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Polycystic Ovarian Syndrome: A lifestyle-related disease?

Polycystic Ovarian Syndrome (PCOS) is common in South African women and affects about one in 10 women globally. It is caused by a complex imbalance of hormones in the ovaries.  Charlene Yared West spoke to Life Kingsbury endocrinologist, Dr Jocelyn Hellig and gynaecologist Dr Philip Zinn to find out more about this condition. 

So what is PCOS?

In a woman’s body, the ovaries release eggs each month as part of a healthy menstrual cycle.  However, with PCOS the egg is not released as easily, which leads to irregular ovulation and menstruation and can impact fertility. “The ovaries are described as polycystic because there is an excess of the fluid-filled, egg-containing sacs called follicles, all of a similar size, when seen on an ultrasound image,” says Dr Zinn. “This excess occurs due to disturbance of the growth of follicles – to the size required for ovulation.”

It’s all about the hormones… or is it? 

Dr Hellig explains that the exact cause of PCOS is unknown. “There is no one singular factor which causes PCOS. It is considered to be a complex trait arising from the interaction of genetic and environmental factors, usually first presenting when mature gonadotropin levels (hormones essential for reproduction)are achieved at puberty. It occurs naturally in primates as well as humans,” she says. “The disorder arises clinically by the presence of two out of three criteria: irregular periods or the absence of ovulation, features of high androgen levels (acne or excess hair growth) and a certain appearance of polycystic ovaries on ultrasound,” she says. 

You could be predisposed to PCOS if…

  • You have insulin resistance.
  • You have Type 2 diabetes.
  • You have unhealthy eating habits.
  • You do not exercise regularly.
  • You are overweight or obese.

Trying to fall pregnant?

If you are trying to fall pregnant, but it is proving difficult, PCOS might be the culprit, says Dr Zinn. “Many women are unaware that they even have PCOS until they start trying to have a baby. Once they start treatment and their symptoms are managed, then their chances of conceiving are increased.”

QUIZ: ✓Tick the boxes below to see if you might have symptoms of PCOS

  •  Irregular menstrual cycle 
  • Thinning hair or hair loss on the scalp (male-pattern baldness).
  • Acne on the face, back and chest. 
  • Too much hair on the face or areas where men usually have hair (hirsutism affects up to 70% of women with PCOS). 
  • Weight gain and difficulty losing weight. 
  • Darkening of skin pigmentation, along the neck, groin and under the breasts. 
  • Skin tags in the armpits or neck area. 

How is PCOS diagnosed? 

“If you think you have PCOS, make an appointment with your gynaecologist. There is no single test to diagnose PCOS, but we take your medical history and can conduct a physical exam with a pelvic ultrasound and do some blood tests,” says Dr Zinn.  Dr Hellig adds: “Of utmost importance is that PCOS is a diagnosis of exclusion and it is important for your medical professional to look for other causes of your symptoms before ascribing it to PCOS.”

  • Physical exam: Checks your blood pressure, BMI and waist size. Also checking for extra hair on the body, skin discolouration, hair loss and any other signs of excess testosterone such as an enlarged clitoris. It is important to exclude other health conditions. 
  • Pelvic ultrasound: A sonogram will examine the lining of the uterus and check the ovaries for the polycystic features. 
  • Blood tests: To check your androgen hormone levels, as well as other hormone checks, including your thyroid. 

Can I be cured from PCOS?

8Dr Hellig explains that there is no cure for PCOS, but symptoms can be effectively managed and therefore treated. “We take into account if you want to conceive, your risk of long-term health problems, especially diabetes and cardiovascular disease, and will help formulate an effective treatment plan through lifestyle changes and medication where necessary,” she says. 

What can I do to alleviate my symptoms?

Dr Hellig and Dr Zinn agree on the following steps that women can take to treat PCOS: 

  • Lose weight: This will help to stabilise your blood glucose levels and alleviate insulin resistance. Even a 5 – 10% loss in body weight can improve your chances of conceiving. 
  • Remove hair: Using facial hair removal creams, laser hair removal or electrolysis. Medication is not very effective for permanent hair removal. 
  • Hormonal birth control for women not wanting to conceive: Can help to regulate  menstruation cycles, stabilise weight, improve acne and reduce new hair growth on face and body. 
  • Anti-androgen medicines: Although not safe for pregnancy, can help reduce PCOS symptoms. 
  • Metformin: A drug used to treat type 2 diabetes and may help some women with PCOS symptoms in certain circumstances. 

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