Polycystic Ovarian Syndrome: PCOS (Part 3)

By Dr Kemi Ailoje

Last week, we discussed symptoms and diagnosis of Polycystic Ovarian Syndrome with its effects on the body. This week, we will conclude on how PCOS can affect fertility and its management.

Pregnancy and PCOS

PCOS interrupts the normal menstrual cycle and makes it harder to get pregnant. This condition can also increase the risk for pregnancy complications. Women with PCOS are twice as likely as women without the condition to deliver their baby prematurely. They are 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 odds of having a healthy pregnancy.

PCOS can cause problems during pregnancy for you and for your baby. Women with PCOS have higher rates of Miscarriage, Gestational diabetes (Diabetes in Pregnancy), Preeclampsia (high levels of proteins and blood pressure) and Cesarean section (C-section). Your baby also has a higher risk of being heavy (macrosomia) and of spending more time in a neonatal intensive care unit (NICU).

You can lower your risk of problems during pregnancy by:

Reaching a healthy weight before you get pregnant.

Reaching healthy blood sugar levels before you get pregnant.

Taking folic acid.

Management of PCOS

Treatment for PCOS usually starts with lifestyle changes like weight loss, diet, and exercise. Weight loss can also improve cholesterol levels, lower insulin, and reduce heart disease and diabetes risks. 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. Thirty minutes of moderate-intensity exercise at least three days a week can help women with PCOS lose weight. 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.

Common Medical Treatments

Birth control pills and other medicines can help regulate the menstrual cycle and treat PCOS symptoms like hair growth and acne.

Birth Control: Taking estrogen and progesterone daily can restore a normal hormone balance, regulate ovulation, relieve symptoms like excess hair growth, and 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. However, it increases the risk for twins and other multiple births. The use must be monitored by a doctor.

Hair Removal Medicines: A few treatments can help get rid of unwanted hair or stop it from growing. Eflornithine 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: This 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 Seek Specialist Care:

Missed periods and you are not pregnant after a pregnancy test done.

You notice symptoms of PCOS, such as hair growth on your face and body.

Unsuccessful attempt at trying to get pregnant despite unprotected regular sexual intercourse for more than 12 months.

You have symptoms of diabetes, such as excess thirst or hunger, blurred vision, or unexplained weight loss.

If you have PCOS, plan regular visits with your specialist.

You will need regular tests to check for diabetes, high blood pressure, and other possible complications.

In Summary: What women especially the young need to know about PCOS

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 specialists recommend for PCOS, and they often work well.

Weight loss can treat PCOS symptoms and improve the odds of getting pregnant and having healthy babies.

Diet and aerobic exercise are two effective ways to lose weight.

Medications are a likely option if lifestyle changes don’t work.

Birth control pills and metformin can both restore normal menstrual cycles and relieve PCOS symptoms.

In vitro fertilization (IVF) may be an option if medication does not work.

You need to consult with your Gynecologist/ Fertility specialist to see what treatment option best suits you.