The Effect of Anovulation on the Sexual Function of Women With PCOS
Polycystic ovary syndrome (PCOS) is a condition in which a woman’s body produces an excess of androgens. Androgens are thought of as male hormones, but women have them too, though usually in small amounts. The hormonal imbalance can cause irregular periods, excess facial and body hair, severe acne, cysts in the ovaries, and/or infertility due to anovulation. Anovulation is the medical term to describe the absence of ovulation, meaning that an egg does not release from the ovary during a woman’s menstrual cycle.
PCOS affects women of childbearing age and is the most common reproductive endocrine disorder, occurring at a rate of 10-15% worldwide. Most of the research on PCOS thus far is related to its diagnosis, treatment, and fertility outcomes. However, a recent Journal of Sexual Medicine study explored the potential effect of hormonal changes and ovulation/anovulation on the sexual function of women with PCOS.
A total of 76 women with PCOS and 133 healthy women between the ages of 20-30 participated in this study. The patients with PCOS were recruited from the Division of Endocrinology of the University Hospital of Patras in Greece, and the women from the control group were recruited from female sexuality workshops that were held at the University of Athens and the University of Patras. All of the participants had been sexually active within the last four weeks before the study.
- The researchers collected the participants’ ages, heights, and weights, then calculated body mass index (BMI).
- Measurements of the following hormone levels were taken during the follicular phase (days 1-4 of the menstrual cycle): luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, total testosterone, and sex hormone-binding globulin (SHBG). The Free Androgen Index (FAI) was also calculated during the follicular phase.
- The participants’ progesterone levels were measured during the luteal phase, or days 18-21 of the menstrual cycle.
- All participants completed the Female Sexual Function Index (FSFI), which is a 19-item tool that assesses sexual function through six domains: sexual desire, arousal, lubrication, orgasm, satisfaction, and pain.
- Finally, all respondents were assessed for depression and anxiety through the Hospital Anxiety and Depression Scale (HADS).
There were no statistically significant differences between the two groups of women with regards to mean age, height, LH, and estradiol levels. Nevertheless, the researchers observed the following differences between the PCOS patients and the control group:
- The women with PCOS had lower arousal, lubrication, orgasm, satisfaction, and total FSFI scores than the women without PCOS, even after the scores were adjusted for BMI.
- When the scores were corrected for total testosterone, the women with PCOS still had lower lubrication, satisfaction, and total FSFI scores than the women in the control group.
- There were no statistically significant differences between the anxiety or depression HADS scores of the two groups.
- When the researchers compared the PCOS patients with ovulatory and anovulatory cycles to the control group, they found statistically significant differences between the PCOS patients with anovulatory cycles and the women in the control group. The PCOS patients who were experiencing anovulation had significantly lower scores than the healthy women in all of the domains except for pain (i.e., desire, arousal, lubrication, orgasm, satisfaction, and total FSFI).
- There were no statistically significant differences between the women in the control group and the PCOS patients with ovulatory cycles.
The findings of this study suggest that anovulation may be a contributing factor to sexual dysfunction or difficulties for women with PCOS. Fortunately, there are ways to mitigate these concerns. Women with PCOS can speak with their health care providers about starting birth control pills or progestin therapy to regulate their menstrual cycles. For concerns about fertility, they could consult a fertility specialist or endocrinologist. Finally, if they are struggling emotionally or in their relationships because of their condition, they may choose to speak with a therapist.
- Mantzou, D., Stamou, M.I., Armeni, A.K., Roupas, N.D., Assimakopoulos, K., Adonakis, G., Georgopoulos, N.A., & Markantes, G.K. (2021). Impaired Sexual Function in Young Women With PCOS: The Detrimental Effect of Anovulation. The Journal of Sexual Medicine, 18(11), 1872-1879. DOI: https://doi.org/10.1016/j.jsxm.2021.09.004
- Mayo Clinic. (2020, October 3). Polycystic ovary syndrome (PCOS). https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439