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Not every woman who has PCOS has ovarian cysts, and not every woman who has ovarian cysts has PCOS.

Women develop ovarian cysts at any time from infancy through menopause, and the majority of ovarian cysts cause no symptoms at all. Even large ovarian cysts may result in no loss of fertility, if they do not grow so large that they twist the ovaries and they do affect both ovaries. When women are infertile, the most likely problem polycystic ovarian disease (PCOS).

But not every woman who has PCOS has ovarian cysts, and not every woman who has ovarian cysts has PCOS.

It is PCOS, a systemic condition, that is more likely to cause problems in trying to conceive than merely having a cyst or multiple cysts in the ovaries. PCOS is a condition that affects not just the ovaries and the uterus, but also the brain. The hormonal signal that tells the ovaries it is time to ovulate, that is, to release an egg, actually begins in the hypothalamus, a gland deep inside the brain. The hypothalamus makes a hormone called GnRH. (This is an abbreviation for gonadotrophin releasing hormone.) Waves of GnRH travel to the pituitary gland, also located in the brain. Responding to the first hormone, the pituitary gland makes two more. These are follicle stimulating hormone, more commonly referred to as FSH, and luteinizing hormone, more commonly called LH. FSH signals the ovaries to get an egg ready for ovulation and LH tells the ovaries to release it. Both of these hormones fall back to normal levels, unless the woman gets pregnant. Then LH levels stay high to stimulate growth of the womb.

When women have PCOS, levels of LH don't go down just because the egg has been released. Many women who have PCOS have LH levels that stay high all the time. The ovaries get the message that the woman is pregnant, so they don't release another egg. Treating PCOS, for these women, isn't about cysts, it's about lowering LH levels or helping the ovaries work as if LH levels were normal. And the simplest way to get LH levels under control, it turns out, is to go on a diet.

It isn't really possible to say which comes first, weight gain or the hormonal changes that keep LH levels too high. It is inaccurate to say that PCOS is a woman's fault. However, losing weight is often enough to correct the infertility that is associated with ovarian cysts without getting rid of the cysts. When women lose just 2 to 5 per cent of the total body weight, sometimes just 3 or 4 pounds (1-2 kg), ovulation is restored. That is because a tiny amount of weight loss allows a lot lower production of insulin. It also stops the production of testosterone, the hormone that causes acne, hair growth, and mood swings. And when insulin and testosterone levels fall back to normal, LH levels follow.

Up to 90 per cent of all cases of ovarian cyst infertility can be reversed with nothing more than diet, usually within 12 months. Be sure to see a physician to rule out other possible causes of infertility and if you are over 40, be sure to see a doctor within six months of trying to get pregnant on your own.

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