POLYCYSTIC OVARIAN SYNDROME (PCOS) PART 2

THEME: ‘CREATING CHANGE TOGETHER ’

Dr. Tariq Jagnarine
Family Medicine, Endocrinology/ Diabetes

Polycystic ovary syndrome (PCOS) is a condition in which the ovaries produce an abnormal amount of androgens, male sex hormones that are usually present in women in small amounts.

DIAGNOSIS OF PCOS
Doctors typically diagnose PCOS in women who have at least two of these three symptoms:
• High androgen levels
• Irregular menstrual cycles
• Cysts in the ovaries
Other questions are asked such as if patients have or had symptoms like acne, face and body hair growth, and weight gain.
A pelvic exam can look for any problems with the ovaries or other parts of the reproductive tract. During this test, a doctor inserts gloved fingers into the vagina and checks for any growth in the ovaries or uterus.
Blood tests check for higher-than-normal levels of male hormones.
Blood tests to check the cholesterol, insulin, and triglyceride levels to evaluate the risk for related conditions like heart disease and diabetes.
An ultrasound uses sound waves to look for abnormal follicles and other problems with your ovaries and uterus.

PREGNANCY AND PCOS
PCOS interrupts the normal menstrual cycle and makes it harder to get pregnant. Between 70 and 80 percent of women with PCOS have fertility problems. This condition can also increase the risk of pregnancy complications.
Women with PCOS are twice as likely as women without the condition to deliver their babies prematurely. They’re also at greater risk for miscarriage, high blood pressure, and gestational diabetes.
However, women with PCOS can get pregnant using fertility treatments that improve ovulation. Losing weight and lowering blood sugar levels can improve your chances of having a healthy pregnancy.

DIET AND LIFESTYLE TIPS TO TREAT PCOS
Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise.
Losing just 5 to 10 percent of body weight can help regulate the menstrual cycle and improve PCOS symptoms. Weight loss can also:
• Improve cholesterol levels
• Lower insulin
• Reduce heart disease and diabetes risks
Any diet that helps to lose weight can help the condition. However, some diets may have advantages over others.
Studies comparing diets for PCOS have found that low carbohydrate diets are effective for both weight loss and lowering insulin levels. A low glycemic index (low GI) diet that gets most carbohydrates from fruits, vegetables, and whole grains helps regulate the menstrual cycle better than a regular weight loss diet.
A few studies have found that 30 minutes of moderate-intensity exercise at least 3 days a week can help women with PCOS lose weight. Losing weight with exercise also improves ovulation and insulin levels. Exercise is even more beneficial when combined with a healthy diet. Diet plus exercise helps to lose more weight than either intervention alone or lowers the risks for diabetes and heart disease.
There is some evidence that acupuncture can help with improving PCOS, but more research is needed.

COMMON MEDICAL TREATMENTS
Birth control pills and other medications can help regulate the menstrual cycle and treat PCOS symptoms like hair growth and acne.
• Birth control
o Taking progestin daily can:
o Restore a normal hormone balance
o Regulate ovulation
o Relieve symptoms like excess hair growth
o Protect against endometrial cancer
These hormones come in a pill, patch, or vaginal ring.
• Metformin
Metformin (Glucophage, Fortamet) is a drug used to treat type 2 diabetes. It also treats PCOS by improving insulin levels.
One study found that taking metformin while making changes to diet and exercise improves weight loss, lowers blood sugar, and restores a normal menstrual cycle better than changes to diet and exercise alone.
• Clomiphene
Clomiphene (Clomid) is a fertility drug that can help women with PCOS get pregnant. It’s important to note that, while discussing family planning, keep in mind that clomiphene increases the chances of twins and other multiple births (26).
• Hair removal medications
A few treatments can help get rid of unwanted hair or stop it from growing.
Eflornithine (Vaniqa) cream is a prescription drug that slows hair growth. Laser hair removal and electrolysis can get rid of unwanted hair on your face and body.
• Surgery
Surgery can be an option to improve fertility if other treatments don’t work. Ovarian drilling is a procedure that makes tiny holes in the ovary with a laser or thin heated needle to restore normal ovulation.

WHEN TO CONSULT A DOCTOR
See a doctor if:
Missed periods, and not pregnant.
Having symptoms of PCOS, such as hair growth on the face and body.
Trying to get pregnant for more than 12 months but haven’t been successful.
Having symptoms of diabetes, such as excessive thirst or hunger, blurred vision, or unexplained weight loss.
If periods are already irregular or absent and trying to get pregnant, do not wait 12 months to see a specialist to be evaluated.
Also, keep in mind that if there is no desire to get pregnant, irregular or absent periods are not birth control in themselves. It may still be possible to get pregnant even under these conditions. It’s best to use contraception in this case even if diagnosed with PCOS.
For those with PCOS, plan regular visits with a primary care doctor. Along with regular tests to check for diabetes, high blood pressure, and other possible complications.

REMEMBER!!
PCOS can disrupt a woman’s menstrual cycles and make it harder to get pregnant. High levels of male hormones also lead to unwanted symptoms like hair growth on the face and body. Lifestyle interventions are the first treatments doctors recommend for PCOS, and they often work well.
Weight loss can treat PCOS symptoms and improve the odds of getting pregnant. Diet and aerobic exercise are two effective ways to lose weight.
Medications are an option if lifestyle changes don’t work. Birth control pills and metformin can both restore more normal menstrual cycles and relieve PCOS symptoms.