Polycystic ovary syndrome (PCOS) is the most common reproductive disorder in women of childbearing age.

It is a result of ovarian dysfunction that manifests with irregular periods or no periods (irregular ovulation or no ovulation) and varying degrees of increased androgen effects (i.e. high testosterone or increased hair growth and/or acne) as well as polycystic appearing ovaries (multiple small follicles in the ovaries).

PCOS is a result of ovarian dysfunction that manifests with irregular periods or no periods (irregular ovulation or no ovulation) and varying degrees of increased androgen effects (i.e. high testosterone or increased hair growth and/or acne) as well as polycystic appearing ovaries (multiple small follicles in the ovaries).

At Footsteps To Fertility Centre, we provide support to women diagnosed with PCOS to help them overcome the syndrome and decrease the impact of its associated health problems.

PCOS is diagnosed by the inclusion of any two of the parameters above, along with the exclusion of other diseases that would present with similar findings.

There is no single test or symptom that would indicate that a person has the disease, but the diagnosis of PCOS is made by a combination of symptoms and blood testing.

It can be associated with other diseases, such as thyroid disease and elevated prolactin hormone levels (the hormone that makes breast milk). Women should be tested for the presence of these disorders if they have PCOS-type symptoms.

Additionally, PCOS patients are at an increased risk for pre-diabetic conditions that can be diagnosed by an elevated insulin level and/or elevated glucose level (glucose intolerance) or even may have diabetes at the time of the diagnosis of this condition.

If the initial workup is diagnostic of PCOS and other diseases are all eliminated by testing, the treatment options are discussed.

Our goal is to provide individualized and effective care, diagnosis and treatment for all women with polycystic ovarian syndrome.

Lack of ovulation can lead to an abnormal overgrowth of the uterine lining (endometrial hyperplasia), which increases the risk of uterine cancer.

Menstrual abnormalities can be treated with medications that might include oral contraceptives to regulate the menstrual cycle.

It is therefore very important to screen patients for diabetes at the time of diagnosis of PCOS. Patients who are overweight or obese are at a higher risk for having or developing diabetes in the future.

The goal of PCOS treatment is to decrease the amount of androgens in the bloodstream, thereby decreasing the clinical effects of androgens on the body such as facial hair growth and acne. The most common treatment is low-dose oral contraceptives. Oral contraceptives decrease androgens in a variety of ways.

For PCOS and facial hair, it is recommended to combine medical treatment with mechanical hair removal methods such as electrolysis, waxing, or laser hair removal.

Insulin resistance and hyperinsulinemia (elevated blood insulin levels) are common in women with PCOS.

These metabolic abnormalities can lead to impaired glucose tolerance and Type 2 diabetes mellitus. Some women achieve positive results by going on the type of diet used for diabetes prevention.

Metformin, an insulin-sensitizing medication, is used for the treatment of patients with PCOS. The goals of treatment include improving insulin resistance and lowering insulin levels. An improvement in ovulatory function can also be obtained.

Women with PCOS are either oligo ovulatory or anovulatory, meaning that they ovulate less often than normal or not at all. If ovulation does not take place, there is no opportunity for egg-sperm interaction and pregnancy to occur. The goal of treatment for infertility in PCOS is to cause ovulation to occur predictably.

Surgical treatment of PCOS involves the destruction of some of the ovarian tissue (laparoscopic ovarian stromal cauterization) to allow ovulation and regular menstrual cycles.

This type of treatment is no longer preferred because of the high success rate with the medical approach.

In some cases, the surgical approach can be useful, but this type of treatment should be individualized.

Surgical treatment does not improve metabolic parameters (such as elevated insulin or glucose levels) and also does not decrease the risk of diabetes.

If ovulation or pregnancy is not attained with these more conservative treatments, they can be combined with gonadotropin therapy (FSH or human menopausal gonadotropin – HMG – injections. However, gonadotropin therapy may include side effects such as increased multiple pregnancy rates and ovarian hyperstimulation syndrome (OHSS).

Weight loss and exercise should be routinely recommended to patients with PCOS because most patients tend to be overweight or obese.

Weight loss of 10-15% of the body weight is sufficient enough to allow ovulation in most cases.

Additionally, the risk of developing diabetes, high cholesterol and heart disease also significantly decreases with weight loss and establishment of normal weight.

Hyperprolactinemia is a condition in which a person has higher-than-normal levels of the hormone prolactin in the blood.

The main function of prolactin is to stimulate breast milk production after childbirth, so high prolactin levels are normal in pregnancy.

Prolactin also affects the levels of sex hormones (estrogen and testosterone) in both women and men resulting in irregular menstrual periods and erectile dysfunction, among other things.

Prolactin is made by the pituitary gland, a pea-sized organ found at the base of the brain. At Footsteps To Fertility Centre in Nairobi, Kenya you can expect peace of mind that you are getting assistance from doctors who are experts in the field and have achieved the highest level of fertility training.

Hypothyroidism is commonly treated with levothyroxine (Synthroid, Lovolet, Levoxyl, L-Thyroxine) and hyperthyroidism with propylthiouracil (PTU) or methimazole (Tapazole).

TSH and thyroid hormone levels are checked at regular intervals to sustain normal thyroid function.

Thyroid hormone requirement increases in pregnancy and the dose of supplemental thyroid hormone needs to be increased in patients with hypothyroidism.

Close follow-up and adequate treatment will optimize the outcome.

Once thyroid disease is under good control, patients can attempt to conceive spontaneously or by using assisted reproductive technologies.

One common cause of hyperprolactinemia is a growth or tumor on the pituitary gland called prolactinoma. The tumor produces high levels of prolactin. These tumors can be large or small and are usually benign, meaning they are not cancerous.

Large tumors can also cause headaches, vision problems, or both. Prolactinomas are more common in women than in men and rarely occur in children. Other causes are:

• Hypothyroidism or underactive thyroid—meaning the thyroid gland does not produce enough thyroid hormone
• Chest-wall injuries or other conditions that affect the chest wall, such as shingles
• Other tumors and diseases affecting the pituitary gland, or radiation treatment for tumors on or near the pituitary
• Chronic liver and kidney diseases

Certain prescriptions can also increase prolactin levels. These include medicines for:

• High blood pressure (such as calcium-channel blockers and methyldopa)
• Depression (tricyclic and SSRI antidepressants)
• Heartburn and gastroesophageal reflux disease
• Nausea and vomiting
• Pain (opiates—drugs derived from opium)
• Serious mental health disorders (antipsychotics such as risperdal and haloperidol)
• Menopausal symptoms (estrogen)

Both men and women may have infertility, decreased sex drive, and bone loss.

Women may also have:

• Vaginal dryness, leading to pain during intercourse
• Problems with menstruation—having no periods or irregular periods
• Production of breast milk when not pregnant or nursing

Men may also have:

• Erectile dysfunction—trouble getting or keeping an erection
• Breast enlargement called gynecomastia
• Decreased muscle mass and body hair

The diagnosis of hyperprolactinemia involves a routine blood test to check prolactin levels.

If the blood levels are elevated, the doctor may want to repeat the test, this time after fasting for at least eight hours. Normal prolactin levels are less than 500 mIU/L for women and less than 450 mIU/L for men

A magnetic resonance imaging (MRI) scan may be ordered to look for evidence of pituitary growth or for damage to surrounding tissues.

Blood tests to evaluate other hormone levels may be useful in ruling out any other possible causes of the symptoms.

Treatment is based on the cause. Some people with high prolactin levels, but few or no signs and symptoms, do not need any treatment.

Options for treating tumors include:

• Prescription medicines. Bromocriptine and cabergoline decrease prolactin production. Medicines work well for most people with prolactinomas.
• Surgery to remove a tumor. Surgery may be used if medicines have not been effective. Surgery is sometimes needed if the tumor is affecting vision.
• Radiation. Rarely, if medicines and surgery have not been effective, radiation is used to shrink the tumor.
• Hypothyroidism can be treated with synthetic thyroid hormone, which should bring prolactin levels down.
• If high prolactin levels are caused by prescription drugs, substitute medications may be prescribed.

Every woman is different, and so are our menstrual cycles. Some of us get them like clockwork, while others are a little less predictable. It can be disconcerting to experience an irregular period.

A typical menstrual cycle tends to vary from 23 to 35 days. Menstrual bleeding is considered irregular if it occurs more frequently than every 21 days or lasts longer than 8 days.

Irregular menstrual bleeding could indicate a health issue, so it’s important to reach out to a doctor if you notice any inconsistencies. Whether you’re concerned about the length, heaviness, or regularity of your period, at Footsteps To Fertility Centre, we specialize in the treatment of irregular menstruation and other hormonal disorders that affect the reproductive system of adolescents and women.

Most women have between 11 and 13 menstrual periods each year. Bleeding usually lasts around 5 days, but this too can vary, from 2 to 7 days.

When menstruation first starts, it can take up to 2 years to establish a regular cycle. After puberty, most women’s menstruation is regular. The length of time between each period is similar.

However, for some women, the time between periods and the amount of blood shed vary considerably. This is known as irregular menstruation.

The main symptom of irregular menstruation is when the cycle is longer than 35 days, or if it comes more frequently than 21 days.

If there are changes in blood flow, or if clots appear that are more than 2.5 centimeters in diameter, this is also considered irregular.

Several common factors can affect the rhythm of your cycles. Here are some possible causes of irregular cycles that are also infertility risk factors:

• Polycystic ovarian syndrome (PCOS): Irregular periods may be a sign of polycystic ovarian syndrome (PCOS).
  Other illnesses: Thyroid disorders can cause irregular periods if blood levels of the thyroid hormone go too low or too high. Other health conditions that may cause an irregular cycle include sexually transmitted diseases, diabetes, fibroids, and endometriosis.
• Birth control: Any changes to your birth control can disrupt your cycles for a few months.
  Age. When teens first start having periods, their menstrual cycles may not always be on the same schedule every month. It may take several years to settle into a pattern. In addition, missed periods and lighter or heavier periods are common in women near menopause.
• Exercise, dieting & weight fluctuations: Extreme exercise, diet or body weight can contribute to irregular periods. Female athletes are more likely to experience infertility for this reason.
• Stress. Chronic stress or even short-term anxiety about a specific problem can wreak havoc with your hormone balance, causing a missed period and irregular cycle.

A missed or irregular period may be the first clue that you have a condition that needs medical attention. If you have consistently irregular periods, you should be evaluated for PCOS.

You should also be screened for thyroid disorders and other diseases that may be linked to irregular periods.

If you’re concerned about the regularity of your menstrual cycle, an easy first step is to keep a written record of your period.

This record can help set your mind at ease if it turns out that you’re more regular than you realized.

You will also be able to recognize when to take proactive measures. Schedule an appointment with your gynecologist if you experience irregularity over multiple cycles.

During your appointment, the OB-GYN will typically review your medical history with you and might also perform tests such as pelvic exams, Pap tests, MRI or CT scans and minimally invasive hysteroscopy.

An irregular cycle can make it more difficult to get pregnant, especially if you’re not ovulating every month. Your doctor can run tests to see if you’re ovulating. Women with irregular periods who are trying to have a baby are sometimes prescribed fertility drugs to increase ovulation.

Irregular or abnormal ovulation accounts for 30% to 40% of all cases of infertility. Having irregular periods, no periods, or abnormal bleeding often indicates that you aren’t ovulating, a condition known clinically as anovulation. If you’re not ovulating, you can’t get pregnant without the help of fertility treatments.

It is therefore a good idea to be checked out by a doctor just to make sure that nothing serious is going on.

Irregular periods are common but you shouldn’t accept them as normal. At Footsteps To Fertility Centre, our trusted fertility specialist advises that we should pay more attention to our lifestyle. The amount of sleep you get, eating habits and stress level all play an important role in your attempt to get pregnant. Another important thing you can do is to take good care of your health and emotional well-being.

Irregular periods are often a highly treatable condition. Understanding the causes of irregular periods and how you can help to restore cycle regularity can help as you embark on your trying to conceive adventure.

To increase the number of your ovulation period, doctors often prescribe medication and fertility drugs. These drugs induce ovulation that can result in multiple gestations in some women.

Timing intercourse around ovulation can increase your chances for pregnancy since you’ll need to have sex during your fertile window to conceive.

Treatments for menstrual irregularities often vary based on the type of irregularity and certain lifestyle factors, such as whether a woman is planning to get pregnant.

Treatment for menstrual irregularities include:

• Treatments for an underlying disorder that is causing the menstrual problem, such as counseling and nutritional therapy for an eating disorder.
• Oral contraceptives
• Use of various nonsteroidal anti-inflammatory medications
• If the cause is structural or if medical management is ineffective, then gynecologic surgery is recommended. It involves minimally invasive surgical techniques such as surgical removal of polyps or uterine fibroids, uterine artery embolization, endometrial ablation and hysterectomy. They provide a faster recovery and fewer complications than traditional open surgery. These approaches also preserve fertility.

You can count on the extensive experience of the team at Footsteps To Fertility Centre to identify the cause and effectively treat irregular periods.

If you have any questions about your menstrual periods, feel free to contact us or schedule an appointment online.