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Polycystic Ovary Syndrome (PCOS)

What is PCOS?
PCOS is a complex syndrome that affects the endocrine system. PCOS affects a woman’s appearance, menstrual cycle, fertility, hormone levels, cardiovascular system, and can have detrimental effects on long-term health. Studies have shown that PCOS is very common, affecting approximately 1 in 5 woman. That’s 20% of all women!

What causes PCOS?

The cause of PCOS is unknown (that’s why it’s called a syndrome!) and is likely to be multi-factorial.

Evidence shows that it is a genetically linked condition meaning if any of your relatives have PCOS, it increases your risk of developing PCOS.

Symptoms

Symptoms associated with PCOS are linked to abnormal hormone levels and the severity and range of symptoms may vary from woman to woman.

In PCOS, women have higher levels of testosterone and higher levels of insulin which can give rise to symptoms of:
Infrequent, absent or irregular menstrual periods

  • Reduced fertility — In fact, PCOS, is the most common cause of female subfertility
  • More facial or body hair than usual
  • Hair loss
  • Acne, oily skin
  • Depression and mood swings
  • Weight gain, obesity
Long Term Health Issues
  • Insulin resistance and diabetes (10-20% of women with PCOS go on to develop diabetes)
  • High blood pressure (hypertension)
  • Heart disease (likely linked to other health conditions – diabetes, hypertension)
  • Endometrial (lining of the uterus) cancer
  • Mood swings and depression
  • Obstructive sleep apnoea
Diagnosis of PCOS

Diagnosing PCOS is often challenging. Often it may take a while (as much as 2 years or more) to get a diagnosis of PCOS as women who have PCOS have different signs and symptoms which may come and go and can also be contributed to other lifestyle stressors.

To diagnose PCOS, you will need to have two of the following criteria present, as long as other causes of menstrual disturbances and hyperandrogenism (eg: thyroid dysfunction,etc) are excluded:

  1. Irregular period, infrequent periods or no periods
  2. More facial or body hair than what is usual for yourself +/- higher blood testosterone levels
  3. Ultrasound scan which shows polycystic ovaries*.

*Polycystic ovaries are very common and affects up to 20% of women. However, only approximately 7% of women with polycystic ovaries have PCOS.

Subfertility & Treatments
There is currently no cure for PCOS. But there are medical treatments that manage the symptoms and consequences of having PCOS.

A healthy lifestyle (weight loss, exercise and balanced diet) and regular health checks are important in the management of women with PCOS.

More often than not, the diagnosis of PCOS arises when there is difficulty in getting pregnant leading on to subfertility or reduced fertility. PCOS is the most common cause of female subfertility.

PCOS and subfertility is a daunting prospect but it need not be. With the aid of your doctor and specialist, the problems associated with PCOS can be addressed and hopefully resolved. Liaising with your doctor will provide great strides towards overcoming subfertility and achieving pregnancy.

Before any intervention is initiated for women with PCOS, preconception counselling should be provided emphasizing on the importance of lifestyle – weight reduction and exercise in overweight women, reduction in smoking, and alcohol consumption.

Usually, the reason for subfertility in women with PCOS is due to the lack of ovulation, where there is no egg released from the ovary for fertilisation due to hormonal imbalances.

Currently the recommended 1st line treatment for inducing ovulation remains using the drug called clomiphene. However, there is a risk of multiple pregnancies with using clomiphene. There are also other treatment available for inducing ovulation and this will be better discussed with your doctor.

In women with PCOS, particularly if they are overweight or have a strong family history of type 2 diabetes or >40 years of age, they should have their glucose levels assess for diabetes. It is also advisable for them to have regular check-ups to assess their cardiovascular risk factors (including blood pressure, cholesterol levels) and treated accordingly.

In women with PCOS, who are pregnant, they should be screened for diabetes before 20 weeks of gestation.

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About Dr. Sim Li Kun

Dr Sim Li Kun graduated from the University of Bristol, UK in 2009 where she has worked for 2 years before moving to Singapore. Currently she is practicing in a private medical group, Dr Tan & partners, in Singapore which has a special interest in men's and women's health, as well as tackling HIV and the spread of STDs.

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