Hi, I am Dr. Parul Chopra Buttan. I am a gynaecologist and obstetrician with 18 years of experience. I am also the co-creator of the conceive effortlessly online program to help you get pregnant faster, naturally, easily & most definitely. 😊
PCOS or PCOD or polycystic ovaries figures prominently in modern times when there is talk of pregnancy, getting pregnant, or delay in conceiving. This article has a clear aim. The first half is dedicated to helping you understand this disorder which is and how it affects your chances of conceiving naturally. And the second half is dedicated to enabling you to begin its treatment even before you visit a doctor!
A secret - you can conceive naturally with PCOS.
It is safe to begin the treatment of PCOS right away and I will be talking about the many positive side effects too that it has on other aspects of your life.
So, the first question - What is PCOS? How is it related to fertility?
PCOS or Polycystic Ovarian Syndrome is a hormonal disorder usually affecting young women. It’s symptoms range from:
Number 1: Menstrual disturbances, which is, change in regularity or flow of periods
Number 2: Difficulty or delay in conception
Number 3: Insulin resistance which can lead to high blood sugar levels or diabetes mellitus; and
Number 4: Skin issues such as acne, scalp hair fall, darkening or pigmentation of the skin, and hirsutism, which is abnormal hair growth over face, breasts, abdomen, back or thighs.
It is most often seen in adolescents and young women in their 20s and 30s. It is more common in women who are overweight and have a sedentary lifestyle.
Having said that, it does not mean you cannot conceive with PCOS. Here is a video of a patient of mine who conceived successfully with PCOS.
What is the criteria used to diagnose PCOS?
Doctors follow the Rotterdam Criteria to diagnose PCOS. This defines PCOS as the presence of any 2 out of the following 3 criteria.
The first criteria is oligo-ovulation and/or anovulation.
This means ovulation happening irregularly or not at all. This is evidenced clinically by a progressive delay of periods or reduction in the flow. For example, if you earlier had a 28 or 30 day cycle, then the periods started getting delayed by 5-10 days, then 15-20 days and then months would get skipped. This means you might have oligo ovulation or anovulation.
Another possible change is that, say earlier you used to bleed for 4-5 days and now the flow has progressively reduced to 1-2 days or in some cases just spotting occurs, this means you might have oligo ovulation or anovulation.
There are other ways of assessing ovulation. The most common one used by doctors is ultrasound where we do a TVS or Trans Vaginal Scan for follicle monitoring.
The second criteria is excess androgen activity.
Androgens are masculine hormones which are normally present in small quantities in young women.
Due to the complex interplay of lifestyle and hormonal imbalance, the amount of androgens rises in PCOS. The clinical symptoms of this are - acne, that is, pimples - you may notice mild to severe degree of pimples on the face, upper back, shoulders, upper arms. These may be recurrent or respond poorly to treatment.
Another clinical symptom of excess androgen activity is hirsutism, that is, excess hair growth over the face, especially the V area… sideburns, jaw-line, chin, neck, breasts, abdomen, upper back, thighs, arms. Doctors follow a scape, called the Ferriman-Gallwey scale to measure the severity of hirsutism. You can use it for yourself and track how the hair growth is improving or deteriorating over time. Serial photographs of the hairy areas also help track progress. Other ways of assessing androgen excess are doing a hormonal profile on a blood test.
The third criteria is an ultrasound picture.
If polycystic ovaries are seen on ultrasound the third criteria is met. In a nutshell if you have 1 or more of the following, you must consult a doctor.
- If you are overweight.
- If your periods are delayed by over 35 days and you’re not pregnant.
- If the flow in your periods has reduced to less than or equal to 1 day.
- If you have acne.
- If you have excess hair growth on usually non hairy areas of the body like face, chin, breasts, abdomen, back, thighs, arms.
- If you notice dark pigmentation on your neck.
- If you are trying to conceive and haven’t been successful over a few months.
When should you visit a doctor to confirm if you have it?
After a clinical evaluation your doctor will advise a hormonal blood evaluation and an ultrasound. These tests are best done on the 2nd and 3rd day of the periods. Irrespective of the amount of flow, the day the flow begins is day 1. The next day is day 2, and the day after that is day 3 and so on.
The big reveal - TREAT PCOS even before you confirm it!
If PCOS is diagnosed, the treatment is individualised depending on what your main concerns are, that is, whether you want to conceive, or is acne the main issue, or are your blood sugar levels elevated, or is it your hormonal levels. However, one aspect of treatment of PCOS is common to all and that is something that is under your control.
That one aspect is lifestyle improvement. A healthy diet, regular exercise, good sleep and low stress is a recipe for a healthy lifestyle in many ways, but more so for PCOS.
Here are 10 tips that I advise are game changing universally for women with PCOS.
Point number 1: Avoid eating junk food and processed food. Reduce your sugar intake. Hidden sugars creep into our diet in cold drinks, biscuits, namkeens, cookies, ketchups, sauces etc.
Point number 2: Eat freshly prepared home cooked simple meals including lots of fresh fruits and vegetables. Check with article written by Neha Ranglani on the 5 point eating plan you can follow to improve fertility and overall health.
Point number 3: Move more during the day. Avoid sitting for more than 30 minutes at a stretch. Getting up and moving for even 2-3 minutes helps.
Point number 4: Regular exercise. Depending on your current fitness level, start an exercise program and gradually increase intensity. 45 minutes to 1 hour of exercise 3-4 times a week is very beneficial. It’s positive side effects include improved digestion, lesser constipation, calmer moods, glowing skin and hair.
Point number 5: Have regular sleep and wake hours, as close to sunset and/or sunrise as possible. Maybe wind down and get in bed by 10 pm, wake up by 5-6 am. This avoids late night snacking, food cravings, day time lethargy, dependence on caffeine.
Point number 6: Quit smoking and alcohol. I have dealt with the effect of smoking and alcohol in detail on lifestyle habits to reduce pregnancy risks before you conceive. It is immensely beneficial to PCOS patients if they smoked or drank alcohol earlier.
Point number 7: Indulge in a hobby. Having downtime where you engage in any activity of your choice works wonders on your mental health and well being. Dedicating 30 minutes of your time a day to do something you love can remarkably alter the hormonal milieu.
Point number 8: Meditate or do breath work or yoga or any centering practice. The stress reduction this offers immediately starts to correct the hormonal imbalance and restores balance.
Point number 9: Involve your partner in making positive lifestyle changes. If you instill positive habits into your life as a couple, it leads to improvement for the health of the family and household. It makes it easier to conceive, builds your partnership and team. Going into pregnancy can be a testing time with ups and downs, and positivity makes it easier to deal with this. Most importantly, it lays the foundation for a healthy family which in my opinion is the best gift you can give your unborn child.
Point number 10: Finally, based on your individual circumstance, you will be advised to follow up with your doctor. It could be after 1 month or 3 months or 6 months. Ensure that you keep up with follow ups diligently.
I have listed down these 10 points for you. I urge you to choose any 1 right now and commit to it for this 1 month. You could choose a sleep or wake up time schedule or exercise or diet change or regular hobby, whatever you want. At Zoe we give a personalized nutrition plan to all our users to help them manage PCOS. You can get it here.
Sticking with 1 change for 1 month will enable you to add a 2nd, then a 3rd one after another and gradually, habit forming will make it easier for you to live a healthier lifestyle in all aspects.
Now let’s talk about the long term complications of PCOS.
If you have PCOS, you have a greater risk of developing the following 5 long terms health issues:
- Diabetes mellitus. Almost 10% of women with PCOS develop diabetes mellitus, especially after 40 years of age or if they have a family history of diabetes mellitus or if they are overweight.
- Hypertension of high blood pressure
- Cardiovascular diseases or heart disease
- Uterine cancer
- Depression or mood swings
The chances of all these complications decrease if you treat PCOS. The medication can be prescribed by your doctor, but adopting and sticking to a healthy lifestyle will go a long way in managing PCOS and avoiding the above complications.
Can PCOS be cured?
There is no cure for PCOS. It can, however, be successfully managed by a combination of a healthy lifestyle and medical treatments individualised for you by a doctor.
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Love and good health,
At Zoe we have created an online program to help you improve fertility and get pregnant faster by adapting small lifestyle changes that focus on weight, nutrition, sleep and mindset. This video series is your and your partner’s perfect pregnancy planner. Check it out here.