Birth control pills regulate periods but don’t cure PCOS – Gynaecologist

Second Vice President of the Society of Gynecology and Obstetrics of Nigeria, Prof Christopher Aimakhu, and a renowned professor of Obstetrics and Gynecology at the University College Hospital, Ibadan, and the University of Ibadan, speaks to TEMITOPE ADETUNJI on Polycystic Ovarian Syndrome (PCOS), its causes, symptoms, and the myths surrounding it

What exactly is PCOS, and why does it happen?

PCOS stands for polycystic ovarian syndrome. It is a condition that affects the hormone levels of women. It is referred to as a syndrome because it consists of a collection of symptoms rather than a single symptom.

PCOS is caused by an imbalance of hormones, particularly androgens, which are male hormones that women also produce in smaller amounts. Common symptoms include ovarian cysts, irregular or absent periods, and excessive hair growth on the body and face.

Women with PCOS produce higher-than-normal levels of androgens, which can lead to irregular or absent menstrual periods and excessive hair growth on the face and body. It can also cause baldness and other health issues.

Aside from irregular periods, are there other lesser-known symptoms?

Yes. In some cases, a woman’s periods may disappear completely, a condition called amenorrhea. The severity of symptoms depends on how high the androgen levels are.

PCOS affects the ovaries, which produce estrogen and progesterone, the hormones that regulate menstruation. When there is an excess of androgens, these hormones become imbalanced, leading to missed or irregular periods.

PCOS is considered a syndrome because it presents with multiple symptoms. The most common signs include cysts in the ovaries, high levels of male hormones (androgens), irregular or skipped periods.

What age group is most affected by PCOS?

PCOS affects women of reproductive age, typically between 15 and 44 years old. Studies estimate that 2% to 25% of women within this age range may have PCOS, depending on the population studied.

Is PCOS a genetic condition? If a mother has it, does that mean her daughter will also have it?

Yes, research suggests that PCOS may run in families or be hereditary. If a mother has PCOS, her daughter may also develop it, but genetics is not the only contributing factor. Many women with PCOS also have insulin resistance, meaning their cells cannot use insulin properly.

Insulin is the hormone that regulates blood sugar levels, and when the body becomes resistant to it, more insulin is produced. This excess insulin can trigger higher androgen levels, worsening PCOS symptoms.

Obesity is a major cause of insulin resistance, which is why many women with PCOS are overweight. Chronic inflammation is also common in PCOS patients.

What are some of the most noticeable symptoms of PCOS?

Irregular periods: Due to lack of ovulation, the uterine lining does not shed regularly. Heavy bleeding: When menstruation is delayed for a long time, the uterine lining builds up, leading to heavier bleeding when periods do occur.

Excessive hair growth (hirsutism), and high androgen levels cause thick, dark hair to grow on the face, chest, back, and other areas, similar to male hair patterns. Acne oily skin and androgens increase oil production, leading to breakouts similar to those in men with beards. Weight gain and difficulty losing weight: Up to 80% of women with PCOS are overweight.

Male-pattern baldness: Some women experience thinning hair or bald patches due to high androgens. Darkening of the skin: some women develop dark patches (acanthosis nigricans) on the neck, groin, and under their breasts.

How does PCOS affect fertility?

Many women with PCOS struggle with infertility because they do not ovulate regularly. If no egg is released, fertilization cannot occur. PCOS is one of the leading causes of infertility in women.

When diagnosing PCOS, doctors not only conduct tests but also discuss fertility options with women who want to get pregnant.

Many women struggle for years before getting a diagnosis. Why is PCOS often misdiagnosed or overlooked?

It depends; sometimes, young girls do not realise that their periods are irregular. There’s this common belief that when you first start menstruating (attain menarche), it takes a while for your cycle to be regular. So, many women don’t bleed every month, and some are even happy about it, not knowing they have PCOS. It’s only when they start noticing that their friends have regular cycles that they begin to worry.

Just recently, I received a text from a patient who told me she hadn’t menstruated since January last year. You ask yourself; how can a woman go a whole year without seeing her period?

Many of these women are overweight or obese, and some develop high blood sugar due to PCOS. However, irregular periods are usually the main reason they seek medical attention.

Doctors often prescribe medication to regulate their periods, but once they stop taking the drugs, their periods disappear again. That’s when the real concern begins. At that point, we conduct an ultrasound. The scan often reveals multiple cysts and fluid-filled sacs around the ovaries. The ovaries are responsible for regulating menstruation.

Further tests, like a hormonal profile, typically show imbalances in female hormones and elevated levels of male hormones. That’s when we can confidently diagnose PCOS.

For someone with PCOS, are there specific foods they should or shouldn’t eat?

The challenge with treating PCOS is that the exact cause varies. After running tests, we may not always pinpoint a single cause. When women come in with PCOS, they usually have two main concerns: either they want to regulate their periods, or they are trying to get pregnant.

If their cycle isn’t regular, conception becomes difficult. One of the primary treatment goals is to reduce their excess male hormones so their periods become more consistent.

Lifestyle changes can make a big difference, weight loss, a healthy diet, and exercise can help regulate their periods. In terms of diet, we recommend low-carbohydrate foods, as they promote weight loss and help lower insulin levels, both of which improve menstruation. So, diet and exercise are crucial for managing PCOS.

What are the key tests used to confirm a PCOS diagnosis?

No. Polycystic ovarian means multiple cysts in the ovaries, which is a defining characteristic of the condition. Doctors confirm the presence of cysts using ultrasound, which provides a clear image of polycystic ovaries.

In addition to ultrasound, a women’s health profile is conducted to check hormone levels. The luteinizing hormone (LH) and follicle-stimulating hormone (FSH) regulate menstruation. In women with PCOS, the LH to FSH ratio is often higher.

Another key factor is androgen levels, women with PCOS tend to have elevated male hormones. Blood tests are also done to check cholesterol, insulin, and triglycerides, as PCOS is often linked to diabetes and heart disease.

Doctors diagnose PCOS when a woman has at least two of these three symptoms; high androgen levels, irregular periods, and cysts in the ovaries.

Being overweight is often associated with PCOS. Can someone with a normal weight still have PCOS?

Yes, a person with normal weight can still have PCOS. However, weight influences hormone production. Obesity can lead to excessive sugar production, which contributes to insulin resistance.

Does having PCOS automatically mean infertility, or are there ways women with PCOS can conceive naturally?

PCOS is one of the leading causes of infertility because it disrupts ovulation. For conception to occur, a woman must ovulate, and release an egg for fertilization. Many women with PCOS do not ovulate regularly, making it difficult to conceive.

About 7-8% of women with PCOS experience fertility challenges. Even when conception occurs, PCOS increases the risk of pregnancy complications such as premature birth, miscarriage, high blood pressure, and gestational diabetes.

Some believe PCOS disappears with age. Is this true?

PCOS symptoms may improve with age due to hormonal changes, but the condition itself does not completely disappear. Women trying to conceive can undergo fertility treatments to improve ovulation.

What role do birth control pills play in PCOS management?

Birth control pills help regulate the menstrual cycle by providing progesterone and estrogen. These hormones restore hormonal balance and ensure a regular cycle; progesterone in birth control pills can regulate ovulation, reduce excessive hair growth, and lower the risk of endometrial cancer.

Apart from birth control pills, medications like metformin (Glucophage) are often prescribed for PCOS. Originally designed for type 2 diabetes, metformin improves insulin sensitivity, aiding weight loss and lowering blood sugar. Clomiphene citrate (Clomid) is another commonly used fertility drug that helps women with PCOS to ovulate.

What are the surgical options for PCOS?

In severe cases, ovarian drilling is performed. This minor surgical procedure involves making small holes in the ovaries to drain fluid-filled cysts (called ovarian drilling) and restore regular ovulation.

To summarize, birth control pills help regulate the menstrual cycle, Metformin improves insulin function and lowers blood sugar, Clomiphene boosts ovulation, Surgery is an option for severe cases affecting fertility, and Hair removal treatments can address excessive hair growth.

How does PCOS affect a woman’s mental health? Do you see a connection between PCOS and anxiety, depression, or low self-esteem?

Yes, there is a connection between PCOS and depression. Hormonal changes and symptoms such as unwanted hair can have a negative impact on a patient’s emotions. Women with PCOS may experience depression and anxiety due to high expectations from treatment.

Another factor is sleep apnea, which is common in women who are overweight. Sleep apnea causes interruptions in breathing during sleep, often leading to snoring and breathlessness. The combination of obesity and PCOS increases the risk of this condition.

What are the latest medical advancements in treating PCOS?

As I mentioned before, treatment depends on a woman’s specific needs. If she wants to get pregnant, there are medications available to improve fertility. If she just wants to regulate her periods, there are different treatment options available for that. Surgery is also an option in some cases.

Some women have reported success with intermittent fasting or keto diets for managing PCOS. Do you recommend these approaches?

Yes, these approaches aim to lower sugar levels and reduce weight, which is key to managing PCOS. Not everyone can do intense exercise. So, dietary changes such as intermittent fasting or keto can be effective alternatives. However, the goal remains weight management, as weight loss improves the chances of conception and overall hormonal balance.

What advice do you have for young girls or women who have just been diagnosed with PCOS and feel overwhelmed?

I always advise them to see a doctor for a proper evaluation. They should ask themselves simple questions: Do I want to regulate my periods? Do I want to get pregnant? Understanding their goals helps in determining the best treatment approach.

There is a lot of conflicting information about diet and PCOS, but anti-inflammatory foods can be beneficial. Foods like tomatoes, spinach, and almonds can help manage symptoms. While diet alone may not be enough, it is worth trying as part of an overall treatment plan.

For those experiencing acne and oily skin due to excess male hormones, certain medications can help improve their appearance. Anti-androgen drugs can reduce male hormone levels and improve symptoms. However, if they use birth control pills to regulate their periods, they should be aware that prolonged use (beyond three months) may lead to weight gain.

What are the most important lifestyle habits every woman with PCOS should adopt today?

Exercise is crucial. Regular physical activity helps with weight management and hormonal balance.

For skin-related symptoms, they should follow a skincare routine; including cleansing with an oil-free moisturiser and avoiding the habit of pulling out unwanted hair by hand.

Dietary changes are also essential. Reducing carbohydrate intake can aid in weight loss and lower insulin levels, which helps in managing PCOS. Additionally, women should monitor their menstrual cycles to identify irregularities early on.

By focusing on exercise, diet, skincare, and hormonal balance, women with PCOS can improve their overall well-being.

Diets and exercise help with weight loss more effectively than either one alone. So, both are important for maintaining a healthy weight.

What message do you have for people who feel that PCOS is not a serious condition?

I wouldn’t say it is ‘serious’, but rather a ‘disturbing’ condition. For example, if you’re a woman who doesn’t get her period regularly, you may not even realise when you’re pregnant, especially if you’re sexually active.

I’ve seen women who experience periods only once every four to six months. Because of this, they assume they can’t get pregnant, especially if they have unprotected sex. But that’s not true.

Even with irregular periods, ovulation can still occur at some point, and pregnancy is possible. Many women only realise they’re pregnant when they start experiencing symptoms, and by the time they get a scan, they’re already two months along.

That’s why it’s important for women with PCOS who are sexually active to still use protection if they don’t want to get pregnant.

In recent years, access to ultrasound has improved significantly. About 10 to 20 years ago, it was much harder for people to get ultrasounds. Now, it’s more accessible, which helps with diagnosis.

However, I’ve seen patients go from one scan centre to another, sometimes three or four times, trying to confirm their condition. This can lead to frustration, anxiety, and even depression.

Some women with PCOS take medication to regulate their periods. But sometimes, when their periods become too heavy, they wish they could go back to when they were irregular.

Should all women get tested for PCOS?

If a woman is trying to conceive and has concerns, then yes, she should get tested. However, routine hormonal tests can be expensive. For example, a woman with PCOS may need to do a hormonal profile to assay luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, progesterone, prolactin, and androgen levels.

The androgens are testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS). Some women become paranoid and start doing these tests every three months, which is costly and unnecessary. The key is knowing what you want; if you want to get pregnant, follow the necessary steps. If you want regular periods, there are ways to achieve that too.