Polycystic Ovarian Syndrome (PCOS)
Polycystic ovarian syndrome is a condition of hormonal imbalance in women. In this condition the ovaries tend to make more male hormones than usual.
The diagnosis is made when a women has two or more of the following:
- Excess hair growth especially around the face and lower abdomen, and/or acne (hirsutism)
- Excess male hormones measured in blood tests
- Irregular periods due to failure of ovulation
- Characteristic changes within the ovaries on ultrasound – polycystic looking ovaries.
11% of women have PCOS.
Doctors are uncertain why PCOS occurs but it does run in families. Other conditions are associated with PCOS although they are not part of the official diagnosis.
- Insulin resistance – high levels of insulin are needed to maintain normal actions of glucose metabolism, unfortunately these high levels of insulin also increase the production of male hormones and add to the symptoms of excessive hair growth and acne.
- Infertility – due the lack of ovulation
- Weight gain especially around the tummy area
- Pre-diabetes or diabetes
- Abnormal blood fats
- Cardiovascular disease
- Precancerous changes of the uterus and cancer of the uterus (due excess estrogens)
Poor diet and lack of exercise may contribute to the worsening of PCOS especially by increasing the insulin resistance and contributing to the amount of excess male hormones. Treatment options are individualised, depending on the primary symptoms.
All women will need to have a discussion about diet and weight management. Weight management helps to regulate blood sugar and insulin levels, control the level of male hormones, improve symptoms of excess male hormones and reduce the risk of heart disease and diabetes. In women who are overweight, weight loss can improve menstrual disturbances and trigger ovulation.
Medical management (with the Pill or the Mirena intrauterine device) will improve menstrual irregularities, protect the endometrium from uterine cancer and improve hirsutism.
If a pregnancy is desired, your fertility doctor will complete a full history and examination including organizing some more specialized hormone studies. As mentioned above, weight management is usually the first line treatment. Should further treatment be necessary, fertility drugs may induce ovulation. Though rarely needed assisted reproduction is sometimes necessary.
Sources of Vitamin D:
How much sunlight is safe?
Expose face, hand and arms/legs to the sun on most days as per below. When UV exposure is above 3 (www.sunsmart.com.au) cover with clothes and apply sunscreen to unexposed areas when in direct sunlight.
Fair to olive skin
- 5 – 10 mins mid-morning to mid-afternoon in summer
- 7 – 30 mins around midday in winter
- 5-10 mins mid-morning to mid- afternoon all year round
- 15 – 60 mins mid-morning and/or mid-afternoon in summer
- 20mins – 3 hours around midday in winter.
- 15 – 60mins all year round
For details on specific parts of Australia see
Vitamin D can be found in small amounts in:
- Egg yolk
- Oily fish (salmon, sardines)
- Cod liver oil
- Bread/cereals/margarines and milk may have added Vitamin D
Can be purchased at any pharmacy and may be recommended by your local doctor if your levels measure to be low on a blood test.
A pregnancy that is lost before 20 weeks is called a miscarriage. Miscarriages unfortunately are common and 20-25% of pregnancies end in a miscarriage. Occasionally this can occur so early that a women only has a briefly positive test or wasn’t even aware she was pregnant. Most miscarriages occur before 10 weeks. Most often the cause of a miscarriage is unknown. 50% of miscarriages are believed to occur due to a genetic abnormality within the fetus.
Some women have a higher risk of miscarrying:
- Women over 35 years.
- History of previous miscarriages
- Some medications
- Alcohol and drug usage
- High number of previous pregnancies
- Previous uterine surgery
- Connective tissue diseases – SLE
- Poorly controlled diabetes, kidney disease or thyroid disease
- Infections especially if associated with high temperatures
- Blood clotting disorders
Miscarriages can be divided into:
- A threatened miscarriage where there is some bleeding, usually no pain and the pregnancy is ongoing. This puts the ongoing pregnancy in some risk of complications.
- An incomplete miscarriage where some of the miscarriage has been lost but some still remains within the uterus.
- A complete miscarriage, where the pregnancy has been lost and all the tissue has been passed spontaneously.
- A missed miscarriage, where the pregnancy stops but there has been no bleeding or pain. The pregnancy may continue for weeks without the mother being aware and is often found on an ultrasound.
- An ectopic or tubal pregnancy where the pregnancy is growing outside the uterus, usually in the tube.
Also see RECURRENT MISCARRIAGES
How do I know I am having a miscarriage?
You might experience bleeding, which can range from a small amount of spotting to heavy period-like bleeding, and associated cramps. If you experience bleeding or pain you should see a doctor. Sometimes as mentioned above there can be no signs or symptoms of a miscarriage and it is only found on one or two ultrasounds.
How do I know that I have an ectopic?
An ectopic is often difficult to diagnose as they are often not seen on an ultrasound and there may be no symptoms. If you have severe pain, or if you feel dizzy or collapse at home, even if the bleeding is light or there is no bleeding, you should attend the nearest emergency department as soon as possible.
What will the doctor do when I visit them?
The doctor will take a full history and do a pelvic examination to determine the source of bleeding. Depending on the findings and how far along in the pregnancy the doctor will organize for you to have some bloods tests and possibly an ultrasound scan.
Can I stop the miscarriage from happening?
Unfortunately there is little we can do to prevent a miscarriage from occurring. Neither bed-rest nor hospital admission can change the course, although many women will need time off to undergo investigations and treatment and to cope with the bleeding and pain.
What treatments are available?
The treatment depends on the type of miscarriage.
A complete miscarriage needs no further treatment, as the pain and bleeding should have settled. You will need to keep in contact with your doctor to make sure that your post-miscarriage course is as expected.
An incomplete miscarriage or missed miscarriage may need further treatment, either medically or surgically and you should seek medical advice as soon as possible if the bleeding is heavy or the pain is severe. You will have close follow up afterwards to ensure that the treatment has been successful.
An ectopic is a special situation that requires urgent review and assistance by a specialist. If you suspect you have an ectopic you should present to the nearest emergency department.
What happens after the miscarriage?
After a miscarriage you should rest for several days, not use tampons and avoid sex, to reduce the risk of infection. You can experience some light bleeding for several weeks that should be getting lighter. If the bleeding is heavier than expected or increases you should see your doctor. Your doctor will also advise you on when you can consider becoming pregnant again.
Women have a wide range of emotional reactions from having experienced a miscarriage. Grief is a normal experience after a loss. It may vary in intensity and duration. If you feel you need further advice or assistance see below.
SIDS and Kids – dedicated to saving lives of children and to supporting bereaved families.
Sids and Kids
24 hour bereavement support line
1300 308 307
SANDS – miscarriage, stillbirth and newborn death support. 24 hours per day, 7 days per week parent (volunteer) supporters.
1300 072 637
Pregnancy Birth and Baby – non commercial government funded information service. In addition offers a 24 hour per day, 7 day per week counseling line.
1800 882 436
Health direct Australia – free service to talk to a nurse or doctor, 24 hours per day 7 days per week.
1800 882 436