original/file-20220323-23-s7x2p7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Many women wait years for a diagnosis.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/waiting-patient-woman-medical-examination-by-1284262312">Roman Kosolapov/ Shutterstock</a></span>
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<p>Having their pain dismissed leads many women on a <a href="https://journals.sagepub.com/doi/10.1177/1049732309338725">quest for “credibility”</a> in the hopes of being believed that symptoms are not just “<a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1365-2702.2005.01231.x?casa_token=piHGCQ8OUigAAAAA:rPAJhVl25OH6050jAoTRGWHYUCtMdLoHkTpemFZugUaK0aJte1Z1cGWOmEucnOGb9Q0lxQJETjE5baBH">in their head</a>”. But when your <a href="https://www.sciencedirect.com/science/article/abs/pii/S0738399121006431?casa_token=INfsTASb3G0AAAAA:5U4n-hULqmLm2x7xhoG886fdNa7yKhkwmM8xu6pDIK5HKuRPlWECij_WPnaeED8epeU5hST3d8I">experiences aren’t believed</a> by healthcare professionals, it can lead to lower self esteem and even depression. </p>
<h2>Gender health gap</h2>
<p>The struggles that many women experience when trying to receive a diagnosis for these types of conditions is part of a larger problem when it comes to women’s health. Historically, women have experienced inequality in the kind of healthcare and treatment they have received – which is known as the <a href="https://lordslibrary.parliament.uk/womens-health-outcomes-is-there-a-gender-gap">gender health gap</a>. </p>
<p>The gender health gap may explain why women are more likely to suffer <a href="https://pubmed.ncbi.nlm.nih.gov/30082406/">poorer outcomes</a> when treated by male doctors. It may also be why women are more likely to <a href="https://www.bhf.org.uk/what-we-do/news-from-the-bhf/news-archive/2019/september/heart-attack-gender-gap-is-costing-womens-lives">die from heart attacks</a>, as their symptoms can be different from men’s, whose symptoms still dominate medical textbooks and messaging around first aid. </p>
<p>Women’s pain is <a href="https://papers.ssrn.com/sol3/papers.cfm?abstract_id=383803">treated less aggressively</a> than men’s even when they rate it more severely, it lasts longer or occurs more often. </p>
<p>The gender health gap is even wider for <a href="https://www.hsph.harvard.edu/news/hsph-in-the-news/discrimination-black-womens-health/">black women</a> living in the US and UK. Black women are <a href="https://pubmed.ncbi.nlm.nih.gov/30908874/">less likely</a> to be diagnosed with endometriosis than white women. They’re also more likely to <a href="https://www.nytimes.com/2020/04/15/parenting/fertility/black-women-uterine-fibroids.html">develop uterine fibroids</a> and are significantly more likely to have <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3787340/">debilitating symptoms</a> because of them. </p>
<p>Black women may also be more <a href="https://rsphealth.org/pcos/">disproportionately affected by PCOS</a>. Though the reasons for this aren’t fully understood, it might partly be due to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6822100/">poorer access</a> to healthcare.</p>
<p>While problems with women’s health are increasingly being recognised, repeated calls in the past to raise awareness and education for <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Endometriosis%20APPG%20Report%20Oct%202020.pdf">girls, women, and healthcare professionals</a> haven’t led to much-needed change. It’s essential that better, <a href="https://bjgp.org/content/71/710/e668#sec-7">evidence-based resources</a> are developed for both women and health professionals to ensure that every woman – no matter her health needs or experiences – can receive the right care. </p>
<p>But it’s simplistic to assume that the difficulties women face in accessing equitable healthcare and the right diagnosis will be solved by more information alone. </p>
<p>We must also address the <a href="https://theconversation.com/endometriosis-three-reasons-care-still-hasnt-improved-157457">larger societal issues</a> of stigmatising and de-prioritising women’s health, the inadequate funding for women’s health research and the implicit gender and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8004354/">racial biases</a> that underpin current health inequalities. </p>
<p>It’s unlikely that significant changes in the way women’s healthcare is delivered will happen anytime soon. So for now, it will be important that women continue to advocate for their own health. </p>
<p>If you suspect you may have endometriosis or PCOS, continue to seek help. Consider <a href="https://www.endometriosis-uk.org/sites/endometriosis-uk.org/files/files/Information/pain-symptoms-diary.pdf">keeping track</a> of your pain and symptoms so you can discuss them with your GP. Remember, pain is not something you have to put up with.</p><img src="https://counter.theconversation.com/content/179500/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anne-Marie Boylan has received funding from the National Institute of Health Research (NIHR). </span></em></p><p class="fine-print"><em><span>Annalise Weckesser has received funding from NIHR and ESRC previously. </span></em></p><p class="fine-print"><em><span>Sharon Dixon work on endometriosis in primary care was funded by the National Institute for Health Research (NIHR) School for Primary Care Research (project number: 403). </span></em></p>The “gender health gap” may be at the root of this problem.Anne-Marie Boylan, Departmental Lecturer & Senior Research Fellow, University of OxfordAnnalise Weckesser, Senior Research Fellow, Medical Anthropology, Birmingham City UniversitySharon Dixon, Researcher, Primary Care Health Sciences, University of OxfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1319082020-02-26T18:56:23Z2020-02-26T18:56:23Z4 myths about polycystic ovary syndrome – and why they’re wrong<figure><img src="https://images.theconversation.com/files/317253/original/file-20200226-24680-vi85vv.jpg?ixlib=rb-1.1.0&rect=27%2C32%2C3639%2C2407&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/stylish-girl-denim-shorts-high-waist-309987251">Shutterstock</a></span></figcaption></figure><p>Polycystic ovary syndrome (PCOS) is a common hormonal condition. When using the definition supported by the international <a href="https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf">guidelines</a>, it affects just under <a href="https://www.ncbi.nlm.nih.gov/pubmed/19910321">one in six young Australian women</a>. </p>
<p>To meet the diagnostic criteria of PCOS, women need to have two of the following three criteria: </p>
<ul>
<li>irregular periods</li>
<li>signs of increased levels of androgens (hormones that give “male” characteristics) such as excess hair growth, acne or hair loss </li>
<li>enlarged ovaries with lots of small follicles containing immature eggs (known as polycystic ovaries). </li>
</ul>
<p>But polycystic ovaries aren’t ovaries with cysts. And having polycystic ovaries doesn’t mean you have PCOS. </p>
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Read more:
<a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Explainer: what is polycystic ovary syndrome?</a>
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</p>
<hr>
<p>Our new research among <a href="https://www.ncbi.nlm.nih.gov/pubmed/31687475">women</a> and <a href="https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/deaa005/5754094?searchresult=1">clinicians</a> found confusion over the name PCOS, limited evidence about the condition, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/30189451">large amount of misinformation</a> online fed into common misconceptions about PCOS. </p>
<p>These myths and assumptions are harming women and standing in the way of appropriate health care.</p>
<h2>Myth #1: Single symptoms indicate you have PCOS</h2>
<p>PCOS is a syndrome, or a group of symptoms, so just one sign or symptom is not enough for a diagnosis.</p>
<p>In our <a href="https://academic.oup.com/humrep/advance-article/doi/10.1093/humrep/deaa005/5754094?searchresult=1">new study</a> of 36 clinicians (GPs, endocrinologists and gynaecologists), many raised concerns about misdiagnosis and overdiagnosis of PCOS. They described seeing many women who had self-diagnosed or had been incorrectly diagnosed based on irregular cycles alone, or on an ultrasound showing polycystic ovaries. </p>
<p>But <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2968725/">many young women have polycystic ovaries</a> but don’t have PCOS. </p>
<p>Symptoms are also on a spectrum of severity, with no clear line separating normal from abnormal. </p>
<p>Women of different ethnicities, for example, have <a href="https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgaa063/5728530">different amounts</a> of facial and body hair.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=395&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=395&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=395&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=497&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=497&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317254/original/file-20200226-24690-gfizpq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=497&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Some women have more noticeable facial hair than others.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/attractive-woman-beauty-salon-on-facial-148182860">Shutterstock</a></span>
</figcaption>
</figure>
<p>And acne is common. <a href="https://www.ncbi.nlm.nih.gov/pubmed/22171979">One study found</a> 45% of women in their 20s had clinical acne, as well as 25% of women in their 30s and 12% of women in their 40s.</p>
<p>There are also several other factors and conditions that can mimic PCOS symptoms, such as stress, hormonal contraceptives such as the pill, obesity, <a href="https://www.womenshealth.gov/a-z-topics/thyroid-disease">thyroid issues</a> (which can affect metabolism), over-exercising and disordered eating. </p>
<p>Mislabelling women with PCOS prevents them from receiving care for their actual issue. Some conditions can have serious health consequences if left untreated, such as <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6374026/">hypothalamic amenorrhea</a> (when periods stop because of stress, weight loss and/or excessive physical exercise), which can lead to bone loss.</p>
<h2>Myth #2: Women with PCOS don’t need to use contraception</h2>
<p>Some women with PCOS may have trouble conceiving naturally and may need medication to help them ovulate when they want to conceive. But many women with PCOS conceive spontaneously and achieve their desired family size. In fact, women with and without PCOS have <a href="https://www.ncbi.nlm.nih.gov/pubmed/29939804">similar numbers of children</a>. </p>
<p>Despite this, <a href="https://www.ncbi.nlm.nih.gov/pubmed/29052216">many women with PCOS believe</a> they won’t become pregnant. This can have <a href="https://www.ncbi.nlm.nih.gov/pubmed/31687475">life-changing consequences</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/i-have-pcos-and-i-want-to-have-a-baby-what-do-i-need-to-know-109800">I have PCOS and I want to have a baby, what do I need to know?</a>
</strong>
</em>
</p>
<hr>
<p>In our <a href="https://www.ncbi.nlm.nih.gov/pubmed/31687475">recent study</a>, women with PCOS talked about how fear of infertility caused long-lasting psychological distress. They felt pressure to conceive early, had difficult conversations with their partners, and a few even altered their parenthood goals and no longer planned to have children. </p>
<p>Many took risks with contraception and a few ended up with unintended pregnancies. Reduced contraceptive use has also <a href="https://www.ncbi.nlm.nih.gov/pubmed/22273414">been shown</a> in <a href="https://www.ncbi.nlm.nih.gov/pubmed/32003425">other studies</a>. </p>
<p>Women with PCOS need reassurance and accurate information about the likelihood of pregnancy so they know contraception is needed if they don’t want to get pregnant. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317282/original/file-20200226-24651-hn40rr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women with PCOS still need to use contraception.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/oral-contraceptive-pill-on-pharmacy-counter-660070831">Shutterstock</a></span>
</figcaption>
</figure>
<h2>Myth #3: All women with PCOS are at risk of ‘metabolic complications’</h2>
<p>PCOS is associated with an increased risk of developing <a href="https://www.diabetes.co.uk/insulin-resistance.html">insulin resistance</a> (when the body doesn’t respond properly to the hormone insulin), type 2 diabetes and metabolic syndrome (a collection of factors such as high blood pressure and poor cholesterol levels).</p>
<p>Consequently, some women with PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/31687475">report persisting anxiety</a> about their long-term health. </p>
<p>However, the potential consequences are not the same for all women diagnosed. Women with no signs of androgen excess, so those who are diagnosed due to irregular menstrual cycles and polycystic ovaries, <a href="https://www.ncbi.nlm.nih.gov/pubmed/27233760">don’t have the same metabolic risks</a> as women with <a href="https://www.ncbi.nlm.nih.gov/pubmed/31306504">androgen excess</a>. </p>
<p>Yet most doctors we interviewed were unaware of this. As a result, some women with PCOS are being wrongly labelled as high risk, causing unnecessary anxiety. </p>
<p>Another assumption frequently stated online is that women with PCOS are more likely to get heart disease. However, the <a href="https://www.ncbi.nlm.nih.gov/pubmed/31638273">limited data</a> to date suggests otherwise. </p>
<h2>Myth #4: PCOS causes weight gain or prevents weight loss</h2>
<p>Although women with PCOS are more likely to be overweight than women without the condition, the relationship between PCOS and weight remains unclear. </p>
<p>While many women with PCOS report <a href="https://www.ncbi.nlm.nih.gov/pubmed/27906550">difficulty losing weight</a> and perceive a greater susceptibility to <a href="https://academic.oup.com/humrep/article/33/1/91/4647370">weight gain</a>, weight management interventions, such as diet and behaviour change programs, have found women with and without PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/28885578">lose the same amount of weight</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/317255/original/file-20200226-24655-7rpfag.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women with PCOS can lose weight.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/portrait-young-obese-woman-working-out-589121444">Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/30496407/">A recent analysis</a> suggests a high body mass index (BMI) is one of the causes of PCOS, with weight gain making symptoms worse. But having PCOS does not appear to affect BMI. We need more research to understand these relationships more clearly. </p>
<p>Encouragingly, even a small amount of weight loss can improve PCOS symptoms. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/weight-loss-improves-polycystic-ovary-symptoms-but-dont-wait-until-middle-age-start-now-113449">Weight loss improves polycystic ovary symptoms. But don't wait until middle age – start now</a>
</strong>
</em>
</p>
<hr>
<p>Optimising healthy lifestyle (eating healthily, being active and avoiding smoking) is <a href="https://www.monash.edu/__data/assets/pdf_file/0004/1412644/PCOS_Evidence-Based-Guidelines_20181009.pdf">first line management</a> for women with PCOS. However, women with PCOS may face additional barriers to implementing these changes, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/22127370">higher levels of anxiety</a> and <a href="https://www.ncbi.nlm.nih.gov/pubmed/21173657">depression</a>, highlighting the importance of access to support.</p>
<p>We must be careful with assumptions and generalisations in the absence of high-quality data. Women with PCOS each have different contributing factors and therefore different levels of risk. Having truly patient-centred health care will help them better manage their condition, improve their outcomes and reduce unwarranted anxiety.</p><img src="https://counter.theconversation.com/content/131908/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tessa Copp receives funding from the NHMRC Centre for Research Excellence in Creating Sustainable Healthcare. She is on the Junior Researcher Committee for the Preventing Overdiagnosis Conference. </span></em></p><p class="fine-print"><em><span>Jenny Doust receives funding from the NHMRC Centre for Research Excellence in Creating Sustainable Healthcare.</span></em></p><p class="fine-print"><em><span>Jesse Jansen receives funding from the NHMRC. </span></em></p><p class="fine-print"><em><span>Kirsten McCaffery receives funding from the NHMRC Centre for Research Excellence in Creating Sustainable Healthcare and an NHMRC Program Grant 'Using healthcare wisely.</span></em></p>Just under one in six Australian women have PCOS but some are being diagnosed when they don’t meet the criteria.Tessa Copp, PhD candidate, University of SydneyJenny Doust, Clinical Professorial Research Fellow, The University of QueenslandJesse Jansen, Senior research fellow, University of SydneyKirsten McCaffery, NHMRC Principal Research Fellow, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1134492019-04-28T20:16:12Z2019-04-28T20:16:12ZWeight loss improves polycystic ovary symptoms. But don’t wait until middle age – start now<figure><img src="https://images.theconversation.com/files/271331/original/file-20190429-194616-1xlihxd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women with polycystic ovary syndrome are more likely to be overweight or obese. But it’s easier to maintain a healthy weight while young than wait until later to shift the kilos. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/back-view-portrait-young-obese-woman-589121366?src=dwhdGRzUZ3ld_4j6I6plKw-1-27">Pressmaster/Shutterstock</a></span></figcaption></figure><p>Women with polycystic ovary syndrome (PCOS) are more likely to be overweight or obese and their symptoms worsen the heavier they are.</p>
<p>What causes this weight gain? How can losing weight help? And how can women shed the extra kilos to improve what they describe as distressing symptoms?</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Explainer: what is polycystic ovary syndrome?</a>
</strong>
</em>
</p>
<hr>
<p>PCOS is the most common hormonal disease in women of childbearing age. Symptoms include irregular periods, or signs of high male hormone levels, such as excessive hair growth or severe acne.</p>
<p>Women find it distressing to deal with these symptoms as they feel their <a href="https://www.ncbi.nlm.nih.gov/pubmed/24719724">feminine identity is challenged</a>. They also report a lack of support from health professionals and peers, and worry about long-term risks, such as developing type 2 diabetes.</p>
<p>Women with PCOS are two to three times <a href="https://academic.oup.com/humupd/article/18/6/618/628147">more likely to be overweight or obese</a> (having a body-mass index of 25 kg/m² and above) compared to women without the condition. And they <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.20213">gain more weight a year (260g more)</a> than women without PCOS of the same age. Many women with PCOS also <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013493/">have trouble losing weight or keeping it off</a>. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-overweight-obese-bmi-what-does-it-all-mean-7011">Explainer: overweight, obese, BMI – what does it all mean?</a>
</strong>
</em>
</p>
<hr>
<h2>Does weight gain make PCOS symptoms worse?</h2>
<p>Heavier women with PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/23114091">tend to have worse symptoms</a>. The question is whether gaining weight worsens symptoms or PCOS itself causes women to gain weight.</p>
<p>To prove gaining weight worsens PCOS symptoms, we need studies in which women are made to gain weight and their symptoms monitored for changes. We doubt if such a study has been done because of ethical issues relating to the potential harm to participants. That’s not to mention the challenges in recruiting women for a study where they would gain weight. So we need to look for other forms of evidence. </p>
<p>An <a href="https://www.ctu.mrc.ac.uk/patients-public/about-clinical-trials/what-is-an-observational-study/">observational study</a> in Finland found an increase in BMI in women from the age of 14 to 31 <a href="https://academic.oup.com/jcem/article/101/2/739/2811201">was associated with</a> greater likelihood of having irregular periods, excessive hair growth or being diagnosed with PCOS.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/in-defence-of-observational-science-randomised-experiments-arent-the-only-way-to-the-truth-49807">In defence of observational science: randomised experiments aren't the only way to the truth</a>
</strong>
</em>
</p>
<hr>
<p>And when women with PCOS lost weight through lifestyle changes such as eating less or increasing physical activity, a <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD007506.pub4/full">Cochrane review</a> showed a reduction in male hormones and excess hair growth.</p>
<p>Given the above evidence, we could conclude that weight gain is likely to make PCOS symptoms worse.</p>
<h2>Does PCOS cause weight gain or stop you losing weight?</h2>
<p>Many women with PCOS say they find it <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4013493/">very hard to lose weight</a>, but we don’t fully understand why that is.</p>
<p>Women with PCOS have the <a href="https://www.sciencedirect.com/science/article/pii/S0261561415000497">same metabolic rates</a> as women without PCOS. They eat <a href="https://www.fertstert.org/article/S0015-0282(13)01602-6/fulltext">a few more calories</a> (about 200 kilojoules a day, or the equivalent of one cube of cheese) than women without PCOS. This could lead to putting on an extra 2-3kg over a year. </p>
<p>Women with PCOS may have different levels of <a href="https://academic.oup.com/jcem/article/89/7/3337/2844354">hormones that control appetite</a>, and the high levels of male hormones could <a href="https://www.sciencedirect.com/science/article/abs/pii/S0031938409002200?via%3Dihub">increase cravings</a> for high-fat foods.</p>
<p>But when provided with similar levels of support, women with and without PCOS <a href="https://www.ncbi.nlm.nih.gov/pubmed/28885578">lose the same amount of weight</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/270633/original/file-20190424-19293-zmtqss.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">When provided with similar levels of support, women with and without PCOS lose the same amount of weight.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/120882769?src=oLgOb28-_3y0NWNu_mMV4g-1-60&size=medium_jpg">from www.shutterstock.com</a></span>
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</figure>
<p>Looking beyond PCOS, all women of childbearing age seem to put on small but persistent amounts of weight. Women, on average, <a href="https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=2ahUKEwjzzILehOjhAhWJA3IKHYcRA3AQFjAAegQIBRAC&url=https%3A%2F%2Fwww.alswh.org.au%2Fimages%2Fcontent%2Fpdf%2Fmajor_reports%2F2007_major_report_b.pdf&usg=AOvVaw0nEjxJbcOE4vnxhMKKME95">gain up to 600g a year</a> from the age of 18. Women who are married or partnered, start work or have children are <a href="https://www.nature.com/articles/0802150">more likely to gain weight</a>.</p>
<p>The reasons women gain weight could relate to <a href="https://www.sciencedirect.com/science/article/pii/S0168822716317752">challenges</a> maintaining a healthy lifestyle due to lack of time, energy, motivation and supporting family and friends. </p>
<p>These reasons tend to be similar for women with and without PCOS. However, women with PCOS may face additional challenges as they describe ongoing stress living with PCOS symptoms such as unpredictable periods.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/how-to-choose-the-right-contraceptive-pill-for-you-87614">How to choose the right contraceptive pill for you</a>
</strong>
</em>
</p>
<hr>
<p>Women with PCOS also have <a href="https://link.springer.com/article/10.1007%2Fs11920-017-0834-2">higher levels of anxiety and depression</a> and lower quality of life, all of which may compromise their ability to adopt a healthy lifestyle. </p>
<p>Recent focus groups we conducted revealed women with PCOS reported “a lifetime of yo-yo dieting” with repeated cycles of weight loss followed by weight regain. Often these cycles result in an overall weight gain over the years.</p>
<h2>What should I do if I have PCOS?</h2>
<p>Instead of going on unsustainable diets, which could lead to weight cycling and a sense of defeat, aim for small (and therefore sustainable) changes in diet and exercise. </p>
<p>Find something you enjoy. Set yourself the overarching goal to maintain your weight and improve your health, whatever that is now. </p>
<p>Keeping track of your weight by weighing yourself regularly (say, once a week) can help. If you have regular medical appointments, having your doctor monitor your weight changes between visits can also help you maintain your weight. </p>
<p>If you are 25 years old now, simply holding on to your current weight would be equivalent to permanently losing more than 20kg when you are 50. We know that is next to impossible. Staying the same weight is a far more achievable goal, and just as beneficial.</p><img src="https://counter.theconversation.com/content/113449/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Siew Lim has received funding from NHMRC for Early Career Fellowship. </span></em></p><p class="fine-print"><em><span>Carolyn Ee has received funding from the NHMRC Centre for Research Excellence in PCOS. </span></em></p>Women with polycystic ovary syndrome say they find it hard to lose weight. Here’s what they can do to improve their symptoms and long-term health.Siew Lim, NHMRC Early Career Fellow/ Monash Health dietitian, Monash UniversityCarolyn Ee, Senior Research Fellow, NICM Health Research Institute, Western Sydney University, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1098002019-02-08T02:02:05Z2019-02-08T02:02:05ZI have PCOS and I want to have a baby, what do I need to know?<figure><img src="https://images.theconversation.com/files/257656/original/file-20190207-174851-174a9i2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Polycystic ovary syndrome can make conceiving more difficult.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/WMetg7EY_5A">rawpixel/unsplash </a></span></figcaption></figure><p>Most women want and expect to have children. But women who have a chronic health condition such as polycystic ovary syndrome (PCOS) often have concerns about childbearing, including whether they can become pregnant.</p>
<p>PCOS is a complex hormonal condition which affects <a href="https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1111/ajo.12730">up to one in five women of reproductive age</a>. Most women with PCOS have elevated levels of a type of hormone called luteinising hormone, which brings about ovulation, and reduced levels of a hormone called “follicle stimulating hormone”, which is essential for pubertal development and the function of women’s ovaries and men’s testes.</p>
<p>Women with PCOS also have an underproduction of oestrogen (“female” hormones) and an overproduction of androgens (“male” hormones). This causes tiny cysts on the surface of the ovaries. </p>
<p>Due to these <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4433074/">hormonal imbalances</a>, women with PCOS often have irregular menstrual cycles because they don’t ovulate or ovulate only occasionally. So women with PCOS are more likely to have trouble conceiving than other women.</p>
<p>While <a href="https://www.ncbi.nlm.nih.gov/pubmed/29939804">most women who have PCOS become pregnant</a>, they often take longer to fall pregnant and are more likely to need fertility treatment than women without PCOS.</p>
<p><a href="https://doi.org/10.1093/hropen/hoy019">In a recent study by Monash University</a>, women with PCOS took part in an online discussion group. They talked about their concerns about pregnancy and what they could do to improve their chances of falling pregnant, the sort of information they would like about fertility and PCOS, and when they would like to receive this information. </p>
<p>Their greatest worry was about whether they would be able to get pregnant. They also wanted to know how best to prepare for pregnancy and what they should do before trying to conceive. They had trouble finding up-to-date, relevant and reliable information.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">Explainer: what is polycystic ovary syndrome?</a>
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</em>
</p>
<hr>
<h2>How to increase chance of pregnancy</h2>
<p>As for all women, being in the best possible health <a href="https://www.yourfertility.org.au/everyone/lifestyle">before trying for a baby</a> increases the chance of pregnancy and gives the baby the best start in life. </p>
<p>According to the international evidence-based guideline for the assessment and <a href="https://www.ncbi.nlm.nih.gov/pubmed/30033227">management of PCOS</a>, adopting a healthy lifestyle – including being in the healthy weight range, not smoking, cutting back on alcohol, eating a healthy diet, getting plenty of regular exercise and enough sleep – is the first thing to do to improve a woman’s chances of becoming pregnant and having a healthy baby. </p>
<p>To get the right kind of advice and support, women planning to get pregnant should have a preconception health check with their GP. This is also an opportunity to discuss a plan of action in case the PCOS causes fertility difficulties. </p>
<p>For women with PCOS who are overweight or obese, a modest weight loss sometimes results in more regular ovulation, which increases the chance of pregnancy. For those who know they ovulate, having sex during the “<a href="https://www.yourfertility.org.au/everyone/timing">fertile window</a>” (the five days leading up to and including ovulation) boosts the chance of conception. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/256781/original/file-20190201-103164-74ersv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Overall, women with and without PCOS have a similar number of children.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/X3DZ1c7MPa4">john looy unsplash</a></span>
</figcaption>
</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
</strong>
</em>
</p>
<hr>
<h2>What are my options?</h2>
<p>If you have tried for a baby for 12 months without success (or six months if you are aged 35 or over) it’s time to seek medical advice. Your GP is your first port of call, but she might refer you to a fertility specialist. </p>
<p>If you have very irregular or only sporadic periods, this is an indication you are not ovulating and need medical help to have a baby. The first line of medical treatment is <a href="https://www.jogc.com/article/S1701-2163(16)34504-2/fulltext">ovulation induction</a>. This involves a course of tablets or injections to stimulate the ovaries to release an egg that can be fertilised, either during intercourse or through intra-uterine insemination (IUI). </p>
<p>If this doesn’t work, there may be other reasons why pregnancy can’t be achieved and more invasive treatments such as <a href="https://www.varta.org.au/information-and-support/assisted-reproductive-treatment">IVF may be needed</a>. </p>
<p><a href="https://www.varta.org.au/information-support/assisted-reproductive-treatment/types-assisted-reproductive-treatment">IVF</a> involves a course of injections to stimulate the ovaries to produce multiple eggs. When they’re mature the eggs are retrieved in an ultrasound-guided procedure under light anaesthetic. Sperm are added to the eggs in the laboratory for embryos to form. </p>
<p>A few days later, an embryo is placed in the uterus where it may implant and grow into a baby. If there is more than one embryo, these can be frozen for later use if there is no pregnancy. </p>
<p>While IVF is safe in the hands of specialists, there are some possible <a href="https://www.varta.org.au/sites/varta/files/Possible%20health%20effects%20of%20IVF%20-%20April%202016_0.pdf">health effects</a> to be aware of, including ovarian hyperstimulation syndrome. This is an over-response to the fertility drugs that are used to stimulate the ovaries to produce multiple eggs. This can lead to abdominal pain, nausea and vomiting, rapid weight gain and blood clots. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/better-health-and-diet-well-before-conception-results-in-healthier-pregnancies-94400">Better health and diet well before conception results in healthier pregnancies</a>
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<hr>
<h2>For more information</h2>
<p>The <a href="https://www.yourfertility.org.au/everyone#pcos">Your Fertility</a> website has more information on PCOS and fertility. The Centre for Research Excellence in Polycystic Ovary Syndrome has also produced <a href="https://www.monash.edu/__data/assets/pdf_file/0009/1401768/PCOS-QPL.pdf">a list of questions for women with PCOS</a> to use in conversations with their healthcare provider and a <a href="https://www.monash.edu/__data/assets/pdf_file/0005/1410854/PCOS-and-Fertility.pdf">fact sheet</a> about PCOS, fertility and pregnancy.</p>
<p>While fertility problems are common among women with PCOS, it’s reassuring that, overall, women with PCOS and women without PCOS have <a href="https://www.ncbi.nlm.nih.gov/pubmed/29939804">similar numbers of children</a>. And, although PCOS is associated with fertility difficulties, women with PCOS should also be aware conception is possible and effective contraception is needed to avoid pregnancy when it’s not wanted. </p>
<hr>
<p><em>This article was co-authored by Louise Johnson, CEO of the Victorian Assisted Reproductive Treatment Authority (VARTA). Louise has no conflicts of interest to note.</em></p><img src="https://counter.theconversation.com/content/109800/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sara Holton has received funding from several sources including the NHMRC and the ARC.</span></em></p><p class="fine-print"><em><span>Karin Hammarberg is affiliated with the Victorian Assisted Reproductive Treatment Authority.</span></em></p>While most women who have PCOS become pregnant, they often take longer to fall pregnant and are more likely to need fertility treatment than women without PCOS.Sara Holton, Research Fellow, Deakin UniversityKarin Hammarberg, Senior Research Fellow, Jean Hailes Research Unit, School of Public Health & Preventive Medicine, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1089102019-02-05T19:15:10Z2019-02-05T19:15:10ZConsidering using IVF to have a baby? Here’s what you need to know<figure><img src="https://images.theconversation.com/files/257135/original/file-20190205-86210-1r11h6n.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Age is the biggest predictor of IVF success, but not all clinics are equal.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/Y3L_ZQaw9Wo">Brooke Cagle</a></span></figcaption></figure><p>If it’s not you, perhaps it’s someone you know. You don’t look infertile, you don’t feel infertile, but after many months (or years) of trying to start a family, followed by several months of monitoring your cycle in a fertility clinic, it’s time to discuss IVF.</p>
<p>This is a big decision. It will impact your time, your finances, your emotions, your relationships and your dreams of being a parent. </p>
<p>Despite the language of “falling pregnant”, inferring absolute simplicity, infertility is a reality for <a href="https://www.health.gov.au/internet/publications/publishing.nsf/Content/womens-health-policy-toc%7Ewomens-health-policy-experiences%7Ewomens-health-policy-experiences-reproductive%7Ewomens-health-policy-experiences-reproductive-maternal%7Ewomens-health-policy-experiences-reproductive-maternal-fert">one in six Australian couples</a>. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/womens-fertility-does-egg-timer-testing-work-and-what-are-the-other-options-109726">Women's fertility: does 'egg timer' testing work, and what are the other options?</a>
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</em>
</p>
<hr>
<h2>Infertility isn’t picky, but it is ageist!</h2>
<p>A woman’s age is the <a href="https://www.mja.com.au/journal/2017/207/3/assisted-reproductive-technology-australia-and-new-zealand-cumulative-live-birth">single best predictor</a> of IVF success. This is because a woman is born with all the eggs she will ever have, somewhere between one and four million. Our eggs are slowly trickling out of the ovary in a steady stream, until at menopause there are no eggs left. </p>
<p>Despite the fact that almost 400 eggs will begin to grow each month from puberty to menopause, only one egg will survive each month, bursting out of the ovary at ovulation ready to be fertilised.</p>
<iframe src="https://datawrapper.dwcdn.net/jtESL/2/" scrolling="no" frameborder="0" width="100%" height="197"></iframe>
<p>Sperm are an equally critical component of both IVF and natural fertility. </p>
<p>Despite the myth that male fertility is not impacted by age, a growing body of evidence shows men’s age – and lifestyle factors such as excess weight, smoking and heavy drinking – <a href="https://www.racgp.org.au/afp/2017/september/male-infertility/">affect fertility</a>.</p>
<p>Intracytoplasmic sperm injection (ICSI) has been developed so fertilisation in the lab can still be successful even if only one good quality sperm is available. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/most-men-dont-realise-age-is-a-factor-in-their-fertility-too-67785">Most men don't realise age is a factor in their fertility too</a>
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</em>
</p>
<hr>
<h2>What is the process and how will I feel?</h2>
<p>IVF artificially increases the number of mature eggs ready for fertilisation. Your treatment very much depends on what your infertility diagnosis is, but for most couples undergoing IVF, the process will look a bit like this.</p>
<p><strong>Step 1: ovarian stimulation</strong></p>
<p>The hormone which makes eggs grow (FSH or follicle stimulating hormone) is given by very tiny, self-given injections just under the skin, in high but tailored doses. This creates a hormone tsunami, giving many eggs a chance to ride this wave. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257143/original/file-20190205-86195-qow55y.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Women self-administer the hormone injections.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/481981426?src=zMXyc3de8wm9uknCGlFhLA-1-1&size=huge_jpg">vchal/Shutterstock</a></span>
</figcaption>
</figure>
<p>Using IVF, we can safely increase the number of eggs the woman produces in a cycle without risking multiple births. We take the eggs out of the body, in a process known as egg harvest or oocyte pickup, or OPU. Leaving the eggs in the body for fertilisation incurs an unacceptable risk of having twins, triplets, or more. </p>
<p>These hormones can have some side effects, which are usually mild, and may include tenderness at the injection site, hot flashes, blurred vision, nausea, headache, irritability and restlessness. Your doctor will outline them, and tell you what to monitor.</p>
<p><strong>Step 2: egg harvest (oocyte pickup)</strong></p>
<p>When the eggs are mature (generally up to 18 mm in size) and your estrogen levels are consistent with the egg numbers and size we need, we plan an egg harvest. </p>
<p>A trigger injection is given to finalise egg growth and development, and approximately 36 hours later, we perform the surgical procedure to collect them, ready to put them together with the sperm for in vitro fertilisation (IVF). </p>
<p>This procedure is more like a blood test than open surgery and in many units this procedure is done with pain relief while the female partner is awake. Other units use a light sedative anaesthetic, while they insert a narrow needle and camera (ultrasound) through the vagina to collect the eggs for IVF.</p>
<p><strong>Step 3: in vitro fertilisation (IVF)</strong></p>
<p>Over the next few hours, the embryologists will wash all the viable eggs and prepare them for fertilisation. They are then placed in a dish with thousands of sperm, which were collected previously and frozen, or collected on the same day from your partner. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257150/original/file-20190205-86213-18qdgf.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">ICSI looks something like this.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-vector/ivf-artificial-insemination-realistic-vector-design-1156125265?src=TwMKPKSqfztCJPeUqkfkrQ-1-21">Apl56/Shutterstock</a></span>
</figcaption>
</figure>
<p>Or, if you’re using intracytoplasmic sperm injection (ICSI), the embryologists directly inject one sperm into the cytoplasm of each egg. </p>
<p><strong>Step 4: embryo culture</strong></p>
<p>The day after IVF, the embryologist or nurse will phone you to tell you how many eggs were fertilised.</p>
<p>For the next few days, your embryos will live in a dish, in an oven heated to body temperature. Staff will monitor their growth and development and will eventually pick the right one for transfer back into the womb. </p>
<p>The embryo is gently transferred back into the womb on day five or six, in a process similar to that of a pap test. If you have many healthy embryos at this stage, they can be frozen for use later. </p>
<h2>Now you wait</h2>
<p>About a week-and-a-half to two weeks after your embryo was transferred, we can test to see if it’s attached to the womb. A simple blood test, or even home pregnancy test, will detect levels of human chorionic gonadotrophin (HCG), a sign that you are finally pregnant.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257149/original/file-20190205-86220-n16iwn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">There’s so much waiting when you go through IVF.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1081646393?src=MkcCgBb3qlTKDrT3OCxh-A-1-10&size=huge_jpg">Rawpixel/Shutterstock</a></span>
</figcaption>
</figure>
<p>For some, the test will be negative. If they have frozen embryos, they can try again without needing to take more injections and have a surgical procedure. </p>
<p>Others will receive a diagnosis after learning something about their eggs, sperm and embryos, which can help the IVF team adjust the cycle plan and improve the couple’s outcomes in future cycles. </p>
<p>For some, it was the last time they were going to try IVF, or fertilisation didn’t occur, or an embryo transfer could not be done. Disappointment, frustration and grief becomes part of the experience and couples may need support and counselling. </p>
<p>For many, a positive pregnancy test is the outcome. But there is still more waiting; after all, you are still 38 weeks away from delivery. A small number of pregnancies miscarry or are lost so support in early pregnancy and good obstetric care is vital. </p>
<h2>How much does it cost?</h2>
<p>The cost of IVF is hugely variable, and is dependent on your level of private health cover. The out of pocket costs, even with the highest level of cover may reach A$9,000 for the first cycle. And each test and process will change the price. </p>
<p>Sit down with your specialist and ask “can you talk me through all of the costs associated with this round of treatment?” and have them break it down.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/women-now-have-clearer-statistics-on-whether-ivf-is-likely-to-work-81256">Women now have clearer statistics on whether IVF is likely to work</a>
</strong>
</em>
</p>
<hr>
<h2>How do you find the right clinic?</h2>
<p>There is a big difference in the quality of fertility care you can receive across Australia, with some clinics having dramatically higher success rates than others. </p>
<p>But keep in mind some clinics may not show all the data. They may quote the pregnancy rates for “every started IVF cycle” or for “every embryo transfer”, meaning the cycles where there is no embryo to transfer are excluded – thus making the rates look unrealistically good. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257148/original/file-20190205-86228-5es6dh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Many factors affect a couple’s success rate.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/rQTNkcUT8uk">Tina Bo</a></span>
</figcaption>
</figure>
<p>Despite the desire to shop for price, asking the clinic specifically about your chance of taking home a healthy baby in their clinic, and finding a health care provider you feel comfortable with is key. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/five-traps-to-be-aware-of-when-reading-success-rates-on-ivf-clinic-websites-68806">Five traps to be aware of when reading success rates on IVF clinic websites</a>
</strong>
</em>
</p>
<hr>
<p>Your personal success may not be equal across two clinics, and you may save yourself money by finding a clinician and clinic with high success rates, and with a specialist who specialises in your condition, whether it’s <a href="https://theconversation.com/explainer-what-is-polycystic-ovary-syndrome-37203">polycystic ovary syndrome</a> (PCOS), <a href="https://theconversation.com/au/topics/endometriosis-2405">endometriosis</a>, or something else. </p>
<p>Never be afraid to ask as many questions as you have, and to ask for clarity when you don’t understand. Undertaking IVF is a big step.</p><img src="https://counter.theconversation.com/content/108910/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Louise Hull owns no shares in any IVF companies. I work independently in private practice in North Adelaide and have an affiliation with REPROMED for embryology services. I also work in New Zealand at Genea-Oxford Fertility.
I am an Associate Professor at The University of Adelaide. I have several small NGO grants for endometriosis and am a CIC on an NHMRC grant for implantation.</span></em></p><p class="fine-print"><em><span>Hannah Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>If you’re one of the one in six Australian couples experiencing infertility, you’ve probably thought about IVF. Here’s a step by step breakdown of how it all works.Hannah Brown, Chief Science Storyteller, South Australian Health & Medical Research InstituteLouise Hull, Associate Professor and Fertility and Conception Theme Leader, The Robinson Research Institute, University of Adelaide, University of AdelaideLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/876142018-05-20T19:49:23Z2018-05-20T19:49:23ZHow to choose the right contraceptive pill for you<figure><img src="https://images.theconversation.com/files/217892/original/file-20180507-166887-wtgu04.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">When looking for the right pill, women want to weigh up the cost, safety, efficacy and side effects of the pill.</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/cvB-vydRJvY">NordWood Themes</a></span></figcaption></figure><p><em>ON THE PILL: In this <a href="https://theconversation.com/au/topics/contraceptive-pill-1650">seven-part series</a> we explore the history, myths, side-effects and alternatives of the pill, and why it’s the most popular form of contraception in Australia.</em></p>
<hr>
<p>The <a href="https://www.fpv.org.au/for-you/contraception/daily-contraceptive-pills/contraceptive-pill">combined oral contraceptive pill</a> is the <a href="https://www.ncbi.nlm.nih.gov/pubmed/27373543">most popular contraception</a> in Australia. It’s less invasive than implants or devices that need to be fitted in the arm or uterus, making it an attractive option for many women. </p>
<p>There are more than <a href="https://www.nps.org.au/australian-prescriber/articles/choosing-a-combined-oral-contraceptive-pill#t1">30 types</a> of oral contraceptive pills. Different types and brands of contraceptive pill contain different types and doses of synthetic oestrogen and progesterone. </p>
<p>But brand names such as Microgynon, Levlen, Yaz, Brenda and Norimin give little indication of the ingredients, dose or who should use them. </p>
<p>When looking for the right pill, women want to weigh up the cost, safety, efficacy and side effects of the pill. Some women might also be seeking non-contraceptive benefits, such as treatment for acne, pre-menstrual syndrome, heavy or painful periods, endometriosis, or polycystic ovarian syndrome. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-what-are-the-options-for-birth-control-18613">Explainer: what are the options for birth control?</a>
</strong>
</em>
</p>
<hr>
<h2>Cost</h2>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=906&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=906&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=906&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1139&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1139&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217897/original/file-20180507-166910-c63ufu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1139&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A year of the pill costs anywhere between A$20 and A$360.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1014012175?src=9Kcm5et53VQ7XKjNKYT-cg-1-24&size=medium_jpg">Areeya_ann/Shutterstock</a></span>
</figcaption>
</figure>
<p><a href="https://www.nps.org.au/australian-prescriber/articles/choosing-a-combined-oral-contraceptive-pill#guiding-pill-prescription">Current guidelines recommend</a> GPs prescribe pills that are subsidised on the <a href="http://www.pbs.gov.au/pbs/home;jsessionid=1tzyuf0uoaqok1i36kl12bp9ad">Pharmaceutical Benefits Scheme</a> (PBS) for women to trial first. </p>
<p>And at less than A$120 a year (A$20 a year for concession card holders), they are the cheapest.</p>
<p>The newer and more expensive pills claim to be superior in reducing <a href="https://www.ncbi.nlm.nih.gov/pubmed/22786490">acne</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/22336820">PMS</a> or <a href="https://www.ncbi.nlm.nih.gov/pubmed/19835717">menstrual bleeding</a>, which is why they end up being prescribed. But all contraceptive pills have these advantages, and the evidence for supporting one over the other is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22696343/">limited or conflicting</a>.</p>
<p>You’ll <a href="http://www.abc.net.au/news/health/2016-09-23/raw-deal-on-the-pill-new-varieties-not-available-on-low-incomes/7868246">pay up to A$360 per year</a> for non-PBS prescriptions. </p>
<h2>Safety</h2>
<p>Healthy women often take the pill for many years, so its safety profile needs to be excellent. <a href="https://wiki.cancer.org.au/policy/Position_statement_-_Oral_contraceptives#_ga=2.66864684.366100634.1525588428-861852034.1525588428">The risk of breast cancer</a> is slightly increased while on the pill, resulting in an extra 1.5 women per 10,000 women getting breast cancer. But the pill actually protects against endometrial and ovarian cancer. </p>
<p>Taking the pill <a href="https://www.ncbi.nlm.nih.gov/pubmed/23825156/">doubles the risk of venous thromboembolism</a> (or VTE, where clots develop in the brain, legs or lungs), but it’s still less than the risk of developing VTE in late pregnancy. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-panic-about-the-pill-its-safer-than-driving-to-work-42325">Don't panic about the pill – it's safer than driving to work</a>
</strong>
</em>
</p>
<hr>
<p>The higher the oestrogen dose, the higher the risk of VTE, which is why pills with 50 micrograms of oestrogen (<a href="https://www.nps.org.au/medical-info/medicine-finder/microgynon-50-ed-tablets">Microgynon 50</a> and <a href="https://www.nps.org.au/medical-info/medicine-finder/norinyl-1-28-day-tablets">Norinyl-1</a>) are very rarely prescribed.</p>
<p>Pills with newer generation progesterones potentially double the risk of <a href="http://www.bmj.com/content/350/bmj.h2135">venous thromboembolism</a>. Yaz Flex – commonly prescribed for its convenient dosing dispenser (<a href="https://www.nps.org.au/medical-info/medicine-finder/yaz-flex-tablets#how-to-take-yaz-flex">Clyk</a>) and its reportedly low risk of weight gain and mood swings – contains one of these newer progesterones. It’s therefore <a href="https://www.ranzcog.edu.au/RANZCOG_SITE/media/RANZCOG-MEDIA/Women's%20Health/Statement%20and%20guidelines/Clinical-Obstetrics/Combined-hormonal-contraceptives-(C-Gyn-28)-Review-March-2016.pdf?ext=.pdf">not recommended as a “first use pill”</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=165&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=165&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=165&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=207&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=207&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217893/original/file-20180507-166874-35t1l1.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=207&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The Clyk dispenser releases the daily pill via machine rather than the traditional blister pack.</span>
<span class="attribution"><a class="source" href="http://yaz.xzw.me/">Yaz screenshot</a></span>
</figcaption>
</figure>
<p>The oestrogen dose in the pill is also responsible for the <a href="https://www.ncbi.nlm.nih.gov/pubmed/9617537">very slightly increased</a> risk of strokes and heart attacks. </p>
<p>The risks of VTE, strokes and heart attacks are also affected by a woman’s background risk of these conditions. Women <a href="https://www.ncbi.nlm.nih.gov/pubmed/9617537">may not be able to take the pill</a> if they <a href="http://www.nevdgp.org.au/files/educationevents/Medical%20Eligibility%20Criteria%20for%20Contractive%20Use%20-%20WHO%20summary.pdf">have a history of</a> heart disease, breast cancer, liver disease, VTE or migraines with aura; are over 50 or over 35 and smoke; have a BMI over 35; or have a family history of VTE.</p>
<h2>Efficacy</h2>
<p>The pill’s <a href="http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/failure-rates-table">failure rate of 9%</a> is high compared to long-acting reversible (LARC) forms of contraception, such as IUDs and arm implants. This means nine out of 100 women becoming pregnant after a year on the pill, compared with less than one women with an IUD or arm implant. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/few-australian-women-use-long-acting-contraceptives-despite-their-advantages-44896">Few Australian women use long-acting contraceptives, despite their advantages</a>
</strong>
</em>
</p>
<hr>
<p>If taken perfectly, the pill should work <a href="http://www.arhp.org/Publications-and-Resources/Quick-Reference-Guide-for-Clinicians/choosing/failure-rates-table">99.7% of the time</a>. But fewer than <a href="https://www.ncbi.nlm.nih.gov/pubmed/28874178">20% of pill takers</a> in one study were able to do that every month. And if you do miss a pill, the <a href="https://www.medscape.com/viewarticle/745447">complicated rules</a> surrounding missed pills are <a href="https://www.ncbi.nlm.nih.gov/pubmed/23040136">difficult to remember and understand</a>. </p>
<p>Decreasing the risk of unwanted pregnancy is best addressed by <a href="https://www.tandfonline.com/doi/full/10.3109/13625187.2010.529969">extending</a> whatever regime you pick. This means that rather than taking 21 active pills and seven inactive (sugar) pills to mimic a menstrual bleed, you take <a href="https://www.nps.org.au/australian-prescriber/articles/choosing-a-combined-oral-contraceptive-pill#effective-regimens">84 active pills</a>, followed by seven inactive pills and have a “withdrawal” bleed once every three months. </p>
<p>By running the pill packs together, you reduce the risk of ovulating if a pill is accidentally missed. </p>
<h2>Side effects</h2>
<p>The unwanted side effects of the pill include breakthrough bleeding, <a href="https://theconversation.com/theres-no-rushing-womens-syndrome-but-hormones-affect-mental-health-28136">mood changes</a>, weight gain, sore breasts and acne.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217895/original/file-20180507-166906-1yeq4yz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pill usually reduces acne, but some women may experience it as a side effect.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1083859292?src=kCBgB50qgLnSMjW8uU5yKQ-1-15&size=medium_jpg">Yurakrasil/Shutterstock</a></span>
</figcaption>
</figure>
<p>After a three month trial, if you experience any of these unwanted effects, but want to stick with the pill as a form of contraception, it might be helpful to change types or doses of hormones. For example:</p>
<ul>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2938905/">headaches</a> can be addressed by reducing the dose of oestrogen or changing to the newer oestradiol in <a href="https://www.nps.org.au/medical-info/medicine-finder/qlaira-tablets">Qlaira</a></p></li>
<li><p>nausea can be alleviated by taking the pill at night or reducing the oestrogen dose</p></li>
<li><p>breast tenderness and bloating can be treated by reducing the oestrogen or changing the progesterone to <a href="https://www.nps.org.au/australian-prescriber/articles/drospirenone-ethinyloestradiol">drospirenone</a>, which acts as a mild diuretic.</p></li>
<li><p>breakthrough bleeding can be addressed by remembering to take the pill at the same time each day. If that isn’t the problem, changing the progesterone type may work, particularly to norethisterone, which is in <a href="https://www.nps.org.au/medical-info/medicine-finder/brevinor-28-day-tablets">Brevinor</a> and <a href="https://www.nps.org.au/medical-info/medicine-finder/norimin-28-day-tablets">Norimin</a>.</p></li>
</ul>
<h2>Non-contraceptive benefits</h2>
<p><strong>Heavy or painful menstrual bleeding</strong></p>
<p>All hormonal contraception will change women’s menstrual bleeding patterns, generally to make it lighter or non-existent. And because you can skip the sugar pills, you can pick when and how often you bleed. </p>
<p>Most women experience <a href="https://www.racgp.org.au/afp/2017/october/the-management-of-irregular-bleeding-in-women-using-contraception/">irregular bleeding</a> when starting on the pill, but this generally decreases over the first three months. </p>
<p>Pills containing higher doses of oestrogen are better at reducing break through or irregular bleeding. <a href="https://www.nps.org.au/medical-info/medicine-finder/loette-tablets">Loette</a> or <a href="https://www.nps.org.au/medical-info/medicine-finder/microgynon-20-ed-tablets">Microgynon 20</a>, which have the lowest dose of oestrogen on the market – 20mcg of ethinyl oestradiol – won’t be as good if heavy and irregular bleeding is your problem. </p>
<p>Pills with the progesterone norethisterone, which is found in <a href="https://www.nps.org.au/medical-info/medicine-finder/brevinor-28-day-tablets">Brevinor</a> and <a href="https://www.nps.org.au/medical-info/medicine-finder/norimin-28-day-tablets">Norimin</a>, are generally considered to reduce bleeding more than the progesterone called levonorgestral (which is found in pills such as <a href="https://www.nps.org.au/medical-info/medicine-finder/monofeme-tablets">Monofeme</a>, <a href="https://www.nps.org.au/medical-info/medicine-finder/levlen-ed-tablets">Levlen</a> and <a href="https://www.nps.org.au/medical-info/medicine-finder/microgynon-30-ed-tablets">Microgynon</a>).</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217894/original/file-20180507-166893-ueyyen.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The pill usually reduces bleeding.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/718679488?size=medium_jpg">Shinja jang/Shutterstock</a></span>
</figcaption>
</figure>
<p><strong>Endometriosis</strong></p>
<p>The pill can be an effective way to treat endometriosis by suppressing the menstrual cycle. A continuous regime, skipping periods, is used to slow endometrial growth. </p>
<p><strong>Acne</strong></p>
<p>Reducing the acne-causing androgen hormones can help treat acne, alongside topical or antibiotic treatments. <a href="http://ep.bmj.com/content/90/4/ep98">All pills will do this</a>. </p>
<p>The progesterone <a href="https://www.nps.org.au/australian-prescriber/articles/cyproterone-acetate-ethinyloestradiol">cyproterone acetate</a> is used by itself for acne and is found in pills such as <a href="https://www.nps.org.au/medical-info/medicine-finder/brenda-35-ed-tablets">Brenda-35ED</a> and <a href="https://www.nps.org.au/medical-info/medicine-finder/diane-35-ed-tablets">Diane-35ED</a>, which are marketed for use in people with severe acne. However, there’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/22696343/">little evidence</a> they’re more effective than other pills at treating acne.</p>
<p><strong>Premenstrual syndrome</strong></p>
<p>Premenstrual syndrome (PMS) is a common condition that causes cramps, irritability, mood swings and tender breasts before a period. It can be debilitating in its more severe form of premenstrual dysphoric disorder (PMDD). </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/chemical-messengers-how-hormones-affect-our-mood-42422">Chemical messengers: how hormones affect our mood</a>
</strong>
</em>
</p>
<hr>
<p>Suppressing the hormonal fluctuations during the menstrual cycle using the contraceptive pill can help alleviate symptoms.</p>
<p>If pills listed on the PBS such as <a href="https://www.nps.org.au/medical-info/medicine-finder/levlen-ed-tablets">Levlen</a> are ineffective, your GP might recommend the combination of low-dose oestrogen and a type of progesterone called <a href="https://www.nps.org.au/australian-prescriber/articles/drospirenone-ethinyloestradiol">drospirenone</a>, found in <a href="https://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0014036/">Yaz</a>. </p>
<p><strong>Polycystic ovarian syndrome</strong></p>
<p>Women with polycystic ovarian syndrome (PCOS) can suffer from acne, irregular periods and excess hair. The pill is <a href="https://jeanhailes.org.au/health-a-z/pcos/management-treatment">one way to treating these symptoms</a>, along with lifestyle changes. </p>
<p><strong>Breastfeeding</strong></p>
<p>The mini pill is a <a href="https://www.fpv.org.au/for-you/contraception/daily-contraceptive-pills/the-mini-pill">progesterone only pill</a>, used mainly by breastfeeding mothers and those who can’t have oestrogen. </p>
<p>Users have a three-hour window to take their daily dose, otherwise it becomes ineffective. This dosing makes it difficult for most people to take effectively. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=469&fit=crop&dpr=1 600w, https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=469&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=469&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=589&fit=crop&dpr=1 754w, https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=589&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/217896/original/file-20180507-166900-1mdl5ch.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=589&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding women on the pill need to take it at the same time every day.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-mother-breastfeeding-her-newborn-1005876886">Tomsickova Tatyana/Shutterstock</a></span>
</figcaption>
</figure>
<p>Given the <a href="https://www.fpv.org.au/for-you/contraception/long-acting-reversible-contraception-larc/contraceptive-implant-implanonand">contraceptive implant hormonal IUD</a> can be used in breastfeeding women and those who can’t have oestrogen, and more reliably prevents pregnancy, the mini pill has few benefits.</p>
<h2>Find what is best for you</h2>
<p>The combined oral contraceptive pill has some great non-contraceptive benefits but some <a href="https://www.ncbi.nlm.nih.gov/pubmed/9617537">serious side effects</a>. Given the number of pills on the market to choose from, unwanted effects don’t need to be tolerated. You don’t need to commit the detail above to memory; your GP will guide you through the process of finding the right pill for you.</p>
<p>If the failure rate of the pill is an issue, or if changing your pill hasn’t alleviated your side effects, talk to your GP about reversible contraceptive options, including non-hormonal IUDs, which further reduce the risk of pregnancy and last five to ten years.</p><img src="https://counter.theconversation.com/content/87614/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anita Phillips does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There are more than 30 different types of contraceptive pills. But brand names such as Microgynon, Levlen, Yaz and Brenda give little indication of the ingredients, dose or who should use them.Anita Phillips, Deputy Director of Clinical Studies, School of Medicine, Faculty of Health, Deakin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823192017-08-16T22:50:18Z2017-08-16T22:50:18ZFive commonly over-diagnosed conditions and what we can do about them<figure><img src="https://images.theconversation.com/files/182175/original/file-20170816-22170-1op0ocd.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some conditions should be classified as normal in some people and don't need treatment. </span> <span class="attribution"><span class="source">from www.shutterstock.com.au</span></span></figcaption></figure><p>Today five influential Australian health-care organisations – representing professionals, the public and policy makers – have <a href="http://wiserhealthcare.org.au/national-action-plan/">released a statement</a> outlining that some medical conditions are being diagnosed too often, and calling for action to tackle over-diagnosis and the over-treatment it produces. </p>
<p>Over-diagnosis occurs when someone is diagnosed with a disease that wouldn’t harm them, or when treatment does more harm than good. It happens because healthy people are often tested or screened to find the early signs of disease, and because diagnostic technology can see ever-smaller abnormalities. </p>
<p>The problem is that early detection of disease is a double-edged sword. While it can be life-saving, for some people the “abnormalities” that are diagnosed and treated would never have caused harm if left alone. </p>
<p>Researchers are <a href="http://wiserhealthcare.org.au">currently investigating</a> the size of this problem, and how many people are over-diagnosed. But <a href="https://theconversation.com/au/topics/overdiagnosis-3771?page=2">existing evidence</a> from Australia and elsewhere suggests it’s a problem across a lot of conditions. </p>
<h2>Thyroid cancer</h2>
<p>Researchers documented in <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1604412">The New England Journal of Medicine last year</a> that Australia, like other nations including the United States, has experienced a recent tripling of the numbers of people diagnosed with thyroid cancer - many of them with very small tumours. </p>
<p>The problem is, as the researchers explain, many of those small tumours are in fact benign, and many of the people being diagnosed, and then treated with potentially risky operations and drugs, are over-diagnosed. </p>
<p>The <a href="http://www.nejm.org/doi/full/10.1056/NEJMp1604412">NEJM piece</a> estimated over 500,000 people may have been over-diagnosed in the past two decades, across 12 countries, including 10,000 people in Australia.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182176/original/file-20170816-4761-h6mu9b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Some thyroid cancers which are operated on don’t need to be, as they’re benign.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<h2>ADHD</h2>
<p>There are <a href="https://theconversation.com/moving-the-diagnostic-goalposts-medicalising-adhd-8675">on-going debates</a> about whether too many children are being diagnosed with and medicated for attention deficit hyperactivity disorder. </p>
<p><a href="http://www.cmaj.ca/content/184/7/755.abstract">A study</a> of almost one million Canadian children found those born in December were much more likely than those born in January to receive an ADHD diagnosis and medication, which could mean immaturity is being pathologised. Researchers concluded: </p>
<blockquote>
<p>These findings raise concerns about the potential harms of over-diagnosis and over-prescribing.</p>
</blockquote>
<h2>Prostate cancer</h2>
<p>Concerns about over-diagnosing prostate cancer date back at least 30 years. Many men will <a href="https://theconversation.com/latest-research-shows-surgery-for-early-stage-prostate-cancer-doesnt-save-lives-81089">die with prostate cancer, rather than of it</a>. Despite evidence of unnecessary diagnoses and over-treatment, the push to test healthy men, with no symptoms, for prostate cancer continues. </p>
<p>While it’s hard to know exactly how many Australian men are over-diagnosed with prostate cancer, <a href="https://www.uspreventiveservicestaskforce.org/Page/Document/draft-evidence-review/prostate-cancer-screening1">recently reported estimates</a> from the US suggest between 20-50% of prostate cancers diagnosed via screening (during the period of screening) may be over-diagnosed – in other words they would not have caused harm if left undetected. </p>
<hr>
<p><em><strong>Read more: <a href="https://theconversation.com/most-people-want-to-know-risk-of-overdiagnosis-but-arent-told-41889">Most people want to know risk of overdiagnosis, but aren’t told</a></strong></em></p>
<p><strong><em><a href="https://theconversation.com/costly-and-harmful-we-need-to-tame-the-tsunami-of-too-much-medicine-48239">Costly and harmful: we need to tame the tsunami of too much medicine</a></em></strong></p>
<p><strong><em><a href="https://theconversation.com/resisting-expanding-disease-empires-why-we-shouldnt-label-healthy-people-as-sick-56924">Resisting expanding disease empires: why we shouldn’t label healthy people as sick</a></em></strong></p>
<hr>
<h2>Polycystic ovary syndrome</h2>
<p>Polycystic ovary syndrome is an example of a condition where changes in the definition have greatly expanded the number of people potentially labelled. In a <a href="http://www.bmj.com/content/358/bmj.j3694">piece published today</a> in the British medical journal, the BMJ, Tessa Copp and colleagues from the University of Sydney show how the proportion of women of reproductive age who could potentially be labelled has jumped dramatically from around 5% using the 1990 definition, to up to 21% when using the 2003 definition. </p>
<p>As the authors suggest, there are concerns many healthy women may be labelled unnecessarily, causing anxiety about their fertility or long-term health. The authors therefore recommended a cautious approach to diagnosing the condition. </p>
<h2>Breast cancer</h2>
<p>Reflecting uncertainty around exactly how to measure over-diagnosis, there are sometimes wide variations in estimates of the size of the problem. A <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61611-0/abstract">major independent review</a> of the global evidence suggested 19% of the breast cancers diagnosed during active mammography screening may be over-diagnosed. This means they would not have caused harm to the women because they may be benign. </p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/19894130">Previous estimates in Australia</a> suggest the rate could be around 30%.</p>
<h2>What can we do about over-diagnosis?</h2>
<p>Together with colleagues Thanya Pathirana and Justin Clark, we’ve today published a <a href="http://www.bmj.com/content/358/bmj.j3879">comprehensive analysis</a> in the BMJ of possible drivers of over-diagnosis and potential solutions. Causes range from cultural beliefs that “more is better” in medicine, to financial incentives driving unnecessary tests and treatments.</p>
<p>The good news is doctors’ groups across the globe – including in Norway, Britain, Canada and now Australia – are now publicly acknowledging the problem of overdiagnosis.</p>
<p>As our <a href="http://www.bmj.com/content/358/bmj.j3879">BMJ analysis</a> highlights, there are many potential solutions. There’s an urgent need for public information and awareness campaigns. New educational curricula for health professionals are a priority. And screening programs need to be reformed to make sure we’re only targeting those at high risk.</p><img src="https://counter.theconversation.com/content/82319/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr Ray Moynihan receives grant funding from the Australian National Health and Medical Research Council, is co-chair of the scientific steering committee for the international Preventing Overdiagnosis conference, and was chair of the planning committee which organized the National Summit on Overdiagnosis in Australia.</span></em></p>Australian health-care organisations are urging action on treatments of people who don’t need them.Ray Moynihan, Senior Research Fellow, Bond UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/673082016-10-20T19:15:53Z2016-10-20T19:15:53ZIs the red wine compound resveratrol a miracle drug for infertility and ageing?<figure><img src="https://images.theconversation.com/files/142445/original/image-20161020-5009-1npr55r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Resveratrol is found at only trace levels in red wine.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/fitzchev/15251314332/in/photolist-peGYpo-6Ujusr-azdEM4-7PFZA1-7uFYiM-84vwYj-fm9mAq-ojZfp-7TKquV-4af16x-9ad82M-6oQEM8-5yQTGe-7i4rdY-9GMxPb-8HAVK9-qgH4JR-9tuGB4-5cnxH3-7zXgtF-6ugZ4-djjuS1-5Diavg-2C1dVt-7GpoNz-ewWBU1-7qvC6y-rnVrzw-5MhNbh-ofTM8X-g3oJU-61Keie-5Twc6L-a4S5mF-dXkC43-e4gTXq-4oqP1t-6Y1hBw-5H49Dy-7WN9vQ-kS6SS-aUSjeB-5E3jEy-3bWTn4-buwxtD-7zpig5-7NETQv-8ku5N1-acTaYC-5SEotn">Cyril Hanquez/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>“A glass of red wine a day could keep polycystic ovaries at bay,” <a href="http://www.dailymail.co.uk/health/article-3848452/A-glass-red-wine-day-polycystic-ovaries-bay-Compound-grapes-nuts-corrects-hormone-imbalance-women-PCOS.html">said a news headline this week</a>. This and <a href="http://www.tv3.ie/xpose/article/fitness-and-wellbeing/220449/Antioxidant-found-in-red-wine-lowers-chance-of-polycystic-ovaries">similar reports</a> were based on research from a team in Poland and California that showed high daily doses – 1,500 mg – of a natural compound found in red wine, called resveratrol, could lower steroid hormone levels in <a href="http://press.endocrine.org/doi/10.1210/jc.2016-1858">women suffering from polycystic ovarian syndrome</a> (PCOS). This, in effect, should lower symptoms of PCOS including weight gain, excess hair, infertility and abnormal menstrual cycles.</p>
<p>This is not the first time resveratrol has been linked to health benefits. Back in 2006, <a href="http://www.nytimes.com/2006/11/01/science/02winecnd.html">headlines announced</a> a “natural substance found in red wine” could extend lifespan in mice. The internet soon became flooded with <a href="http://www.ebay.com/sch/i.html?_from=R40&_trksid=p2050601.m570.l1313.TR0.TRC0.H0.TRS0&_nkw=resveratrol&_sacat=0">online sellers</a> of resveratrol supplements ranging from highly pure, to pills containing mashed up grape skins with very little resveratrol. </p>
<p>The fact resveratrol is naturally found in the skin of red grapes then led to the happy idea that drinking lots of red wine can make you live longer. But unfortunately, resveratrol is found at only <a href="http://www.ajevonline.org/content/43/1/49">trace levels</a> in red wine - so you would need to drink over a thousand bottles per day to obtain the amount of resveratrol found in two 250 mg pills.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142455/original/image-20161020-15094-2x04fx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Resveratrol is naturally found in the skin of red grapes.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/mynameisharsha/3596243364/in/photolist-6tMFRW-bwpyGC-73unWw-pWcx7-iuRtWL-b694Yp-d3nYTS-9k5qNd-8dVNzh-4mVb8E-d33AjL-gBz2xt-bvJU9y-76MeHq-a7KK33-5dgo9C-5XMkRM-5nSwQG-6Brg7c-9dagin-eCnugf-c7gK27-APMUiX-aqq92y-83zNeD-9VCuPx-d33AiQ-9yNNQ9-85iu3F-6rp3HC-91kt5u-v3tW2-efTaX2-85iukt-owjtYv-85mDiw-xxKy9D-85mDmj-tLXVjd-vzz8VE-vdm3XE-62F7Uz-ncrvi5-cDWQtY-jKpcKS-4C7hsn-swgMCF-pNciGd-qrF5Z-7p84hw">Harsha K R/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>The 2006 reports - based on a paper <a href="http://www.nature.com/nature/journal/v444/n7117/abs/nature05354.html">published in the esteemed journal Nature</a> – were exciting for science though. Resveratrol <a href="https://www.ncbi.nlm.nih.gov/pubmed/12939617">turns on an enzyme called SIRT1</a>, which is thought to enhance the age-delaying benefits of diet and exercise. The Nature study showed resveratrol extended lifespan in a mouse, an animal far more complex than the simple organisms the compound had previously been tested on, such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/12939617">yeast</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/15254550">worms and flies</a>.</p>
<p>Other studies of resveratrol in mice then showed benefits to <a href="http://www.nature.com/nature/journal/v444/n7117/abs/nature05354.html">lifespan</a>, diseases such as <a href="https://www.ncbi.nlm.nih.gov/pubmed/8985016">cancer</a> and <a href="http://www.nature.com/nature/journal/v450/n7170/full/nature06261.html">diabetes</a>, and <a href="http://www.ncbi.nlm.nih.gov/pubmed/15013856">inflammation</a>. So why has resveratrol not been made into a drug yet?</p>
<p>When it is taken as a pill, the liver <a href="https://www.ncbi.nlm.nih.gov/pubmed/15779070">quickly degrades the majority of resveratrol</a> before it can make it into the rest of the body. This means only a very small amount actually gets to other tissues where it could have an effect. So it would have to be given at very high doses. </p>
<p>But at doses where it can have an effect, resveratrol can <a href="https://www.ncbi.nlm.nih.gov/pubmed/20935227">cause gut problems</a> such as diarrhoea. Despite this, small <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782695/">clinical trials using resveratrol</a> in humans have shown some benefits to their <a href="https://www.ncbi.nlm.nih.gov/pubmed/21385509">metabolism</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/22520621">markers of inflammation</a>, and <a href="https://www.ncbi.nlm.nih.gov/pubmed/26362286">Alzheimer’s disease</a>. </p>
<p>There has also been controversy as to how resveratrol actually works; in particular whether it activates SIRT1, the enzyme thought to delay the ageing process. </p>
<p>David Sinclair, an Australian based at Harvard Medical School, first showed resveratrol could “turn on” SIRT1 in 2003. With a series of papers in quick succession, Sinclair showed resveratrol extended lifespan in <a href="https://www.ncbi.nlm.nih.gov/pubmed/12939617">yeast</a>, <a href="https://www.ncbi.nlm.nih.gov/pubmed/15254550">worms, flies</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed/16461283">fish</a>, and <a href="http://www.nature.com/nature/journal/v444/n7117/abs/nature05354.html">mice</a>. </p>
<p>Controversy struck when it was <a href="https://www.ncbi.nlm.nih.gov/pubmed/20061378">suggested</a> resveratrol was working through “off target” effects, meaning it was interacting with enzymes other than SIRT1. As a small molecule with a simple structure, it is likely resveratrol has non-specific interactions throughout the body, especially at higher doses. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=448&fit=crop&dpr=1 600w, https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=448&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=448&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=563&fit=crop&dpr=1 754w, https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=563&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/142456/original/image-20161020-15081-1a8bx7z.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=563&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Products containing resveratrol range from being highly pure, to pills containing mashed up grape skins with very little resveratrol.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/streamishmc/5547704360/in/photolist-qHpaYN-61HftU-fxFESK-5x3fQ1-bo2BFc-rsHUc-6zSN93-66kzUa-8HoMuq-7t6ZoF-akvYHo-69XFwT-nxgqkc-61mnoc-az1gPm-9sereb-8eRWdx-BWQB1S-v9gasS">Jason Tester Guerrilla Futures/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>But then in 2012, these doubts were assuaged, when mice genetically engineered to be missing the SIRT1 gene were found to be <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3545644/">immune to the effects of resveratrol</a>. In 2013, it was found resveratrol <a href="https://www.ncbi.nlm.nih.gov/pubmed/23471411">binds to and activates SIRT1</a> in a very intricate manner. So that part is clear.</p>
<p>There are still uncertainties as to how specific it is; such as with the recent study involving women with PCOS. PCOS is a <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/polycystic-ovarian-syndrome-pcos">common endocrine condition</a> that occurs when follicles in the ovary, which contain egg cells, swell up and the egg cell itself does not mature properly. The eggs contained in these cysts fail to be released at ovulation, which can cause infertility in women. </p>
<p>PCOS is thought to be caused by high levels of male steroid hormones known as androgens. Key risk factors for PCOS are metabolic problems such as high insulin levels, obesity, insulin resistance, and type II diabetes. Body weight reductions can therefore reduce PCOS risk.</p>
<p>Women suffering from PCOS experience irregular or no menstrual cycle, acne, hair growth and elevated levels of the male steroid hormone testosterone. In the recent study, resveratrol treatment lowered levels of testosterone, and its precursor DHEAS – two key steroid hormonal markers of PCOS. </p>
<p>But it’s actually not clear whether the testosterone reduction was due to a direct effect on the release of the hormone itself. This is because insulin, which at high levels can cause metabolic disease, was also reduced. As with other studies, it may be that resveratrol is actually improving metabolism, with reduced PCOS severity as a secondary side-effect. So there is still a lot we don’t know about the compound.</p>
<p>Should people want to go online and buy resveratrol, be aware it has not yet been approved as a drug by regulatory authorities. Also, plant-based resveratrol extracts such as Japanese knotweed contain a crude cocktail of compounds, some of which may be harmful, with only a small amount of resveratrol. Meanwhile, red grape skin pills are likely to contain vanishingly small quantities. </p>
<p>Stay tuned though: efforts to formulate resveratrol so greater proportions actually reach the rest of the body are underway.</p><img src="https://counter.theconversation.com/content/67308/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lindsay Wu's lab receives funding from Cancer Institute NSW, the National Helath and Medical Research Council (NHMRC) of Australia, and MetroBiotech NSW Pty Ltd. He is a director of Metro Biotech NSW, Intravital Pty Ltd, and Liberty Biosecurity Pty Ltd, and is a shareholder in Intravital, EdenRoc Sciences, and Hydra Capital. </span></em></p>You would need to drink over a thousand bottles of red wine per day to get the amount of resveratrol - the compound said to have many health benefits - needed to even have an effect.Lindsay Wu, Senior Lecturer, School of Medical Sciences, UNSW SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/644302016-10-05T01:59:54Z2016-10-05T01:59:54ZWeekly Dose: metformin, the diabetes drug developed from French lilac<figure><img src="https://images.theconversation.com/files/140206/original/image-20161003-20217-1bqbxvj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Metformin was originally developed from natural compounds found in the plant known as French lilac.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/evergestis/14755129566/in/photolist-f53VB7-knNu4-f4NEY6-f53WnU-f53WLA-f53Vdu-ou2PVN-eo8vmw-ou2QgY-nXnEdz-fdVFFa-ocKcep-f9cDq4-cfyKeL-ouePbD-phNTVh-oTngVd-6qciLK-cRNFbh-cSifP9-otRTXC-wdReZL-J7MpWf-2EA72-53WPXo">Vlad Proklov/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Metformin is the most widely used drug to treat type 2 diabetes globally. In Australia, approximately <a href="http://www.ncbi.nlm.nih.gov/pubmed/17565410">two-thirds of patients</a> with type 2 diabetes are prescribed metformin, either alone or in combination with other pills, or with insulin injections. </p>
<p>Alongside diet and exercise, metformin is considered the <a href="http://www.racgp.org.au/your-practice/guidelines/diabetes/8-managing-glycaemia/83-glucose-lowering-agents/">first-choice drug</a> to improve glucose control in type 2 diabetes. </p>
<p>Metformin hydrochloride is the <a href="http://www.nhs.uk/chq/pages/1003.aspx?categoryid=73">scientific or generic name</a> for the active ingredient in tablets sold in Australia under 40 different <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&t=&q=metformin">proprietary or brand names</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=870&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=870&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=870&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1093&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1093&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140417/original/image-20161005-15886-zrlnzp.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1093&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
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</figure>
<h2>History</h2>
<p>Metformin was originally developed from natural compounds found in the plant <em>Galega officinalis</em>, known as French lilac or goat’s rue. </p>
<p>Synthetic biguanides were developed in the 1920s in Germany, but their use was limited due to side effects. During the 1940s, however, French physician <a href="http://onlinelibrary.wiley.com/doi/10.1002/pdi.606/pdf">Jean Sterne</a> examined a new biguanide called dimethylbiguanide or metformin. At the time, it was being studied for the treatment of influenza, but Sterne recognised it had glucose-lowering properties. He proposed calling it glucophage, meaning glucose eater, a name with which it is still commercially associated today.</p>
<p>Metformin has been used to treat diabetes since the late 1950s. It is now on the World Health Organisation’s <a href="http://www.who.int/medicines/publications/essentialmedicines/en/">List of Essential Medicines</a> needed for a basic health care system. </p>
<h2>How does it work?</h2>
<p>Insulin suppresses the production of glucose by the liver. One reason glucose levels remain high in those with type 2 diabetes is due to insufficient insulin. The liver continues to inappropriately make large amounts of glucose, even when glucose levels are already high. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/138385/original/image-20160920-11131-12u3ppo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A French physician pioneered metformin for the treatment of diabetes and proposed calling it glucophage, meaning glucose eater.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Metformin is able to reduce glucose production by the liver by approximately one-third, through <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4676264/">mechanisms that remain to be fully understood</a>. When taken as directed, it will reduce the HbA1c, a marker of glucose control, by approximately <a href="http://www.ncbi.nlm.nih.gov/pubmed/27088241">0.5% to 1%</a>. </p>
<h2>Who uses it?</h2>
<p>Metformin is only indicated for lowering glucose levels in people with type 2 diabetes. However, it is also used off-label (<a href="https://theconversation.com/explainer-why-are-off-label-medicines-prescribed-44783">when medications are prescribed for conditions other than what they’ve been approved for</a>) to treat women with polycystic ovarian syndrome (PCOS) where it can be <a href="http://www.ncbi.nlm.nih.gov/pubmed/26060208">effective in some cases</a>.</p>
<p>Metformin is not used to treat people with gestational diabetes or type 1 diabetes, who must take insulin injections as required to control their glucose levels.</p>
<h2>How is it used?</h2>
<p>To work effectively, most people will take <a href="http://care.diabetesjournals.org/content/35/2/446">two to three grams of metformin</a> every day. To fit this much into a tablet, all medications containing metformin are the size of a small bullet and easily the biggest tablets people with type 2 diabetes will have to take. </p>
<p>Most people take their metformin twice a day (morning and night), although extended release formulations also allow for <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4006121/">once-daily dosing</a>. </p>
<p>Because metformin is most commonly <a href="http://www.ncbi.nlm.nih.gov/pubmed/17565410">used in combination</a> with other glucose-lowering drugs to manage type 2 diabetes, <a href="https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/PICMI?OpenForm&t=&q=metformin">fixed-dose combinations</a> combining metformin with other oral glucose-lowering agents are also available. </p>
<h2>What are the side effects?</h2>
<p>The most commonly reported side effects from metformin are gastrointestinal disturbances, such as nausea, diarrhoea, cramping and flatulence. These effect around <a href="http://www.nps.org.au/conditions/hormones-metabolism-and-nutritional-problems/diabetes-type-2/for-individuals/medicines-and-treatments/metformin">one in five people to some degree</a>. </p>
<p>Usually the symptoms are mild and seen when people use high doses, when first starting metformin or increasing doses.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=530&fit=crop&dpr=1 600w, https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=530&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=530&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=666&fit=crop&dpr=1 754w, https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=666&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/140254/original/image-20161004-20213-158cq1f.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=666&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Around one in five people taking metformin will experience side effects to some degree.</span>
<span class="attribution"><a class="source" href="https://upload.wikimedia.org/wikipedia/commons/d/db/Metformin_500mg_Tablets.jpg">Wikimedia Commons</a></span>
</figcaption>
</figure>
<p>The likelihood of developing side effects can be reduced by starting off with low doses and increasing them gradually. It is also recommended to take metformin with or after meals to reduce the initial risk of side effects. But even despite these precautions, side effects <a href="http://www.nps.org.au/conditions/hormones-metabolism-and-nutritional-problems/diabetes-type-2/for-individuals/medicines-and-treatments/metformin">prevent about 10% of people</a> with type 2 diabetes from taking meformin.</p>
<p>Metformin is associated with a rare but life-threatening condition known as <a href="http://www.ncbi.nlm.nih.gov/pubmed/26773926">lactic acidosis</a>, where the body builds up too much lactic acid. This can be caused by factors such as heart, liver or kidney failure. There is still controversy over whether metformin is the cause of lactic acidosis or whether it exacerbates the condition. </p>
<p>Unlike <a href="http://www.racgp.org.au/your-practice/guidelines/diabetes/11-glycaemic-emergencies/">some other anti-diabetic medications</a>, low blood-glucose levels are seldom observed when metformin is used on its own. Metformin also has the advantage over other agents in that it does not cause weight gain and in some people (especially women) with type 2 diabetes it may reduce their weight slightly.</p>
<p>Because metformin is largely removed from the body by the kidneys, people with type 2 diabetes who have impaired kidney function will <a href="http://www.nps.org.au/medical-tests/tests-by-conditions/for-individuals/kidney-problems-and-disorders-tests/for-health-professionals/medicines-to-be-aware-of/metformin-and-gfr">require lower doses</a> to maintain safe levels and prevent side effects. </p>
<h2>How much does it cost</h2>
<p>Metformin is fully funded through the <a href="http://www.pbs.gov.au/medicine/item/1801T">Pharmaceutical Benefits Scheme</a> for use in people with type 2 diabetes, with a maximum consumer price of A$19.08. </p>
<h2>Drug interactions</h2>
<p>Metformin competes for clearance by the kidneys with drugs including <a href="https://theconversation.com/weekly-dose-digoxin-the-heart-medicine-that-may-have-given-us-van-goghs-starry-night-57980">digoxin</a> (for heart rhythm problems) trimethoprim and vancomycin (antibiotics), ranitidine and cimetidine (for heartburn), nifedipine and furosemide (for blood pressure) which all have the potential to modestly increase metformin levels. </p>
<p>In practice, metformin can be safely given in people taking these other agents with cautious observation.</p>
<h2>Controversies</h2>
<p>Metformin was not approved by the United States Federal Drug Agency (FDA) until <a href="https://web.archive.org/web/20070929152824/http://www.fda.gov/bbs/topics/ANSWERS/ANS00627.html">late 1994</a>. This was because one arm of a large clinical trial was stopped prematurely in 1971 when participants receiving a potent biguanide (known as phenformin) <a href="http://jama.jamanetwork.com/article.aspx?articleid=338569">died more often</a> and had an increased risk of lactic acidosis. </p>
<p>It remains controversial as to whether metformin can be used to prevent diabetes as well as treat it. Some clinical trials have shown that metformin is at least as effective as diet and exercise for <a href="http://www.ncbi.nlm.nih.gov/pubmed/22442395">preventing diabetes</a> in those at high risk of developing it.</p>
<p>The requirement to always discontinue metformin in patients with renal impairment has also undergone a <a href="http://www.ncbi.nlm.nih.gov/pubmed/27330130">rethink</a> in the last few years, as the risks of its use appear to be less than those associated with alternative therapies that expose patients to risk of hypoglycaemia, fluid retention or other side effects.</p><img src="https://counter.theconversation.com/content/64430/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Merlin Thomas has received honoraria for educational symposia conducted on behalf of pharmaceutical companies that manufacture drugs for the management of diabetes, including metformin. He has received funding from NHMRC and JDRF for research into diabetes. </span></em></p>Metformin has been used to treat diabetes since the late 1950s. It is now on the World Health Organisation’s List of Essential Medicines needed for a basic health care system.Merlin Thomas, Adjunct Professor of Preventive Medicine, Baker Heart and Diabetes InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/372032015-02-11T04:08:33Z2015-02-11T04:08:33ZExplainer: what is polycystic ovary syndrome?<figure><img src="https://images.theconversation.com/files/71549/original/image-20150210-24697-dqhq5v.jpg?ixlib=rb-1.1.0&rect=0%2C288%2C1300%2C667&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Women diagnosed with PCOS often will have good outcomes with diet and lifestyle changes.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/hey__paul/7687804892">Hey Paul Studios/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Polycystic ovary syndrome (PCOS) is a hormonal condition that disrupts ovulation and the menstrual cycle. It’s the most common female hormonal condition, affecting <a href="http://www.ncbi.nlm.nih.gov/pubmed/19910321">roughly one in 12 Australian women</a>. </p>
<p>Women with PCOS often have enlarged ovaries that contain small fluid-filled follicles, or cysts. These cysts are where the condition gets its name: polycystic = many cysts. </p>
<p>But although up to a third of women may have polycystic ovaries seen on an ultrasound, not all have the hormonal problems and physical symptoms that define PCOS. </p>
<p>For women with PCOS, the hormonal imbalances cause a number of symptoms such as irregular or absent periods, weight gain, acne, excessive body hair, mood changes, dark patches of skin and thinning head hair. </p>
<p>Because women with PCOS may not ovulate regularly or may not ovulate at all, some women may have difficulties getting pregnant. </p>
<p>While the cause for the hormonal imbalance is not yet known, it is believed to have some genetic basis.</p>
<h2>Symptoms and related illnesses</h2>
<p>PCOS is often first diagnosed in the late teen years, when young women notice the greasy skin of adolescence refusing to go away, as well as irregular and unpredictable periods.</p>
<p>To diagnose PCOS, GPs assess the patient’s symptoms and may take some blood test to check her hormone levels. The GP may also order an ultrasound of the uterus, ovaries and pelvis. </p>
<p>Women with PCOS are often more likely to put weight on around their waists. This form of body fat distribution is associated with the development of diabetes and heart disease later in life, so GPs may do further testing for these conditions.</p>
<p>Women with PCOS are also at increased risk of cancer of the womb, as the irregular periods and absent ovulation can lead to uncontrolled thickening of the lining of the womb. </p>
<p>But while some women with PCOS can present with a range of conditions, others may have no symptoms at all. These women may never develop any significant symptoms, or only experience symptoms when they are above a healthy weight.</p>
<h2>Treatment</h2>
<p>To decrease the risk of cancer, heart disease and diabetes, women with PCOS need to take particular care with their health from an early age. Doctors will provide advice to women with PCOS about diet and exercise, and some women may find their symptoms resolve as they lose weight.</p>
<p>To alleviate symptoms of PCOS, doctors may prescribe the contraceptive pill. The pill regulates hormones and is an excellent way to control greasy skin and irregular periods, as well as providing contraceptive protection.</p>
<p>Woman with early signs of diabetes may be prescribed <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">metformin</a>, which addresses the cause of diabetes and helps with the symptoms of PCOS. It can also lead to regular ovulation for woman trying to get pregnant. Interestingly, if taken during pregnancy it may <a href="https://clinicaltrials.gov/ct2/show/NCT00994812">reduce the risk</a> of miscarriage. </p>
<p>The downsides to metformin treatment is it can make women feel sick, bloated or cause diarrhoea. </p>
<p>For symptoms related to high male hormones such as increased body hair, thinning head hair or acne, doctors may prescribe <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">anti-androgen medications</a> to reduce these hormone levels. These medications are often combined with birth control pills and should not be taken when trying to get pregnant. </p>
<h2>Fertility</h2>
<p>Women with PCOS who are trying to get pregnant can often conceive naturally by achieving and maintaining a healthy weight. </p>
<p>Some women may need gentle stimulation of the ovary, by <a href="http://www.womenshealth.gov/publications/our-publications/fact-sheet/polycystic-ovary-syndrome.html">tablets or injections</a>, to stimulate ovulation (this also allows women to time sex around ovulation). Expert fertility doctors must oversee this process to ensure patients are not at risk of a multiple pregnancy. </p>
<p>Unless a woman has problems with her fallopian tubes or her partner’s sperm count, it’s rare that she will require IVF to get pregnant.</p>
<p>If, for other reasons, a woman with PCOS does need IVF treatment, she has a increased risk of an exaggerated response to the drugs: a condition known as “hyperstimulation”, where the ovaries become swollen and painful. However, under the care of a fertility doctor, the risk of hyperstimulation is very low.</p>
<p>If you’re concerned about PCOS, talk to your GP to get your symptoms under control and help reduce the risk of complications such as diabetes, heart disease and fertility problems.</p><img src="https://counter.theconversation.com/content/37203/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Roger Hart consults and owns shares in Fertility Specialists of Western Australia. He receives funding from National Health and Medical Research Council. </span></em></p>Polycystic ovary syndrome (PCOS) is a hormonal condition that disrupts ovulation and the menstrual cycle. It’s the most common female hormonal condition, affecting roughly one in 12 Australian women. Women…Roger Hart, Professor of Reproductive Medicine, The University of Western AustraliaLicensed as Creative Commons – attribution, no derivatives.