Polycystic Ovarian Syndrome (PCOS)

What is PCOS?

Polycystic Ovary Syndrome (PCOS) is a common hormonal disorder that can affect a woman’s menstrual cycles, her fertility, aspects of her appearance and  her long term metabolic health. Understanding PCOS and mechanisms causing it  is crucial for effective management.

Genetic Basis of PCOS

Research indicates a genetic predisposition to PCOS. Family studies have shown that first-degree relatives of affected individuals are more likely to have PCOS, suggesting that genetic factors play a role. Specific genes related to insulin signaling and hormonal regulation have been implicated. Most women with PCOS have a family history of Type 2 Diabetes. 

Insulin Resistance 

Who is at risk of Polycystic Ovarian Syndrome (PCOS) in Singapore? 

PCOS can affect women of all ethnicities and backgrounds, but certain risk factors may increase the likelihood of developing the condition, particularly within Singapore’s diverse population.

• Family history of PCOS — having a mother or sister with PCOS raises your risk significantly.

• Insulin resistance or type 2 diabetes — common in women with PCOS and often runs in families.

• Obesity or excess weight — especially weight gain around the abdomen, which worsens hormonal imbalance.

• Sedentary lifestyle — lack of regular physical activity may contribute to insulin resistance and hormonal disruption.

• Early onset of puberty — girls who begin menstruating at a younger age often are over weight and go on develop PCOS 

• Ethnic background — studies suggest women of South Asian, Malay, or Middle Eastern descent may have a higher prevalence of PCOS and more severe symptoms.

• Hormonal imbalances in adolescence — irregular periods and acne from an early age or into adulthood may indicate underlying hormonal issues.

• Stress and poor sleep patterns — both can contribute to hormonal dysregulation and inflammation, which may aggravate PCOS symptoms.

How is Polycystic Ovarian Syndrome (PCOS) diagnosed?

At Holistic Gynaecology & Fertility, we understand that PCOS can be a confusing and frustrating journey. We will guide you through effectively managing your symptoms and run a thorough diagnostic process — not just to confirm PCOS — but to understand how it affects your body specifically.

What to expect during your consultation

• Taking a detailed including Family History, details of your mother’s pregnancy and your birth weight.
• Medical History and Physical Exam: Assessment of menstrual history, symptoms
• Hormonal Blood Tests: To measure hormone levels
• Pelvic Ultrasound: To check for the presence of polycystic ovaries, endometrial polyps.
• Metabolic Screening: Height weight and waist circumference. Bloods to evaluate for insulin resistance, glucose tolerance, liver function, inflammatory markers, Vit D etc.

Metabolic parameters	Waist Circumference Blood Pressure Insulin resistance tests HOMA-IR, OGTT,  HbA1c Lipid panel Inflammatory marker  CRP
Hyperandrogenism	Total Testosterone (ng/dL), Sex Hormone-Binding globulin
Ovarian Dysfunction	Luteinizing Hormone (LH)  Follicle-stimulating Hormone (FSH) Anti-Müllerian Hormone (AMH) Antral Follicle Count (AFC) Menstrual Cycle Regularity (Days between cycles)
Stress hormones	Serum Cortisol (Morning)DHEA-SProlactin

• Exclusion of other conditions — we may run additional tests to rule out thyroid disorders, elevated prolactin levels, or adrenal gland conditions that can mimic PCOS symptoms.

Rotterdam Criteria is the most widely accepted criteria to diagnose PCOS. Diagnosis of Polycystic Ovary Syndrome (PCOS) is typically made when at least two of these three main criteria are met:

• Irregular menstrual cycles (or no periods),
• Signs of excess male hormone (androgen) like increased facial or body hair, acne or elevated androgen levels on blood tests and 
• Due to the high levels or sensitivity to male hormones, the regular egg growth and ovulation is unable to happen. Ovaries may develop numerous small cysts and  appear polycystic on ultrasound - often described as a ‘string of pearls’. 

Diagnosis is never rushed. Our goal is to help you understand your body better and work with you to manage your health in a way that aligns with your lifestyle and long-term goals.

How is PCOS treated in Singapore?

There is no cure for PCOS — it is a genetically linked disease. However lifestyle modifications can help both with symptom relief as well as reduce the risk of long term health effects.  

Lifestyle Modifications for Managing PCOS 

Even modest weight loss (5-10%) can improve symptoms and restore regular ovulation and also reduce chronic inflammation associated with PCOS improving long term metabolic health.

• Dietary Suggestions:

• Focus on a balanced diet with whole foods: fruits, vegetables, whole grains, lean proteins, and healthy fats.
• Choose low carb, high protein foods to manage insulin resistance, such as lean meat, legumes and non-starchy vegetables.
• Reduce intake of processed foods and sugars, particularly refined carbohydrates.

• Food sequencing is very important -  start meals with a salad and eat carbs only after
• Hydration: Aim to drink over 2 liters of water at regular intervals daily.
• Meal Timing: Avoid very prolonged intermittent fasting as it stresses out a woman’s body; Time restricted eating (10 hours to eat a well balanced diet, 14 of fasting) with probiotics have been shown to reduce insulin resistance. So do consider finishing dinner by 7 PM and eating again at 9 AM. Try to eat a light and early dinner, try not to skip breakfast
• Food Diary: Keep a log of food intake and timing for evaluation.
• Continuous Glucose Monitoring (CGM): esp for those struggling with weight loss.
• Regular Physical Activity: Aim for at least 150 minutes of moderate-intensity exercise per week to improve insulin sensitivity and aid in weight management. Post meal walks reduce insulin levels and are strongly recommended.
• These strategies will help in reducing post meal sugar peaks and crashes - low sugar levels (AKA food coma) and more cravings.
• Stress Management: Stress is a part of urban life and an important cause of weight gain. Stress results in release of cortisol, a hormone that makes the body be in a “fight or flight" state and makes us crave high calorie foods resulting in weight gain. Engage in mindfulness practices, yoga, or meditation to reduce stress.

Nutritional Supplements

Consider discussing with a healthcare provider about:

• Inositols are carbohydrates found in the body and some foods and can improve insulin sensitivity and ovarian function leading to improvement in several PCOS symptoms 
• Omega-3 Fatty Acids: Can reduce inflammation and improve metabolic health.
• Vitamin D: Many individuals with PCOS are deficient in vitamin D, and supplementation may help regulate menstrual cycles.
• Chromium: May assist in improving insulin sensitivity.

Medical Management for managing symptoms and treatment options

• Hormonal Treatments: Birth control pills can help regulate menstrual cycles and reduce symptoms such as hirsutism and acne.
• Insulin Sensitisers: Medications like Metformin can improve insulin sensitivity and assist with weight loss and menstrual regulation.
• Anti-androgens: Such as spironolactone, may help reduce hirsutism and treat deep-seated, cystic acne on the lower face, jawline, or neck.
• Fertility Treatments: For individuals seeking to conceive, options include Letrozole, gonadotropins, and assisted reproductive technologies like IVF.

Fertility Treatments

Having PCOS does not mean you cannot conceive, but it can be more challenging. Thankfully, there are several medical treatments that effectively boost ovulation or support fertility, such as:

• Letrozole: Helps up to 80% women with PCO ovulate and 50-60% manage to conceive. 
• Gonadotropins: Injectable hormones may be used if oral medications are ineffective.
• Assisted Reproductive Technologies: Intrauterine insemination (IUI) or In vitro fertilisation (IVF) may be considered for those who do not respond to other treatments.

Conclusion

PCOS is a complex condition with various symptoms and may have long-term health implications. A comprehensive, holistic approach including dietary changes, lifestyle modifications, supplements, medical treatments, and psychological support is essential for effective management. It is essential to educate young girls and women about PCOS, its consequences and treatment strategies including lifestyle modifications to empower them to live with this lifelong condition.  

PCOS is one of the most common, yet most misunderstood reproductive disorders and fertility is never just about one organ or one hormone. We look at the whole picture and support you in a way that feels informed, empowering, and deeply personalised.
If you are experiencing irregular periods, hormonal symptoms, have difficulty conceiving, and suspect PCOS, schedule a consultation with us today for a detailed diagnosis and personalised treatment plan.