PCOS and Pregnancy!


 Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among women between the ages of 18 and 44 affecting 10-20 % of females. It is one of the leading causes of menstrual irregularity and poor fertility.  The PCOS can also affect the pregnancy adversely.

What is the cause of PCOS?

Exact cause of PCOS is not known. However, it is due to a combination of genetic and environmental factors. The basic pathology of PCOS is believed to be due to insulin resistance and hyperinsulinemia leading to elevated male hormones in females and erratic female hormonal milieu.

Risk factors include obesity, not enough physical exercise, and a family history of someone with the condition.

PCOS symptoms

What are the symptoms of PCOS?

The symptoms are:

  • Irregular or no menstrual periods.
  • Heavy periods or no periods.
  • Excess body and facial hair,
  • Acne, Oily skin, Dandruff.
  • Hair fall (Alopecia) and thin scalp hair.
  • Pelvic Pain,
  • Difficult getting pregnant,
  • Patches of thick, darker, velvety skin at nape of neck, arm-pits, and groin or over knuckles (Acanthosis Nigricans).
  • Skin tags on armpits and neck.
  • Obesity and food craving. Patient may have difficulty to lose weight in spite of vigorous efforts. (However, 15 % females may be thin.)
  • Obstructive sleep apnea,
  • Type II diabetes, high cholesterol, high blood pressure, heart disease,
  • Mood disorders.

What other diseases can cause similar symptoms?

  • Adrenal pathology.
  • Hypothyroidism
  • Increased Prolactin levels in blood.

Can Polycystic Ovarian Syndrome (PCOS) Place A Woman At Risk For Any Other Conditions?

Women who have been diagnosed with PCOS seem to be at a greater risk of developing endometrial cancer, diabetes, high blood pressure, high cholesterol, and heart disease. Getting symptoms controlled as soon as possible can decrease a woman’s chance of developing any of these other conditions.

How is PCOS diagnosed?

The most popular Rotterdem’s criteria which is supported by European society of Human Reproduction and Endocrinology (ESHRE) and American Society of Reproductive Medicine (ASRM) considers presence of two out of 3 criteria in the absence of any other cause as diagnosis of PCOS.

  1. Oligoovulation (wherein egg ruptures late or not at all leading to menstrual cycle more than 35 days).
  2. Excess Androgen activity (Clinical markers such as central obesity, acne, acanthosis, hirsuitism, alopecia etc or Biochemical marker such as excess Sr. Testosterone or DHEAS in blood).
  3. Polycystic appearance of ovary in USG or Laparoscopy. (small fluid filled cystic structures arranged peripherally in ovary like a pearl necklace.)


How is PCOS treated?

PCOS has no permanent cure. However, since it is a metabolic disorder it can be controlled with lifestyle changes such as weight loss and exercise. Successful weight loss is the most effective method to regulate the cycles.

    • Diet modification and Regular exercise is the primary treatment of PCOS by regulating insulin resistance.
    • In women who are not trying to conceive, Birth control pill (Combined Oral Contraceptive pills)may help in regulation of periods, excess hair growth, and acne. However the symptoms may recur after stopping  the pills.
    • Metformin is a insulin sensitizing drugs that help by correcting pathophysiology of insulin resistance and especially is helpful in pcos patients with obesity and increased BMI.
    • Anti-androgens drugs like spironolactone helps to regulate symptoms caused by excess androgen activity. These medicines should only be prescribed if the woman is not trying for pregnancy.
    • Ovulation induction drugs may be prescribed for ovulation induction for assisted reproduction.
    • Surgery is the last resort with limited benefits. Controlled ovarian drilling may be helpful by reducing the levels of testosterone and increasing the ovulation. However, vigorous drilling may destroy the significant portion of ovary and leads to ovarian failure.

How Can Polycystic Ovarian Syndrome (PCOS) Affect Pregnancy?

Women who have PCOS appear to have an increased risk of miscarriage, pregnancy induced hypertension, gestational diabetes, premature delivery and increased risk of cesearean delivery.

How is pcos managed in pregnancy?

The primary management of PCOS in pregnancy is again diet modification and regular exercise under the guidance of Obstetrician and Dietcian.

According to National institute of health, USA, the use of metformin throughout pregnancy in women with PCOS has shown to reduce the risk of complications to both mother and fetus.

Metformin is a category II drug where benefits in pregnancy outweighs the risk.

pcos metformin in pregnancy


The information is shared to create awareness towards Pregnancy and Childcare to reduce maternal and child deaths. Atmost care has been taken by the author to include the verified information from authentic sources. However, kindly discuss the same with your health care provider before implementation.