Dr Kumari Naidoo, a local specialist physician, endocrinologist and diabetologist sheds light on many misconceptions and possible solutions around PCOS.
With health information becoming so easily accessible on social media, and previously marginalised conditions being talked about, how do we separate fact from misinformation? Polycystic Ovary Syndrome (PCOS) is common, affecting around 10% of reproductive-aged women, yet it is also one of the most misunderstood conditions. With fit-fluencers and online “experts” offering conflicting advice and explanations, we need clear, reliable information.
PCOS is a reproductive, metabolic, and psychological condition which impacts women across their lifespan. A diagnosis for PCOS is made when a woman has two out of the following three criteria:
- Irregular periods.
- Signs of excess androgens (acne or excess hair growth) or elevated androgen levels in the blood.
- The appearance of multiple cysts in the ovaries on ultrasound.
Multiple factors are responsible for PCOS, including genetic and hereditary factors, exposures during pregnancy, environmental and lifestyle factors, insulin resistance and inflammation.
PCOS affects many systems in the body, including:
- Reproductive changes (irregular menstrual cycles, infertility, endometrial cancer and pregnancy complications).
- Metabolic features (insulin resistance, weight gain, metabolic syndrome, type 2 diabetes).
- Skin manifestations (acne, excessive hair growth).
- Increased risk of cardiovascular disease.
- Psychological complications (anxiety, depression, sleep and eating disorders).
There are many lingering misconceptions. Here are three common myths:
- All women with PCOS have ovarian cysts: Based on its name, many people think PCOS refers to cysts, but this is false. For many women, tiny follicles are present in the ovary and may resemble a “strand of pearls” on an ultrasound.The follicles may resemble small cysts, but they are distinctly different. These follicles are not cancerous and do not cause pain.
- Women diagnosed with PCOS can’t have children: PCOS is a common cause of fertility problems for women, but that doesn’t mean carrying a pregnancy to term is impossible. Many women with PCOS can conceive on their own or with the help of fertility treatments. Lifestyle changes and a healthier diet can also improve the chances of conceiving.
- Women with PCOS can’t lose weight: It may be harder for women with PCOS, but it’s not impossible. Many women with PCOS have a lowered sensitivity to insulin, a hormone that regulates sugar in the blood. This is known as insulin resistance, which is a risk factor for type 2 diabetes and may make it difficult to lose weight, even if you are following a healthy lifestyle. Working with a registered dietician and endocrinologist can also help with weight loss goals.
But how does this condition affect fertility? Due to irregular periods and lack of ovulation (anovulation), women may experience difficulty conceiving. Obesity is an important factor that can negatively impact the chances of falling pregnant, and is associated with a higher risk of miscarriage and poorer pregnancy outcomes. Preconception weight loss with lifestyle modification and possibly medication and surgical interventions is therefore important.
In women who are not ovulating spontaneously, medications such as metformin, clomiphene citrate and letrozole can be used to induce ovulation. Second-line agents for ovulation induction include gonadotrophins. In some cases, assisted reproductive techniques like IVF may be needed.
Lifestyle intervention is an integral part of managing PCOS. Healthy eating, exercise and behavioural strategies help to improve general health and cardiovascular fitness, psychological well-being and the metabolic profile and produce weight loss, although this is usually modest. These interventions are recommended for all women with PCOS as they are beneficial, even in the absence of weight loss.
Various medical therapies may be advised based on the symptoms, including metformin for women who have metabolic abnormalities (insulin resistance and prediabetes), for cycle regulation and ovulation induction; medical therapy for weight loss (liraglutide, semaglutide), the OCP to assist with managing menstrual irregularity and excessive hair growth, and anti-androgens for more severe androgen excess. A shared decision-making process with the patient is essential to determine which treatment options are acceptable.
Alternative therapies have been explored, and Inositol could be considered for women with PCOS based on individual preferences and values. It has potential for metabolic improvement and does not cause harm, but the effects on ovulation, hirsutism or weight are minimal. Vitamin D and folate supplementation are also possible alternative treatment options.
PCOS can feel overwhelming, but the good news is that with the right support, guidance, and care, women can take control of their health. It starts with access to accurate information and the understanding that managing PCOS is not one-size-fits-all.
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