What is Polycystic Ovary Syndrome (PCOS)?

Genea fertility specialist Dr. Sonal Karia talks us through it.

PCOS is notoriously tricky to diagnose – what are some common symptoms to look out for. Is there a diagnostic test?

Polycystic Ovary Syndrome, in my opinion, is not one single disease or condition. Instead, it encompasses a wide spectrum of clinical features and associated implications. Some common symptoms to look out for are:

Irregular menstrual cycles
Acne, oily skin
Hirsutism – excess skin hair growth
Weight gain
Thinning of scalp hair/hair loss

There is no single diagnostic test, diagnosis is based on a detailed history, examination, series of blood investigations including female and male hormonal profile, testing for insulin resistance and pelvic ultrasound scan to look for features suggestive of polycystic ovaries.

Once diagnosed, is PCOS a major concern for fertility?

It can be, but it depends on the severity, age of the woman, and the presence or absence of other subfertility factors. In general, a single mature egg is released from the ovary every month, a process called ovulation. The fact that ovulatory dysfunction is an important feature of PCOS can lead to fertility issues.

If you know you have PCOS, is there anything you can do to increase your fertility? Should you consider starting ‘trying’ a little earlier?

If you know you have PCOS and you want to have children, starting a little earlier to try for a pregnancy is recommended as irregular ovulation and lesser than usual frequency of ovulation are factors that may lead to longer than usual time to conception. Here are some other things you should consider:

Lifestyle modification with sensible diet control and exercise to maintain one's weight in the healthy range is a very important part of the overall management of PCOS. Monitoring and correction of metabolic risk factors – regularly check blood pressure (at least once a year), glucose tolerance testing for insulin resistance and/or type 2 diabetes, and testing for cholesterol levels (at least once every two years).

Is PCOS curable or reversible?

The answer to this question is not black and white. In my opinion, PCOS needs ongoing management as it not only affects fertility, but is also associated with an increased risk of type 2 diabetes, cardiovascular disease and in severe cases, an increased risk of precancerous/cancerous changes in the uterine lining (endometrium). Management largely depends on the individual's goal at the time of treatment i.e. fertility management, symptom control or prevention/treatment of long-term health-related implications.

Is it possible to ‘develop’ PCOS or is it something you either have or don’t have?

Again, I'm afraid there's no straightforward answer to this question. Usually, a person has PCOS but it may not be obvious. Often, PCOS can be asymptomatic or the symptoms may be very mild. A reasonable proportion of cases remain undiagnosed. Sometimes, PCOS may become obvious following weight gain or following a significant change in metabolic profile.

Ovarian cysts are fairly common - if you have one, does that mean you have PCOS or are prone to it?

PCOS in one sense is a misnomer; it does not mean having multiple cysts in the ovaries. Women with PCOS tend to have a larger than usual numbers of follicles (fluid-filled bags in which the eggs mature), giving an appearance of multiple small cysts in the ovaries on an ultrasound scan. While follicles are physiological and desired, ovarian cysts may be pathological and undesirable (unless it is a simple hormonal cyst that usually disappears on its own). Having an ovarian cyst does not increase the risk of having or being prone to PCOS.

What’s your number one piece of advice to women with PCOS who are hoping to start a family?

Lifestyle management and maintaining your weight in the healthy range is one of the most important factors as far as fertility management and/or treatment are concerned.

I would recommend women to consider completing their family in the most reproductive years of their life (20-38 years of age), give themselves enough time to try naturally for pregnancy and seek advice from a fertility specialist if conception is delayed beyond 12-18 months of trial (due consideration to be given to the age of the female partner and presence of other subfertility factors which may require earlier intervention).


Amelia Freer with client Boy George

Like so many women, British celebrity nutritional therapist and best-selling author Amelia Freer just assumed she'd one day be a mother. But as she ended her thirties, she suffered a spate of miscarriages - including one that occurred while Freer was appearing on live TV, promoting one of her best-selling books - and doctors told her to prepare for a life without children.

Her chances of becoming pregnant, they said, were incredibly low. "It was quite brutal to accept that my future was going to look different to how I had imagined," she says. "But I don't think I really accepted it or gave up, I just quietly hoped for a miracle. I saw it as yet another of life's hurdles and I do have an attitude of just seeing how things turn out." It's this attitude – and a healthy dose of reproductive luck, of course – that saw Freer fall pregnant at 41 with her first child. Her beautiful daughter, Willow, is now two and a half.

During her pregnancy, Freer's attitude to health stayed as sensible as it has always been. With a focus on gut health, vegetables and good fats, Freer has always steered away from fad diets and trend-based superfoods when it comes to her clients (who include Victoria Beckham, James Corden and Sam Smith, among others). Victoria Beckham has said Freer taught her "so much about food; you've got to eat the right things, eat the right healthy fats."

She's written four books (her fourth book Simply Good For You celebrates the joy and the nutrition of food, and features over a hundred delicious, quick and non-nonsense recipes that are as healthy as they are tasty). Her third book, Nourish and Glow: The Ten Day Plan was borne of Freer's no-nonsense approach to nutrition. Based on a modified version of the Mediterranean diet, Freer says the book is a great place to start for anyone looking to improve their nutrition. As in all of her work, there's an emphasis on fresh fruits and vegetables, healthy fats and complex grains.

We caught up with the inspiring Freer to talk motherhood, the experience of miscarriage and more. In our conversation, we cover:

-The joy and the nutrition of food.
-The psychological and social aspects of nutrition.
-How Amelia's approach is driven by 'Positive Nutrition' and it's not perfectionist.
-Why we aren't understanding that diets simply don't work.
-What should we actually eat in a day?
-How many of us are dehydrated and how this has a massive impact on our wellbeing.
-Pregnancy loss and her motherhood journey
-How to nurture our bodies after we have children.
-Time management and the power of "no"

To find out more about Amelia Freer, go to ameliafreer.com

Amelia Freer

Amelia Freer holding her book Simply Good For You

Amelia Freer with her daughter Willow

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