PCOS: Getting the Right Medical Care

By Sidika E. Karakas MD

This is an interactive, dynamic book which makes PCOS easily understandable. It uses, tables and illustrations to explain every aspect of PCOS. It provides answers to the questions patients ask about their menstrual periods, excess hair, weight gain, insulin resistance, fertility, and many other health issues related to PCOS. It guides them to organize their medical history and laboratory tests, and understand the reasons for the physical changes in their bodies. It also provides a road map for setting short-term and long-term goals in order to gain control of their lives. It teaches, encourages and empowers. Reading this book is like having an expert consultant on the bookshelf.

• Language: English
• Publisher: BookBaby
• Release date: Sep 7, 2018
• ISBN: 9781543945829

Book preview

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Chapter 1

Do You Have PCOS?

If you are reading this book, you either know or think you have PCOS. Polycystic ovary syndrome is a complex condition. It is crucial to make the correct diagnosis and asses different presentations in each patient. As a consultant, I often see patients who have received incorrect diagnoses or incomplete treatments. Successful treatment depends on correct diagnosis and complete evaluation of each individual patient.

Medical history

In this age of technology, the art of medical history-taking is dying. We rely on blood tests and imaging studies rather than talking with patients about their experiences. In PCOS, medical history is invaluable. It provides the information necessary for the right diagnosis and can guide treatment.

In this section, I will take your medical history by asking you the same questions I ask my own patients. I don’t want to influence your answers, so I will not offer you any explanation until you finish. If you feel tempted to skip the questions and go to the information in the next sections, please don’t. By answering these questions, you will gain insight into your body. As we progress to the tests and treatments, you will know how those apply to your personal case. We will use your answers later to design your individual treatment plan.

Questions related to your periods and fertility

If you are taking birth control pills (BCP), have received depo-provera injections, have a progesterone implant, or have an intra-uterine device (IUD) which stops your periods, you need to answer these questions thinking back to the time before these treatments. Describe your natural patterns before starting any hormone treatment.

1. At what age did you have your first period?

2. Do you have a period every month?

3. If not, what was the longest time you skipped periods (in months)?

4. What is the fewest number of periods you have had in one year?

5. Are you an athlete? How many hours a week do you exercise?

6. Do you have an eating disorder? Anorexia? Bulimia?

7. Do you have milky discharge from your breast?

8. Have you tried to get pregnant?

9. Have you had sex without contraception (protection) regularly? If yes, for how long?

10. How many pregnancies have you had?

11. Did you suffer any miscarriages?

12. Did you need to use clomiphene, letrozole or IVF to get pregnant?

13. How much did your babies weigh at birth?

14. Did you have gestational diabetes?

Questions related to excess hair and hair loss

Excess hair can be difficult to document because each woman interprets excess hair differently. Some women consider peach fuzz to be excess hair. Others ignore dark sideburns or a moustache because it runs in the family. The medical definition of excess hair (hirsutism) is dark, coarse hair, which lifts and separates from the skin surface and curls. The following questions will assess the location and severity of any excess hair you may have. This information is very important for designing treatment strategies and monitoring your progress.

15. Please circle each area where you have excess hair in the drawings below.

Next to each circle, put the following numbers based on how often you remove the hair in that area:

Once a month or less often

Once a month to once a week

Once a week to once a day

More than once a day

For example if you shave your chin daily, you will mark 2C; if you shave your chest twice a month, you will mark 3B.

Figure 1. Areas of excess hair. Excess male hormone causes hair growth in areas 1-8 and 10. Women with no male hormone excess can have hair on the lower arm (9) and lower leg (11).

16. Are you losing your scalp hair–specifically at the top? Do you have a widow’s peak? Do you consider your hair loss severe enough for medical treatment?

Figure 2. Scalp hair loss. Excess male hormone causes hair loss on the top of the head and at the temples.

Interpreting your answers

Thank you for answering the questions. Please compare your answers to the information provided here.

Onset and frequency of periods (questions 1-4):

Compare your periods with the typical patterns listed below. See if you are having too few periods or bleeding more than the average, and if your weight changes relate to your periods.

In the United States, on the average, girls have their first period at age 12 years and nine out of ten girls have regular monthly periods within three years.

Menstrual cycles shorter than 21 days or longer than 35 days are not typical. Having fewer than nine periods a year requires medical attention.

In PCOS, periods can relate to body weight: when women gain weight, periods can become irregular and less frequent; when they lose weight, periods become more frequent and regular again. Body weight can also affect fertility. When women lose weight, they can get pregnant; when they gain, they cannot.

If you have been skipping periods, having fewer than nine periods a year, getting less regular when you gain weight and more regular when you lose, you may have PCOS.

Eating disorders and excessive exercise (questions 5-6):

If you have an eating disorder or exercise excessively, this section will help you understand how these interact with PCOS causing menstrual irregularities.

Athletes and women with eating disorders have very little body fat. Our bodies know that low body fat can not support the growth of a baby, so we don’t menstruate or reproduce if our body fat is too low. The medical term for this is hypothalamic amenorrhea.

There is an awesome signaling system between fat and the brain. Fat makes a protein called leptin. When our bodies have enough fat, leptin signals the brain that the body is ready, and the brain produces hormones (LH, FSH) to stimulate the ovaries.

Both too little and too much fat work against regular cycles and fertility. To make things even more complicated, obese PCOS patients can develop eating disorders when they attempt to control their weight. Therefore, it is very important to develop a healthy weight loss plan with your doctor.

Milky breast discharge (question 7):

Polycystic ovary syndrome does not cause breast discharge. However some conditions causing milky breast discharge can also stop menstrual periods and mimic PCOS. I have seen patients misdiagnosed as having PCOS who actually had one of the following conditions:

A hormone called prolactin, produced in the pituitary gland in the brain, can cause milky breast discharge and stop periods. In general, patients with high prolactin levels have regular periods to start with. When