Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is the most common hormonal abnormality to affect menstruation in women of reproductive age.
Women with PCOS often complain of
1. irregular menstrual cycle, with menstruation coming once in a few months
2. very light menstrual flow
3. difficulty in getting pregnant
4. and a tendency to gain weight.
Studies have shown women with PCOS have a higher male hormone level, Luteinizing Hormone level and varying degrees of Insulin resistance. Hence some specialists will consider PCOS as a form of metabolic condition with gynaecological symptoms.
The exact cause of PCOS is not known but there appears to be a family link.
How is PCOS Diagnosed?
Women who have at least 2 of the 3 criteria are said to have PCOS
❖ Evidence of elevated male hormone levels like increased facial hair, pimples, and male pattern baldness
❖ Reduced menstrual frequency and flow as well as anovulation
❖ Ovaries that are enlarged with multiple small cysts (< 10mm)
What are the issues with PCOS?
❖ Irregular menstrual cycles : PCOS is the most common cause of irregular menstrual cycles. Often the menstruation is very light. Sometimes it can be heavy especially if the last menstruation was months ago.
❖ Subfertility : With irregular menstruation, women with PCOS often find it hard to get pregnant. Even with a regular menstrual cycle, some women with PCOS do not ovulate, hence the difficulty in getting pregnant.
❖ Pregnancy Risks : PCOS predisposes to miscarriage as well as diabetes and hypertension in pregnancy
❖ Metabolic Disturbances : In older women with longstanding PCOS, there is a higher chance of developing hypertension, diabetes and raised cholesterol.
❖ Risk of Endometrial Hyperplasia and/or Cancer : In a small percentage of women with longstanding PCOS, there is an increased risk of "womb" or Endometrial cancer as they approach middle age. This is especially so when there are many years of very infrequent or irregular menstruation.
How is PCOS Treated?
❖ Healthy diet and exercise aiming for a 10% reduction of body weight.
❖ Hormonal medication like Progestegen Norethisterone or Diane-35 birth control pills to regulate menstruation.
❖ Clomiphene or Letrozole tablets to stimulate ovulation for pregnancy. IVF may be needed if ovulation cannot be achieved with these tablets.
❖ Laparoscopic Surgery may be needed for some women with PCOS. The procedure of Ovarian Drilling has been shown to help ovulation and pregnancy.