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Many women experience hormonal fluctuations throughout their lives but for some, these imbalances can become a chronic condition. Polycystic ovary syndrome, or PCOS, is a common hormonal disorder affecting up to 15% of women during their reproductive years.  While the exact cause remains unknown, PCOS can impact a woman’s health in various ways.

This blog article serves as your guide to understanding PCOS and its implications. We’ll explore the signs and symptoms, potential risks, and how this condition can be managed.  Whether you’ve been recently diagnosed or are simply curious to learn more, this information can empower you to take charge of your health.

 

Book a consultation with Dr. Pam Tan today.

 

Symptoms and Diagnosis

Common symptoms of PCOS include irregular periods, excess body hair, acne, and difficulty getting pregnant. PCOS may also increase risk of diabetes, heart disease, and endometrial cancer. 

Possible late sequelae refers to long-term health problems or complications that can arise after an initial illness or condition has been treated. These are health issues that develop later, sometimes years after the original condition. In the case of PCOS, the risk of developing cancer of the uterine lining increases due to prolonged exposure to unopposed oestrogen (estrogen). The table below details more symptoms that are commonly seen together in patients with PCOS.

Box 1. The spectrum of clinical manifestations of polycystic ovary syndrome

Symptoms

    • Hyperandrogenism (hirsutism, acne, alopecia)
    • Menstrual disturbance
    • Infertility
    • Obesity

Possible late sequelae

    • Type II diabetes mellitus
    • Dyslipidaemia
    • Hypertension
    • Cardiovascular disease
    • Endometrial carcinoma

PCOS is often diagnosed using a variety of blood tests to check levels of chemicals and hormones in the body, as well as through an ultrasound. The blood tests are commonly used to see whether the levels of male (androgens) and female reproductive hormones are higher or lower than normal, though blood tests are also used to check insulin levels.

Serum Endocrinology in PCOS refers to studying the hormones present in the blood of someone with that condition. By analysing these hormones in the blood, doctors can better understand and manage the symptoms associated with PCOS. It is thought that genetic variations in the control of insulin have an effect on how PCOS is expressed in the body. This is further influenced by environmental factors. Commonly seen hormone levels in pcos include:

    • ↑ HIGH or normal androgens (testosterone (T) and androstenedione)
    • ↑ HIGH or normal luteinising hormone (LH) – elevated in 40%, usually slim women
    • NORMAL follicle stimulating hormone (FSH)
    • LOW ↓ or normal fasting insulin (not routinely measured; insulin resistance can also be assessed by oral glucose tolerance test, OGTT)
    • ↑ HIGH or normal sex hormone binding globulin (SHBG), results in elevated “free androgen index” calculated by (T x 100) ÷ SHBG
    • ↑ HIGH or normal estradiol and Anti-müllerian hormone (AMH)

Prolactin usually normal, occasionally slightly elevated

Doctors diagnose PCOS based on Rotterdam criteria. According to the Rotterdam consensus, polycystic ovarian syndrome (PCOS) is diagnosed if two out of these three criteria are present: 

    1. High Levels Of Male Hormones 
    2. Irregular Ovulation
    3. Having Polycystic Ovaries (12 or more small follicles and/or an ovarian volume greater than 10 mL in at least one ovary)

Other conditions that cause similar symptoms are ruled out first, especially since tests for PCOS can be inconsistent, and a normal hormone profile doesn’t rule out PCOS. Ultrasound can show polycystic ovaries, but the definition of “polycystic” may change.

Moreover, PCOS and ovarian cysts are two distinct conditions that affect the ovaries, yet they often cause confusion due to their overlapping symptoms and impact on female reproductive health. While both conditions can involve the presence of cysts on the ovaries, their underlying causes, associated risks, and treatment approaches differ significantly. Cysts refer to a fluid filled sac in an organ but the kinds of cysts in an ovary can vary greatly. 

 

Impact of PCOS on Fertility

It is important to note that the severity of symptoms varies from patient to patient and can change over time. The manifestations of PCOS also have ethnic diversity. For example Japanese women have less body hair than Mediterranean women despite having similar circulating androgen levels. South Asian women in the UK with anovulatory PCOS have greater insulin resistance compared to white Caucasians with the same condition. 

In the context of PCOS, high Anti-Müllerian hormone (AMH) levels might suggest a strong ovarian reserve. However, this is often misleading as it actually points to problems with how the ovarian follicles develop, which can make ovulation difficult. This hormonal imbalance directly impacts fertility and can also affect how well fertility treatments work, often necessitating customised treatment plans that may include medications to help stimulate ovulation.

While PCOS can make it more challenging to get pregnant, it doesn’t necessarily mean it’s impossible. There are treatment options available to help women with PCOS improve their chances of conception.

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PCOS Treatment Options

PCOS is often underdiagnosed and requires a team approach to manage all aspects of the condition. PCOS symptoms can significantly reduce a woman’s health-related quality of life or HRQoL, which includes physical, mental, and social well-being. Treatments for PCOS should consider how they improve not just physical symptoms but also emotional and social aspects of life.

For example, even though treating excess hair growth (hirsutism) might seem cosmetic, it can be a major source of stress and embarrassment for women with PCOS. Infertility and weight struggles can also negatively affect social interactions, self-esteem, and mental health. The cycle of weight gain worsening PCOS symptoms and PCOS making weight loss difficult can be frustrating and lead to poor body image, impacting a woman’s willingness to exercise. As such, approaches to treatment of PCOS should be tailored to the individual and the symptoms they experience.

Hirsutism or excessive hair growth can be caused by high testosterone levels. Treatment options for this include electrolysis, waxing, shaving, medication (birth control pills with anti-androgens, spironolactone, eflornithine). A more permanent option is laser hair removal.

On the opposite end of the spectrum is hair loss which may be managed by anti-androgen medication and checking for iron deficiency.

Irregular periods may be treated with cyclical hormone therapy (birth control pills) to regulate periods and prevent endometrial hyperplasia (thickening of the lining).

As for endometrial cancer risk, early detection with ultrasound and endometrial biopsy is important. Management to reduce cancer occurrence may involve: 

    • Regular cyclical progesterone to shed the lining and prevent thickening (at least once every three months).
    • Progesterone-releasing IUD (Mirena).
    • In severe cases where precancerous cell changes are detected (atypical hyperplasia) , hysterectomy (surgical removal of the uterus) may be recommended.

Another cause for concern with PCOS is infertility. The principles of management for this is to optimise health before starting therapy, including weight loss for those of high bmi (especially if more than 30). Full comprehensive assessment may include fallopian tube patency testing and semen analysis, and then inducing regular ovulation for those with irregular periods and ovulatory issues. Most women respond well to oral medications like letrozole or clomiphene but some may require follicle stimulating hormone ( FSH ) injections. Folic acid is often recommended as a daily supplement.

 

Lifestyle Changes to Manage PCOS

Weight is a major factor in PCOS and fertility. Obesity makes it harder to monitor ovulation with ultrasounds and increases risks during pregnancy. The debate is ongoing about weight requirements for fertility treatment. Some guidelines suggest delaying treatment until a BMI below 35, while others recommend aiming for below 30 for younger women. Even moderate weight loss (5-10%) can improve fertility and overall health.

There’s no special PCOS diet, but a balanced, low-sugar diet with complex carbs and reduced fat is recommended. Dietitians can help create a personalised plan. Regular exercise is crucial, with 30 minutes daily for health and 60-90 minutes for weight loss. Behavioural therapy can support weight loss efforts. No medications currently exist for long-term weight loss however increased fertility has been reported for obese women who lost weight on GLP-1 agonist drugs (e.g. Ozempic, Mounjaro, Rybelsus).

Bariatric surgery is an option for some with a BMI over 40 or with weight-related health problems (comorbidities). Note that PCOS itself can be considered a comorbidity.

You may also consider getting enough quality sleep because of its importance in overall health and in regulating hormones. Connecting with others who understand the challenges of PCOS can also provide support and encouragement. 

Remember, these are general recommendations, and it’s important to talk to your doctor about the best approach for managing your individual case of PCOS.

10 Tips in Choosing The Right OB-GYN For You in Singapore

 

PCOS Management in Singapore

At our clinic, we’re dedicated to supporting your journey through motherhood,  including those with PCOS. We empower expectant mothers with knowledge to promote well-being during pregnancy, childbirth, and the postpartum period. We also provide insights into potential concerns you or your baby might face, and can help you manage PCOS symptoms for a smoother pregnancy journey.

Why Choose Us?

  • Expert Guidance: Our team includes qualified obstetricians like Dr. Pamela Tan, a certified specialist in minimally invasive procedures. Dr. Tan has extensive experience in managing PCOS and creating personalised treatment plans to optimise your fertility and pregnancy health.
  • Personalised Care: We understand every pregnancy is unique. Through in-depth consultations, we tailor advice and treatment plans to your individual needs,taking PCOS into consideration.

Ready to begin? Schedule an appointment today! Call us at +65 6254 2878 or send us a message here.

SOURCES:

  1. Bairn AH. Polycystic ovary syndrome (PCOS). The Obstetrician & Gynaecologist 2017;19:119-29. D01:10.1111/tog.12345
  2. SingHealth. (n.d.). Polycystic Ovary Syndrome (PCOS). Retrieved from https://www.singhealth.com.sg/patient-care/conditions-treatments/polycystic-ovary-syndrome
  3. National University Hospital. (n.d.). Polycystic Ovary Syndrome (PCOS). Retrieved from https://www.nuh.com.sg/Health-Information/Diseases-Conditions/Pages/Polycystic-Ovary-Syndrome.aspx

 

 

Dr Pamela Tan
About Dr Pamela Tan

Dr Pamela Tan is a board certified obstetrician and gynecologist in Singapore. She finished her undergraduate studies at the National University of Singapore and earned her post-graduate degree at the Royal College of Obstetricians and Gynaecologists in the UK. She is an accredited specialist by the Specialist Accreditation Board (Ministry of Health), and a fellow of the Academy of Medicine, Singapore. She subspecialises in colposcopy and is certified to perform Level 3 minimally invasive keyhole surgeries such as laparoscopic hysterectomy, myomectomy and cystectomy. Dr Pam also supports the natural birthing method and she strives to provide a personalised care and treatment for each patient.