Pregnancy and PCOS

Written by Gaute Tyssebotn 13.11.04 Updated 23.01.06

Originalspråk: Norwegian

---

Many people see having children as a given, but more and more women are experiencing problems getting pregnant. The diet can be the problem.

One of the most important reasons for involuntary childlessness among women is polycystic ovary syndrome (PCOS), but in many cases it can be improved with the help of diet.

As obesity becomes increasingly common in the population, the number of women who cannot have children also increases. This is no coincidence as obesity can often be a symptom of an imbalance in the body's hormones. Insulin is central, and in many ways can be seen as the "boss" among the hormones.

Avoid being overweight

Too much of this hormone can also help create disturbances in other hormone systems, including stress hormones, metabolic hormones and growth hormone, and in the reproduction hormones. A diet rich in carbohydrates, such as bread, pasta, rice, cereal products in general, potatoes, sugar, ready-made products and the likes, will cause a greater rise in blood sugar and, in turn, more secretion of insulin.

Eventually, you can develop what we call insulin resistance, a condition where large amounts of insulin are produced, but the insulin no longer works well enough. Since insulin is responsible for storing fat in the fat depots, a carbohydrate-rich diet can lead to obesity, which can further worsen insulin resistance.

Perhaps the most common reason for involuntary childlessness in women in the Western world is PCOS, and this syndrome is strongly linked to precisely insulin resistance. Although insulin resistance is most common in obese people, there are also many exceptions. The most effective way to improve insulin resistance is diet, and therefore it is no coincidence that many women have experienced becoming pregnant after changing to less carbohydrates and more fat.

Poly cystic ovary syndrome – PCOS

It is important to distinguish between PCO and PCOS, as they are two different things. PCO, or polycystic ovaries, is characterized by growths or cysts on the fallopian tubes, and nothing else. These cysts can either sit together or be spread over the entire fallopian tube.

A few cysts that come and go are not uncommon in many women of childbearing age, but only when there are eight or more cysts in a cross-sectional view on an ultrasound scan or 12 or more in total on the entire fallopian tube is the condition called PCO.

PCO is much more common than PCOS and initially no problem, although you should always have a doctor examine the cysts regularly. If you have reached menopause or past it, and you still have such cysts, it is important to be vigilant. The cysts can become malignant and cause cancer, and therefore your doctor will probably choose to remove any cysts at this time. Why you get PCO is unclear, but it is believed that genetic factors play a role, among other things. It is claimed that 20-25 percent of all women of childbearing age have PCO.

PCOS, or Poly cystic ovary syndrome, is a spectrum of various ailments or symptoms and not only linked to cysts on the fallopian tube. Usually, PCOS will always be found in PCOS, but some doctors give the diagnosis of PCOS without the presence of cysts on the fallopian tubes. With PCOS, it is very common to have higher production of the male sex hormone testosterone and insulin resistance. This can cause many disturbances, and the three most common indications of PCOS are obesity (applies to up to 80 per cent), unwanted/larger hair growth (applies to up to 90 per cent) and irregular menstruation (applies to up to 90 per cent).

Other typical problems are acne, hair loss, bleeding and reduced fertility, but it can also be more or less common with concentration difficulties, high blood sugar, enlarged ovaries, increased risk of miscarriage, depression, migraines, metabolic problems, PMS symptoms, swollen hands, feet and face, problems with the stomach (slow or loose stomach), low heart rate, fatigue and impaired memory. As many as 10 percent of women of childbearing age may have PCOS, making up a significant proportion of those struggling to conceive.

Diagnosis of PCOS

Finding out if you have PCOS can be done in several steps. Your doctor will want to get a detailed medical history about your menstrual cycle, contraceptive use and any pregnancies. The doctor will also carry out an abdominal examination to find out if you have cysts on swollen/enlarged fallopian tubes. If cysts are found, it is common to carry out an ultrasound examination, but also to take blood tests to check the hormone status in the body.

Women with PCOS may have elevated levels of testosterone and insulin. Besides checking the levels of these two hormones, it is also a good idea to check SHBG (sex hormone binding globulin). The sex hormones are fat-soluble and use to bind to special accompanying proteins, called hormone binders. SHBG has an easier time binding to testosterone than estrogen. Estrogen increases the production of SHBG, which is also the reason why women normally have more SHBG in their blood than men. Low levels of SHBG in a woman indicate that there is more free testosterone than usual. Triglyceride and cholesterol levels are also checked occasionally, as they are often abnormal in PCOS.

Early indications of PCOS can already be seen at the age of 12-13 when puberty begins. Many doctors believe that girls who have not menstruated before the age of 16 should be examined for PCOS. It is also not unusual for menstruation to be normal at the start, but as the girls approach their 20s it becomes more and more unstable. The use of birth control pills can cause a "false" menstrual cycle, since these drugs increase the amount of estrogen and thus balance out the increased amounts of testosterone. When they stop taking birth control pills to get pregnant, the period does not return or is very irregular.

What causes PCOS?

Things may indicate that genetics play a role in this syndrome, but there are also clearly lifestyle factors involved, as PCOS has become more common in recent decades. Studies show clear connections between insulin resistance and greater production of male sex hormones.

Usual medical treatment

For women who do not want to become pregnant, it is common to use birth control pills to control the many and problematic symptoms. Use of cyclic progestagen, a progesterone-like hormone, but also progesterone is occasionally given for PCOS.

Women who want children are often given injections and other drugs to improve the development of egg cells. The treatment requires accuracy and is usually carried out by experienced doctors in the field. Some of the medicines increase the chance of overstimulation, so that the chance of becoming pregnant with more children increases. Insemination and test tube treatment are also not uncommon.

Type 2 diabetes is characterized by insulin resistance, and since insulin resistance is also common in PCOS, it is not surprising that up to 40 percent of those with PCOS develop type 2 diabetes. Medicines for type 2 diabetes, metformin and glucophage, which aim to lower insulin secretion by improving insulin sensitivity, has also been shown to be helpful for PCOS patients who want to get pregnant. As well as lowering insulin secretion, it is believed that these medicines also enhance the effect of other medicines, which stimulate ovulation.

Get pregnant with the right diet?

There is no complete cure for PCOS, but like type 2 diabetes, it can be controlled. Leading experts believe that diet is the most important thing in the treatment of PCOS. With the help of the diet, one can easily get the body to produce less insulin, thereby improving a probable insulin resistance. The higher the rise in blood sugar after a meal, the greater the insulin secretion, and the greater the obesity can become.

Since it is mainly the amount and type of carbohydrates that affect blood sugar and insulin secretion, it is of great importance in PCOS to reduce the amount of carbohydrates in the diet. Carbohydrates are found in abundance in bread, pasta, rice, cereal products in general, potatoes, sugar, many ready-made products, juices, sweet drinks, jams, etc.

It is advantageous to replace many of these foods with other foods rich in natural fat, such as eggs, bacon, meat, fatty fish (but also other types of fish), fatty dairy products, coconut fat, olive oil, etc.

Fat has the great advantage that it does not affect the secretion of insulin to any significant extent, it stabilizes blood sugar and it has a very positive effect on feelings of hunger and satiety. Less insulin secretion will most likely result in weight loss, and studies and experience have shown that just a few kilos of weight reduction will make it easier for women with PCOS to get pregnant. Since low-carbohydrate diets have a particularly good effect on reducing weight, they have also been shown to be very useful in infertile women with PCOS.

The essential fatty acid omega 3 can prove effective in PCOS, since among other things it will be able to lower the need for insulin. Since there are few foods that contain larger amounts of this fatty acid, it is often wise to take supplements in the form of capsules, cod liver oil, Udo's Choice or Vega Max. Other supplements that can be good are chromium, which helps insulin to do a better job. Improving the calcium balance, through supplements of calcium, magnesium and vitamin D3, has been shown in studies to improve the chances of women with PCOS having children. Finally, it is always recommended to take a multivitamin and mineral product rich in antioxidants.

References:

Thatcher SS. PCOS – The hidden epidemic. Indianapolis: Perspectives Press, 2000.Murray RK, Granner DK, Mayes PA, Rodwell VW. Harper’s Biochemistry – 25th edition.New York: Appleton & Lange, 2000Harris C. PCOS dietbook. London: HarperCollinsPublisher Limited, 2002Thys-Jacobs S et al. Vitamin D and calcium dysregulation in the polycystic ovarian syndrome. Elsevier Science 1999; 64: 430-435