Polycystic ovary syndrome (PCOS) in pregnancy

Polycystic ovary syndrome (PCOS) is a condition that affects a woman's menstrual cycle, fertility, hormones, insulin production, circulatory system, and appearance. Women have both male and female hormones, but women with PCOS have higher levels of male hormones and have irregular or absent menstrual cycles and small fluid-filled cysts on the ovaries. It is estimated that 5-10% of women of childbearing age suffer from PCOS.

What causes PCOS?

Unfortunately, the exact cause of PCOS is unknown. PCOS may be a genetic factor, but further testing is needed. Many women with PCOS also have weight problems. Researchers are currently studying the relationship between the body's ability to produce insulin and PCOS. A symptom of PCOS is that the body produces too much insulin. This can lead to excess production of male hormones, which can cause acne, hair growth, weight gain, and ovulation problems.

What are the symptoms?

Symptoms of PCOS include:

Infrequent, irregular, or absent menstrual cycles
Infertility due to irregular or absent ovulation
Increased hair growth on face, neck, stomach, back, hands, and feet
Acne, oily skin, and dandruff
Pelvic pain
Weight gain/obesity- normally around the waist
High cholesterol
High blood pressure
Thinning hair
Skin tags located on the neck or armpits
Dark or thick skin located on the neck, arms, thighs, and/or breasts
Sleep apnea

How is it diagnosed?

Unfortunately, there is currently no specific test to diagnose PCOS. Usually, the diagnosis of PCOS is made after your doctor takes a medical history, physical exam, pelvic exam, ultrasound, and various blood tests. Blood tests check hormone and glucose (sugar) levels. During a physical exam, a health worker will examine the ovaries and lining of the uterus. Any abnormal findings are often checked with an ultrasound.

What treatments are available for women diagnosed with PCOS?

There is no cure for PCOS, but it can be managed in ways that prevent other problems. The treatment plan is determined by the symptoms a woman is experiencing. The doctor may use one plan or a combination of plans, depending on the woman's situation.

The following list includes common treatment options:

Healthy lifestyle and weight. Maintaining a healthy weight is also a way to treat PCOS. A healthy diet and exercise help control weight, help the body use insulin more efficiently, lower glucose levels, and help regulate the menstrual cycle.
Birth control pills. Women who are not trying to conceive may benefit from starting birth control pills. They can help regulate periods and improve acne and hair growth. Symptoms may return if the woman stops taking the pills. Progesterone-only birth control pills may help with irregular periods, but won't help with acne or abnormal hair growth.
Medicines for infertility. The main fertility problem in PCOS is the lack of ovulation. However, additional fertility tests may be done to make sure there are no other problems. Various medications may be prescribed to help the ovaries release eggs, but women taking such medications should be aware that they are at an increased risk of multiple pregnancies. In vitro fertilization can also be used to help a woman with PCOS conceive a child.
Medications for diabetes. Metformin/Glucophage can regulate the production of glucose and male hormones. Abnormal hair growth should slow down and ovulation may return in a few months. Taking metformin will not make a person diabetic.
Medication for increased hair growth or too many male hormones. These medicines should only be used if the woman is not trying to get pregnant. Non-medical treatments such as electrolysis or laser hair removal are effective in treating unwanted hair. Hormones may be taken to prevent new hair growth. If a woman is pregnant or trying to get pregnant, she should consult her healthcare provider before resorting to any unwanted hair treatment.
Surgery. Although surgery is not usually used as the first line of treatment, a laparoscopic procedure (in which a weak electrical current is applied to the ovary) may be considered. A small part of the ovary is destroyed, which can reduce the production of male hormones and increase ovulation. This will not help with excessive hair growth, and also carries the risk of scar tissue on the ovaries. Usually, the results last only a few months, after which the symptoms return.

How can PCOS affect pregnancy?

Women with PCOS appear to be at an increased risk of miscarriage, pregnancy-induced hypertension, gestational diabetes, and preterm birth.

Can PCOS expose a woman to other diseases?

Women who have been diagnosed with PCOS are at higher risk for endometrial cancer, diabetes, high blood pressure, high cholesterol, and heart disease. Controlling symptoms as soon as possible can reduce a woman's risk of developing any of these conditions.