Polycystic Ovarian Syndrome
In my career of nearly 3 decades as a medical doctor and fertility specialist, I have come across several cases of PCOS and pregnancy. Let me start off with one such case study.
Mrs. Shivani, 28 years old, had been married for 3 years. She had been trying to conceive ever since. She came to my clinic with her husband. I noticed other health issues, such as subtle problems with weight gain, occasionally delayed periods and the seemingly innocent appearance of pimples. I diagnosed her condition as Polycystic Ovarian Syndrome (PCOS.) With the right treatment for her PCOS, Shivani is now a proud mother of a 6-month old. I’ve been fortunate to meet and treat many women like Shivani during my career.
Polycystic ovary is when each ovary has tiny cyst-like structures, more than 12-14 of them in each. This can be seen through a trans-vaginal ultrasound scan. In addition, women with PCOS may also experience delayed periods, weight gain, and excess body hair. This is in areas that men usually have hair growth, such as on the upper lip or chin, chest, etc. Some women may also experience an outburst of pimples and discolouration of skin in the neck and around armpits. PCOS can also result in several long-term complications like Type II diabetes mellitus, cholesterol abnormalities, cardiac problems and even an increased risk of cancer.
There’s also a strong link between PCOS and pregnancy. PCOS can also be associated with difficulty in conceiving, early miscarriages, abnormal blood sugars in pregnancy, big baby and a host of other complications.
For a couple to conceive, one of the most important factors is the development and release of egg (ovulation) in the female. This usually happens around the 14th day of her monthly periods, when you count the first day of bleeding as Day 1. However, in a woman with PCOS, either the eggs are not produced at all or they are of poor quality. That’s because the ovaries of women produce an excess of male hormones — a condition not ideal for egg development.
Another problem with PCOS and pregnancy is the increased risk of miscarriages. Reports suggest that the rates at which PCOS women lose their pregnancies could be as high as 50%. There are several reasons why PCOS increases the risk of a miscarriage, including:
Yes, it is possible to conceive with PCOS without treating the underlying condition. However, the percentage of women who conceive without addressing their PCOS first is quite small. Most of them, like Mrs. Shivani, would need to deal with their PCOS first, before they can embark on a journey to a safe pregnancy. Also, in order to be a healthy mother after you give birth, you need to address your underlying PCOS, so why not do it right to begin with?
There’s a viscous cycle between PCOS and weight. Excess weight worsens the symptoms of PCOS, while PCOS itself may lead to weight gain. Lifestyle change is critical to address the challenge of PCOS and pregnancy. I have seen that losing even 5% of existing body weight can dramatically reduce the symptoms of PCOS. Thus, healthy eating with regular exercise (lifelong and not just in short spurts) is the need of the hour.
PCOS is the most common reason women, especially ones with menstrual problems, visit a gynaecologist. According to some reports, nearly 15-22% of women in the reproductive age are affected by the condition worldwide. While the condition is seen across the globe, it is believed to be more prevalent among Asians. We don’t yet fully know how the disease evolves, but a genetic inheritance (from the mother) cannot be ruled out. Some reports have even linked the inheritance of PCOS to the father, for symptoms like excessive body hair or a genetic condition known as Klinefelter syndrome.
While PCOS gene may be inherited, not everyone manifests symptoms early enough. Also, not all the symptoms are present in everyone. Researchers say that the PCOS gene is “switched on” under certain conditions like weight gain, excessive stress, sedentary lifestyle and so on. Even certain life-changing events could trigger PCOS. I have seen cases where after delivery, women failed to shed the excess weight. This can lead to delay of periods and eventually, PCOS. I have even seen cases where there are two sisters; one is obese and has delayed periods and PCOS, while the other does not. This would suggest that lifestyle and maintaining appropriate weight may be crucial to avoiding PCOS.
PCOS can indeed be controlled and managed but not cured entirely. The current scientific evidence strongly suggests a genetic component. This means – yes, with the right medical help and lifestyle changes, you can reverse your PCOS, but as soon as you can go back to living a poor lifestyle, you will likely get it right back. That is why I advise that the changes you make to your lifestyle must be sustainable and lifelong.
Various medications are prescribed to manage the symptoms of PCOS. Drugs like Metformin and Myoinositol, which are insulin sensitizers, may help in losing weight, regulating periods and even increasing fertility by restoring ovulation.
Also, a deficiency of Vitamin D increases insulin resistance, a finding that is seen in many women with PCOS. This deficiency must be corrected by getting adequate sunlight and eating Vitamin D-rich foods and dietary supplements.
There are specially-formulated oral contraceptive pills, which may help in losing weight, reducing pimples, reducing hair fall, and also regularizing periods. However, it must be understood that all medicines will have some side effects.
Medicines are excellent for short-term therapy. But, they can never be considered as the first line therapy, especially for PCOS where lifestyle changes can make such a dramatic difference to the symptoms of the condition.
My advice to you as a doctor and fertility expert is the same as my advice to all my patients. Make the right changes to your diet and lifestyle and you will be laying the foundation for a long and healthy life as a parent and as an individual. Wish you fantastic health and parenthood!