Overview

Polycystic ovarian syndrome, more commonly known as PCOS, is a hormonal condition that is categorized by irregular menstrual cycles, cysts on the ovaries, and higher levels of androgen hormones. This disorder is unfortunately common, affecting up to 20% of women worldwide. There aren’t any direct causes that we know of when it comes to developing this condition, but genetics tend to play a significant role. PCOS can cause difficulties when it comes to conceiving, which is why it’s so crucial to test for it as soon as it’s suspected and to and start a treatment protocol to help manage the condition.

Symptoms

PCOS is a spectrum of hormonal disorders. Women with PCOS might not experience any symptoms and live normally without obvious health issues. However, women with PCOS commonly encounter symptoms ranging from mild to moderate severity.

Common symptoms include:

• Menstrual irregularities
• Difficult to conceive
• Excessive body & facial hairs
• Scalp hair loss
• Oily skin or acne
• Weight gain
• High blood sugar

Causes

There are multiple factors that contribute to developing PCOS.

• Thyroid deficiency. Ovaries developed multiple cysts (polycystic) in the presence of thyroid hormone deficiency. Low thyroid hormone level stimulates production of prolactin, disrupting the balance between Follicular-stimulating hormone (FSH) and Luteinzing hormone (LH). This, in turn, over-stimulates ovaries, causing cystic formations.
• Insulin resistance. Insulin helps to convert blood sugar to energy. If your cells are resistant to insulin action, blood sugar will remain high. In response to that, your pancreas produces more insulin, leading to insulin excess. Insulin excess disrupts the balance of estrogen and androgen, subsequently suppresses ovulation.
• Genetics.Certain genes are associated with higher risk of getting PCOS.
• Androgen excess. In PCOS, ovaries produce more androgen instead of estrogen. Androgen excess causes excessive body hairs, acne, and occasionally hair loss.
• Increased GnRH pulse. GnRH is produced in pituitary in a pulsatile pattern. Increased in pulse frequency stimulates LH production, resulting in excess androgen production from the ovaries.

Health Consequences

• Infertility
• Diabetes mellitus
• Miscarriage and stillbirth
• Premature birth
• Obesity
• Depression
• Uterine fibroid
• Uterine cancer

Diagnosis

PCOS is a spectrum of health disorders including hormonal imbalance, infertility, menstrual disorder, metabolic disorder etc. Several tests might be offered by doctors to assess your health condition.

• Hormone test. Blood sampling was usually sent for testing for hormone level. It could help to identify PCOS and the underlying hormonal changes which could contribute to PCOS. It can also check if you are ovulating.
• Ultrasound scan. Ultrasound scan uses ultrasound wave to look at the internal organ such as uterus. It can identify ovarian cysts, uterine fibroid, and endometrial thickness.

A classical PCOS is diagnosed if a woman fulfills Rotterdam Criteria. However, most women present within the spectrum of disorder, and may not necessarily to meet classical PCOS features. Rotterdam Criteria requires 2 of the following:

1. Infrequent period or absence of ovulation
2. Signs of excess androgen, such as abnormal blood result, abnormal hair growth, or acne
3. Multiple ovarian cysts on ultrasound scan

Other important features of PCOS include:

• Insulin resistance
• High blood sugar
• FSH/LH imbalance
• Low estrogen
• Low progesterone
• Fatty liver
• Obesity

Current treatment approach

Since PCOS is often tied to insulin resistance, women with PCOS often have diabetes and obesity. Furthermore, studies have shown women with PCOS could suffer more complications during the pregnancy, which bring adverse health effects to both the mother and the baby.

The current available treatment option in Malaysia for those living with PCOS solely lies on incorporating lifestyle modifications such as altering the diet and increasing the level of exercise they get. Your doctor may advise a balanced diet incorporated with regular moderate exercise. These changes can understandably be difficult for someone dealing with such intense hormone imbalances, though.

In recent years, special diet plan such as low carbohydrate diet, Mediterranean diet, and intermittent fasting are getting popular. Studies have shown that these special diet plan could produce short term weight loss. Be mindful that these special diet plan could give side effects if it’s not done properly or under professional supervision.

Metformin, an anti-diabetic medicine, is one of the few medicines currently prescribed by doctors to improve fertility and pregnancy outcome. Many times, doctors might even prescribe birth control pills to regulate the menstrual cycle and reduce acne, but this artificial method really just masks the symptoms associated with PCOS and does not actually improve pregnancy outcome.

Medication, such as clomiphene could help women with PCOS to have ovulation. Despite ovulation could increase the chance of getting pregnant, however, studies have shown that this medication may not improve the pregnancy outcome. Women might develop other complication during the pregnancy and affect both mother and fetal health.

Despite current treatment, many women with PCOS in Malaysia still faces pregnancy complications, difficulty to conceive and develops diabetes later.

Our approach

Our approach prioritizes correcting the deficiencies and imbalances to support natural and healthy pregnancies. PCOS is a complex hormonal imbalance affecting insulin, thyroid hormones, estrogen, and progesterone. It is hard to manage PCOS without addressing the underlying hormone imbalance.

Thyroid hormone
Thyroid gland produces thyroid hormone (T4). The gland is located at the neck. Thyroid hormone plays a role in many different systems in our body. It regulates our energy consumption and other hormones. Optimizing thyroid hormone can increase energy consumption, promote weight reduction, stabilize mood, and improve focus.

Insulin hormone.
Insulin hormone is produced in the pancreas, which is located near to our stomach. Insulin helps your body cells to utilize sugar in the blood and convert them into energy. Rebalancing insulin level improves ovarian function, and optimizing progesterone supports healthy stable pregnancy.

Progesterone
After ovulation, corpus luteum is formed in the ovary. It produces progesterone, an important hormone to ensure your uterus ready for embryo implantation and pregnancy. PCOS is often associated with progesterone deficiency. Optimizing progesterone regulates period cycle, oppose excess androgen, and prepare uterus for pregnancy.

The use of bio-identical hormones also ensures the PCOS treatment is compatible with human, allowing self-healing. Bio-identical hormones are produced chemically similar to human hormones. They better safety profiles compared to conventional synthetic hormone pills. Most bio-identical hormones are prepared in capsules form, while some are prepared in liposomal cream.

Each individual is different and requires a course of treatment that is unique to them. A comprehensive hormone panel can identify the deficiencies and enable our consultants to create personalized treatments to meet the needs of each individual we work with.

Get started with a test

PCOS is a complex hormonal imbalance involving wide range of hormones. Identifying the affected hormones helps to decide the subsequent treatment plan. In addition, it’s also essential to understand the degree of the deficiencies and guide the physician to determine the suitable dosage during hormone therapy. Furthermore, it’s important to screen for other medical conditions which are often associated with PCOS.

Our telehealth service allows online booking for hormone test as well as PCOS treatment for pregnancy in Malaysia. Whether you are currently in a place where you’re ready to conceive or knowing that someday you will wish to, our test allows you to get your health right and embrace not only a healthy pregnancy, but also overall long-term wellness.