Saturday, January 23, 2010

The Difference Between PCOD and PCOS, Fear of Birth Control Pill Protocol


Hi, thank you very much for your help in advance. I am 22 years old and not sexually active. I had my first period may be at about 16 yrs. of age. My period was always relatively irregular and it was normal for me to miss 2 to 4 months (4 months usually happened once a year in the spring). I have gone to a gynecologist several times and after the exams all have told me that I have irregular hormonal levels and should take birth control pills. As I have heard many times that such pills are bad for my health, I refused to follow that advice. The problem which greatly concerns me is that I now have not had a period for about 6 months (last time was in March).

I am very worried and will go to the doctor, however, I would appreciate your opinion as well. I have a good figure, good eating habits, no excessive stress. What could this be? If this is PCOS would it have significant negative effects on my ability to get pregnant? Are hormonal pills really bad (weight gain, hair growth, adaptation of the body to constant supplements)? Could this be due to my lack of sexual experience/activity? If so, is this a problem? Is there a "body cleansing" pill that I could take to induce a period and see how things go without significant negative effects? Do you think that traditional Chinese medicine could be of help? In short, what is you opinion on this? I would appreciate as much detail as possible.

Thank you for taking the time to answer my questions.


From your history, it sounds like you have PCOD (polycystic ovarian disease). This has not become the syndrome (PCOS) yet because the disease eventually turns into PCOS (polycystic ovarian syndrome) when it manifests by increased weight gain (obesity), excessive hair growth, increased male hormone, decreased voice, hair loss (male pattern loss), diabetes. This disorder is due to a dysfunction of the ovary, whereby the ovary does not process the FSH and LH from the brain appropriately so that ovulation does not occur. If the ovulatory process does not occur, the hormone precursors do not go down the estrogen/progesterone pathway to make those hormones and instead go down the testosterone pathway, leading to excess testosterone. This leads to the manifestations explained above. These are long term changes and occur slowly. They are not reversible, so you don't want to go down that road.

The other problem with not having a period regularly is that the endometrial lining can thicken leading to several problems: hemorrhagic bleeding when you do have a period requiring hospitalization and transfusion, a precancerous state and endometrial cancer. You also don't want to go down that road. Another problem is that with the lack of estrogen in your body, you can suffer other long-term consequences such as a very dry vagina, vaginal shrinkage, inadequate lubrication with intercourse, shrinking of the breasts, increased heart disease, bone loss, dryness of the skin.

If you are not intending to become pregnant, then the treatment of choice is to use the birth control pill. This is the recommendation that medical doctors in my field will give you. That is mainly because the pill/patch/ring are made of estrogen and progesterone and override your ovaries. It basically puts your ovaries at rest and gives you the hormones your body needs. Several studies have shown long term benefits from the pill including a significant decrease in ovarian cancer if used for greater than 7 years. I also believe that it helps to preserve your fertility longer because the ovary is quiescent. The things you heard that are "bad" about the pill are wives tales and not true. The one truth is that you may not be able to become pregnant after stopping the pill, but that is because you will go back to the way you were prior, which is not conducive to pregnancy because you are not ovulatory. So, my recommendation is to go on the pill.

In terms of sexual activity. The value of sex, if you are not trying to get pregnant, is for recreation. Because it feels good or gives other good feelings. It is not a physiologic requirement, so don't feel compelled to have sex just because you have to. It should be fun.

I cannot comment regarding Chinese medicine, as I have no knowledge of this subject. I have recommended acupuncture for my infertility IVF patients as a complimentary part of my protocol and have seen improved pregnancy results.

I hope this gives you the information that you were looking for.

Follow-up question:

I wonder if I can take up a bit more of your time by asking a follow-up question.

From what I understand, birth control pills do not treat the problem, they simply override it, for lack of a better term. At this stage in my life, I am not looking to become pregnant; however, this is a natural progression in life. As such the question is as follows: If I can't become pregnant without taking the pill due to the absence or scarcity of the ovulation process, and the pill while restoring that process, will be acting as a contraceptive, what are my options?

One of my concerns about the pill is that by taking it I will be decreasing the possibility of having natural period, as my body will become used to constant supplements. Consequently, my chances of ever becoming pregnant suddenly become almost null. As for sexual activity, I certainly understand the value thereof, I have been told, however, that sexually activity will stimulate the production of the hormones which are missing in my body. This was the assertion the validity of which I was looking to confirm. From what I understand, that belief is erroneous. Is that correct?

Furthermore, I was a bit unclear as to why you believe that I have not yet developed a "syndrome". You also mentioned that the pill will prolong my fertility. Are you then suggesting that I will likely lose fertility at some point due to PCOD?

Again, thank you for your time and assistance!

Follow-up answer:

Hello Again,

The answer to your first question is that the pill will not inhibit your ability to become pregnant in the future. As you said, it overrides the ovary and puts it into a quiescent state. The active state returns after stopping the pill and you will return to where you were previously. That is, if you are not ovulating prior to the pill, you will still not ovulate after stopping the pill. Your body will not "become used to constant supplements" so you don't need to worry about that.

Sometimes, being on the pill causes the ovary to straighten itself out and I have had patients get pregnant immediately upon stopping the pill (the opposite reaction to what you are thinking.)Sexual activity has no influence on the regular hormones in your body. You can have many sexual encounters per day and your hormones and ovaries would still be abnormal from the PCOD. Of course, you will be exhausted every day too. :) Just kidding!

From how you described yourself in your first question, you do not seem to be exhibiting the "classic" symptoms of hirsuitism, weight gain etc. that manifest themselves with PCOS. That is why I am assuming that you have PCOD. I have had many patients that are PCOD with no symptoms whatsoever. To diagnose latent PCO you need to see an infertility specialist who will ultrasound you during your cycle to determine whether you are overproducing follicles.

Lastly, you will lose your fertility potential with increasing age, not because of PCOD. At age 30 the pregnancy rate is 85% per year, 35 PR is 30% per year, 40 yo PR is 10% per year.
Hope all this makes sense and answers your questions.


Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program


  1. i am 21 years old, and i am single,i am suffering from pcod......
    so is there be any problem after marriage that i am not get pregnant ........
    is there be any problem after my marriage.
    please answer me.......

  2. Hello Ankita,

    I have covered PCO pretty extensively in this blog site so would recommend that you review the articles and comments.

    PCO is an ovarian dysfunction that lead to the lack of ovulation. Ovulation is where your ovaries give off an egg. Without ovulation, there will be no egg to fertilize and so pregnancy will not ensue. This makes it difficult to achieve pregnancy in patients with PCOD. The treatment is therefore to induce ovulation and various fertility medications are used for this purpose. You will need to see an infertility specialist for this treatment when you decide to become pregnant.

  3. Hello Doctor!

    I am a 30 yr old woman married about 3 months back. My Husband & I are planning for a baby and hence thought it would be appropropriate for me to take some tests and pelvic sonography before me conceiving.

    My test results for the Sonography show that my Ovaries are enlarged and show tiny cysts. I am howver mensturating regulary. My cycle ranges between 30 -32 days. Also the Uric Acid levels in my Body are on the higher side along with my Cholestrol levels which seem to be at the Borderline high. I am on the heavier side. Was just wondering whether this could be PCOD or PCOS although I am mensturating regularly?.. I am beginning to get a little worried as we would like to have a baby soon. Does this mean that I will not be able to conceive?

  4. Hello February 20th,

    You are what we call a tendency to have PCO, but you do not have it yet. The diagnosis is NOT made by ultrasound, rather, it is an ovarian dysfunction- ovulation disorder so you can't have regular periods as the first criteria. Then you have to have a second criteria such as the ultrasound findings. By "tendency to be a PCO" that means that based on the appearance of your ovaries, it is possible that you might develop PCO. I cannot tell you what would push you over, but increased weight can certainly do it. There might be some weight limit that once you pass it, the ovaries will stop functioning normally.

    For now, since your cycles are regular, you should continue trying for pregnancy. With a 30-32 cycle, ovulation is occurring around CD#16-18, begin having daily intercourse from CD#14 and continue through CD#19.

    Good Luck

  5. hello sir,
    iam 21 years old woman married about 1 year back. we are planning for a baby. but i have a problem of PCO'S. so i am worry about this.

    this starts from my first time ovulation.2 or 3 months after get period. now i consulting a doctor and he prescribed me METPHORMIN HYDROCHLORIDE tablet 500mg. it is suitable for this.

    please give me a suitable reply. and more information about pcos and caring matters.

    sorry sir i have a doubt, homeopathy is suitable for PCOS.

    1. Hello,

      I cover PCO very very extensively in this blog including appropriate treatments. Please review these subjects on my blog for the answers that you seek.

      Dr. Edward J. Ramirez, M.D., FACOG
      Executive Medical Director
      The Fertility and Gynecology Center
      Monterey Bay IVF Program

      Monterey, California, U.S.A.

      for additional information check out my blog at check me out on twitter with me at @montereybayivf and facebook @montereybayivf. Skype and internet comprehensive consultations now available via my website for those who want a more extensive evaluation that this site can accommodate

  6. Hi.. i m 28yrs old and since last 3 months i have been suffering from irregular periods wherein its been 2.5months i havent got my periods and before that the last period i got was delayed for 10days.i had gone to see a doctor and got the blood test and scanning done.Blood test showed that my haemoglobin is 10.8 and i am anaemic whereas my scan showed that there are cysts which are developed around my ovaries.Before this my periods were regular and i never ahd this kind of problem.
    Doctor has advised me to take medicine for 5days and wait for periods to come which would come within 7days and on the second day of my period he has called me for some test again.i have not gained much weight except in my stomach area which is a bit bloated because of no periods and i do not have any other symptoms like extra growth hair,change in voice,etc.
    i have got the following questions-
    1)How serious is PCOD and will it actually create a problem in pregnancy or is it curable?
    2)what kind of a test will it be on the second day of my period?and if PCOD is detected then what measures has to be taken?
    3)Does PCOD can also happen because of some stress(as i had some family problems since 3 months after which i dint get my periods)?
    4)Normally how many days or months does it take rid of PCOD and what measures should i take?

    1. Hello,

      PCOD is a very common subject and you will see multiple articles in this blog regarding this. In answer to your questions:

      1. PCOD causes a hormone imbalance that can have long term side effects and problems. It is NOT curable. Patients with PCOD do have problems conceiving naturally but certainly can conceive with medical assistance.
      2. The cycle day #2 or 3 test is for hormones. These hormones check the ovaries, thyroid, pituitary and hypothalamus. Some will do hormones to check male hormone and adnrenal function as well.
      3. Stress does not influence this but weight can, as well as, insulin resistance.
      4. You cannot get rid of PCOD.

      Good Luck

  7. Hello Doctor,
    i am a 24 years old woman.I was having intermenstrual spotting and discharge on the 15th or 16th day of my cycle for sometime though my periods were regular.An ultrasound was conducted and the results said that i have PCOD . A PCOD profile test was conducted and all my tests were normal except of increased testosterone.Insulin test was also conducted and they were normal too.
    Doctor gave me progesterone tablets for sometime and then birth control pills for some time.The treatment continued for around 11 months and after that my problem of intermenstrual spotting stopped.But after 7 months of stopping the treatment i am again experiencing watery discharge from vagina on the 16th day of the cycle.If there is no cure for PCOD then does that mean that i have to be on these medicines over and over gain whenever the problem starts again?
    Also my weight is very normal,i might even be slightly underweight.

    1. By definition, despite what the ovaries look like on ultrasound, in order to have PCOD, you have to have an ovarian or ovulation dysfunction. This is manifested by IRREGULAR cycles. If you are having regular menstrual cycles, that is your periods are predictable within 7 days, then you DO NOT have PCOD by definition. Instead, you are having intermentrual spotting which is many cases can be normal. We call it "post-ovulatory" spotting. Unless it is causing a major problem, I'm not sure that I would treat that.

      If you had PCOD, the problem is that because the ovaries are not performing correctly, it leads to a hormonal imbalance and some unpleasant long term side effects such as facial hair, male pattern hair loss, obesity, diabetes, etc. For that reason, the birth control pill is used to put the ovaries at rest (they are supressed) and gives the female hormones that are needed. The correct birth control pill will also block any testosterone in your system.

      In your case, I don't think you have PCOD, so you have been misdiagnosed.

  8. Hello doctor,
    i am 24 years and married since 2year.i lost my baby last year during 6 week of my pregnency.after 6 months of that incident we are trying for a baby but not successed.after consulting with dr he told me that i have the problm of pcod.can i be conceive i am apcod powder medicine as dr prescribed.thank u.

    1. Your question "can i be conceive again" is not very specific and therefore not answerable. PCOD will make it difficult to get pregnant but not necessarily prevent pregnancy. In the right doctor's hands, you certainly can achieve pregnancy again.

  9. Hello Doctor Ramirez,

    Your article is extremely informative and well explained. Thank you for helping patients like me :) I wanted to check with you if i am on the right track in understanding and treating my PCOD condition, something that i've been diagnosed with a month back. I had no problems with my menstrual cycle ever, except for the past one year the cycle would sometimes be 25/26 days, and some months 30/32 days. I have very mild hirsutism.

    I am 30 years of age, and have been married for 7 months now. In my pre pregnancy counselling last month i learnt i have PCOD with a Transvaginal scan done on me. I have gained 20 kgs in last 8 months. I am 103kgs now ( morbidly obese with 5'4'' height) and have been diagnosed with Insulin resistance as well. Also, i have hypothyroid that is around 4.46 in the scale.
    My doctor has prescribed a birth control pill and Metformin hydrochloride 500 SR for the next 6 months. I've been asked to lose 10/12 kgs of weight minimum before she allows me to plan a pregnancy after 6 months.

    I have few questions in mind about my condition and the treatment.

    1) Am i ovulating at all? (I find contradictory articles online and they confuse me.)If no, how will i ovulate when i plan for a pregnancy and i am put off a birth control pill?

    2) Insulin resistance can cause PCOD, that's what i have read online. I also read that Metformin is known to reduce weight. So if this drug is administered for next 6 months and my insulin resistance is under control, shall i have an ovary that isn't dysfunctionary? If no, what good are these drugs ( i.e birth control pill and Metformin) doing to my body now.

    3) What should i do in the next stage of treatment after 6 months when i am planning to conceive?

    4) One honest answer needed on this one doctor, does my case sound like a "no hope" case of pregnancy? Do women with my complications conceive naturally at all? If not, how do you treat them further?

    Too many thoughts on this doctor. Hope that isnt too much to ask for :) Will be very glad if you could help me with the queries because my doctor has no time to answer my questions.

    Waiting to hear from you soon.


    A 30 year old with PCOD

    1. Hello,

      Your post is a little longer than I like to have to read but let me answer your questions:

      1. If you have regular and predictable cycles that don't vary more than 7 days from month to month, then that is a sign that you are ovulating. A diagnosis of PCOD/PCOS REQUIRES and ovarian dysfunction leading to irregular menstrual cycles. It is NOT diagnosed by ultrasound. Having PCO-type ovaries on ultrasound is a criteria to make the diagnosis but not the only criteria.
      2. In some PCO patients, the cause of the ovulatory dysfunction, that leads to the hormonalimbalance, is insulin resistance and treatment with Metformin reduces the blood insulin levels and lead to the ovary functioning normally.
      3. If you are not ovulating then you will need fertility drugs to cause ovulation in order to get pregnant. If you are ovulating (as mentioned above) then you don't need to do anymore than control your diabetes and thyroid function.
      4. Yes, people with PCOD do conceive naturally and spontaneously without medication, but the majority will need help. Pregnancy is not out of the question.

  10. Hello Sir

    I have been diagnosed of PCOD. I am keeping my self on diebetic diet and am taking contraception tablets too. Apart from that I want to know what are are the supplimentary medicines that I should take to help my body secret hormones to a normal level againg. By this I mean the calcium, iron, follic acid, or anyother suppliments that I should take and for how long

    1. I do not have any specific advice in regards to vitamins. Probably a regular multi-vitamin is sufficient, but adds nothing to the treatment of PCOD.

  11. Dear sir
    My wife is diagnosed with pcod, she was given ovacet twice a day And birth control pill, after three months of medication problem still persist

    Can u please advice

    1. PCO is not a curable problem. The use of the birth control pill is to put the dysfunctioning ovary at rest and provide the female hormones that the ovary is not producing. I've written extensively about PCO in this blog so I would advise that you read the posts. It will give you the understanding that you need. Once your wife goes off the BCP, she will return to the state that she was in before starting it. So the treatment is dependent on your wife's goal. If she is not interested in pregnancy, then she goes on the birth control pill and stays on that indefinitely. This will control her cycles, give her the hormones she needs, prevent the long term side effects of PCO and prevent the hormone from producing too much male hormone. If her goal is to get pregnant then she needs to use fertility medications to stimulate the ovary to ovulate.

  12. I'm 25 years old. I have been on antidepressants for over 6 years. I have managed to stop 3 tablets with my doctors consent as he suggested that I was misdiagnosed that it was Bipolar when I just had anxiety. I started developing slight facial hair last October 2014 and I was diagnosed with Telogen effluvium around the same time. The dermatologist suggested that I get my hormones checked and get an ultrasound done as well but everything came back normal.

    He then blamed "Wellbrutin" to be the cause for my hair loss. I stopped the medication. In about a month's time I started developing acne. It started off very mild, I've tried different creams gels etc and was even put on an antibiotic. I refused to take it because I thought that it could be the withdrawal effects of the medication.

    It's now September 2015, I do get my periods but ever since I stopped my meds there have been about 5-6 days of variation in my periods. This happened only during the time when I stopped the medicines.
    My periods have never stopped and the last three months I get it on the same date every month.

    I got an ultrasound done this month as my dermatologist said that I no more have Telogen Effluvium and it's Androgenic Alopecia. Considering that I have regular periods, developed mild facial hair and acne I decided to get an ultrasound done to check if there's actually something wrong. My blood work is normal. The ultrasound confirmed that I have Bilateral polycystic ovaries. I want to know if there a link between stopping antidepressants and developing this condition? Or could this also be caused by chronic stress?
    I haven't gained any weight Infact I've lost weight due to stress. My hair loss is reduced but I still have acne and the facial hair.

    Note: Lamitrogen, Wellbrutin, Quitipaine, Venlafaxine. I was on these drugs, stopped Venlafaxine and then wellbrutin. During this time I was only on Lamitrogen and Quitipaine. Quitipaine is known to increase prolactin levels, I had prolactin level of 129 and still got my periods. My psychiatrist was surprised because I was on the least dosage that is available 25mg. I've stopped Quitipaine as well.

    I've been switched to Alprozolam 1mg and I'm still continuing with Lamitrogen 50mg twice a day.

    It would be great if you could help me find a link between stopping these medicines and pcos. I'm still quite shocked that my hormone levels are normal, I get my period, but I've been diagnosed with this condition.

    I'm 5'6 1/2, weigh about 51kgs. I am iron and Vitamin D deficient. This has been a very exhausting process of trying to find answers and after reading your blog I'm hoping that maybe you'd be able to figure out if there is a link.

    I've always had acne since school days but it's been under control and Infact it did clear up as well. It's been about 6 months and I think it's just been getting worse with all the stress that I'm going through. I have worked really hard to stop the medications because I didn't need them in the first place. And after this diagnosis just feels like it's a waste of time struggling so hard to just go back on a new set of medications.

    I apologise for writing so much but I thought it's always best to know the history before jumping to a conclusion.

    Here's the impression:
    Uterus: Antiverted. Normal in size and echo pattern measures 6.9x2.9x3.4cms(Vol of 36cc). Small anterior wall subserosal fibroid noted measuring 9x9mm. Another posterior wall fibroid notes measuring 7x6mm. Endometrium is normal in size and measures 10mm. Cervix is normal.

    Ovaries: Both ovaries enlarged in size and show multiple peripheral cystic areas with central echogenic stroma - Bilaterial polycystic ovaries.
    Left ovary measures 4.3x2x2.5 (Vol of 12.9cc). There is a dominant follicle measuring 15x13mm. Right ovary measures 4.02x2.01x3.1s (Vol of 14cc). There is mild fluid in POD.

    Thank you :)

  13. Hello Doctor:
    I have one doubt. Whether PCOD and PCOS are same? If not, what is the difference between them? Can you give me a brief explanation.

    1. Hi. The "D" in PCOD means that you have the ovarian dysfunction but the problem is limited to the ovary. The "S" means you have a syndrome which is the involvement of other organs or systems.

  14. Hello doctor,
    I am 24 years old.I have pcod but my periods in regular circle.can I cure pcod through tablets???how long it takes?

  15. hello doctor,
    i am married 9 months before.before 1 yr i was diagnosed with pcod on my right ovary and my gyno suggested me to take valuecoc-l tabs for 3 months and had it regularly.just 10 days before marriage i was sick with mumps infection and i got my periods on my marriage day. after marriage my doctor asked me to stop the tablets and my periods got stopped completely and nw every month i have to use deviry 10 mg tablets to induce my periods..i was frustrated as i wish to i went to doctor to get pregnant..i had siphene 50 mg for 2 months and had follicular study but no dominant follicle and my doctor prescribed me to take ovacet forte tablets..and doctor asked me to take several tests everything got normal(FSH,LH,PROLACTIN,FASTING SERUM,VDRL,HBsAg,retrovirus1,2)but AMH IS ABOVE OPTIMAL LEVEL ie 19.42..after seeing the reports doc told me not to increase clomid dosage since it affect ovaries and results in overstimulation which lead to infertility...i was so confused so i show my reports to another gyno..she asked to have clomid 100 mg with metformin and reduce my weight from 64 kgs to 58 height is 165 cm..with confusion i went to another gyno,she asked to stop all the tablets and suggested to take duphaston10 mg fron day 15-day 24 after inducing my periods..i am desperate..what to do? i am having thyronorm 25 mcg every morning for 2 yrs but nw it is in it because of pcod or of mumps infection?

  16. Hii Sir,
    I am 23 years old, when i was 21 years old my mom see changes in body such as hair growth in body,irrmenustral by the gap of 1 month.For relating thess problem i have go the doctor they said me to do sonography in sonography report we came to know that i having problem of PCOD doctor suggets me to take Overall. I have a started taking the pills but after taking this pills their is no result. Still i couldnt cure from PCOD & I can see the Excessive hair growth in body please help regarding this thanking you

  17. PCOD or PCOS which is more dangerous ? I am 21..and suffering from PCOS ...plz doctor tell me something



Related Posts with Thumbnails