PCOS and Miscarriage

Polycystic ovarian syndrome is also referred to as PCOS. It is a reproductive condition in women that strongly affects fertility, insulin production, the menstrual cycle, miscarriage rate, and the hormones inside the woman’s body.  Women with PCOS have too many male hormones in the body and will have cysts on their ovaries and menstrual cycles that are too long or completely absent.

PCOS affects 5-10 percent of women. As the number one cause of infertility in women, PCOS is a significant public health concern and most women with PCOS should consider treatment in order to avoid the complications of having the disease.

Causes of PCOS

No one knows exactly why some women get PCOS and others do not.  In some cases, the disease may be hereditary as it seems to run in families.  Some of the biggest problems among women with PCOS include weight gain, insulin resistance, difficulty ovulating, excess acne, and abnormal hair growth.  There seems to be a strong link between insulin resistance and the development of PCOS and many PCOS patients take medication to control their insulin resistance.

Symptoms of PCOS

The main symptoms of PCOS include infertility from a decrease in ovulation, rare menstrual periods or menstrual periods that are irregular, abnormal hair growth with hair growing on the parts of the body typically found in men, sleep apnea, thickened skin in certain areas of the body, skin tags in the armpits or neck, thinning hair, hypertension, elevated cholesterol levels, truncal obesity, pelvic pain, dandruff, oily skin, and acne.

Diagnosis of PCOS

There are no specific blood tests for PCOS; however, it can be determined through a thorough physical examination, an ultrasound of the ovaries, and blood tests for male hormone levels, and blood sugar testing.  The ultrasound showing multiple cysts on the ovaries clinches the diagnosis of polycystic ovarian syndrome in most cases.

PCOS and Fertility

PCOS is the main cause of infertility in women, resulting in an increase in endometrial cancer if the woman does not have treatment for the condition.  While no one knows how it causes infertility, they do know that PCOS is related to insulin resistance.   Insulin resistance is directly connected to the risk of miscarriage, which is why miscarriages are more common among women with PCOS and diabetic women.

Women with PCOS have a problem getting pregnant.  In order to get pregnant, women with the disease often need to resort to fertility treatments, such as IVF and the taking of hormones to enhance ovulation.  Sometimes, the woman with PCOS is placed on Glucophage (metformin), which is a drug that directly affects the insulin resistance and can help the woman with PCOS get pregnant.  With metformin therapy, the woman is able to ovulate and, with the help of fertility drugs, is usually able to become pregnant.

PCOS and Pregnancy Risks

Women with PCOS have a greater risk of pregnancy complications.  The main complications seen in pregnant women with PCOS are an increase in miscarriage rate, an increase in the incidence of gestational diabetes and large infants, high blood pressure in pregnancy, blood clotting disorders in pregnancy, and preeclampsia. The preterm birth rate is also higher among women with PCOS.  No one knows why these risk, including the risk of miscarriage, are higher among women with PCOS.

Treatment of PCOS

PCOS cannot be cured but there are several ways to manage the disease so that women with PCOS can go on to have healthy lives and can become able to conceive a child.  There are many ways to manage PCOS, including the following:

• Birth control pills. If the PCOS woman isn’t trying to get pregnant, birth control pills can both improve the acne and hair growth seen in the disease and can regulate the menstrual cycles. Birth control pills are not a cure for PCOS, however, as the symptoms return once the birth control pills are stopped.
• Healthy lifestyle choices. If the PCOS woman diets and exercises to the point in which she has a normal weight, the insulin resistance can be lessened and this can directly affect her ability to regulate glucose levels, get pregnant, and have a healthy baby.
• Diabetic medicines. Some women with PCOS will take metformin in order to reduce insulin resistance.  This returns the periods to normal and decreases the amount of male hormones in the system.  Blood sugars are stabilized and the chances that the woman with PCOS will go on to have diabetes decreases dramatically.
• Fertility drugs. Drugs aimed at causing ovulation can be used to induce ovulation so the woman with PCOS can get pregnant.  Fertility drugs do have their downside as all fertility drugs and treatments (such as IVF) increase the risk of multiple births.
• Medications to reduce male hormone levels. If the woman is not trying to conceive a child, she can take medications to reduce the levels of male hormones.  This should reduce the hair growth but, if hair growth persists, the woman with PCOS can have things such as laser hair removal and electrolysis.
• Rarely is surgery recommended in the management of PCOS.  In severe cases that don’t respond to medical treatment, laparoscopy can be performed and an electrical current can be placed directly on the affected ovaries to destroy the tissue that is making too many male hormones and too many cysts.  This can increase the rate of ovulation and can restore some measure of fertility in the woman with PCOS.

Other Conditions that come out of having PCOS

Besides an increase in miscarriages, women with PCOS can have pregnancy complications as noted above, elevated cholesterol levels, diabetes, endometrial cancer, high blood pressure, and an increased risk of developing heart disease. This is why it is important to treat PCOS rather than allowing the syndrome to go unchecked.  Proper treatment can relieve the woman with PCOS of the unwanted symptoms of the disease and can improve ovulation, which ultimately affects her fertility.

References:

1. Polycystic ovary syndrome. http://americanpregnancy.org/womens-health/polycystic-ovarian-syndrome/. Accessed 5/30/16.
2. The link between PCOS and Miscarriage. http://www.womens-health.co.uk/miscarriage-and-pcos.html/. Accessed 5/30/16.