Bright side to PCOS paradox

Women with PCOS should be closely monitored during pregnancy ... study concludes.
Women with PCOS should be closely monitored during pregnancy ... study concludes. 

Sufferers have more pregnancy problems but they remain fertile for longer, research shows.

Swedish researchers have found women diagnosed with Polycystic Ovarian Syndrome (PCOS) are more likely to suffer pregnancy complications, regardless of whether they have used fertility treatments.

With between 3 and 15 per cent of women of reproductive age diagnosed with PCOS, the common disorder is a major barrier for many women trying to conceive. Linked to hormonal imbalance, PCOS generally presents itself with small cysts on the ovaries and its symptoms include weight gain, acne, excessive hair growth, irregular, heavy and painful periods and problems with ovulation. It has been linked to higher blood pressure, high cholesterol and insulin resistance putting women with PCOS at risk of developing diabetes and cardiovascular disease. As sufferers' periods are more irregular, less frequent ovulation means there are fewer chances of become pregnant. However the new study shows fertility is only the first hurdle for potential mothers with PCOS.

The study, undertaken by the Karolinska Institutet and the Karolinska University Hospital in Stockholm, found women with PCOS were more than twice as likely to develop gestational diabetes or to give birth prematurely. In the womb, their babies were generally large for their age and more prone to being deprived of oxygen (asphyxia) during labour. Women with PCOS were also 45 per cent more liable to developing  pregnancy-induced high blood pressure (pre-eclampsia).

Using nationwide data on 3787 PCOS-related births against 1,191,336 births without the condition, the results showed using reproductive technology to fall pregnant was not connected to the increase in pregnancy complications as previously believed.

The researchers concluded that pregnant women with PCOS should be more closely monitored. 

"It is clear that women with polycystic ovary syndrome should be considered 'high risk' obstetric patients ... and[they] should be monitored as such", wrote Professor Nick Macklon from the University of Southampton in an accompanying editorial published by the British Medical Journal.

There is perhaps a evolutionary twist to the prevalence of PCOS among women. Since the condition causes women to ovulate less regularly, they tend to have better fertility than other women later on in their reproductive years. In a manner of speaking, their bodies hold on to their eggs, so they last for longer. One evolutionary explanation is that female bodies adapted to times of famine by increasing insulin resistance to save calories and extend the reproductive years.

"PCOS might have been a good thing to have in times of food scarcity because it allowed the window of fertility to be extended and it allowed women to survive and preproduce in low fuel environments. Today we have calories all around us, and yet the body's possible adaptation to another time still remains for some women. One way to look at PCOS is as a past adaptation gone astray." Dr. Sarah Berga says, speaking on PCOS at a recent conference.


Reducing risk

PCOS is a manageable condition that can be controlled through a combination of medication and lifestyle management. Being overweight can exacerbate infertility in PCOS, so losing weight is an important part of managing the condition.

1. Follow a low GI diet 

Eating foods that encourage even blood sugar levels will help reduce the chance of developing insulin resistance and help fight obesity. Reduce the chance of high cholestrol, high blood pressure or heart disease by choosing foods low in salt, sugar and saturated fat and limit alcohol. In short, eat well.

2. Regular exercise

Exercising daily will help reduce cholestrol, fight obesity and increase your body's response to insulin. Resistance exercises like weights have been shown to be especially effective. There is evidence that moderate exercise without weight loss still improves PCOS symptoms and fertility.