How to ensure a normal period when you're suffering from PCOS?

Polycystic ovary syndrome (PCOS) is a hormonal disorder affecting 12-18% of women of reproductive age. PCOS is a condition where at least two of the following conditions occur:

1. Appearance of acne, excessive hair on your body

2. Irregular delayed periods

3. The presence of 10 to 12 small cysts in the ovaries.

You do not ovulate each month, and some women do not ovulate at all if they are suffering from PCOS. This is because although the ovaries of women, suffering from PCOS, usually have many follicles, they do not develop fully and so ovulation often does not occur. If you do not ovulate, you may not have periods.

So what can you do to have normal periods?

Although some women with PCOS have regular periods, high levels of androgen and also the hormone insulin, can disrupt the monthly cycle of ovulation and menstruation. If you have PCOS, your periods may be irregular or may stop altogether. The average menstrual cycle is 28 days with one ovulation, but anywhere between 21 and 35 days is considered normal, and for a woman suffering from PCOS, this cycle can take as much as 3 months to complete.

To ensure a normal period during PCOS, your doctor can prescribe hormonal contraception. The medication can also reduce menstrual cramps, acne, and excess hair growth. The estrogen and progesterone in hormonal contraception act to override the body's normal hormonal control of menstrual cycle and ovulation. Production of hormones such as testosterone is greatly reduced by the oral contraceptive pill. Some oral contraceptive pills not only aim to block the effects of testosterone but also increase insulin resistance.

By allowing the regular shedding of the uterus lining during menstruation, the pill can reduce the risk of developing endometrial cancer while ensuring you get normal periods.

Note: it is important that you closely watch your weight. Lifestyle changes and weight reduction help a lot when you are suffering from PCOS.

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Related Tip: How Not to Miss Your Workout During Your PERIOD

How to Ensure a Normal Period When You're Suffering from PCOS?

What is recurrent miscarriage?

If you have three or more miscarriages in a row, doctors call it recurrent miscarriage. If you have experienced recurrent miscarriage, your GP or midwife will refer you to a gynaecologist. Your gynaecologist will try to identify the reason for your losses.

Having miscarriage after miscarriage may leave you feeling utterly drained of hope. At times, it may be hard to keep trusting in the future. This experience affects every aspect of a woman s life from her mental and emotional health to her physical health and social well-being. 

If you can, try to draw comfort from the fact that most women who experience recurrent losses do go on to have a baby. This is especially the case if tests can find no reason for the losses. Six out of 10 women who have had three miscarriages will go on to have a baby in their next pregnancy.

Treatment of Recurrent Pregnancy Loss

Treatment for anatomic abnormalities of the uterus involves surgical restoration through removal of local lesions such as fibroids, scar tissue and endometrial polyps or timely insertion of a cervical cerclage (a stitch placed around the neck of the weakened cervix) or the excision of a uterine septum when indicated.

A thin endometrial lining has been shown to correlate with compromised pregnancy outcome. Often times this will be associated with reduced resistance to blood flow to the endometrium. Such decreased blood flow to the uterus can be improved through treatment with sildenafil (Viagra), Terbutaline and possibly aspirin.

Sildenafil (Viagra) Therapy Viagra has been used successfully to increase uterine blood flow. However, to be effective it must be administered starting as soon as the period stops up until the day of ovulation and it must be administered vaginally (not orally). Viagra in the form of vaginal suppositories given in the dosage of 25 mg four times a day has been shown to increase uterine blood flow as well as thickness of the uterine lining. To date, we have seen significant improvement of the thickness of the uterine lining in about 70% of women treated. Successful pregnancy resulted in 42% of women who responded to the Viagra. It should be remembered that most of these women had previously experienced repeated IVF failures.

Terbutaline this is a medication that relaxes the muscle in the uterine wall and so permits improved hormone delivery to the endometrium. The use of Terbutaline will often cause an increase in heart rate. It should not be prescribed to women who have irregular heart beats (arrhythmias), and women who have decreased cardiac reserve.

Aspirin this is an antiprostaglandin that improves blood flow to the endometrium. It is administered at a dosage of 81mg orally, daily from the beginning of the cycle until ovulation.

Selective Immunotherapy Using Intralipid, heparin, aspirin and corticosteroid

Many causes of pregnancy loss or failure can be treated with immunotherapy comprising combinations of aspirin and heparin and corticosteroids (dexamethasone or prednisone) and Intralipid (IL) to regulate increased NKa. Achievement of optimal success with Intralipid/corticosteroid therapy requires that the treatment be initiated well before ovulation takes place (about 7-14 days prior to anticipated implantation). Given the fact that only 10-15% of natural cycles (with or without the use of insemination and/or fertility drugs) will result in a pregnancy, it follows that repeated administration of Intralipid will be required in most cases before a pregnancy will occur. IVF achieves pregnancy rates that are often 2-3 times higher. This often makes IVF a treatment of choice in cases of immunologic recurrent pregnancy loss.

Role of IVF

Preimplantation genetic diagnosis (PGD) a procedure whereby the embryo can be tested for genetic or structural chromosomal abnormalities requires the use of IVF to select the best embryo(s) for transfer to the uterus. In cases of structural chromosomal (translocations) egg or sperm donation is often another option worth considering.

In those cases where due to intractable anatomical or alloimmune dysfunction IVF repeatedly is unsuccessful or is not an option, Gestational Surrogacy might represent the only recourse other than adoption.
If a couple with Recurrent Pregnancy Loss is open to all of the diagnostic and treatment options referred to above, a live birth rate of 70%   80% is ultimately achievable.

Recurrent Miscarriage - How to Deal With It?

When it comes to giving birth, vaginal delivery is considered to be the most natural process. However, several women nowadays opt for C-section or Cesarean section to avoid the labour pain that accompanies natural birth.If you are pregnant and weighing the pros and cons of natural and C-section delivery, here are a few things to consider.

Vaginal Delivery
The Pros of this method of delivery are as follows:

1. From the psychological perspective, women who undertake a vaginal delivery have a positive birth giving experience. Women undergoing this method think they should be present in the process. 
2. The recovery time for women opting for vaginal delivery is shorter. The mother and the baby can make skin contact right after the delivery, which enhances the bonding process.
3. Babies who are born through vaginal delivery develop much fewer medical complications. There are fewer respiratory problems, allergies and the baby can start breastfeeding soon.

The Cons of vaginal delivery are as follows:
1. Vaginal delivery is a stressful process for the women undergoing it and the time required cannot be predicted. Some deliveries take less time, while others may take hours.
2. Usually, there are no cons for the babies who are born via vaginal delivery. In very rare cases, brain injury can be experienced.

Cesarean Section
The pros of this type of delivery method are as follows:
1. Many women choose Caesarean sections to avoid long labor hours. Planned C-section surgeries enable the mother to plan the birth. Better control is acquired over the delivery, which can be predicted properly.
2. In case your baby is large, or if you are carrying twins, C-section is the best delivery option. 
3. If the mother has diseases such as HIV or the mother's blood has a high viral load, C-section surgeries should be opted as the risk of the infection being passed on to the baby is decreased.

The cons of Cesarean section surgery are as follows:
1. C-section is a major surgery and a long time is required for recovery. There may be risks of infection, but they can be prevented by caring for the surgical wound properly. C-section delays the breastfeeding process and the mother cannot have immediate contact with her baby, which can affect the bonding.

2. Some babies, delivered through C-section may have respiratory problems. C-sections may also cause complications, such as problems with anaesthesia.

While both processes have their pros and cons, it is best to discuss with your doctor to understand which process will suit you more. Depending on your pregnancy and whether there are any complications involved, your doctor will suggest the best way possible.

Vaginal Birth Vs C-section - Pros and Cons

Female condoms are generally pouches made of latex and polyurethane, which are used by women during sex in order to prevent pregnancy and thereby reduce the chances of infection by sexually transmitted diseases. Each end of these pouches are made of rings that are flexible. They should be inserted deep inside the vagina before sex is initiated and held in the position by utilizing the rings available at the closed end while the rings which are at the open end remain outside the vagina during sex.

Even though it can be safely used by most people, some women would find female condoms to be an inappropriate form of contraception and would not feel comfortable with their genital areas being touched. Thus, it is very important that the appropriate form of contraception be considered for you and your partner. Condoms should be used correctly. In case of need for extra protection, other options of contraception should be considered.

Pros of female condoms
1. Since the exchange of bodily fluids, such as semen and vaginal fluid is prevented, female condoms aid in offering protection against many sexually transmitted diseases such as HIV.

2. Condoms can prove to be reliable pregnancy averting methods if they are properly and consistently used.

3. Female condoms are only needed during the time of sex. Any form of advance preparation is not required, hence making them suitable for unplanned sex.

4. Prescriptions are not needed

5. The condoms are usually small in size, disposable as well as easy to carry

6. Usually, using condoms does not show any medical side effects.

7. Insertion of female condoms can be done up to a duration of eight hours before sex. The responsibility for utilizing condoms properly should be shared by the woman as well as the partner.

Cons of female condoms
1. Even though condoms are generally very strong, they are prone to splitting or tearing in case of improper use.

2. Availability of female condoms pales in comparison to the male counterparts and they are usually more expensive.

3. The outer ring might produce a cumbersome feeling.

Pros and Cons of Female Condoms

Miscarriage is termed as the loss of the fetus in or before 20th week of pregnancy. Medically, miscarriage is known as spontaneous abortion, though the word spontaneous is more of a keyword as it is not an abortion.

Symptoms of Miscarriage 
Miscarriage happens due to weakness, back pain, fever, abdominal pain along with severe cramps and bleeding, which starts from slow to heavy.

Cause of Miscarriage 
Common cause of miscarriage is when the fetus is known to have fatal genetic problems and these are not related with the mother. The other causes are infection, medical problems like thyroid and diabetes, immune system rejection, hormonal imbalance, abnormalities of the uterus, and physical problems of the mother. If a woman is over 35 years of age, has thyroid and diabetes and had an miscarriage earlier then that woman is at a high risk of getting a miscarriage.

Sometimes a miscarriage might take place due to the cervical insufficiency. This is due to the weak cervix, also known as the incompetent cervix, which is unable to hold the pregnancy. A miscarriage in this condition usually occurs in the second trimester. Though there are a very few symptoms in this, but there might be a feeling of sudden pressure that the water is going to break and tissues from the placenta and fetus are released without any pain. This can however, be treated by a stitch in the cervix at 12 weeks. This stitch helps to hold the cervix until the full term is completed. If it is first pregnancy and cervical insufficiency is diagnosed, then also a stitch can be applied, thus resulting in full term and avoiding miscarriage.

Diagnosis of Miscarriage: 
-   The doctor does a pelvic test, an ultrasound and blood tests to confirm a miscarriage
-   Blood tests are done to analyze the pregnancy hormone hCG. This is monitored regularly if miscarriage is suspected
-   Genetic tests, blood tests and medication are important in women who have a history of prior miscarriages
-   Pelvic ultrasound and hysterosalpingography are tests, which are done when there are repeated miscarriages
-   Test like hysteroscopy is also done. In this the doctor observes the inside of the uterus with a device, which is thin telescope like device. This is inserted in the vagina and cervix.
-   If the cervix is dilated, then the woman might be diagnosed with an incompetent cervix and this can be corrected by cerclage, a procedure done to close the cervix.
-   If the blood type of the pregnant woman is Rh negative, she is prescribed a blood product called Rh immune globulin (Rhogam). This prevents from forming, antibodies which could turn to be harmful for the baby.

Bleeding in Early Pregnancy: Diagnosing Miscarriage

Why every 1 in 5 Women in India suffers from PCOS? (And what they need to know)

Polycystic ovarian syndrome (PCOS) is a medical condition related to a woman’s endocrine system. Generally, this disorder is characterised by an imbalance of the sex hormones (oestrogen and progesterone), which leads to the development of multiple small cysts in the ovaries. Symptoms of PCOS include acne, irregular menstrual cycle and depression to name a few.
The causes of PCOS have not been accurately identified so far, but researchers suggest that the following factors might contribute to the onset of the condition.

1. Increased amount of insulin secretion- Women suffering from insulin resistance may get PCOS as their body is not able to effectively use this insulin, which results in increased insulin secretion by the pancreas. This, in turn, triggers more androgen (male sex hormone) production in the ovaries, making it difficult for the ovaries to ovulate.

2. Lower inflammation levels- The white blood cells present in your body form resistance against infections through a response termed as inflammation. Women with lower inflammation levels are likelier to get PCOS as the decreased levels stimulate polycystic ovaries, thereby producing more androgens.

3. Genetic factor-  If you have a family history of PCOS, it’s highly probable that you may also get it as the disease is linked with your genes.

How To  Live with PCOS

PCOS comes with numerous side effects like acne, obesity, infertility, excessive facial or body hair among others. There are certain lifestyle changes, which you may consider to manage PCOS and minimise its side effects.

1. Change your diet - Opt for a low carbohydrate, low sugar diet to keep your insulin levels in control, as insulin is responsible for increasing the severity of PCOS symptoms. 

2. Try to maintain an ideal body weight - Obesity is known for worsening insulin resistance, and you can prevent this by regularly keeping your weight in check. You can practice some easy at-home exercise to reduce weight besides having a balanced diet.

3. Get yourself checked regularly - Visit a doctor and get yourself checked regularly for potential health risks as PCOS is often associated with increased chances of diabetes, heart diseases, certain forms of cancer, hypertension, and high LDL (bad) cholesterol levels.

4. Join a support group - Joining a PCOS support group will help you cope with your emotional difficulties, while helping you to live a better life by cultivating an optimistic outlook.

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Every 1 in 5 Women in India suffers from PCOS! Why? (And what they need to know)

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