QuestionQUESTION: Hi dr. Ramirez, I am a 19 year old black female in dallas 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 ovary syndrome, but I have been tested numerous times for such and I don't have that. And during my long periods, it was thought I had uterine fibroids, for which I also tested negative more than one. I've lost 35 lbs, but I still have the same issue, but now I have a "bloodless period", with a brownish or clear fluid. I have been to 4 different ob-gyn's, none 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: Hello,
You have PCOD. There 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 hirsuitism, 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 dysfunctioning and not processing FSH and LH correctly. Because of that 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 that clarifies things for you. You might want to see a fertility specialist, called a Reproductive Endocrinologist, because they specialize in PCO.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
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QUESTION: Thank you so much for your prompt answer! But on my blood tests, it said that my fsh/lh levels were normal, pcos/pcod was ruled out (as of 03/2009). Are there any alternatives to taking birth control, I've been on all types, and everything but the mini pill causes me to have a "mask of pregnancy" (hyperpigmentation), and even more weight gain...
AnswerHello again,
So you have a variant of PCOD where the FSH/LH ratio is normal. If there are no other hormonal reasons for your ovarian dysfunction, then you have PCOD by default.
There are no good alternatives to the birth control pill. I would recommend one called Yasmin or another called Yaz. They use a different form of progesterone that is ideally suited to PCO patients. You should not get a mask with these.
Sincerely,
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF program
www.montereybayivf.com
Monterey, California, U.S.A
