PCOS: Challenges in Menstruation and Fertility

Polycystic Ovary Syndrome (PCOS)

Hello, doctor.
After my first menstrual period, I had my second one about a year later.
I thought it was normal, but when the third period was delayed, I went to the hospital for consultation.
After 1-2 years of examinations and changing doctors, I was informed that I have polycystic ovary syndrome (PCOS) and was prescribed progesterone to induce menstruation.
Later, the doctor advised me to return when I need to get married and have children, and did not schedule any follow-up appointments for medication.
Since the doctor was very confident, I went without a period for 7-8 years.
I heard that not having periods can lead to endometrial hyperplasia and future fertility issues, so I returned to the hospital.
The same doctor confidently told me that when I want to conceive, I can just take ovulation medication.
I would like to ask, considering that conception is more difficult with PCOS, and given my long absence of periods, is it really as simple as the doctor says when it comes to future conception? Additionally, a friend with PCOS mentioned that I could take inositol and metformin.
Can these two be used together?

Yang, 30~39 year old female. Ask Date: 2016/03/31

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, the treatment for Polycystic Ovary Syndrome (PCOS) is summarized as follows:
For patients who do not wish to become pregnant: Regular administration of progesterone (every 45 to 60 days) can be used to induce menstruation and reduce the risk of endometrial cancer.
Alternatively, oral contraceptives can be prescribed, which suppress the secretion of gonadotropins, inhibit ovarian production of androgens, and help maintain regular menstrual cycles.
If there are significant signs of hyperandrogenism, stronger anti-androgen contraceptives may be used.
The occurrence of PCOS is primarily due to the body's poor utilization of insulin.
Therefore, medications used to treat type 2 diabetes, such as metformin, can be effective in managing PCOS.
Inositol is currently classified as a dietary supplement and is not considered a standard treatment.
For patients with PCOS who wish to become pregnant: The main reason for infertility in PCOS patients is anovulation.
The most commonly used medication is the oral ovulation inducer Clomiphene Citrate.
For those who do not respond to oral ovulation medications, injectable ovulation drugs such as HMG, FSH, and r-FSH may be considered.
Thank you! Wishing you peace and health.
Dr.
Zhang

Reply Date: 2016/03/31

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Your experience with prolonged amenorrhea (absence of menstruation) and the challenges you face regarding fertility are not uncommon among women with PCOS.
Firstly, it is important to understand that while PCOS can complicate conception, it does not make it impossible. Many women with PCOS successfully conceive, but they may require specific interventions to regulate their menstrual cycles and improve ovulation. The fact that you have not had a menstrual period for an extended period raises concerns about the potential for endometrial hyperplasia, which can occur due to prolonged exposure to estrogen without the counterbalancing effect of progesterone. This condition can increase the risk of endometrial cancer, making it crucial to address your menstrual irregularities.

Regarding your question about the ease of conception in the future, it is essential to recognize that while some women may find it straightforward to conceive after addressing their PCOS symptoms, others may require more comprehensive treatment. The use of ovulation-inducing medications, such as Clomiphene Citrate or Letrozole, is common for women with PCOS who are trying to conceive. These medications help stimulate ovulation and can increase the chances of pregnancy. Additionally, lifestyle modifications, including weight management, regular exercise, and a balanced diet, can significantly improve insulin sensitivity and hormonal balance, which are crucial for ovulation.

As for the use of inositol and Metformin, both have been studied for their potential benefits in managing PCOS. Inositol, particularly in the form of myo-inositol, has been shown to improve insulin sensitivity and ovarian function, which can help restore regular menstrual cycles and enhance ovulation. Metformin, a medication commonly used to treat type 2 diabetes, can also improve insulin sensitivity and has been shown to help regulate menstrual cycles in women with PCOS.
It is generally considered safe to use inositol and Metformin together, but it is crucial to consult with your healthcare provider before starting any new supplements or medications. They can provide personalized advice based on your medical history and current health status.

In summary, while PCOS can present challenges to menstruation and fertility, many women successfully conceive with appropriate management. It is essential to work closely with your healthcare provider to monitor your condition, address any menstrual irregularities, and explore treatment options that can enhance your chances of conception. Lifestyle changes, along with medications like inositol and Metformin, can play a significant role in managing PCOS and improving fertility outcomes. Remember, you are not alone in this journey, and support is available to help you navigate the complexities of PCOS and achieve your goal of motherhood.

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