Preconceptional Counselling & PCOS (Polycystic Ovarian Syndrome)
What is preconception counseling?
As soon as you start thinking about having a baby, a visit to your doctor at least 3-6 months before planning a pregnancy is known as preconception counseling.
Board details:
When a couple goes for preconception counseling, a detailed history and examination is done. The goal is to identify factors that may harm you or your baby during pregnancy. A treatment plan can be developed afterwards.
The only major obstacle is that most pregnancies are unplanned and most women take it for granted. So ideally it should be offered to all women of childbearing age, regardless of their intention to become pregnant.
This is a golden opportunity to ask your doctor any questions you have about pregnancy. Any doubts about a pregnancy accident in the family should be discussed. You should also discuss the reasons/complications associated with premature birth, repeated pregnancy loss, intrauterine death, and ectopic pregnancy, as many of these are preventable. Many unfortunate events can be avoided by dealing with them before conception. If the mother is over 35, there is a risk of Down syndrome in the baby which can be diagnosed by certain advanced tests. Also ultrasounds of a history of congenital anomaly, mental retardation, blood clotting disorders, congenital blindness in the family and consanguineous marriages justify genetic counseling.
Some important things you can do for preconception health are:
Take 400 to 800 micrograms of folic acid each day. It reduces your risk of birth defects of the brain and spine.
Stop smoking and drinking alcohol. Avoid contact with toxic substances. Stay away from cat or rodent droppings.
If you have a medical condition, such as anemia, asthma, diabetes, oral health, obesity, epilepsy, thyroid disease, hypertension, epilepsy, tuberculosis or a kidney disease, make sure it is under control.
PCOS (polycystic ovary syndrome) and YOU
A typical case scenario commonly seen in our clinic is that of a young obese girl with intractable acne, irregular cycles, and increased facial hair. On ultrasound, polycystic ovaries are seen, creating a lot of anxiety in her mind. But it is the most common endocrine disorder affecting 25-30% of young women. About 75% of anovulatory women have polycystic ovaries.
About the disease
PCOS, called Stein-Leventhal syndrome, is a syndrome of ovarian dysfunction with features of increased male hormones and ovaries with polycystic morphology in the absence of other explanatory endocrinopathy.
The etiology is complex with recent studies suggesting the role of insulin resistance. Obesity exacerbates the signs and symptoms of PCOS by worsening the symptoms of insulin resistance. Symptoms can be as varied as irregular or missed periods, excessive hair growth on the face, around the nipples and/or around the lower abdomen, obesity, thinning hair on the head, intractable acne, infertility, miscarriages and type 2 diabetes or pre-diabetes.
Management
A good anamnesis, a clinical examination followed by a pelvic ultrasound and a hormonal profile complete the diagnosis of PCOS. Ultrasound shows enlarged ovaries, with multiple small cysts generally oriented peripherally, of the “string of pearls” type. The hormonal profile reveals high levels of DHEA, LH, AMH and a normal level of FSH. Elevated LH levels with normal FSH level are typical of PCOD
Purpose of processing
Weight loss through diet and exercise is the most effective treatment. It lowers insulin resistance which restores regular cycles and ovulation. Antidiabetic drugs like metformin, glitazone, newer drugs like D-chiro-inositol, myo-inositol, vitamin D3, and acupressure are other supportive therapies.
Restoration of fertility – Not all women have difficulty conceiving. For those who do, ovulation is induced with drugs like clomiphene or HMG/FSH injections. Some may require laparoscopic ovarian drilling (a laser or cautery is used to drill 4 to 10 multiple holes through the thickened ovarian capsule). Those who are unresponsive to these and diet and lifestyle modification, IVF (in vitro fertilization) is the option. The results of treatment with PCOS are good
Treatment of hirsutism or acne
Restoration of regular menstruation, to prevent endometrial hyperplasia and endometrial cancer using progesterone or the combined contraceptive pill. If menstruation occurs at least every three months, no treatment is necessary.
Early diagnosis and treatment can reduce the long-term risk of type 2 diabetes and heart disease.
Is there a remedy?
There is no simple remedy. Medical treatments reduce the symptoms and consequences of PCOS. Majority of women respond perfectly to lifestyle changes alone
