The issues most women with PCOS face are not having regular periods and infertility. So,the question that haunts them is how to get pregnant with pcos and no period. Read on and you will find elaborate answers.
PCOS – Polycystic Ovarian Syndrome
As the name suggests it may manifest with women having multiple small cysts in their ovaries but it need not always be so. Women may present with any of the symptoms of polycystic ovarian syndrome such as excessive facial and body hair, obesity, dark patches of skin over neck and body creases, acne, menstrual irregularities or infertility with or without polycystic ovaries. Each woman may present with varying degrees of severity of the symptoms.
PCOS is a condition in women where there is hormonal imbalance. The imbalance may be as a result of improper functioning and signalling by the hypothalamic-pituitary-ovarian axis which controls the secretion of various sex hormones.
There is excessive levels of androgens in women with pcos. Androgens are male sex hormones which are usually present in small quantities in women. Another problem in women with pcos is decreased sensitivity to insulin which is termed as insulin resistance. Insulin resistance causes the body to produce more insulin as a compensatory mechanism. The excessive circulating insulin stimulates the pituitary gland to produce more LH (leutinising hormone). A sudden LH spike during the menstrual cycle is responsible for successful ovulation. The persistently high levels of LH leads to excessive stimulation of the ovaries which inturn lead to development of multiple small follicles in one or both ovaries, none of which mature enough so as to ovulate. Excessive androgen which is a male sex hormones also leads to male pattern of fat distribution. Therefore women with pcos accumulate fat in the upper body and abdomen. Obesity in turn aggravates the problem of insulin resistance thereby keeping the vicious cycle going on.
Why is there no period or irregular period in PCOS?
Menstrual irregularities or absence of periods termed as amenorrhoea are as a result of anovulation. Anovulation is because despite the presence of multiple developing small follicles in the ovaries, none of them mature enough to release an ovum. The Leutinising hormone (LH) surge that is required so as to ovulate successfully is not there in women with PCOS. LH levels are very high throughout the menstrual cycle. Menstruation happens when the progesterone released from the ovary after ovulation is withdrawn. Progesterone is withdrawn if there is no fertilization of the ovum by a sperm resulting in pregnancy. So, failure to ovulate means the events leading to menstruation also do not occur.
Sometimes even in the absence of ovulation menstrual bleeding which may be scanty may happen which is termed anovulatory bleeding. As it may be irregular it is called breakthrough bleeding.
Infertility in PCOS
Anovulation is the cause for infertility in women with PCOS. PCOS may not necessarily lead to infertility in everyone. PCOS is known to be associated with anovulatory cycles, where an ovum is not released during the course of menstrual cycle, but there could be ovulatory cycles too during which the woman may conceive.
If ovulation is achieved in a woman with PCOS, she can get pregnant.
Now with the problem of PCOS and no period how can a woman manage to get pregnant? Let us guide you through every required detail on how to get pregnant with pcos and no period.
Step-wise guide on how to get pregnant with PCOS and no period
Step 1: Weight Loss
Most women with pcos can conceive spontaneously just by losing weight. Weight loss reduces the insulin resistance, thereby decreasing the insulin production which further brings the hormones involved in ovulation under control. Restoration of hormonal balance and ovulation can improve chances of successful pregnancy.
Obesity is believed to be both the cause and effect of PCOS. So, in most women it tends to run a vicious cycle of obesity leading to pcos which further results in difficulty to loose weight. Weight loss helps in alleviate symptoms of pcos, improve ovulation and fertility and reduces chances of developing diabetes in women with pcos.
Moderate exercise on a regular basis will help you lose weight steadily. You may target to lose anywhere around 5% of your body weight. The improvement in symptoms may start becoming evident with that much of weight loss. In many women ovulation also resumes with losing about 5% of their body weight. The actual target depends on your initial BMI and the extent of problem and needs to be decided after discussing with your doctor. For some women it may seem impossible to lose weight with pcos as pcos itself triggers fat deposition. But persistent efforts to eat healthy and exercise regularly will help one achieve weight loss in pcos.
Apart from a regular exercise routine, a healthy diet is also equally important for losing weight. A healthy diet will be a one is low in saturated fats, rich in proteins, minerals and vitamins. The diet should include plenty of green leafy vegetables, fruits, coloured vegetables, fish rich in omega3 fatty acids and lean meat such as skinless chicken and turkey. Snacking on whole nuts will provide your body with essential unsaturated fats. The foods to avoid in PCOS are sugary foods, saturated fats and dairy products. Sugary foods will lead to increased insulin production. Avoid refined carbohydrates such as refined flour which has high glycemic index, which means that after a meal containing foods with high glycemic index, your blood sugars rise rapidly. Dairy products contain IGF-1 which mimicks actions of insulin in the body leading to worsening of pcos problem.
Step 2: Fertility chart to track your fertility
Maintaining an accurate chart of your menstrual cycle will help you determine the time during your cycle when you are likely to be most fertile.It will coincide with the time you may have most probably ovulated. It may be extremely difficult to keep track of fertility and pinpoint time of ovulation for women with highly irregular cycles owing to PCOS. Ovulation may be very much delayed even upto day 50 of the cycle in women PCOS.
You can watch out for other symptoms of ovulation too such as slight increase in basal body temperature and change in the consistency of the cervical seceretions and note them down in your menstrual chart or diary.
Fertility awareness will help you get an idea of the time around which you may have ovulated and are most fertile, so that intercourse can be timed appropriately if you are trying to get pregnant. If intercourse is timed around the time of your ovulation you are more likely to get pregnant.
Step 3: Fertility expert consultation
You may need help from a fertility expert with extensive experience in the management of PCOS and infertility. The doctor may suggest some lab tests and work up so as to confirm the diagnosis. Following test may be recommended:
- Thyroid function tests
- Serum prolactin level
- Testosterone level
- Serum HCG level
- Cortisol level
- Insulin level
- LH and FSH levels
- GnRH levels
Other blood tests:
- Blood sugar levels
- Lipid profile
- Oral glucose tolerance test
- Ultrasound abdomen and pelvis – Pelvic ultrasound may reveal multiple (12 or more) small follicles in one or both ovaries. The ovaries may be enlarged.
- CT or MRI may help in detailed evaluation of the pelvis
Step 4: Clomiphene citrate for inducing ovulation
If your cycles persist to be anovulatory and fail to conceive despite weight loss, your doctor may prescribe you medicines to stimulate ovulations so as to get you pregnant. The medicines modify hormone levels in the woman so as to get them to ovulate successfully.
Clomiphene citrate is usually the first choice as an ovulation inducing agent.
Step 5: Metformin to improve insulin sensitivity
If insulin resistance is profound and there is severely impaired glucose tolerance which contributing to problem of PCOS, you may require medicines like metformin to help increase your body’s sensitivity to the insulin produced. Metformin is also known to improve fertility in women with pcos.
Metformin and clomiphene citrate used in combination have shown better results with respect to fertility in some women.
Step 6: Gonadotrophin injections
If clomiphene citrate fails to induce ovulation in a woman,the next line of treatment would be gonadotrophin injections. They are used for more aggressive form of treatment. Gonadotrophins act by stimulating growth of a dominant follicle to result in ovulation.
In comparison to clomiphene citrate gonadotrophins are associated with higher risk of multiple pregnancy and hyperstimulation of the ovaries.
Step 7: Rule out other causes for infertility
Before proceeding to further steps it is very important to be sure that all other possible causes of infertility have been ruled out. As infertility is not the rule with PCOS and many women with PCOS conceive naturally, other reasons for infertility should also be considered and looked for before attributing infertility solely to PCOS problem.
Step 8: Surgery-laparoscopic ovarian drilling
If multiple cycles of therapy with ovulation stimulation drugs have failed and all other causes of infertility have been ruled out,laparoscopic surgery may be attempted.
PCOS surgery comprises of laparoscopic drilling or puncturing of not more than 4 cysts in each ovary. The cystic fluid released brings about improvement in hormone levels. Though it may not cure the condition completely, it helps in restoring hormonal balance and thereby improving fertility. It may avoid the need for IVF in women with pcos having difficulty in conceiving. Other causes for infertility like tubal block can be looked for during laparoscopy. Endometriosis can be looked for during laparoscopy and treated by cauterization which involves electrically burning the uterine lining tissue lying outside the uterine cavity. Women mostly get pregnant within one year of the treatment and it is much more cost effective when compared to in-vitro fertilization (IVF) treatment.
Step 9: In-vitro fertilisation
You do not have to lose hope even if you are unable to conceive with the above treatments.In this era of advanced medical technology,artificial reproductive techniques (ART) has emerged as a new hope for couples with infertility problems. If in case all the other treatment options have been exhausted, In-vitro fertilization commonly known as IVF is an option. In IVF an ovum is directly retrieved from the womans ovary after giving her hormones to ovulate and it is fertilised in the laboratory with sperms collected from her spouse. The embryo is then transferred into the womans uterus. Pregnancy tests are done to confirm successful implantation of the embryo in the uterus.
It may be surprising for a mother of a child to discover that she is unable to conceive a another baby. This is called secondary infertility. Read on to know about secondary infertility in PCOS.
PCOS – Secondary Infertility
A woman having PCOS may have conceived normally before but may face problems with getting pregnant again if her hormones have gone haywire. A new risk factor like obesity may also be the reason for PCOS manifesting its symptoms.
Can secondary infertility in PCOS be treated?
The treatment methods of secondary infertility in PCOS is in the same lines as the treatment of primary infertility in PCOS.Usually the woman is able to conceive following restoration of hormone levels. Here again it is important to look out for probable other new reasons for infertility.
So finally if I have managed to get pregnant with pcos and no period,are there any pregnancy related complications I need to be aware of ?
Obstetric complications of PCOS
- Women with PCOS have a higher risk of miscarriages. It may be due to the prevailing hormonal imbalances and inadequate levels of progesterone hormone. It can be prevented by regular antenatal follow ups, nutritious diet and progesterone support therapy during early pregnancy if suggested by the doctor.
- Gestational diabetes mellitus – Women with PCOS are prone to develop diabetes during pregnancy. If there is markedly impaired glucose tolerance, it may worsen during pregnancy leading to gestational diabetes. Diet and weight control is important to prevent its complications.
- PCOS also makes women prone to pregnancy induced hypertension (PIH).
- Women with PCOS may end up in caesarean section delivery more often due to large size of baby resulting in difficult vaginal delivery.
- Risk of preterm labour and complications in newborn is also higher in women with PCOS.
So that was all about how to get pregnant with pcos and no period. Hope it was an informative read and filled all the gaps in your knowledge about pcos.