Polycystic ovarian syndrome (PCOS) is a common condition that affects one in 15 women and can impact women's bodies in different ways, including making it more difficult to lose weight, adding in acne and unwanted hair growth, causing infertility, and more.
One of the most prevalent ways that women are affected is with either completely absent or irregular periods. "When it comes to polycystic ovarian syndrome, one of the things that can happen is that women don't get their periods or they get them irregularly," explained Dr. Stephanie Long, MD at One Medical. This can cause harmful changes in the uterine lining that can be life-threatening. "We want to help protect those women against having uterine changes that could lead to uterine cancer later in life." This includes "endometrial hyperplasia [thickening of the uterine lining that can lead to cancer] and changes to the uterine lining that are unhealthy, from having unchecked or uncontrolled signals to their uterus."
There are different approaches to treating PCOS's uterine impact (including natural remedies, like exercise and acupuncture); many women opt for hormonal birth control pills to help with those aforementioned "unchecked or uncontrolled signals to the uterus." But what if you can't take the pill? There are over a dozen reasons that might prevent someone from taking hormonal birth control pills (including blood clots, migraines with auras, lupus, and even diabetes), but in some cases, you can use a hormonal IUD as a way to prevent unhealthy uterine changes and cancers.
"There's a cycle that involves your brain, ovaries, and uterus to make a period come — that is changed with polycystic ovarian syndrome," she said. "The end result is that you don't get your period, but we want to make sure that we protect the uterus." How does that happen? "The way we do that is that we help with irregular signaling through giving birth control. Traditionally that has been with pills, but we also know that using a progesterone-based IUD helps prevent the lining of your uterus from getting signals to grow and shed irregularly."
What About the Cysts?
But what about your cysts? One of the (rare) side effects of the IUD can be ovarian cysts — so why would you add an IUD into the mix when you're already dealing with a cyst issue? Dr. Long explained that "it's not so much that the IUD creates more cysts — IUDs, even the ones that have hormones in them, they really just work in your uterus. The amount of hormones in the rest of your body is so low that it doesn't prevent ovulation." She said that "for someone who might develop ovarian cysts, an IUD's not going to help protect against that the same way another birth control would."
So how do you treat the cysts? Do you need to? "With polycystic ovarian syndrome, you have lots of follicles — things that could become eggs — that don't get the signals in the right way to have one dominant one mature to become an egg," she said. "With an IUD, those cysts will stay in their half state and not progress to be enlarged cysts that have clinical significance or a ruptured cyst." Dr. Long explained that there are many different "pathways" to treat cysts.
"We pick a combination of things that creates the right pathway," she said, explaining the treatment method varies for each woman. "We look at the root cause of PCOS, what it causes for you, side effects you don't like, and think about the things we have to help prevent for your health for the future."
The root cause of PCOS is unclear, but as far as Dr. Long knows, it's "some degree of insulin resistance in your ovaries," she shared. There are a number of solutions, but doctors look at it holistically in addition to treating with an IUD. "We help your tissues across your whole body be more sensitive to the effects of insulin so that we help with your diabetes risk, weight control issues, with ovulation, and with the cardiovascular disease risk factors."
"When I talk to young women about PCOS, I want them to understand that yes, there's some direct focus on your period, but let's know why we're talking about your period," she said. She emphasized that the most important part is "the lifestyle treatment," which includes "exercising regularly and healthy diet changes" (she mentioned lightening the glycemic load is paramount). "I want to protect you from premature coronary artery disease and diabetes in the future, regardless of what's going on with our fertility conversation."
What About Fertility?
Cysts become an issue when someone wants to get pregnant, but Dr. Long shared that "PCOS is one of the most correctable forms of infertility we can identify, from a pure 'how do we get you to ovulate' perspective." She noted that the IUD won't negatively impact fertility.
In addition to using an IUD as a treatment, consider working with a nutritionist and a healthcare provider (read: your general practitioner or OBGYN). "There are full treatment centers for PCOS," she said, which provide "educational and nutritional support," but you can get this from your primary care provider as well. She noted that "a healthy lifestyle that helps mitigate disease" is your best bet. Your combination of treatments and "pathways" will be unique to your body and its response to each kind of treatment, but an IUD can play a major part in protecting your body in the long run.