Dr. Tariq Jagnarine
Family Medicine/Endocrinology, Diabetes
Polycystic ovary syndrome (PCOS) is a common hormonal condition that affects women of reproductive age. It usually starts during adolescence, but symptoms may fluctuate over time.
• Polycystic ovary syndrome (PCOS) affects an estimated 8–13% of reproductive-aged women.
• 1 woman in 7 is suspected to have PCOS.
• Up to 70% of affected women remain undiagnosed worldwide.
• PCOS is the most common cause of anovulation, and is a leading cause of infertility.
• PCOS is associated with a variety of long-term health problems that affect physical and emotional wellbeing.
• PCOS runs in families, but there are ethnic variations in how PCOS manifests itself, and how it affects people.
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
The doctor should also ask whether the person 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, the 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.
Patients might also have blood tests to check their cholesterol, insulin, and triglyceride levels, to evaluate their risk for related conditions like heart disease and diabetes.
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 per cent 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 baby 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 the 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 per cent 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 you lose more weight than either intervention alone, and it lowers your 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
Taking progestin daily can:
• Restore a normal hormone balance.
• Regulate ovulation.
• Relieve symptoms like excess hair growth.
• Protect against endometrial cancer.
These hormones come in a pill, patch, or vaginal ring.
• METFORMIN
Metformin 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, and keep in mind that clomiphene increases the chances of twins and other multiple births.
• 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 the face and body.
• 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 SEE A DOCTOR
See a doctor if:
• You’ve missed periods and you’re not pregnant.
• You have symptoms of PCOS, such as hair growth on your face and body.
• You’ve been trying to get pregnant for more than 12 months, but haven’t been successful.
• You have symptoms of diabetes, such as excess thirst or hunger, blurred vision, or unexplained weight loss.
If a woman’s periods are already irregular or absent and she is trying to get pregnant, she should not wait 12 months to see a specialist to be evaluated.
Also, keep in mind that if you do not wish 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 with PCOS.
PCOS can disrupt a woman’s menstrual cycle and make it harder for her 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.
