by Sanaz Majd, MD
Bella is a 31 year old nervous gal who came to see me because she and her husband have been trying to get pregnant, but have not been successful. She has been so afraid that she will never have kids that she started to cry in my office. Her husband has another child from a previous relationship, so she worried that there is “something wrong” with her.
Why Can’t You Get Pregnant?
Problems conceiving are actually quite common. It’s not always as easy to get pregnant as television makes it seem. In fact, it takes the average healthy couple an average of one year to get pregnant. Yep, that’s right--that means some get pregnant before one year, and some take a tad longer than one year.
Bella told me that she had been off birth control and trying for about two years, so I knew it was possible that there was more going on with her story.
Once I dug a little deeper, I learned that Bella’s periods have “always” been irregular since the very beginning. She does get her periods, but perhaps once every one to three months; and during a time when she gained 10 pounds, she went as long as six months without a period.
What Causes Irregular Periods?
The top cause of irregular periods in young women such as Bella is something called Polycystic Ovarian Syndrome (PCOS). The name is a misnomer--meaning that “cysts in the ovaries” is not a defining feature of this condition. Many women have ovarian cysts, but don’t have PCOS. So what are the PCOS defining features, then?
What Are the Signs of PCOS?
Now, just by examining Bella in my office, I did notice a few important potential signs of PCOS:
Being overweight: She is about five feet tall and twenty pounds overweight, and she carries most of her weight in the mid section. She admits that she has a tough time losing weight, no matter how hard she tries.
Acne: She suffers from a mild case of acne on her face and upper back.
Hirsutism: She has a little bit of hair growth on her upper lip, chin, stomach, and feet.
Acanthosis Nigracans: The back of her neck has a thickened, dark brown, leather-like quality to it. That is referred to as Acanthosis Nigracans, and is often a sign of pre-diabetes or diabetes. Bella had never noticed this herself until I pointed it out.
How is PCOS Diagnosed?
Being that Bella suffers from irregular periods, I did test her for a few other health conditions that can cause that, like thyroid disorder. But I made sure to test her for PCOS by ordering the following blood tests:
Testosterone Level: Women with PCOS tend to have higher testosterone levels than what is considered normal. This is likely partly genetic, so Bella can thank her parents for their wonderful genes. High testosterone causes women with PCOS to exhibit male-like qualities--such as acne, excess hair growth in awkward places (like the face, hands, feet, etc.), and possibly even some diffuse thinning of the hair on the scalp.
Elevated Fasting Sugars: One of the defining features of PCOS is a phenomenon called “insulin resistance,” meaning there’s an elevated amount of insulin in the body. Well, this elevated insulin attacks the ovaries and causes the ovaries to produce more testosterone. This insulin resistance is quite common in those with prediabetes and diabetes, and women with PCOS have a greater tendency to develop diabetes later in life if they are not careful.
Bella’s testosterone level was slightly above normal and her fasting blood sugar was normal.
So, her test results were pretty normal—but that’s what makes diagnosing PCOS tricky. There is a subset of PCOS women whose labs are normal. Bella's seemed to fall into that category. Despite her test results, I diagnosed her with PCOS because of her irregular periods, acne, excess hair growth, extra pounds, and Acanthosis Nigracans.
What Are the Effects of PCOS?
So, what does it mean to have PCOS? Women with PCOS have a greater propensity towards diabetes. It’s really important for them to exercise, eat right, and be at a normal healthy weight in order to prevent diabetes.
PCOS can also make it a little more difficult to get pregnant, but pregnancy is usually very achievable with the right treatments.
Lastly, women with PCOS may have a higher risk of endometrial cancer if they don’t have regular periods. It’s important to have a period (but only if you are not on hormones) at least once every two to three months in order to allow the lining of your uterus to shed. If it doesn’t shed, cells can build up and place you at risk for cancer of the uterus later in life.
What Is the Treatment for PCOS?
There are many ways to treat PCOS. But here are the top Quick and Dirty lifetime tips to self-treat your PCOS:
Maintain a lower carbohydrate diet. Like a diabetic, PCOS women don’t metabolize sugar and carbohydrates efficiently. So limit foods like bread, pasta, potatoes, tortillas, and sweets. You shouldn’t eliminate them altogether, but do try and keep a balanced diet that is not high in carbs.
Exercise: Studies have shown that getting regular cardiovascular exercise improves insulin resistance, thereby improving PCOS and causing weight loss. Exercise at least thirty minutes about five times a week, with such workouts as fast walking, running, biking, swimming, or using the stair master or elliptical.
With even a five percent weight loss, you’ll notice that your acne and body hair will improve, your periods will become more regular, your sugar levels will normalize, and you are more likely to conceive.
Medications for PCOS
If the above methods are not sufficient, there are a few prescriptions to help women with PCOS:
Hormonal Contraceptives: If you are not trying to get pregnant, this will help you regulate your periods and improve your acne and abnormal hair growth.
Metformin: This medication has been used to treat diabetics and is also FDA approved for women with PCOS. It helps with weight loss—as long as you are taking care of your diet and exercise--and it also helps women with PCOS ovulate and get pregnant.
Spironolactone: This is normally a blood pressure medication that also works to lower testosterone levels, thereby improving acne and excessive hair growth. However, women who are trying to get pregnant cannot take it due to potential harmful affects on the fetus.
What Happened to Bella?
Bella started a weight loss program by incorporating exercise and a low carb nutritional diet into her life. I also started her on Metformin, and she started to lose some of her weight. She got pregnant six months later.
Please note that all content here is strictly for informational purposes only. This content does not substitute any medical advice, and does not replace any medical judgment or reasoning by your own personal health provider. Please always seek a licensed physician in your area regarding all health related questions and issues.