Polycystic ovary syndrome (PCOS) and pregnancy

The causes of polycystic ovary syndrome are not known, but they may also be linked to some genetic factors. In fact, it seems that it occurs predominantly within the same family group, and that women who are in this family condition are more likely to develop it. As well as those who were born in those families in which other women (of their own family) had also had irregular cycles or diabetes: in this regard it should be noted that polycystic ovary syndrome can be “inherited” both from the paternal part of the family, and from the maternal one.

The signs and symptoms related to this polycystic ovary syndrome

When the signs and symptoms of polycystic ovary syndrome occur, they usually manifest in their late teens or early twenties.

Not all women have them all, and each of these (signs or symptoms) can be mild or severe: some women only have menstrual problems or are unable to conceive, while others have both.

Here are the most common signs and symptoms of polycystic ovary syndrome:

• irregular periods, or no periods at all,
• difficulty getting pregnant – this is due to irregular ovulation or failure to ovulate,
• excessive hair growth (hirsutism): usually on the face, chest, back or buttocks,
• weight gain,
• thinning and hair loss;
• oily skin,
• acne.

infertility and PCOS

Although, as we have said, polycystic ovary syndrome is not synonymous with infertility, it is nevertheless one of the most common causes of female infertility. Many women find that they are affected by ovarian polycystosis when they are trying, without success, to get pregnant. In fact:

• During each menstrual cycle, the ovaries release one egg into the uterus.
• This process is called ovulation and usually occurs once a month.
• Women with polycystic ovary syndrome often fail to ovulate (or rarely ovulate), which means they have irregular or absent periods, and have difficulty getting pregnant.

Health problems in old age

Stein-Leventhal syndrome can increase the chances of developing certain health problems in old age. For example, women with polycystic ovary syndrome are at greater risk of,

• type 2 diabetes,
• depression and mood swings,
• sleep apnea,
• endometrial cancer.

Diagnosis of PCOS

In order to diagnose (or not diagnose) polycystic ovary syndrome, the attending physician:

• He will ask the woman some questions about her health in general, the symptoms she notices and her menstrual cycles;
• visit you to look for any characteristic signs of these disorders, such as unwanted hair and high blood pressure;
• will check your height and weight to determine the index of your body mass;
• will order laboratory tests to check your blood sugar, your levels of insulin and various hormones: hormonal tests are used to rule out the existence of certain problems with the thyroid and other glands that can cause symptoms similar to those of a PCOS;
• He will also prescribe (possibly) a pelvic ultrasound to have images of possible ovarian cysts: this examination is not necessarily necessary, but can facilitate the doctor in his diagnosis.

Treatments of symptoms related to PCOS

There is no cure for PCOS polycystic ovary syndrome. However, its symptoms can be treated. Also effectively. As for the related treatments, the main options are as follows.

1) the adoption of correct lifestyles from a young age

By means of excess weight loss, overweight women can see greatly improved,

1. both their symptoms,
2. and the overall risks of developing long-term health problems due to polycystic ovary syndrome – PCOS.
3. Even a 5% weight loss can lead to a significant improvement in the symptoms of polycystic ovarian disease.

Therefore it is necessary to exercise regularly and follow a healthy and balanced diet which includes,

• plenty of fruit and vegetables (at least 5 portions a day),
• whole grain foods (such as whole grain bread, whole grain cereals, and brown rice),
• lean meats,
• fish and chicken.

If you need specific dietary advice, your GP may refer you to a dietitian.

2) pharmacological treatments

Today, there are numerous medications that are helpful in treating the different symptoms associated with this condition.

a) in the case of irregular or absent periods

In order to induce regular menstrual periods, the contraceptive pill can be useful:

1. even with an intermittent course of progestogen-only pills or mini-pills (or POPs, progestogen-only pills) periods can be induced;
2. This will also reduce the risks of developing long-term cancer of the lining of the uterus (endometrial cancer) associated with not having regular periods.

Other hormonal contraceptive methods — such as an intrauterine system (IUS) — can also reduce this risk by keeping the lining of the uterus thin, but they may not cause menstruation.

b) in cases of fertility problems

With the appropriate treatments, most women with polycystic ovary syndrome manage to get pregnant.

Most of them can be treated successfully by a short course of tablets to be taken at the beginning of each cycle for several cycles. If this cycle is not successful, injections or IVF treatment may help.

Usually the first treatment that is recommended for women with PCOS who are trying to get pregnant is to take a drug called clomiphene tags. Clomiphene promotes the monthly release of an egg from the ovaries (ovulation).

If clomiphene fails to help ovulate, she may be prescribed another medicine called metformin .

Metformin is often used to treat type 2 diabetes, but it can also help lower insulin and blood sugar levels in women with polycystic ovary syndrome – PCOS.

In addition to stimulating ovulation, encouraging regular periods, and reducing the risk of miscarriage, metformin may also have other beneficial effects on a woman’s long-term health, such as lowering her cholesterol levels (high ) and reducing the risk of heart disease.

The use of metformin during pregnancy is permitted since several studies have demonstrated its good safety profile on the health of the fetus.

Possible side effects of metformin are nausea, vomiting, stomach pain, diarrhea and loss of appetite.

If you are unable to get pregnant despite taking oral medicines, you may be offered a different type of medicine, gonadotropins .

c) in case of unwanted hair growth and hair loss

Among the drugs useful for controlling excessive hair growth (hirsutism) and hair loss (alopecia) there are particular combined oral contraceptive tablets, cyproterone acetate, spironolactone, etc.

These drugs work by blocking the effects of “male hormones” such as testosterone. Some of these also suppress the production of these hormones by the ovaries.

3) Laparoscopic ovarian drilling (LOD)

With regard to those fertility problems (associated with PCOS) that do not respond to medicines, an alternative to be evaluated may be a surgical procedure: laparoscopic ovarian drilling (LOD).

1. Under general anesthesia, the doctor makes a small cut in the woman’s lower belly and then passes a long, thin microscope called a laparoscope through the abdomen.
2. The ovaries are then surgically treated using heat or a laser to destroy the tissue that produces male hormones – androgens.

Laparoscopic ovarian drilling (LOD) has been found to lower testosterone and luteinizing hormone (LH) levels while increasing follicle stimulating hormone (FSH) levels.

This fact leads to a correction of the hormonal imbalance and can restore the normal function of the ovaries.

Risks related to PCOS if you are pregnant

Women with polycystic ovary syndrome are at increased risk of having some complications typically related to pregnancy, such as:

• hypertension,
• preeclampsia ,
• gestational diabetes ,
• the .

These risks are particularly high in obese women: if this is your case, you can reduce your risk simply by losing weight before trying to get pregnant.