Polycystic Ovarian Syndrome (PCOS)

Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder in females and happens when the body generates abnormal levels of male hormones (androgens) in the ovaries. The abnormal levels of androgens prevent the ovaries from producing oestrogen, the hormone required for a women’s menstrual cycle. When oestrogen is low or not present in the ovaries, a women can experience irregular periods.

PCOS is common, occurring in about 10% of all women of reproductive age and a common cause of infertility.

Common Symptoms of PCOS

  • Irregular periods
  • Overweight and obesity
  • Acne
  • Excess body or facial hair
  • PCOS is diagnosed using a combination of ultrasound and blood tests.

Conditions and health risks associated with PCOS include infertility, miscarriage, premature birth, mood disorders, depression, diabetes, cardiovascular disease, metabolic syndrome, sleep apnea, endometrial cancer, and obesity.

What are the causes of PCOS?

While the exact cause of PCOS is unknown, researchers suggests that genetics may play a major role. Those with family members living with PCOS are much more likely to also develop this condition.

  • Obesity is an important factor that may increase your chances of developing PCOS, as this can create insulin resistance in your tissues and problems with the adrenal, thyroid, or pituitary glands.
  • Insulin resistance. As you develop insulin resistance (often called a pre-diabetic state), your body must make more insulin to maintain blood sugar levels. Other hormone imbalances typically seen in PCOS patients include high levels of Luteinising Hormone and low levels of FSH. These imbalances in combination with increased insulin levels can induce and maintain abnormally high levels of androgen (termed hyperandrogenism) to be produced in the ovaries.
  • Excess of Male Hormone, Androgren. The presence of excess male hormone androgen can cause physical symptoms including hair loss, excess facial and body hair, and severe acne.
  • Low levels of FSH, Follicle Stimulating Hormone. In ovaries with normal hormone production, FSH (follicle-stimulating hormone) mediates follicular development. This is the monthly process whereby immature egg follicles compete and mature before descending into the fallopian tubes for fertilization. However, many patients with PCOS have decreased levels of FSH, causing follicular development to slow or stop. These follicles then stop before they are fully developed and become ovarian cysts, and mature eggs cannot be released. This is what causes irregular periods and some of the pain associated with PCOS.

PCOS and Fertility

Unfortunately, PCOS is one of the most common causes of infertility due to the lack of ovulation. Due to the disturbances in follicular development by hormonal imbalances, eggs are not matured or released into the fallopian tubes each month, making it difficult or impossible to become pregnant without medical intervention.

PCOS can also cause miscarriage or premature birth due to the hormonal imbalances, especially the elevated androgens. It is important to see a physician or fertility specialist as soon as possible when trying to become pregnant with PCOS to maximize your chances of success.

What Treatment Options are Available?

There are several options for treatment and management of PCOS, and your specific treatment plan may be tailored to your condition, symptoms, and specific needs. Most women experiencing PCOS will need to address their insulin resistance in their course of treatment to reduce their risk of developing type 2 diabetes and to reduce their androgen levels. This involves lifestyle changes such as smoking cessation and adjustments to diet and exercise regimens, as well as taking daily medications such as metformin to manage insulin and blood sugar levels.

For women who do not want to become pregnant, the first line of treatment is the use of hormonal birth control containing estrogen and progestin. This will significantly help to regulate hormonal imbalances caused by PCOS, reduce symptoms such as acne and body hair, and reduce the risk of developing endometrial cancer. If this does not improve symptoms after several months, anti-androgenic medications such as finasteride can also be prescribed to reduce symptoms of hyperandrogenism.

For women who want to become pregnant, the first line of treatment is to increase or jump-start ovulation using medications such as clomiphene or letrozole. Steroids or injectable hormone supplements can also be used to treat your symptoms and improve your chances of becoming pregnant, however these will almost always be used in conjunction with metformin to control your insulin.

If you are experiencing irregular menstrual cycles, symptoms of hyperandrogenism, or both, it is important to see a physician as soon as possible to diagnose your condition, treat your symptoms, reduce your chances of developing diabetes or endometrial cancer, and if desired, help you to become pregnant.

Discuss your options with our fertility specialists. The Monash IVF Singapore team is always here to help.