PCOS and Fertility Series Part 1

by Dr.Agilan Arjunan, Fertility Specialist, KL Fertility Centre (Malaysia)

PCOS : Suffering In Silence.

Part 1: “Oh, what is it?”

‘Get your facts right and you don’t have to suffer in silence anymore’

The month of March is very special for women. We celebrate International Women’s Day on 8th of March and the theme for 2016 is ‘Pledge For Parity’ . Various topics that revolves around women would have been discussed. The education process should not just stop in March, therefore I am going to educate you today about a condition that plagued women for over 75 years now.

I do not wish to take much of your time with a lengthy write up, so this educational write up is divided into 3 parts.

Part 1: “Oh, what is it?”

Part 2: “So what?”

Part 3: “ I see, what can I do to help myself?”

 Hope this benefits all of you.

PCOS (PolyCystic Ovarian Syndrome) is a condition that has been diagnosed for over 75 years ago but yet many women still has little understanding of PCOS , let alone combat it.

Just a few days ago I saw a couple who were married for 8 years and trying to conceive for nearly 6 years. She had seen a few general doctors over the years and was told that she has ‘imbalanced hormones’. She was given tablets to induce her periods and to make her ‘eggs’ to grow.

This simple real life example illustrates how much PCOS can affect a women’s life on a long term basis. Appropriate diagnosis and treatment can save time, money and most importantly avoid unnecessary emotional trauma and guilt.

Many women have been diagnosed with ‘imbalanced hormones’ when they have irregular periods. Many of them probably have PCOS but undiagnosed. So what is PCOS ?

PCOS is a condition in which female and male hormones are not in their usual balance. PCOS is one of the most common hormonal endocrine disorder in women. Let’s look at some facts:

1. It affects about 5-10% of women. However, less than 50% of this women were diagnosed correctly.

2. Studies has shown that nearly 70% of women suffering from infertility (due to difficulty ovulating) have PCOS.

3. In addition, nearly 40% of women who suffer from Diabetes / glucose intolerance have PCOS.

How do you know if you have PCOS ?

The diagnostic criteria for PCOS has evolved over time as we gain more insight into this condition. Currently, PCOS is diagnosed based on your medical history, physical examination, ultrasound scan of your ovaries and with/without a blood test.

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What are the common complaints a women with PCOS tells her doctor ?

  1. “Doc, I have very few periods in a year or a long interval between periods” .
  2. “ I’ve been putting on weight even with careful diet and exercise! It’s like my body is resistance to exercise”
  3. “ I have put on weight since marriage. I used to weigh 55kgs and nows I’m 70kgs! ”
  4. “ I’m getting bit worried doc. My friends said that I have more facial hairs now than before. I realised that too cause even my regular hairdresser had pointed it out!”
  5. “ We are married for 3 years now and no luck with pregnancy”.
  6. “ The other doctor told me that I have many cysts in my ovary. Do I need a surgery?”

These are some of the common worries that a woman with PCOS has.

The doctor would then proceed to examine the women. What are we expecting to see?

  1. The woman may be overweight (BMI >25 kg/m2) or obese (BMI > 30kg/m2). However, some  women are slim and within their normal BMI range.
  2. She may have more than usual facial and body hair, especially hairs above her lips and chin.
  3. She may have pimples  and thinning of scalp hair. The hair loss may resemble ‘male pattern’ hair loss.

An ultrasound scan of the ovaries may show ‘high number of  resting eggs’, usually more than 10-12 on each ovary. The resting eggs are arranged in a particular fashion known as ‘Ring of Pearls’.

Sometimes your doctor will arrange a blood test to look at female hormone imbalance and also at the level of male hormone (Yes, you read it correctly. Women have male hormone in them but in a low level). In PCOS, the male hormone level can be higher than usual.

“ Mrs JC visited me for inability to get pregnant for 4 years. She has been putting on weight for the last 2 years despite on diet control. She has been noticing that she needs to shave and thread her facial hair more frequently now than before. She has sometimes missed her periods and her average period cycle length (from Day 1 to Day 1 of next period) is about 30-40 days . She used to have regular monthly periods at her teenage years. Her ultrasound scan of her ovaries showed a typical ‘Ring Of Pearls’ ” .

The problems of PCOS may not necessarily manifest itself early in life.  Sometimes the symptoms begin in late teenage years or more often in their 20s-30s. Many only knew they are suffering from PCOS once they have visited their fertility doctor.

It’s scary isn’t it ? To live with a condition and never knew you ever had it. However, you won’t be terrified once you know what is PCOS, what are the health consequences and how to minimise or overcome the consequences.

I will educate and explain to you all about it in my next 2 parts . Till then, live healthy…

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