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     PCOS    

I was diagnosed with Polycystic Ovarian Syndrome in November of 2000… but I have had it for years… it was just a matter of finally finding a doctor that knew something about PCOS.   I had been telling my one doctor the last several years that I thought I had it but was always brushed off.  My normal for having periods would be 3 to 4 a year, if I was that lucky… sometimes it would only be twice a year.

What is PCOS?   A complex hormonal disturbance that affects the entire body and has numerous implications for general health and well being.  If the hormone imbalance is left untreated, it could lead to life threatening illnesses such as diabetes, heart disease, stroke and uterine and endometrial cancers.  It is a condition in which ovulation is rare and tiny cysts (actually five to ten millimeter follicles) accumulate in the ovaries.  These follicles contain eggs, but instead of the follicles growing and going on to ovulate, they stall and secrete male hormone into the blood.  There is an imbalance of pituitary hormones and male hormones in the blood that perpetuates the PCOS problem. 

How is the diagnosis made?    The place to start in any medical evaluation is a complete past medical history.  There are three major ways to diagnosis PCOS:

1.      Clinical findings – these include confirming menstrual disturbances, hair and skin problems, and obesity.

2.      Laboratory testing – an explanation of the commonly used and recommended tests is given below.

3.      Ultrasound scan – transvaginal ultrasound is the most powerful diagnostic imaging tool for the evaluation of PCOS.  This painless, quick, safe, and relatively inexpensive technique allows the observer a window through which to evaluate the structure of the uterus and ovaries. 

What should be checked at physical examinations?  The major physical findings in PCOS of weight and skin problems are usually and unfortunately too obvious to most:

1.      Vital signs:  weight, height, body mass index (BMI), waist-hip ratio, blood pressure and pulse

2.      Skin:  degree of hirsutism, acne, discoloration

3.      Thyroid:  fullness, mass

4.      Breast:  development, mass, discharge

5.      Genitalia:   size of clitoris, health of vaginal lining, cervical discharge

6.      Size and position of uterus, consistency, tenderness

7.      Size and tenderness of ovaries

Which tests to expect??  Ideally you should start out with a consultation to discuss what tests should be done.  Generally the first step is a physical exam that includes checking your breasts, lymph nodes, and pressing on your abdomen to feel ovaries and uterus.  A pap smear is done if its been over a year since your last one, and depending on how things look, cultures may be taken.  You should also have an ultrasound to look for cysts and any abnormalities which may be visible.  Sometimes both an abdominal and a transvaginal ultrasound will be done. 

Usually blood work would be the next step.  Most OB/GYNs will do the tests at once, while RE’s will do specific levels on different days of the cycle. *See www.fertilityplus.org for more information… excellent site.  They also have a Hormone Levels and Fertility Bloodwork Levels Chart including charts on:  Female Hormone Levels, Blood Glucose Levels, Glucose Tolerance Test with Insulin Chart, Cholesterol, Triglycerides and C-Peptide, Male Hormone Levels, Progesterone in Pregnancy, hCG Levels in Early Pregnancy and Oral Glucose Tolerance Test for Gestational Diabetes. 

1.      Androstenedione

2.      Cortisol

3.      Dehydroepiandrosterone (DHEA) or Dehydroepiandrosterone Sulfate (DHEAS)

4.      Estradiol

5.      Estrogens

6.      Estrone

7.      Follicle stimulating hormone (FSH)

8.      17-Hydroxyprogesterone (17-OHP4)

9.      Luteinizing Hormone (LH)

10. Prolactin

11. Sex hormone binding globulin (SHBG)

12. Testosterone

13. Thyroid stimulating hormone (TSH)

General Health – For Women – the following are factors which can affect your ability to ovulate, conceive or carry a pregnancy to term:

       Excessive, or very low, body fat can affect ovulation and fertility

       Chronic diseases, such as diabetes, lupus, arthritis, hypertension, or asthma

       Abnormal pap smears which have resulted in treatment such as cryosurgery or cone biopsy

       Hormonal imbalance – periods exceeding six days, cycles shorter than 24 days or more than 35 days apart; irregular, unpredictable cycles, very heavy periods, excessive facial hair, or acne on face, chest and abdomen

     Multiple miscarriages – two or more early pregnancy losses

Sites to check for more info:

www.fertilityplus.org  - Fertility Plus

www.americaninfertility.org - American Infertility Association

www.pcosupport.org - Polycystic Ovarian Syndrome Association, Inc.

www.resolve.org - Resolve

Leslie’s Personal Journal

After reading several woman's journals of their experiences, I thought it might help me to do deal with this better by doing the same. I am currently trying to get pregnant yet again... but at least this time so far I have gotten a doctor to admit that I do have PCOS... now I just have to get one to give me medication to help get the symptoms under control, so that maybe by some slim chance I can have a baby. I am not exactly sure where to begin it this time around...

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