One of the most common issues faced by women of reproductive age in Trinidad and Tobago is polycystic ovary syndrome and its implications on short and long-term health. Not everyone diagnosed with PCOS will have significant symptoms as some patients have minimal or no symptoms. However, there may be implications to your health as this condition can be related to non-communicable diseases (NCDs) such as hypertension and diabetes, especially if you are obese.
PCOS can be diagnosed by clinical or biochemical features of hyperandrogenism (excess hair growth, acne, hair loss) and infrequent, irregular or prolonged menstrual cycles.
Appropriate investigations must be done by a medical practitioner to exclude other causes of menstrual disturbance before a PCOS diagnosis can be made. Therefore, you should not be diagnosed with PCOS solely by an ultrasound report in the absence of other clinical features. You may need blood tests in some cases to help make an accurate diagnosis.
Not everyone requires formal treatment of PCOS as some patients have little physical, social or psychological health related problems.
There is no wonder treatment or magic for PCOS as seen in various forms of advertisement. Each patient is different and may require an alternative type of management based on the complaint. For example, a young woman whose only complaint is acne should not be treated with fertility drugs, which may be required by other patients. You should always consult a health professional rather than online search engines and nameless social media experts. However, the following general guidelines can be useful in managing PCOS and maintaining general good health.
Weight loss, diet and exercise
Attention to your diet, exercise and weight are the first management options. Thirty minutes of brisk, daily exercise is recommended but longer periods are required for sustained weight loss. You may not need to take medication for other PCOS problems. However, weight management can be frustrating as the metabolic issues associated with PCOS tend to make sustained weight loss challenging. Frequent smaller, lower calorie, low fat, low complex carbohydrate meals may be appropriate. Consulting with a dietitian or nutrition expert is advisable. Bariatric surgery is now becoming an option for severely overweight patients.
Acne and excessive hair growth
There are many topical, over the counter acne treatments which are effective, especially for mild cases. In more severe cases, there are prescription level medications, including antibiotics that can be used. A dermatologist is a specialist doctor who can assist especially in complicated cases. When it comes to excess hair growth, there are personal, social and genetic considerations for what may be considered abnormal. There are many treatments including local hair management techniques such as waxing, plucking, threading, electrolysis, bleaching, creams, and laser. You should tell your doctor if you are already on treatment as excess hair growth might not be noticeable when you are assessed. Drug therapy, such as the contraceptive pill and anti-androgens, may sometimes be used to reduce the amount of free male hormones (testosterone levels). They can take at least 6-9 months to make a difference due to the natural slow growing lifespan of hair follicles. They will also treat acne throughout the body. These treatments should not be used except under medical supervision and certainly should not be started or continued for any prolonged period by purchasing directly from a pharmacy.
If periods are infrequent, unpredictable and sometimes heavy, it would be a good idea to use prescribed medication to induce a regular period. You should have a period at least once every three months. This will reduce the chance of an abnormal overgrowth of the lining of the uterus. If there is no immediate plan to become pregnant, you can discuss an appropriate contraceptive as well. These include the use of the contraceptive pill or the insertion of an intrauterine device.
There are many causes of female infertility. In Trinidad and Tobago, blocked fallopian tubes and irregular ovulation (anovulation) are two common causes. PCOS is a major cause of anovulation. Male factors are also a common cause of infertility.
Treatment starts with weight management. Other treatments may involve use of a drug called mefformin and specific drugs to induce ovulation (clomifene citrate, tamoxifen). These are not over the counter drugs and should not be purchased directly from your pharmacy without the supervision of your doctor. Metforrnin should not be used as the first treatment for PCOS. Ovulation inducing drugs can also cause multiple pregnancies as well as rare serious complications. Some patients may require consultation with an infertility specialist depending on their clinical situation including their age and length of time of infertility despite other treatments.
Patients with PCOS are more likely to have problems with the inability to stay asleep due to airway obstruction. This may cause snoring and a condition called sleep apnea.
Surgery is not usually the first treatment for the management of PCOS. It is considered only after other management interventions have not been successful and is dependent on the woman’s age. The technique that is now commonly used is laparoscopic ovarian drilling. This is a surgical procedure performed by trained specialists involving general anaesthesia and the insertion of instruments through small incisions in the lower tummy area.
Research has shown that pregnant women with PCOS may have an increased risk of developing diabetes, high blood pressure, preterm birth and adverse neonatal outcomes. It is important to note that these complications do not occur in every woman with PCOS and your health care provider will be vigilant for these problems. You should make sustained steps toward improving your health before beginning fertility treatments.
The Directorate of Women’s Health is a newly created unit at the Ministry of Health, charged with the responsibility of implementing policies that specifically target and bring about improvement to women’s healthcare issues.
This series of articles is penned by Dr Adesh Sirjusingh, Director of Women’s Health, and is based on frequently asked questions and comments from women throughout Trinidad and Tobago. The information contained in these articles is not meant to replace advice from your healthcare provider.
When it comes to personalized health information, your qualified healthcare professional is the best person to consult, rather than self-diagnosis and recommendations from the Internet. Medical research. treatment and technology are always evolving and every effort was taken A provide ee-le-dale advice at the time of preparing this article.
Healthy me...Healthy you...Healthy T&T.