The Connection Between Cervical Health, Fertility, and PCOS

Did you know that January is cervical health awareness month? Though this body part is often overlooked when it comes to diagnosing and discussing PCOS, it’s important to understand whether polycystic ovarian syndrome affects cervical health, and if so, how. In this article we’ll be covering: 

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• What is the cervix?
• Are women with PCOS at increased risk for cervical cancer?
• Fertility and PCOS 
• Fertility treatments 

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Let’s begin!

What is the cervix? 

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You may have heard of the cervix, but a surprising number of the population (men and women included) may not know what it does, or exactly where it lies in the female body. The organs in the female reproductive system include the uterus, ovaries, fallopian tubes, cervix, and vagina. Situated at the entrance to the uterus, the cervix carries out a number of tasks: for instance, it not only acts as a bridge between the vagina and the uterus, but it also directs blood during menstruation, dilates before childbirth, and helps gatekeep sperm before they’re able to reach the fallopian tubes. 

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Check out the following diagram to see how it all slots together:

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Source: Research Gate 

Is there a link between PCOS and cervical cancer? 

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Given how important the cervix is, and its critical role in the female reproductive health system, many women with PCOS (understandably) worry if they’re at increased risk for cervical cancer. The good news is that there is no evidence that women with PCOS are at increased odds of being diagnosed with cervical cancer. 

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Of course, it’s still of utmost importance that you have your regularly scheduled pap smear. This is a routine gynecological test that checks abnormal cells that could indicate cervical cancer; evidence suggests that 83% of cervical cancer cases could be prevented through a smear test. That’s how effective they are at catching any issues early - and especially given that they are typically required only every year (or every other year), they are well worth attending. It’s also worth noting that the CDC offers a National Breast and Cervical Cancer Early Detection Program that provides “low cost breast and cervical cancer screenings” if you are based in the U.S. Criteria for eligibility includes your age, whether you have health insurance or your insurance fails to cover these screenings, as well as other factors (keep in mind that there are always exceptions, so if you don’t fit 100% of the criteria, you are still encouraged to contact a program in your area!). 

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That being said, there is reason to believe that women with PCOS may be at heightened risk for endometrial cancer. The National Library of Medicine released this article which posited that women with polycystic ovary syndrome have a 2.7x risk of developing this disease, potentially as a result of the endometrium’s prolonged exposure to estrogen, which causes the endometrium to become thick, and leads to a precancerous condition called endometrial hyperplasia. The article goes on to point to “recent data that suggest the use of metformin may be protective for both endometrial and breast cancer,” but more research needs to be conducted before any definitive conclusions can be reached. 

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Though this information can feel alarming and distressing, the above findings do not mean that if you have PCOS you are guaranteed to get any type of cancer. Like with most health conditions, lifestyle, genetics, environment, and several other factors combine over the course of years to produce health outcomes. So, as a woman with PCOS, how could you theoretically reduce your risk for endometrial cancer? 

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• Maintaining a healthy diet (check out these tips on how to follow a PCOS diet)
• Being physically active 
• Taking oral contraceptives for at least one year (although these can come with side effects)
• Taking a combination of estrogen and progestin as part of hormone therapy (as opposed to just estrogen)

Fertility and PCOS

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Being a reproductive health condition, PCOS has the ability to impact a woman’s ovulation and fertility. If you have PCOS, there is the possibility that you may have increased difficulty getting pregnant (if you want to). This could be thanks to a culmination of factors, including high levels of female androgens (male sex hormones), small cysts on the ovaries, thickening of the outer portion of the ovaries, and high insulin levels in the blood. The above can then result in missed or irregular periods. 

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Now, this does not mean that if you have PCOS you will have fertility issues. However, if you do fall into this camp, there are options available. Because although there is no known cure for PCOS, there are treatment options that help you manage symptoms effectively. 

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Fertility treatments

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• Clomifene 

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This medication promotes the monthly release of an egg from the ovaries. It is often the first line treatment for women with PCOS, alongside a healthy diet and increased physical activity. 

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• Metformin 

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Often used to treat type 2 diabetes, this medication can lower insulin and blood sugar levels in women with PCOS. It can stimulate regular monthly periods, lower the risk of miscarriage, and even lower high cholesterol as well as the risk of heart disease. Like many medications, metformin can come with side effects, so keep this in mind (for supplements that may help offset some negative effects of metformin, check out this article). 

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• IVF 

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In vitro fertilization, otherwise known as IVF, is where eggs are collected from the ovaries and subsequently fertilized by sperm in a lab. The fertilized egg is then transferred to the uterus. IVF can be carried out with one’s own embryos, or that of a donor. Typically, each cycle takes around 3 weeks to complete. 

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IVF is generally considered a “third line treatment” for women with PCOS, if first line treatments don’t work (more on these below!). That being said, IVF does boast high efficacy rates, “with pregnancy rates reaching up to 50% from a single treatment cycle.” Of course, outcomes need to be weighed against the challenges with this line of treatment, such as multiple births and high treatment costs. 

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• Nutritional and lifestyle changes 

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Supplements, nutrition, and lifestyle are concerned first line treatments when approaching PCOS and fertility. 

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We have an entire article dedicated to the best evidence-backed supplements for PCOS, but remember to always consult with a medical professional before supplementing. Some supplements are fat soluble, which means they are stored in the body. In this scenario, any excess of the vitamin or mineral does not pass out of the body as easily as its water-soluble counterpart, and so some vitamins or minerals can lead to things like Vitamin D toxicity, or zinc overload, for instance. When working with a medical provider, they will likely conduct blood tests to evaluate not only what you may be deficient in, but they will also help monitor your progress and ensure that your body is kept well balanced. (Learn more about how Allara Health pairs you with your own personal medical team to run diagnostics, understand your body, and cater to what it needs). 

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Of course, exercise and lifestyle choices are also a key part of the picture. When considering what reasonable and accessible changes you’d like to make (such as aiming to exercise more each week, switch out some processed foods for home-made foods, and so on), it’s important to focus on the bigger picture. That means working with a medical professional, such as a registered dietitian, to look at things like your work schedule, personal commitments, and personal goals, and create a realistic, holistic plan of attack that will work for your mental and physical health. 

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It’s also worth mentioning that just as metformin’s efficacy is - at least in part - bound up in its ability to reduce insulin sensitivity, there are other ways to try and prevent sugar spikes and crashes, as well as mitigate health complications associated with undesired weight gain. Evidence suggests weight loss can yield improvements in endocrine function (such as reduction in testosterone and free androgen index): however, it’s important that any changes are carried out under the advisement of a trusted healthcare provider. We’d like to emphasize here that crash dieting (though normalized on social media and online) is extremely unsustainable and dangerous; since food can be an emotionally and psychologically charged subject, it may be worth it to work with a registered dietitian to make sure - first and foremost - that your long-term health and physical needs are looked after before making any changes. 

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Allara Health provides personalized treatment for hormonal, metabolic & gynecological conditions that utilizes a holistic plan that merges nutrition, lifestyle, medication and supplementation, and ongoing, expert support to heal your body.

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