Polycystic Ovarian Syndrome, better known as PCOS, is a common hormonal disorder that affects a woman’s chances of having a baby. According to the National University Hospital Women’s Centre website, it is the most common hormonal disorder in women of reproductive age and affects about 10 per cent of women in this age group.
“Polycystic Ovarian Syndrome is one of the most common hormonal problems affecting young women,” explains Dr Loh Seong Feei, senior consultant in Obstetrics & Gynaecology and medical director at Thomson Fertility Centre.
“It is a condition where the ovaries are enlarged with multiple small cysts in them and/or there is an excess of male hormones in the body. Most of the time, the affected women will have problems with ovulation,” he adds.
PCOC is easily diagnosed through an ultrasound examination, which will show multiple small cysts in the ovaries. Your doctor will also do blood tests to check your hormone levels. “Hormonal blood tests will show an imbalance in follicle stimulating hormones (FSH) and luteinising hormones (LH) hormones, as well as sometimes an elevated level of male hormones,” says Dr Loh.
According to Dr Seng Shay Way, specialist in Obstetrician and Gynaecology, and consultant at the Raffles Women’s Centre in Raffles Hospital, women need to be diagnosed with two of the following three conditions before they are said to have PCOS:
- Irregular periods. This is the most common characteristic. Examples include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy.
- Excess androgen. Elevated levels of male hormones (androgens) may result in physical signs such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne, and male-pattern baldness (androgenic alopecia).
- Polycystic ovaries. Polycystic ovaries become enlarged and contain numerous small fluid-filled sacs which surround the eggs.
The Absence Of Ovulation
Many women who suffer from PCOS don’t know they have it – until they’re diagnosed when they have issues trying to conceive. PCOS sufferers usually have fertility problems, as ovulation doesn’t take place or happens only some of the time.
“Patients with PCOS have elevated androgens (male hormones), which in turn will stop ovulation,” says Dr Seng. “If there is no ovulation or infrequent ovulation, the chances of pregnancy decreases.”
Dr Seng says the causes of PCOS are unknown, although these factors may play a role:
- Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose), your body’s primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. Excess insulin might also affect the ovaries by increasing androgen production, which may interfere with the ovaries’ ability to ovulate.
- Low-grade inflammation. “Your body’s white blood cells produce substances to fight infection in a response called inflammation. Research has shown that women with PCOS have low-grade inflammation that stimulates polycystic ovaries to produce androgens.”
- Your genes. “If your mother or sister has PCOS; or if your father has male pattern baldness, it may be linked to you having PCOS. Researchers are also looking into the possibility that certain genes are linked to PCOS.”
“There is not much that a woman can do to avoid getting PCOS,” says Dr Loh. “However, if she is overweight, losing the weight could help her normalise her chaotic hormones and help her to regain normal, regular menses and fight PCOS.”
A Treatable Condition
The good news is that PCOS can be treated. “PCOS treatment generally focuses on management of your individual main concerns, such as irregular menses, infertility, hirsutism, acne or obesity,” says Dr Seng. “Your gynaecologist may recommend weight loss through a low-calorie diet, combined with moderate exercise. Even a modest reduction in your weight – for instance, losing five per cent of your body weight – might improve your condition.
“For irregular menses, hormonal pills will be recommended to regulate menses; for infertility, the use of ovulation induction medications to induce ovulation; and for excessive hair and acne, both hormonal or topical treatment may be required.”
Dr Loh adds: “Regular ovulation is important even if a woman is not keen to conceive. This is because, without ovulation, the lining of the womb will be subjected to prolonged exposure to oestrogen, which can cause the lining to thicken and sometimes, cancer of the womb can develop.
Without regular ovulation too, your menses could be prolonged and heavy. “If pregnancy or fertility is not desired, the woman should take regular cyclical progesterone to induce regular shedding of the uterine lining,” Dr Loh adds.
You Can Still Get Pregnant
Women who have PCOS don’t have to say goodbye to their hopes of having children. “There are many fertility treatments available to help women with PCOS conceive,” says Dr Loh. These treatments include:
- Inducing ovulation. Ovulation can be induced via oral medication and sometimes, with an insulin sensitiser (medication which lowers insulin resistance). It can also be induced by injecting a hormone called gonadotrophin, which contains follicle-stimulating hormones that help to develop follicles in a woman’s ovaries.
Adds Dr Loh: “The risks of induction of ovulation in women with PCOS are multiple ovulation, multiple pregnancy (twins, triplets or quadruplets) and ovarian hyper stimulation syndrome (OHSS), when there is too much hormone medication in your system. Your ovaries become swollen and painful. Severe OHSS causes abdominal pain, vomiting and shortness of breath.”
- In-vitro fertilisation. If simpler measures fail or if there are other infertility factors such as sperm issues, endometriosis (a condition where the endometrium is found outside of the womb) or blocked fallopian tubes.
- Laparoscopic ovarian drilling. This procedure, done via keyhole day surgery, can help women with PCOS ovulate spontaneously. A laser is used to destroy small portions of your ovary, which then reduces the production of male hormones and restores regular ovulation cycles.
However, women with PCOS are also prone to having more complications during pregnancy due to their condition. “They are at higher risk for pregnancy and delivery complications,” Dr Seng notes. “These include a three-fold increase in miscarriage risk in early pregnancy compared to women without PCOS, gestational diabetes (diabetes during pregnancy) which can lead to large babies, pre-eclampsia which is characterised by sudden elevated blood pressure, preterm birth, and C-section delivery.
“Patients can help ensure their baby’s health and their own health by working closely with their obstetrician and endocrinologist to get proper medical care before, during and after pregnancy. It is also beneficial to maintain good blood glucose levels, follow a healthy eating plan and be physically active. The good news is that, with careful planning, proper medical care and good self-care, you can have a safe pregnancy and a healthy baby,” says Dr Seng.