I have had many, many questions regarding Polycystic Ovarian Syndrome or Polycystic Ovarian Disease. As an infertility specialist, I see women every week that suffer from either the syndrome or the disease. If not treated, it can lead to serious health problems such as diabetes and heart disease. It can also cause infertility. PCOS or PCOD is common and affects as many as 1 in 15 women. Often the symptoms will begin in a woman's teen years, like the following questioner from Texas.
Question:
Hi Dr. Ramirez,
I am a 19 year old black female in Texas looking for answers. I started having periods at 12, but I have never had a normal, monthly cycle. I generally skip 3-6 months, after which I have a period lasting anywhere from 2 weeks to 3 months. At first, because I am hirsute and I was overweight, it was thought that I had polycystic ovarian syndrome, but I have been tested numerous times for such and I don't have that. During my long periods it was thought that I had uterine fibroids, for which I was also tested negative more than once.
I've lost 35 lbs. but I still have the same issue. Now I have a "bloodless period", with a brownish or clear fluid. I have been to 4 different ob/gyn's, non with a conclusive answer. The reason I post this in the infertility section is because I don't believe I am fertile, but I want to know what is causing my infertility so maybe I can go and get help to resolve the issue.
Thank you so much!
Answer:
You have PCOD. The is NO specific test for this disorder. It is a clinical diagnosis, which means that it is based on the signs and symptoms. If you have hirsutism, increased weight and very irregular periods, that is enough to make the diagnosis. PCOD has a wide variety of presentations. Some will have an FSH/LH imbalance on blood testing, but not all. Some will have irregular periods, but not all. Some will have increased hair growth, but not all. Some will have elevated insulin levels, but not all. The point is, your doctors are wrong. You have PCOD.
Therefore, you should be on the birth control pill to control your cycles. The problem with PCOD is that the ovary is dysfunctional and not processing FSH and LH correctly. Because of the dysfunction, it does not lead to ovulation and estrogen and progesterone are not produced. Instead, the precursors, the chemicals that usually are made into estrogen and progesterone, proceed to making testosterone, a male hormone. That leads to the increased hair growth, hair loss, obesity etc. By using the birth control pill, the ovaries are shut down, so that no testosterone is formed, and the estrogen and progesterone replace the hormone that you are not producing. The best pill for this purpose is Yasmin because the progesterone type, Drospirenone, blocks the testosterone receptors as well.
There are fertility issues with PCOD patients because they are not ovulating, which means, they are not giving off an egg each cycle. Those patients need to use fertility medication to get the ovaries to ovulate. Once ovulation is resumed, they have a normal chance of getting pregnant.
I hope this clarifies things for you. You might want to see a Reproductive Endocrinologist because this kind of doctor specializes in women's hormonal disorders and understands PCOD.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
Monterey, California, U.S.A.
Check me out on Facebook http://www.facebook.com/ejramirez and Twitter with me at @montereybayivf
Hello!
ReplyDeleteI hope you don't mind my adding a question to this entry, and I just wanted to thank you very much for all of the useful advice you've given on this site.
I am a 26 year-old white and Hispanic female. As a teenager I had very irregular periods (I'd skip cycles or my cycles would never be consistent month-to-month when I did have them). I also had extremely painful cramps and back pain, heavy periods, and at times would have have nausea, vomiting, and diarrhea associated with my period (although I'm not sure if all of those things were related, to be honest). I've also always had trouble with unwanted body hairs (excessive hair on my arms and legs, hair on my chin and face). At about age 16, asked to be put on birth control pills when my doctor advised me that the hormones might help with my periods and their associated symptoms, and they worked wonderfully. My periods became regular, and my symptoms were much more bearable.
This continued while I was BC pills, and I went off them for a period of time in college since I still wasn't sexually active. My periods became irregular again for about a year, although I did not have the problematic symptoms that I did as a teenager. When my husband and I met, I was 21 and decided that I wanted a more long-term method of BC, and I got a ParaGard IUD. My periods remained irregular and I had a return of problematic symptoms (which I understand is not unusual with that particular method), but when I had it removed two years later, I got pregnant immediately and had a healthy baby.
I did, however, have abnormal thyroid tests during my pregnancy; I started losing my hair, I had very dry skin, and had issued with lightheadedness and dizziness and lots of anxiety (very unusual for me). My doctor at the time said that my results were unusual enough that I needed followup after my pregnancy (but not treatment right then), and that I might need an MRI (although I'm not entirely sure why).
It's been 2 years since my son was born, and although I'm not necessarily worried about getting pregnant again (we've only been trying for 2-3 months), I am concerned about some new symptoms I've had since. I've gained about 10 pounds (I'm 5'7" and 165 lbs) without any particular changes in behavior; I came off Depo Provera in early February, so that may account for that. But I've also had increasing problems with unwanted hair - more on my face and chin, and I am starting to find hair on my chest, and I am starting to have issues with my hair and lightheadedness again.
My concern is this: if my periods continue to be irregular as they have been without hormonal intervention, and I'm having other thyroid-related symptoms, could this affect my fertility in the future? Should I try to get this treated, if only to head off problems down the road?
I appreciate any help you can offer!
S.
Hello Dr.Ramirez,
ReplyDeleteI've been reading ur blog and it's been of great help. I'm hoping u could help me too.
I,m a 33 yr old foreigner, with grade 4 endometriosis and had a frozen embryo transfer on 23rd april 2018. On 4th May I got a positive b Hcg and it was 1000 after 48 hrs. But since then, I've had mild pink/brownish spotting. I was on progynova 4mg bd, cyclogest 400mg bd and duphastone 10mg bd even before fet.
So due to spotting I was started on prolutan depot as well every once in 4 days. The spotting stops with the injection but begins every 4th day.i checked my progesterone level today before all medications and it was 6.83. My uss is due on 20th for assessment of a heart beat.. what would be ur opinion on further management?
Thank u very much Dr for ur kind service!
.
Dear Dr Ramirez
ReplyDeleteThank u for this blog! It has helped me relax much after reading ur kind responses.
I'm a 34 yr old foreigner who had severe adenomyosis/ endometriosis grade 4. I did a frozen embryo transfer on 23rd april with positive b Hcg n it being above 1000 in 48 hrs.
I was on cyclogest 400mg bd , duphastone 10mg bd and progynova 4mg bd even b4 fet.
But I got mild spotting sometimes pink and some times dark brown. So I was started on prolutan depot injection every 4 days. The spotting stops after the injection but re-appears every 4th day. Today I checked my progesterone levels b4 all treatment and it was 6.83. My scan is due on 20th May.. a days wait.. what can u suggest as my further management Dr? Can this be a threatened miscarriage? Should I continue prolutan?
Thanking u for ur great service.