PCOS and Pregnancy Symptoms: What to Know

Question
"My last period was on Oct. 24, 2007 - it lasted
approximately 9 days. Around the same time I began Metformin therapy for PCOS - hoping it may  help my hormones regulate themselves and in turn I may ovulate more
regularly. Since then, I haven't had a period, in the last 3 weeks I've become increasingly fatigued, bloated, and weepy and the craving for sweets is out of control. My breasts ache and have some shooting pains every so often, and I'm nauseated, especially in the last 3-5 days. I've also had some light brown discharge in the last 2 days and now nothing except a wet feeling. I've noticed some weight gain in the last few weeks. We've been trying to conceive for 7 years, doing our last in vitro in Nov. '06. I haven't taken a HPT just because of fear of being let down yet again.  Any advice?"  

Answer
Dear Liz,

The symptoms you describe are hormonal in nature and can also be related to hormone fluctuations within your cycle. That is why it so difficult to "diagnose" a pregnancy based on symptoms alone. A test just has to confirm it or rule it out.

The problem with Metformin is that it is relatively new in the treatment of PCOS. It has shown to be promising in reducing insulin levels, lowering testosterone, and improving hirsutism and acne. However, when improvement in resuming a normal menstrual pattern are seen - amenorrhea (the absence of periods) is typically not a desired effect of this medication.

A study of 48 women with PCOS and infertility was conducted at the Baylor College of Medicine. They were first given metformin and 19 of them resumed menstruating and showed indications of ovulation. But 10 required clomiphene (a fertility drug) in addition to metformin in order to show evidence of ovulation.

There is a possibility that you may have actually ovulated in November as a result of the medication and conceived at that time. Therefore, your periods have not resumed. Again, the only way to confirm this or rule it out as the reason for your lack of periods and the other symptoms you are experiencing is to test for pregnancy.

Although some tests claim accuracy on the first day of a missed period, I usually suggest that women wait until the week after a missed or spotty period before testing for pregnancy. This tends to minimize the incidence of false negative results and also avoids wasting money on a test for a simple delay of a period by a few days. You should be beyond that point if you conceived in November. When you test make sure to use 1st morning urine to get a concentrated sample for the most accurate results.

If those results are negative, you can either wait another week and re-test or have your doctor's office do a quantitative blood pregnancy test (serum beta hCG). That test will give an actual amount of hCG in your bloodstream rather than just a positive/negative result. Any amount of 25 mIU/ml or more would be considered positive for pregnancy.

I hope this has helped you and answered your question. I wish you well and a Merry Christmas.

Brenda