Polycystic ovary syndrome: How losing weight can help with irregular periods, acne and infertility

A 5 to 10 per cent weight loss could help improve health issues associated with PCOS, according to gynaecologist Tan Thiam Chye

Weight and polycystic ovary syndrome are closely associated, with each influencing the other. PHOTO: GETTY IMAGES

Weight gain and obesity, irregular menstrual cycles, acne and infertility are some signs and symptoms of polycystic ovary syndrome, or PCOS. Data from the World Health Organization (WHO) suggests that approximately 116 million women (3.4 per cent) are affected by PCOS globally and around 10 to 15 per cent of women in Singapore have this condition.

The exact cause for PCOS is unknown, says Dr Tan Thiam Chye, consultant obstetrician and gynaecologist at Mount Elizabeth Novena Hospital. What doctors do know is that it is a metabolic condition caused by high insulin resistance and related to increased levels of the male hormone androgen.

The excess androgen can also lead to excessive facial and body hair, thinning of hair on the head, deepening of the voice, and decreased breast size, notes Dr Tan. Very often, there are no symptoms at all, which means the condition can go undiagnosed well into adulthood.

In recent years, the correlation between PCOS and excessive weight ( a body mass index of 25 and above) has also come to the forefront, notes Dr Tan, highlighting the importance of weight loss to effectively manage this condition.

The link between PCOS and weight

While a few factors can contribute to PCOS, such as genetics, high levels of insulin or insulin resistance, PCOS and weight are closely intertwined, with each influencing the other.

Dr Tan explains: “Just like it is hard to determine which came first, the chicken or the egg, doctors have not determined definitively if PCOS causes metabolic issues or vice versa. However, we know with certainty that weight gain and obesity worsen PCOS and cause irregular periods.”

For those with excess weight around the waistline, this could contribute to insulin resistance and impair the body’s ability to effectively use insulin. This, in turn, could further promote weight gain and metabolic issues, hindering weight-loss efforts, and even heightening the risk of Type 2 diabetes.

Adds Dr Tan: “Diabetes and endometrial (womb) cancer risk are increased in those with PCOS in the long term, and we monitor for these two conditions closely.”

The silver lining? Even a 5 to 10 per cent weight loss can improve ovulation, fertility and menstrual cycles in those who have PCOS, according to studies, says Dr Tan.

How is PCOS diagnosed?

According to Dr Tan Thiam Chye, PCOS can be diagnosed clinically with blood tests and/or a pelvic ultrasound.

“The ultrasound will show small cysts in one or both ovaries, also known as polycystic ovaries. Blood tests will show hormonal imbalance and high anti-mullerian hormone (AMH) levels,” he explains.

These cysts are fluid-filled sacs of immature eggs that were not ovulated due to elevated levels of male sex hormones.

Strategies for weight management

As weight loss is an important aspect of PCOS management, diet combined with exercise is important.
Prioritise whole foods such as whole grains, lean proteins, fruits, vegetables and healthy fats, advises Dr Tan. These are nutrient-dense and provide essential vitamins and minerals while promoting fullness.

Limit processed foods and added sugars as these can contribute to weight gain and insulin resistance, he adds.

Include cardiovascular exercises to elevate the heart rate and burn calories through activities such as brisk walking, running, cycling and swimming. Strength training also helps to build lean muscle mass that can increase one’s resting metabolism.

Stress can also impact hormonal balance and exacerbate PCOS symptoms, cautions Dr Tan, who recommends meditation, deep breathing exercises, and making self-care a priority.

When the symptoms of PCOS are severe, medical intervention is sometimes needed.
Dr Tan explains: “Key-hole surgery (laparoscopy) and ovarian drilling (removal of the ovarian cysts) can help to rectify the polycystic ovaries. This has been shown to improve ovulation in 80 per cent after surgery.

“Ovulation medications can also improve fertility, as can hormonal medications. There are also pills to regulate menses. Metformin helps to reduce insulin resistance and improve menstrual cycles and ovulation.”

There is a new class of medication called glucagon-like peptide-1 receptor agonists (GLP-1 RAs) that may be effective in reducing weight in women with PCOS with a body mass index of above 27 kg/m2 by 5 to 10 per cent in 16 weeks, he says.

These findings are based on a 2022 study1 conducted by the Woman’s Hospital Research Center in Louisiana, in the United States, and supported by global healthcare company Novo Nordisk.

The 32-week survey included 82 women, who were obese and had PCOS, aged 18 to 45. Some were randomly assigned to take GLP-1RA once daily with lifestyle interventions, while the others were given a placebo.

The study found that more than half the participants in the group who took GLP-1RA once a day with lifestyle interventions achieved at least a 5 per cent weight reduction. This was 75 per cent higher compared with the participants who were on the placebo.

“GLP-1RAs support weight loss by reducing hunger and increasing satiety – food intake decreases as a result,” explains Dr Tan. “This treatment significantly improves the regularity of periods in women with PCOS.

“Menses occurrence was also significantly increased with significant reduction in the amount of excess male sex hormones being produced, and the GLP-1RA also improved blood glucose levels.”

Patients may experience some common side effects such as nausea, vomiting, diarrhoea and constipation.

Dr Tan cautions that the GLP-1 class of drugs is not recommended for those who have a personal or family history of medullary (soft-tissue) thyroid cancer, multiple endocrine neoplasia (tumours), are allergic to any ingredients in the drug, are pregnant, or trying to conceive.

“We have seen improvements in PCOS patients with proper weight management. Ultimately, it’s up to you to take charge of your health, so speak with a doctor first about the best course of treatment,” advises Dr Tan.

1Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study Elkind-Hirsch KE, Chappell N, Shaler D, Storment J, Bellanger D. Liraglutide 3 mg on weight, body composition, and hormonal and metabolic parameters in women with obesity and polycystic ovary syndrome: a randomized placebo-controlled-phase 3 study. Fertil Steril. 2022;118(2):371-381. doi:10.1016/j.fertnstert.2022.04.027

Read More
5 Confinement truths or myths

Confinement is enshrouded in Asian culture and many practices are deep-rooted. But are these confinement practices medically sound?

Confinement is a special time for your body to recuperate from childbirth. Confinement is cultural to many Asians. But remember that these practices were relevant to those ancient days when mother and baby mortality rates were high. It was a time without proper sanitation or even antibiotics. Thus, it was a safe practice to confine both baby and mother indoors during the first month. This was meant to protect mother and baby from ill health. This was the origin of confinement practices.

By now, you may not agree with them but many of these are deep-rooted in our Asian culture. Some may not be medically sound. They range from the prohibition of doing certain daily tasks to the restriction of certain food intake — with the strong belief that these can provide adequate rest and replenishment during this period.

Myths vs Truths

Myth #1

No bathing or hair-washing for one month

Bathing keeps you clean, relaxed and hygienic. It also reduces the episiotomy or C-section wound infection. You can try with TCM herbal bath if you feels safer with these baths.

Myth #2

No drinking of water

Hydration is so crucial for survival and also ensures good lactation. Otherwise, milk flow will diminish drastically. Remember to drink up.

Myth #3

No leaving of house for a month

This negative practice is done to prevent infection to the mothers during ancient times. And it will worsen her postnatal blues and cause her to lapse into depressions.

Myth #4

To take food with ginger to purge the “wind” in the body

Eating yummy confinement food to replenish the weakened body is appreciated by the new mum. Remember to eat healthy food containing liver and red meats to replenish blood loss at delivery. This positive practice can be advocated.

Myth #5

Not to think negative thoughts

This is good practice so that the new mothers can be positive. Postnatal Blues are common and should be coped with supportive family. I strongly aw advocate this.

Read More
Do I need to get pregnant by IVF or IUI?

6 months have zoomed past in 2022!

How is your fertility journey?

If you are trying to conceive (TTC) for a year, it is timely to think of IUI or IVF (test tube baby). For most couples, getting pregnant is luckily smooth and easy. Unfortunately, for 1 in 10 couples, they may experience stress in conceiving.

What is Assisted Conception?

Couples who have been trying for over a year but can’t conceive, should see a gynae to check the cause of their subfertility. Polycystic ovaries syndrome (PCOS) is a common cause of subfertility in some women. PCOS causes hormonal imbalance and ovulation problem.

The problem could also lie in your partner due to poor sperm quality or numbers. There are effective sperm supplements to improve sperm quality and number. Unfortunately, some partners may have azoospermia, ie no sperms and need help to retrieve their sperms through surgery.

What is IVF and IUI?

2 most common reproductive treatments are intrauterine insemination (IUI), when sperms are injected into the womb at ovulation, and in vitro fertilisation (IVF), when the egg and sperm are fertilised in IVF lab and the fertilised embryos are replaced into the womb.

When is IUI needed?

IUI works best for couples with difficulty in sex, ovulation or poor sperm quality. Ovulation is first triggered with medications. The sperm washing helps to eliminate poor sperms and chemicals to improve pregnancy rate. Only the best “commando” fast-swimming sperms are injected into the womb. Success rate is 25% per try.

Do I need IVF?

IVF may be needed for some couples, especially for blocked fallopian tubes, or if the sperms are very poor in quality. Failing to conceive through IUI is another indication. IVF works best if you are younger (less than 40 years old). So, do not procrastinate and seek help early. In Singapore, women over 40 are not eligible for the Ministry of Health’s subsidy grant in public IVF centres like KKH, SGH or NUH.

Stay positive and we hope that you will be a parent soon!

Read More

Epidural side effects

Epidural analgesia is said to have many side effects, how true are they?

Epidural analgesia (EA) is reliable and effective way to relieve labour pain. Pain relief is achieved by the injection of local anesthetic drugs through a small tube into the epidural space of the lower back. This is performed by an anaesthetist.

Although epidural reduces labour pain substantially, some pain may still be felt, especially when pushing of the baby.


Experienced OBGYN Dr Tan Thiam Chye shares science-backed facts in the face of epidural myths.

Epidural Myths vs Truths

Myth #1. “There are side effects associated with epidural

Some minor side effects may occur but they are often transient. These includes:

  • Loss of sensation and weakness: Numbness of the legs and lower part of the body is expected. The urge to urinate may also be lost. As the epidural effect wears out, sensation and strength are restored in the legs.
  • Nausea: This may result from a drop of blood pressure or effect of the epidural drugs. It can be treated with medication.
  • Shivering: This occurs although the woman may not be feeling cold. This is harmless and does not require treatment.
  • Itch: A mild itch on the body is more common. This is self-limiting and will subside very soon.
  • Headache: There is a 1% chance of headache after EA. The headache occurs after delivery and is worsened by the upright posture. Medications and a procedure called epidural “blood patch” can be used to treat severe headaches. In most cases, the headache resolves with time.

Myth #2. “Epidural causes chronic backache

Studies show no link between chronic back pain and epidural. Backache is common after childbirth, with or without EA. Proper back care during pregnancy and after childbirth is important.

Myth #3. Epidural harms the baby

Epidural is safe although some transient change in the baby’s heartbeat may occur.

Myth #4. “Epidural can cause paralysis

This is actually very rare. The risk of permanent damage is 1 in 50,000 – 100,000. The risk of paralysis is 1 in 1,000,000.

Myth #5. Epidural prolongs labour and leads to C-section

EA does not result in a greater chance of C-section. There is slightly increased chance of instrumental delivery.

This article is contributed by Pregnancy Singapore < https://www.pregnancy.com.sg/>

Read More

How to have a healthy weight gain during pregnancy?

Discover the foods to avoid to achieve a healthy diet during pregnancy.

Healthy diet throughout pregnancy is the best thing you can do for your baby. Good nutrition optimizes the growth and development of your baby and safeguards your own health. During pregnancy, your energy requirement increases by only 300 kcal a day. On average, every woman needs 1700 kcal a day. So eating for two is a myth!

Requirements for micro-nutrients (folate, calcium, vitamin D and B vitamins) are significantly higher. Make smart choices by choosing nutrient-rich food, rather than just eating more food!

foods to avoid during pregnancy

Foods to avoid during pregnancy

Food safety is important during pregnancy. This is because bacterial toxins and certain harmful heavy chemical such as mercury can pass to baby and cause undesirable outcomes. Avoid these food items.

  • Unpasteurized milk; soft cheese, e.g Brie, feta, Camembert and Roquefort; liver pates. These foods are prone to Listeria infection, a bacteria, which may result in miscarriage and stillbirth.
  • Raw seafood and meats e.g. raw oyster, cockles, sashimi and sushi; and raw or half-boiled eggs: Raw and undercooked animal foods contain germs, bacteria and parasites. Especially when your immunity is now weakened.
  • Avoid swordfish, shark, tilefish and king mackerel. Limit canned albacore tuna. This is to avoid heavy metal poisoning.
  • Alcohol: Mothers who drink excessive alcohol have higher risk of miscarriages and stillbirth, and may result in fetal alcohol syndrome, including facial mal-development, small baby and mental impairment.
  • Unwashed salad and raw vegetable sprouts, including alfalfa, clover, radish and mung bean: Unwashed salads may be contaminated with bacteria from the soil, while raw vegetable sprouts contain high levels of germs, which can be harmful to health.
  • Durians (an Asian delight!) contain excessive calories and potassium. So eat in moderation.

This article is contributed by Pregnancy Singapore < https://www.pregnancy.com.sg/>

Read More

Feeling a little queasy? Wondering why your breasts are so tender? What about those crazy mood swings?

Am I possibly pregnant?


You may suspect that you are pregnant when you have unusual pregnancy symptoms after missing your period. For a start, check out your suspicion by using an urine pregnancy test kit. There are many brands of pregnancy test kits available in the market, which are reliable. These are available at our local pharmacies or stores. Alternatively, you could go to your doctor for a test.

#1 What is hCG pregnancy test?

During pregnancy, a hormone called human chorionic gonadotrophin (hCG) is produced, which circulates in the blood and is also present in the urine. The pregnancy test kit detects the presence of hCG in your urine. Most pregnancy test kits are sensitive and will detect hCG between 4-5 week of pregnancy. This means that for those with regular cycles, the test should be positive once you have missed your period by a few days.

#2 Should I test with first-morning urine?

Although you can test at any time of the day, your first-morning urine specimen is the most concentrated urine sample and most accurate. Go for it.

#3 When should I take the test if I suspect that I am pregnant?

You can test your urine as early as one week past ovulation but testing after the first few days of your missed period is recommended for better accuracy.

#4 Do I need a blood test to confirm my pregnancy?

Blood tests for hCG are more accurate in detecting HCG and they can also measure the actual levels of the hormone. These tests may be useful to tell a miscarriage when the blood hCG will drop with time. In a healthy pregnancy, the blood hCG level will double every 2 days. A blood test for progesterone hormone can also be useful as a good level would signify a healthy pregnancy.

This article is contributed by Pregnancy Singapore < https://www.pregnancy.com.sg/>

Read More

Early Pregnancy Symptoms

Do you know the early symptoms of pregnancy?

From nausea to fatigue, know what to expect.

There are many common symptoms in pregnancy. You may or may not experience every one of them. These are associated with the hormonal and physical change of pregnancy. It is important that you are aware of these symptoms so that you will not worry unnecessarily.

early pregnancy symptoms

#1 Nose bleeds during pregnancy

Nose bleeds tend to occur more often due to the increased blood supply to the mucosa of the nose. This increased flow leads to increased pressure, which ruptures the delicate blood vessels. Nose bleeds are usually harmless and stop spontaneously.

#2 Headaches during pregnancy

It may be common to experience mild headaches due to stress or migraine. However, seek immediate medical attention if the headaches worsen despite painkillers. Other associated symptoms such as vomiting, vision blurring or weakness may suggest serious medical conditions. Also, headaches could be a sign of high blood pressure. Be wary.

#3 Aches and back pain during pregnancy

There is an increase elasticity of the ligaments to prepare for delivery. However, the joint instability can result in pain. The affected joints involve the back and pelvis (pubic bones). Occasionally, as the baby grows bigger, you may even experience some discomfort in rib cage. Aggravating factors include pre-existing back pain or excessive physical strenuous activities during your pregnancy.

#4 Constipation and bleeding in my stools

It is common to experience constipation and develop piles during your pregnancy. Both conditions can have blood in your stools. Nonetheless, do inform your doctor of any bleeding especially if it is persistent. A referral to the colorectal doc may be necessary.

#5 Navel (belly button) pain during pregnancy

Belly button (umbilical) pain is common. Your abdominal wall is the thinnest around the navel. This increased pressure due to pregnancy may cause sensitivity and pain in this area. This is harmless and will come and go.

#6 Blocked ears during pregnancy

This is due to swelling of the inner ears and block the ear tubes. Simple measures such as decongestants or nasal sprays prescribed by your doctor may be helpful.


This article is contributed by Pregnancy Singapore < https://www.pregnancy.com.sg/>

Read More