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

PCOS : Suffering In Silence.

Part 3: “I see, What Can I Do To Help Myself?”

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

Hi ! I wish all the readers good health always.

There is a saying :

“ No one saves us but ourselves. No one can and no one may. We ourselves must walk the path”.

In the last 2 parts of this series, you have come to know more about PCOS and what are the health consequences of PCOS. The last thing that is left is to educate you on how to take your step to fight back. You must take the first step in this journey towards freedom from PCOS.

Lifestyle Changes

I’m sure most of the women with PCOS, who are overweight or obese, are familiar with a common advice given by their doctor : “ Please lose some weight”. Am I right?

The first and foremost action to take is to lose weight. Years of research has confirmed the advantage of weight loss in the treatment of PCOS. Studies has shown that even with a weight loss of 5-10% , it can regulate the women’s period cycle. The weight reduction can also improve the probability of ovulation in the women.

What’s the recommended way to lose weight ? There is no special regime for PCOS. You can follow any weight loss programme that you are comfortable with. The usual weight loss programmes consist of nutritional classes, dietary modifications and exercise. In very severe cases, bariatric surgery is recommended to lose weight.

As I have mentioned earlier, insulin level also plays an important role in obesity. Treatments to lower your insulin level can also help you to lose weight. Common medication used to lower body insulin is called ‘insulin sensitising agents’ such as Metformin.

If you are a smoker, it’s a good idea to try to cut down or completely stop smoking. This is because smoking has been shown to increase androgen (male hormone) level in the body.

Too much of facial hair can be treated with simple measures such as waxing and shaving. There are many commercially available products that can do this. Laser hair removal is also effective. There are oral tablet and creams which can reduce hair growth but you need to be cautious if you are planning for pregnancy.

Medical Management

Medical management in combination with lifestyle changes is a very effective arsenal in combating PCOS.

Types of medical management is tailored to the women depending on her fertility wishes.

Doctor, I want to get pregnant:

The major concern in PCOS is inability to ovulate.

1. Weight loss is an effective way to re-start the women’s ovulatory cycle. However, it do not help all women.

2. Some women need to take ovulation inducing medications to ‘kick start’ her egg development. Commonly used medications in this group are oral tablets such as clomifene citrate, tamoxifen and letrozole. Sometimes, the medications are given in an injectable form if the women do not respond to oral medications. The danger with injectable medication is over-stimulation of the eggs, since the injectable medication is generally more powerful in their action. Your doctor may even give you oral plus injectable medication to control egg development.

The oral medications are also given in combination with Metformin. There are many combinations but your doctor will be able to tailor-make a combination that suits you best.

3. When a women with PCOS failed to respond to oral or even injectable medications, sometimes a keyhole (laparoscopic) surgery called ‘ovarian drilling’ is recommended. In this surgery, few tiny holes are made on each ovary. This surgery has been proven to help with ovulation. However, with the availability of IVF (in-vitro fertilization) treatment, this surgery is rarely done now.

Once a women establishes her ovulatory period cycle, she has a good chance of getting pregnant naturally. In the event this does not happen, simple treatments such as an IUI (Intra-Uterine Insemination) can be tried. In some cases, more advanced treatment in the form of an IVF will be needed.

Take home message is : If you are keen for a pregnancy , you need to ovulate first regularly !

No doc, I don’t intend to get pregnant yet:

Even if you don’t intend to conceive yet, lifestyle modification as mentioned above is very important. It improves PCOS symptoms and also your general health.

Commonest medication used in a women with PCOS who do not have regular periods is oral contraceptive pill or birth control pills (OCP). OCP can regulate a women’s period such that she will have a regular monthly bleeding. It also can reduce the amount of bleeding and this is useful for someone with heavy bleeding. Many women also complaint of painful periods and OCP is effective in treating this.

Certain OCP contain a hormone which can reduce a women’s male hormone level and this is particularly useful in PCOS. In certain circumstances, OCP is used together with androgen-lowering medication ( to reduce level of male hormone).

In addition to this, yearly medical check-up for Diabetes and high blood pressure is recommended.

Take home message is : Even if pregnancy is not a concern for now, you still need to make sure that you have periods at least 3-4 monthly !

Isn’t prevention better than cure ? Why a women need to go through all this when she can prevent PCOS ?

The straight forward answer to this is there is no preventive measures for PCOS. You can’t prevent PCOS but early diagnosis and treatment can prevent it’s complications such as metabolic syndrome, obesity, heart disease and infertility.

Finally, I hope with a better understanding of PCOS , every women who has been diagnosed with PCOS can stand up now and fight back. PCOS is not your fate but just a temporary road-block in achieving a well balanced healthy life style.

You don’t have to suffer in silence anymore!