PCOS–long name Polycystic Ovarian Syndrome, affects around 10 percent of the female population between the ages of 15 and 44…the childbearing years. A hormonal condition that can affect menstruation, appearance (skin health, hair patterns resembling those of males), and probably most well known, fertility. PCOS is typically diagnosed when women are trying to get pregnant and have difficulty. But, it can show up any time after puberty.
In younger women, PCOS can show up as irregular periods (spaced out or unusually long periods), excess facial or body hair, severe acne, or sometimes even hair loss that resembles male pattern baldness.
PCOS pretty much hits females in all the places it really hurts.
So, who gets PCOS?
It doesn’t seem to discriminate much. There is equal risk of PCOS across races and ethnicities; however, the risk may be elevated if you are markedly overweight or if you have a mother, sister, or aunt with the condition.
Okay, so if we don’t know much about who’s at higher risk for it, do we at least know what causes it?
Not exactly. What doctors do know is this:
- women with PCOS have higher levels of the so called “male” hormone – androgen, which seems to explain the hair issues
- excess insulin might be responsible for the increase androgen production, causing difficulty with ovulation
- research has shown that women with PCOS have a type of low-grade inflammation (white blood cells’ production of substances to fight infection) that stimulates polycystic ovaries to produce androgens, which can lead to heart and blood vessel problems
And this all affects fertility how?
If you have PCOS, the hormonal imbalance interferes with your eggs. The eggs naturally grow in structures called “follicles,” which are found in your ovaries. When the egg matures, the follicle cracks open to release the egg from the ovary making it available to be fertilized; it’s the process referred to as “ovulation.” If you don’t ovulate, you can’t get pregnant. It’s tough, but it’s really common. In fact, among female infertility causes, lack of ovulation is to blame 40 percent of the time.
This graph from Shady Grove Fertility explains the PCOS numbers a bit more. Among the 40% of ovulatory disorders that cause infertility, 85% of them are diagnosed as PCOS.
And how is all of this related to MTHFR?
MTHFR is necessary for about a million crucial bodily processes, like detoxification, energy production, repairing and building DNA and RNA, building immune cells, repairing cell membranes, processing hormones and more. In order for the ovulation process to run smoothly, specific hormones are necessary.
A further PCOS/MTHFR connection: women with PCOS are predisposed to higher homocysteine levels than other women. In general, the most common cause of elevated homocysteine levels (hyperhomocysteinemia) is reduced activity of MTHFR.
And there’s a folate connection. If you’ve studied MTHFR at all, you’re likely aware that a mutation or variant that causes reduced MTHFR presence or function is also strongly associated with folate deficiency. We know that folate is important for women who are trying to conceive or who are pregnant, due to the effects it has on the development and health of the fetus; but studies also show that it’s helpful to reduce symptoms in women with PCOS.
Truth: there’s still no “eureka” answer to the cause of PCOS. But it seems there are too many connections between MTHFR and PCOS to treat it like a coincidence.
If I get tested and find out I have an MTHFR variant, and I treat THAT, will I increase my chances of fertility?
When you have polycystic ovary syndrome (PCOS), it’s important to understand that it’s not just something in your ovaries; it can influence weight, blood sugar, excess male hormones, etc…it’s complex and requires a comprehensive approach.
If you have an MTHFR variant, like more than half of the population does–or even if you just suspect it–taking an active, easily absorbed form of folate is a great big step in the right direction (there may also be low B12, low B6 and/or low zinc). By and large, lifestyle and dietary changes, plus the addition of ovulation-related medications, is the treatment plan for women who are going through infertility due to PCOS. But don’t forget that PCOS isn’t just about fertility.
Whether you’re trying to build a family or you’re just trying to feel better, your symptoms CAN BE addressed. Go get healthy.