Dr Raelia Lew and Dr Alice Rudd
Polycystic Ovarian Syndrome (PCOS) is a very real disorder affecting many reproductive-aged women. PCOS can have many effects on the skin including acne and hair concerns There are many different care modalities that can be used to support those suffering with the condition. However when women start trying for a baby some skin treatment options are not safe leaving many sufferers anxious about the outcome for their skin. Join Dr Raelia Lew, CREI Fertility Specialist and Dr Alice Rudd, Dermatologist about how PCOS sufferers can best care for skin during pregnancy planning.
1. Dr Lew, what exactly is Polycystic Ovarian Syndrome (PCOS)?
Polycystic Ovarian Syndrome or PCOS is a condition that affects a woman in many domains. It involves ovarian hormone imbalance, where high levels of male hormones (androgens) are present in the context of a large, powerful ovarian reserve. Insulin resistance also plays a role in this syndrome. Carrying excess body weight exacerbates symptoms of the syndrome and having PCOS in turn makes it harder metabolically for a woman to lose weight.
2. Dr Lew, what are some special concerns for women trying to conceive with PCOS?
Women with PCOS are often surprised at how readily they are able to conceive with my help in regulating their cycle. We focus on a variety of care elements including lifestyle change, metabolism altering therapies, diet, exercise and where needed, ultrasound monitored ovulation induction.
However, aside from fears about infertility, women with PCOS who are trying to conceive also face fears of skin breakout, facial and body hair growth and scalp hair loss returning when they cease their regular PCOS control regimen.
3. Dr Lew, how can I keep my symptoms in control and prepare for pregnancy?
Women with PCOS need professional support. Your medical management team may consist of:
- Your GP
- Your Reproductive Endocrinologist/CREI Fertility Subspecialist
- Your Dermatologist
- Your Endocrinologist
- Your fitness guru or exercise physiologist
- Your mind-body support professional
- Your Nutritionist
- Your lifestyle coach or naturopath
4. Dr Rudd, can you provide some more insight into the skin concerns PCOS sufferers present with?
PCOS can have a range of skin manifestations from none at all to multiple and severe. The most common skin issue is acne. Acne tends to be located around the chin and cheek area and commonly worsens with the menstrual cycle. Excessive facial hair growth (hirsutism) affecting the face or body is another common unwanted effect. Hair thinning on the crown and at the hairline (androgenetic alopecia) is also common and debilitating for many women. Other less common issues such as boils in the groin and armpits, and rashes related to excessive weight may also be seen.
Treatment of the skin involves can vary. For mild acne and hair growth, simple measures such a good skin care routine, skin treatments, and hair removal techniques such as laser may be employed. For more severe symptoms, medication may be required. This could be as simple as certain skin directed oral contraceptive pills, up to low dose vitamin A medications.
5. Dr Rudd, during conception, many treatments for PCOS sufferers are contraindicated. What is safe to continue?
Many of the oral medications used to assist PCOS sufferers must be stopped during the preconception phase. These medications are not appropriate or safe in the lead up to pregnancy. However there are many things we can still do to help.
We recommend in-clinic treatments/skincare or a combination of both. The type of acne and the severity of the acne will determine the treatment solution. Treatments that work best include chemical peels, extractions and light therapies such as LED or Kleresca. These treatments are not invasive and completely safe during the conception phase and in many cases pregnancy also (your Dermatologist or Dermal Clinician can advise you).
If you are experiencing abnormal or excessive hair growth that is concerning you, laser or IPL hair reduction technologies are safe during this time. They can be administered on the face or body on even the most sensitive areas. The stomach and pelvic area must be avoided once conception has been successful.
6. Dr Rudd, once pregnant what skin products and treatments can be safely used throughout pregnancy?
Niacinamide in a topical form a fantastic skincare option for helping to manage oil production and balance hydration of the skin if acne prone and completely safe during pregnancy. It works similarly to a topical antibiotic, helping to combat nasty bacteria and improving inflammation in the skin. Another recommendation is Benzac which is a good option for pregnant ladies that are after a safe spot treatment for pustular acne. A skin care routine directed to the individuals type of acne can be suggested. There are certain prescription medications that can be safely used during the conception and pregnancy phases but should be used on medical advice from your dermatologist. Injectable cortisone may also be beneficial in large acne cysts that can arise during pregnancy.
Other hair removal techniques such as dermablading are safe in the conception phase. It is also important to address diet, reducing dairy and sugar levels (if safe to do so as advised by your specialist).
In-clinic treatments including extractions, LED Healite and fruit-extract peels are completely safe during pregnancy. These treatments can be completed regularly to help rejuvenate fresh healthy skins cells and reduce inflammation associated with acne.