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Treatments for conception with PCOS
Q:I came off the pill at end of January, at the request of my gynaecologist. I had a withdrawal bleed, which was controlled fairly well with tranexamic acid. However, since this I have not had a period at all. I have PCOS and I don't know whether to be concerned that I've not had a period yet. I have experienced sore enlarged breasts, abdominal twinges that aren't really period cramps, nausea and tiredness, though I don't know if this is just changes from coming off the pill. Pregnancy tests to date have been negative. cl-nemo01
A: Sometimes it can take several months for a normal menstrual cycle to return after stopping the Pill. If you have PCOS, this is the most likely reason why your periods have not returned, rather than having taken the Pill itself. If you do not want to conceive, then treatment is not necessary unless you have troubling symptoms. Absent or irregular periods are often treated with synthetic progesterone hormones or the oral contraceptive pill to produce a regular bleeding pattern (although recent evidence suggests the Pill may worsen insulin resistance and that oestrogens are better given as a patch rather than in tablet form). Excess hair (hirsutism) and/or acne are treated with an androgen blocker (for example, cyproterone acetate found in a brand of Pill called Dianette).
Researchers have also found that PCOS responds to treatment with the anti-diabetes drug, metformin, which improves insulin resistance so that more glucose is taken up into muscle cells. Metformin helps to reduce weight gain, lowers androgen levels and improves cycle irregularities. When used together with clomiphene, metformin may improve ovulation rates and chances of pregnancy in women with PCOS - certainly in those of normal weight. Women with PCOS who aren't obese tend to respond better to treatment with metformin than those who are very overweight. If you wish to conceive, then treatment with the fertility drug, clomiphene, is effective in triggering ovulation in four out of five women with PCOS but does increase the chance of a multiple pregnancy, most commonly with twins. Stronger fertility drugs such as gonadotrophins will help up to 95 per cent of women ovulate, but significantly increase the risk of multiple pregnancy (14 per cent to 36 per cent). If drug treatment does not work, a laser beam may be used to literally drill holes in the surface of the ovaries using keyhole (laparoscopic) surgery. It is as effective in improving fertility as clomiphene and gonadotrophins although why it works is unknown.
Lose any excess weight - even modest weight losses of around six kg (one stone) can correct hormone abnormalities, reduce unwanted hair and improve your chances of conceiving. Take regular exercise and, if you smoke, do your utmost to stop, as smoking reduces ovarian function.
Back to main question page
Treatments for conception with PCOS
Q:I came off the pill at end of January, at the request of my gynaecologist. I had a withdrawal bleed, which was controlled fairly well with tranexamic acid. However, since this I have not had a period at all. I have PCOS and I don't know whether to be concerned that I've not had a period yet. I have experienced sore enlarged breasts, abdominal twinges that aren't really period cramps, nausea and tiredness, though I don't know if this is just changes from coming off the pill. Pregnancy tests to date have been negative. cl-nemo01
A: Sometimes it can take several months for a normal menstrual cycle to return after stopping the Pill. If you have PCOS, this is the most likely reason why your periods have not returned, rather than having taken the Pill itself. If you do not want to conceive, then treatment is not necessary unless you have troubling symptoms. Absent or irregular periods are often treated with synthetic progesterone hormones or the oral contraceptive pill to produce a regular bleeding pattern (although recent evidence suggests the Pill may worsen insulin resistance and that oestrogens are better given as a patch rather than in tablet form). Excess hair (hirsutism) and/or acne are treated with an androgen blocker (for example, cyproterone acetate found in a brand of Pill called Dianette).
Researchers have also found that PCOS responds to treatment with the anti-diabetes drug, metformin, which improves insulin resistance so that more glucose is taken up into muscle cells. Metformin helps to reduce weight gain, lowers androgen levels and improves cycle irregularities. When used together with clomiphene, metformin may improve ovulation rates and chances of pregnancy in women with PCOS - certainly in those of normal weight. Women with PCOS who aren't obese tend to respond better to treatment with metformin than those who are very overweight. If you wish to conceive, then treatment with the fertility drug, clomiphene, is effective in triggering ovulation in four out of five women with PCOS but does increase the chance of a multiple pregnancy, most commonly with twins. Stronger fertility drugs such as gonadotrophins will help up to 95 per cent of women ovulate, but significantly increase the risk of multiple pregnancy (14 per cent to 36 per cent). If drug treatment does not work, a laser beam may be used to literally drill holes in the surface of the ovaries using keyhole (laparoscopic) surgery. It is as effective in improving fertility as clomiphene and gonadotrophins although why it works is unknown.
Lose any excess weight - even modest weight losses of around six kg (one stone) can correct hormone abnormalities, reduce unwanted hair and improve your chances of conceiving. Take regular exercise and, if you smoke, do your utmost to stop, as smoking reduces ovarian function.
Back to main question page
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