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Ask the Expert: PCOS

I recently gained a significant amount of weight in a short period, and my doctor discovered it is because I have PCOS. I also have irregular periods and low energy even after exercising every day for a month. My doctor prescribed birth control pills to help, but are there other options I can consider?

Polycystic ovary syndrome or PCOS is a common hormone-related condition. Its symptoms range from mild to severe and can include weight gain, fatigue, and irregular periods, as well as fertility problems, unwanted hair growth or acne, and an increased risk of type 2 diabetes. No two women with PCOS have the same symptoms, lifestyle, or treatment goals. So, the way it is managed has to be individualised.

The first line of treatment of PCOS involves making lifestyle changes by improving diet and exercise patterns. This is important for all PCOS patients and helps address the hormone imbalances that lead to weight gain and increase the risk of developing type 2 diabetes. It can also potentially have reproductive benefits and, in many cases, could be all that is required to reduce symptoms.

Other treatments will depend on individual goals. Birth control pills play a vital role in PCOS management for women who are not immediately considering pregnancy. This is because they can help improve hormonal imbalances, manage irregular cycles, and help prevent womb lining overgrowth. They can also tackle skin-related symptoms like unwanted hair growth and acne. It is important to remember that birth control pills have come a long way since they were first introduced a few decades ago and are now safer. Moreover, a doctor will assess each woman for potential risk factors before prescribing them. If those are found, they may consider other options.

Alternatively, single hormone (progesterone) preparations may be considered. These also help achieve better period patterns and reduce the risks of overgrowth of the womb lining. In selected cases, doctors may prescribe a non-hormonal medication like Metformin. Metformin can potentially help regulate menstrual patterns in 30-50% of women and improve insulin levels. Other drugs that can be used include those that target the increase in male hormones seen in PCOS. But these are typically prescribed when birth control pills are not as effective. Of course, other treatments to target specific symptoms can be offered, such as laser therapy for unwanted hair growth and creams/ lotions or other medications for acne.

Best regards

Dr Suruchi Mohan

Attending Physician in Obstetrics and Gynecology

Sidra Medicine


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