Breaking barriers: Conquering PCOS, embracing pregnancy – ET HealthWorld


New Delhi: PCOS (polycystic ovarian syndrome) is a hormonal disorder that is widely seen in women. The cause of this disorder is still unspecified, but there are a few factors that may contribute to it. One of the major possible factors is the imbalance of androgen, also known as male hormones; the other factors are genetic and environmental determinants of occurrence. The major endocrinopathy among reproductive-aged women affects 4-20 per cent of women of reproductive age worldwide.

According to the experts, most women encounter PCOS in their 20s and 30s, when they have problems getting pregnant and then they consult a medical professional. But PCOS can happen at any age after hitting puberty. In some instances, women begin to experience symptoms right before the beginning of their period. And rest; others don’t find out they have PCOS until they’ve put on a lot of weight or struggle to conceive. Medical specialists advise tracking menses, as the most common symptom of PCOS is irregular periods, heavy bleeding, hair growth, acne, weight gain, male pattern baldness, darkening of the skin, and headaches.

Since PCOS symptoms are similar to regular menses, most women tend to ignore them, which may further lead to some serious illnesses and complications. One of the major complications women face due to PCOS is during conception. Premature birth is twice as likely to occur in women with PCOS than in women without the disorder. Additionally, they have a higher risk of miscarriage, hypertension, and gestational diabetes.

Signifying the consequences PCOS could be the most common reason for infertility, and experts believe it is treatable with an early diagnosis and appropriate management. ETHealthworld spoke with IVF experts and gynaecologists to better understand the importance of being aware of the symptoms and getting proper diagnosis and treatment, especially for pregnant women, as symptoms may get critical and can even vary.

Effects of PCOS on different pregnancy stages

“Women with PCOS often have difficulty conceiving due to irregular ovulation or lack of ovulation. Ovulation induction medications or assisted reproductive technologies, such as in-vitro fertilisation (IVF), may be used to help women with PCOS conceive,” said Dr Rashmi Baliyan, Gynaecologist and Obstetrician Consultant, Primus Super Speciality Hospital. Apart from this, Dr Baliyan also spoke about the effects of PCOS in early pregnancy. Hormonal imbalances or metabolic factors with PCOS are some of the higher risks. Women with PCOS have a higher risk of early pregnancy loss, including miscarriage.In addition, notably, PCOS is associated with an increased risk of developing gestational diabetes mellitus (GDM) during pregnancy. GDM is a type of diabetes that develops during pregnancy and can lead to complications for both the mother and the baby.

Women with PCOS have a slightly higher risk of pre-term birth, which is the birth of a baby before 37 weeks of gestation. It can also lead to pre-eclampsia: PCOS is also associated with a higher risk of developing pre-eclampsia, a condition characterised by high blood pressure and organ damage during pregnancy. Pre-eclampsia can be dangerous for both the mother and the baby if left untreated, suggested Dr Srividya P, Consultant, Infertility and IVF, Esha IVF Fertility.

Read more on: World Preeclampsia Day: Understanding the silent threat to maternal health

While talking about cesarean or c-section delivery, Dr Srividya, expressed, “Pregnant women with PCOS are more likely to have c-sections because of the pregnancy complications associated with PCOS, such as pregnancy-induced high blood pressure.”

Treatment options for timely detection and management of PCOS

The timely detection of PCOS is done through an ultrasound examination of the ovaries, which can help identify the presence of ovarian cysts and evaluate them. Blood tests are conducted to measure hormone levels. The treatment options for PCOS include focusing on managing the symptoms, improving hormonal balance, and reducing the long-term health risks associated with the condition.

The specific treatment plan will depend on individual symptoms, goals (such as improving fertility or managing symptoms), and other factors, voiced Dr Pooja Reddy Nimma, Fertility Specialist, Oasis Fertility, Gachibowli, Dr Nimma added, “Adopting a healthy diet that focuses on whole foods, high-fibre carbohydrates, lean proteins, and healthy fats can help manage insulin levels and promote weight loss if needed. Engaging in regular physical activity can help improve insulin sensitivity, promote weight loss, and regulate menstrual cycles.” She suggested aiming for at least 150 minutes of moderate-intensity aerobic activity per week. If overweight or obese, losing as little as 5-10 per cent of body weight can significantly improve PCOS symptoms and hormone levels.

In cases where fertility treatments are necessary, assisted reproductive technologies like ovulation induction / IVF may be recommended to help achieve pregnancy. “Regular antenatal care (ANC) for timely diagnosis and treatment, insulin sensitising agents like metformin have shown promising results in these women. Lifestyle modifications like diet and exercise are the first line of treatment. Pharmacological management is used in girls or women with menstrual abnormalities, hirsutism, infertility,” elaborated Dr Vimee Bindra, Consultant Gynaecologist and Robotic Surgeon, Apollo Hospitals, Jubilee Hills, Hyderabad.

For specific symptoms like unwanted hair growth on the face, acne and hair loss medications, procedures or treatments to manage these would be recommended. The lifelong health condition continues far beyond the child-bearing years. “Even after pregnancy, women have to diet, exercise and maintain the lifestyle measures adopted. PCOS might require further treatment well into late middle age. So women need to consult their gynaecologist regularly,” added Dr Revathy Ramaswamy, Consultant Gynaecologist & Gynae Endoscopic Surgeon, Apollo Hospitals, Secunderabad.

Post pregnancy challenges

After pregnancy, women with PCOS may face certain challenges, which can vary depending on individual circumstances. Dr Baliyan mentioned, “Challenges like postpartum hormonal changes can have hormone levels undergo significant changes, which can affect women with PCOS. Some women may experience a worsening of PCOS symptoms or a return of irregular menstrual cycles after pregnancy.”

According to the experts, women with PCOS often struggle with weight management, and postpartum weight loss can be challenging. PCOS may impact milk production and breastfeeding success for some women. Lactation consultants and healthcare providers can provide guidance and support to overcome any breastfeeding challenges. Postpartum depression and anxiety can affect women with PCOS, as they can for any new mother.

“If women are unable to reduce the excess weight postpartum this makes insulin resistance worse and one prone to metabolic syndrome. If blood sugar levels aren’t in control postpartum (which is common with insulin resistance) this could also make the new mother diabetic. PCOS also increases one’s chances of suffering from hypertension pre and post-pregnancy,” remarked Dr Srividya.

PCOS is a chronic condition that persists beyond pregnancy. Experts advise women with the condition to continue to manage their symptoms, monitor their health, and seek regular follow-up care to reduce the risk of long-term complications such as type 2 diabetes, cardiovascular disease, and endometrial cancer. By staying proactive with their healthcare, women with PCOS can navigate these challenges and take steps to maintain their overall well-being.

Precautionary measures to prevent impact of PCOS on pregnancy

Dr Nimma emphasised on preconception planning and consulting with a doctor even before trying to conceive, as they can provide personalised guidance and recommendations based on specific situations. Apart from weight management and adopting a healthy lifestyle, Dr Nimma, said, “Attend all scheduled prenatal check-ups to monitor the progress of your pregnancy, assess any potential complications, and receive appropriate care and guidance. Closely monitor your blood sugar levels & blood pressure as advised by your doctor. Follow any recommended dietary changes, exercise, or medications to keep blood sugar & pressure levels within a healthy range.”

Depending on the individual circumstances, healthcare providers may prescribe medications or treatments to manage specific PCOS symptoms during pregnancy. Doctors recommend a single treatment that addresses both reproductive and metabolic abnormalities. Some of the most common treatments used for the chronic management of PCOS include hormonal contraceptives, progestins and metformin. Treatment of infertility focuses on ovulation induction therapies which may involve drugs such as letrozole, clomiphene or gonadotropin therapy and hirsutism often involves the combination of hormonal contraceptives and the adjuvant use of anti-androgens with the prescription from a doctor.

Regular blood pressure tests, prenatal vitamins and regular medical check-ups help ensure the safety of a woman with PCOS throughout her pregnancy, suggest medical professionals. While it may not be possible to completely prevent the impact of PCOS on pregnancy, experts believe these measures if followed can minimise potential risks.

  • Published On Jun 25, 2023 at 05:27 PM IST

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