Polycystic ovary syndrome (PCOS) is a common hormonal disorder that disrupts a woman's menstrual cycle and affects fertility. But, what are the other lasting health implications?

As September marks PCOS Awareness Month, experts share their thoughts on the long-term impacts of PCOS and also debunk some of the common myths about the condition.

In women with PCOS, ovaries produce an excessive quantity of androgens, the male sex hormones typically found in minimal quantities in the female body. The excessive androgen production could be due to multiple cysts on ovaries and in some cases, it might be because of insulin resistance – a condition wherein cells do not respond well to insulin.

According to the WHO, PCOS affects around 8-13% of reproductive-aged women globally, and as many as 70% of them may remain undiagnosed.

Common misconceptions about PCOS

Myth 1: Women with PCOS cannot get pregnant.

Fact: PCOS indeed affects fertility as the hormonal imbalance limits the frequency of ovulation. However, by correcting the underlying metabolic issue that contributes to the infrequent ovulation, most people with PCOS can get pregnant.

"By ovulating more frequently/monthly, women with PCOS should have the same chances of getting pregnant as anyone else their age who is ovulating. Treatment options for PCOS include medications such as clomiphene citrate (also known as Clomid) or letrozole (Femara) that can result in more frequent ovulation. These medications can be combined with the use of insulin-sensitizing agents, which can reverse the insulin resistance that can also contribute to infrequent ovulation. Not all women with PCOS have insulin resistance, so the latter intervention may not be beneficial for all women with PCOS," Dr. Molina Dayal, a board-certified obstetrician-gynecologist and fertility specialist at STLFertility in St. Louis, Missouri, told Medical Daily.

To ensure the success of treatment, it is also important to rule out other contributing fertility issues such as sperm or tubal issues, Dr. Dayal said.

Although PCOS disrupts the menstrual cycle and ovulation, many women may conceive even without intervention, according to Dr. Lora Shahine, a reproductive endocrinologist at Pacific NW Fertility in Seattle.

"Irregular and unpredictable ovulation can make it more difficult to time trying to conceive and take longer, but many women with PCOS conceive without intervention. I recommend people with irregular, unpredictable menstrual cycles not wait for a year of trying before they see a doctor while trying to conceive – they should have a thorough evaluation and know options for ovulation induction and treatment," Dr. Shahine told Medical Daily.

Myth 2: You need to be taking care of PCOS only if you are trying to be pregnant.

Fact: PCOS is not just a fertility issue, but also a metabolic disorder that has long-term impact on physical and mental health.

"PCOS is often diagnosed when someone is trying to conceive so that can be the focus of medical care but patients should realize PCOS can impact cardiovascular health, metabolism, insulin resistance and more," Dr. Shahine said.

Studies have shown that apart from reproductive complications, women with PCOS have a higher risk of developing diabetes, hypertension, heart disease, asthma and musculoskeletal problems. They are also more likely to develop mental health disorders like depression and anxiety.

"Women with PCOS tend to have an increased incidence of insulin resistance (pre-diabetes), diabetes, hypertension and elevated cholesterol/lipid levels. All of these can potentially increase the likelihood of long-term health and cardiac problems. In addition, because women with PCOS infrequently ovulate, they have a higher incidence of developing endometrial (uterine) pre-cancer and cancer," Dr. Dayal explained.

Myth 3: PCOS always requires treatment with hormonal drugs.

Fact: The treatment depends on the end goal of the patient.

"PCOS symptoms can be relieved with many options. Each person is unique and no one lifestyle change, supplement or medication will work for everyone," Dr. Shahine noted.

Since PCOS is also a metabolic disorder, many of the symptoms can be relieved by making lifestyle modifications.

According to Dr. Dayal, diet and exercise are key to the success of treatment and long-term maintenance of health.

"Every woman with PCOS should be counseled about diet and exercise with the knowledge that these can be difficult lifestyle changes to start and continue. Support from a licensed nutritionist and possibly a personal trainer/gym membership/exercise buddy can be pivotal in helping women with PCOS treat (and possibly reverse!) their underlying metabolic disorder," she said.

Myth 4: Women with PCOS always have polycystic ovaries.

Fact: The name polycystic can be misleading as many people with PCOS may not have cysts on their ovaries.

"The presence of polycystic ovaries is not specific to PCOS. Not all women with PCOS have polycystic appearing ovaries. Conversely, some women without PCOS can have polycystic appearing ovaries," Dr. Dayal explained.

Other symptoms of PCOS include irregular menstrual cycles, excessive facial or body hair growth, acne, male pattern baldness, skin tags on the neck and in the armpits, weight gain around the abdomen and pelvic pain.

Myth 5: All PCOS patients are obese, and it is impossible to lose weight.

Fact: It might be difficult and even frustrating to lose weight with PCOS. But with the right food choices and lifestyle modifications, weight loss can be achieved.

"Weight loss can be difficult with or without the diagnosis of PCOS. The key to success is not just losing weight at the beginning but also maintaining the achieved weight loss. Lifestyle changes such as making smarter food choices like eating less processed food, decreasing caloric intake, increasing caloric expenditure and improving sleep can help with weight loss," Dr. Dayal told Medical Daily.

"Many times, it is difficult to achieve these goals on one's own, and getting assistance from a licensed nutritionist and/or personal trainer will be helpful in the short and long term. In addition, finding an exercise buddy can be useful in sharing goals and being consistent with follow-through. If you don't know where to start, then reach out to your healthcare provider as they can provide you with resources and methods for achieving your goals," she added.