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Who is this baby?
That’s Singaporean fashion influencer Velda Tan’s baby.
Velda found out she had polycystic ovary syndrome (PCOS) when she went to her first gynae check after she got married to her husband, Fred.
But today, she and Fred are parents of multiple children, proving that PCOS doesn’t preclude your ability to have children.
It is estimated that 1 out of every 10 young women of reproductive age in the world has PCOS.
In Singapore, the prevalence of PCOS is not well-studied. There is also a lack of standardisation in its diagnosis. More than 80% doctors in Singapore surveyed in 2022 agree that more standardised educational materials are needed.
Understanding PCOS can be a confusing process – enough for a Singapore theatre production to detail the struggles of understanding and living with PCOS.
If you have PCOS or are just not very sure, you are definitely not alone.
But we have good news!
PCOS does not mean infertility. Most people with PCOS will be able to get pregnant and have the number of children they dedame.
Plus, if you are done having kids or don’t want to have kids, your PCOS can be managed easily.
What exactly is PCOS?
PCOS is a syndrome, or a group of symptoms.
One sign or symptom is not enough for a diagnosis.
To meet the diagnostic criteria of PCOS, women need to have two of the following three criteria:
- Irregular periods
- Signs of increased levels of androgens (hormones that give “male” characteristics) such as excessive facial/body hair growth, acne or hair loss from the head
- Enlarged ovaries with lots of small follicles containing immature eggs (known as polycystic ovaries)
Your doctor would decide which tests you should have based on your age, symptoms, and individual situation. Possible tests include:
- Blood tests to measure levels of hormones, blood sugar, and cholesterol
- A pregnancy test if you have missed any periods
- Pelvic ultrasound: this test uses sound waves to make a picture of your uterus and ovaries. This test may be used sometimes to help doctors identify if you have polycystic ovaries.
What causes PCOS?
The exact cause of PCOS is not completely understood.
It is believed that in PCOS, the ovaries do not work normally and produce too much androgen. Androgens like testosterone are commonly referred to as a “male hormone” but everyone male or female have some levels of androgen.
About once a month, the ovaries are supposed to make a structure called a “follicle”. As the follicle grows, it makes hormones. Then, it releases an egg. This is called “ovulation.”
In PCOS, the ovary makes many small follicles instead of one big one. Hormone levels can get out of balance. Ovulation does not happen every month the way it is supposed to.
There is also a genetic link suggesting that if your relatives (e.g. mother, sister) are affected, your risk of developing PCOS may be higher.
What are the chances of getting pregnant with PCOS?
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Most people with PCOS are able to get pregnant, however as ovulation is not regular, it may take longer to become pregnant.
Studies have shown that there are no significant differences in the number of dedamed children between women with or without PCOS. Velda Tan currently has two children. That is almost double Singapore’s fertility rate (1.05 in 2022).
If you are overweight, research has shown that even a modest amount of weight loss can help make your periods more regular and improve your chances of getting pregnant. In addition, weight loss can improve the effectiveness of other infertility treatments.
If you are of healthy weight, adopting a healthy lifestyle – not smoking, cutting back on alcohol, eating a healthy diet, getting plenty of regular exercise and enough sleep – is the first step towards a healthy pregnancy. A fertility evaluation can also be pursued to address concerns and identify possible treatment options.
Treatment for women with PCOS who want kids centres around encouraging ovulation
Clomiphene is an FDA-approved oral medication that stimulates the ovaries to release one or more eggs. It can trigger ovulation in approximately 80% of women with PCOS and approximately 50% of these women will become pregnant.
I don’t want kids (for now?) or I am done having kids. What treatments are available for PCOS?
Although PCOS is not completely reversible, there are a number of treatments that can reduce or minimise bothersome symptoms.
Most women with PCOS are able to lead a normal life without significant complications.
Birth control pills for PCOS
Birth control pills with combined estrogen and progestin are the most commonly used treatment for regulating menstrual periods in women with PCOS.
Birth control pills do not cure PCOS, symptoms generally return when the medication is stopped.
Birth control pills can protect against endometrial cancer
In a normal menstrual cycle, ovulation occurs and the endometrium (lining of the uterus) sheds uniformly and regrow.
Irregular or absent menstrual periods can result in ovulation not occurring. The endometrium may shed irregularly and become thicker. This results in heavy and/or prolonged bleeding, increasing a woman’s risk of endometrial overgrowth or even endometrial cancer.
Birth control pills induce a monthly menstrual period, protecting women from endometrial cancer.
Birth control pills can improve acne and excessive facial/body hair growth
Birth control pills can effectively treat acne and excessive facial/body hair growth by reducing the body’s production of androgens.
Here at Dame, other than pills, we also offer a patch version that is as effective. We’ve made birth control easy to understand in this article.
Some women may choose IUDs or implants containing a type of progesterone to induce a monthly menstrual period and for contraception. However, unlike birth control pills and the patch, IUDs or implants are not effective for treating acne and/or excessive facial body hair growth.
Birth control pills are safe and effective in women with PCOS
There is currently no evidence that women with PCOS are at greater risk for adverse side effects of birth control pills.
Some women who take birth control pills (not just those with PCOS) stop having monthly bleeding or develop irregular spotting and bleeding. Irregular bleeding usually resolves after a few menstrual cycles.
Many women worry that they will gain weight on the pill. In general, this is not a concern with the currently available low-dose pills available at Dame.
Some women may develop nausea, breast tenderness and bloating after beginning the pill, but these symptoms usually resolve after two or three months.
The pill is safe and effective, although it slightly increases the risk of blood clots in the legs or lungs; this is a rare complication in young, healthy women who do not smoke, but it is more of a concern in women who are obese and in older women.
In such a scenario, progestin-only pills are available as an alternative to induce a monthly period and protect from endometrial cancer. However, progestin-only pills are not effective for acne and excessive facial/body hair growth.
If you are considering birth control but don’t want to take pills every day, there are many other methods.
Spironolactone for PCOS
After six months of treatment with birth control pills, Spironolactone can be added on if results for cosmetic concerns such as acne and/or excessive facial/body hair growth are not satisfactory.
Spironolactone is a medication that can reduce the effect of androgens. When used in combination with birth control pills, it can reduce acne and/or excessive facial/body hair growth.
Other prescription skin treatments (e.g. medicated acne creams/gels) or oral antibiotics can also be recommended for acne.
Metformin for PCOS
Metformin is a medication that improves the effectiveness of insulin produced by the body. It was developed as a treatment for type 2 diabetes but may be recommended for women with PCOS in selected situations.
If a woman does not have regular menstrual cycles, the first-line treatment is usually a hormonal method of birth control such as birth control pills.
Metformin is normally prescribed as an alternative if a woman cannot take birth control pills. This is usually recommended together with a progestin-only pill.
Metformin can help make your periods more regular, but studies have shown that it only works in about half of the people who try it.
My symptoms are mild, I am not too sure if it is PCOS. Should I still see a doctor?
Yes, here at Dame – we would still advise you to consult a doctor for a formal medical evaluation.
Although the risks differ for everyone, there is evidence that PCOS could increase your risk of other health problems, including:
- Diabetes (high blood sugar)
- High cholesterol levels
- Cardiovascular disease (hypertension, heart attack, stroke)
- Sleep apnea, a sleep disorder that causes people to briefly stop breathing while they sleep
- Endometrial cancer (cancer of the womb)
An early diagnosis results in early management of PCOS; this reduces the risks of long-term health complications and improves your quality of life and well-being.
What else can I do besides medications?
It is possible to live a full and normal life with PCOS.
A good diet and exercise program is the first step for overweight and obese women with PCOS. Weight loss has been found to be one of the most effective approaches for managing symptoms of PCOS such as irregular menstrual periods.
Here at Dame, we advise you to see a doctor for a full medical evaluation if you suspect you may have some of the symptoms of PCOS but are just not very sure.
Early diagnosis and treatment will help your symptoms and protect you from other complications.
At Dame, we can navigate through PCOS together. Effective medications to manage your PCOS symptoms are available. Book a consultation with us today.
Disclaimer: Articles on Dame are for informational purposes only and do not constitute medical advice, diagnosis, or treatment. If you have concerns about your health, please consult a licensed doctor for personalised medical advice.
Speak with a Licensed Doctor Online
Our doctors are experienced in women’s health and provide confidential consultations through our secure telemedicine platform. If you have questions about symptoms, treatment options or your overall health, our team can help guide you with evidence-based medical advice.
Speak with a Licensed Doctor Online
Our doctors are experienced in women’s health and provide confidential consultations through our secure telemedicine platform. If you have questions about symptoms, treatment options or your overall health, our team can help guide you with evidence-based medical advice.
