News
PCOS
Infertility may be a consequence of PCOS but is often not necessarily an issue, particularly if there is a strong focus on maintaining a lean body shape and an active lifestyle. Women with PCOS should use contraception when not desiring pregnancy. PCOS women with abdominal weight gain will often recommence regular ovulatory menses with more exercise and weight loss. It is important to recognise appropriate waist measurements and BMI for different ethnicities. For example, Asian and Indian women often have metabolic changes and irregular cycles due to PCOS at a lower BMI than a person of European descent.
There are two physical appearances (phenotypes) of PCOS women – lean and overweight. Lean women with PCOS will often have symptoms from puberty. Heavier women with PCOS may be relatively asymptomatic in their teens while maintaining a fit and lean physique and only develop menstrual irregularity when a more sedentary lifestyle after school leads to weight gain and less overall exercise and activity. Immigrant women often present with this history. PCOS can be associated with longer term risks, including diabetes, raised blood pressure, abnormal cholesterol, sub fertility and cancer of the uterus. Mostly these can be avoided or delayed by a healthy lifestyle, such as non-smoking status, maintaining a strong exercise ethic, avoiding weight gain, and checking health with your general practitioner on a regular basis. Periods should arrive every 3 to 5 weeks and longer cycles should be reported. Women with a family history of diabetes need to be extra cautious.
Warning signs – when to seek help
- Cycles shorter than 3 weeks or longer than 5 weeks
- No periods at all
- Unwanted hair growth
- Jawline acne
Medical Treatment
The condition of PCOS is managed rather than cured. Early diagnosis is encouraged. Women with PCOS are advised to maintain significant levels of exercise and a slim body mass index (BMI) (ideal BMI i 20-22) so that the risks of diabetes and subfertility are minimised. A diagnosis of PCOS should be sought in women with persistent acne and allows judicious use of anti-androgen therapy. Anti-androgen therapy (except for metformin) cannot be used if conception is desired but can provide significant relief from excessive hair growth and recurrent acne otherwise. Anti-androgens are best used in combination with physical methods of hair removal and always need effective contraception in conjunction.
Very lean PCOS women may need assistance to ovulate and there are several interventions which are useful (clomiphene, metformin, and ovarian diathermy). Usually a fertility specialist would assist the general practitioner in this situation, and more complex assisted technology is not often required. PCOS women should be aware, however, that they may be more at risk of pregnancy related-complications, especially gestational diabetes.
For PCOS women who need ovarian stimulation treatment with gonadotrophins, such as for IVF treatment, ovarian stimulation can be more complex to manage than with non-PCOS women. Sometimes the difference in drug dose between giving rise to under stimulation and overstimulation is very fine, and can vary from one cycle to the next. Women with PCOS also have a higher risk of Ovarian Hyperstimulation Syndrome (OHSS), which is the most common (and potentially serious) side effect of IVF treatment. IVF drugs and procedures are often adjusted to allow for this increased risk in PCOS women.
Contributed by Dr Stella Milsom
Self Help Dietary and Lifestyle Guidelines
- Lose weight: there is a link between obesity and PCOS, and studies show that losing weight (in all but very lean women) may be the best way to treat PCOS. An important Australian study showed that a 10% weight loss often leads to improvement of menstrual cycles and return of ovulation. A study in Fertility&Sterility (2009) compared the effect of clomiphene, metformin and lifestyle modification on treatment of patients with PCOS. It showed that the highest clinical pregnancy rate was achieved with lifestyle modification. Waist circumference, insulin and lipids were also lower in the lifestyle modification group compared with the other groups on the drug regimes. The authors conclude that lifestyle modification proves to be the first and foremost way of dealing with PCOS.
- Follow a low glycaemic index diet: this not only helps in weight-loss, but may help to prevent problems with blood sugar levels and insulin-resistance, which are also implicated in PCOS. A glycemic index diet is an eating plan based on how foods affect your blood sugar level. Carbohydrate-containing foods have a number assigned to them, according to how much each food increases blood sugar. The purpose of the low glycemic index diet is to eat carbohydrates that are less likely to cause large increases in blood sugar levels, which ultimately can cause insulin resistance, which in turn can cause the hormonal disturbances seen in PCOS. More can be read in the following study http://www.ncbi.nlm.nih.gov/pubmed/23999280
- Exercise regularly: this will aid in weight loss and maintaining healthy weight, as well as helping to regulate blood sugar levels.
- Foods to increase to achieve weight loss
- High fibre-containing foods: oats, brown rice, nuts, seeds, flax, psyllium, unpeeled fruits and vegetables; these will help you feel full on less food and help regulate blood sugar levels.
- Fresh fruit and vegetables, especially berries, leafy greens, and brightly coloured vegetables: do not consume more than 1 or 2 serves of fruit per day as they can disrupt blood sugar levels.
- Foods high in essential fatty acids - Omega 3 in particular (oily fish, flaxseeds, pumpkin seeds, walnuts).
- Healthy protein sources such as chicken, fish, lean meat and vegetable protein sources such as nuts, seeds, legumes. Protein is important in the regulation of healthy blood sugar levels – include a source of protein at every meal.
- Eat small meals frequently to stabilise blood sugar levels
- Foods to minimise
- Foods containing refined carbohydrates (white flour, white rice, white pasta, white crackers etc) - these foods have a high glycemic index and can contribute to elevated blood sugar levels, insulin resistance and obesity
- Sweet foods and sugars
- High fat foods, especially saturated fats: these can contribute to obesity
- Alcohol has a very high glycemic index and can cause elevated blood glucose levels
Self Help information contributed by Loula George
Causal Factors
We don’t really know what causes PCOS and it seems unlikely to be just one factor. Genes do matter – brothers and sisters of women with PCOS often have similar changes in their blood tests. Weight gain exacerbates abnormal androgen levels and symptoms.