Polycystic Ovary Syndrome: Explained

Do you sometimes worry about your menstruation? Bakit hindi monthly dumarating ang period ko?

Or is your skin bothering you? You’ve tried all the creams, toners and lotions but your pimples don’t seem to go away.

http://sp.life123.com/bm.pix/facial-mask-at-home.s600x600.jpg

Nagkaka-bigote ka ba? Are you constantly plucking or shaving your facial hair?

You might be suffering from Polycystic Ovary Syndrome. It is a common cause of irregular menstruation and excess male hormones in women. It occurs in 10% of all females.

The cause of PCOS is unknown. It is mainly due to too much androgen production by the ovaries. The current data shows that it is a combination of genetics and environment.

Most women with PCOS will have a mother with PCOS or a father with Metabolic Syndrome (it is a disease complex having all three illnesses: heart disease, stroke and diabetes). Thirty-percent (30%) of patients with PCOS will have a sister with PCOS.

Environmental factors involve exposure of a female fetus to excess male hormone during pregnancy, disturbed fetal nutrition while in the mother’s womb and being overweight during adulthood. All these lead to insulin-resistance and later to PCOS.

Different scientific groups have different criteria in diagnosing PCOS. Basically, the patient should have menstrual irregularity, physical or chemical evidence of increased male hormones (excessive facial hair, acne or male-pattern baldness) and/or PCOS by ultrasound.

PCOS may cause metabolic abnormalities like elevated cholesterol levels, insulin resistance and diabetes. It can also lead to infertility or pagkabaog.

The continuous absence of ovulation brought about by PCOS can increase the risk for endometrial hyperplasia and possibly, cancer of the uterus later in life.

Treatment of PCOS should be patterned towards the goals of the patient.

If obesity is the issue, then a weight loss regimen monitored by a nutritionist with an exercise program should be started along with metformin, which is an anti-diabetic drug. Its action is primarily to lower insulin levels. Metformin is usually given at 500 mg three times a day. Patients happily notice a decrease in their weight after a few months of metformin … coupled with exercise, of course. Even 30 minutes of walking after dinner is adequate exercise. No need to run a marathon or join a tri-team.

If infertility is the problem, then steps to improve fertility is the first priority. The patient may be given a trial of ovulation induction agents like clomiphene citrate beginning at 50 mg once a day for 5 days beginning on the 2nd to 6th day of her period. This can be done for a maximum of 3 cycles only. Prolonged intake of clomiphene may cause ovarian hyperstimulation syndrome. Approximately, 80% of women with PCOS will ovulate and 50% will get pregnant with this regimen.

If excess male hormones, like acne, baldness or too much facial hair (hirsutism),  is the patient’s reason for consulting then anti-androgen medications should be initiated. Anti-androgen drugs are cyproterone and spironolactone. Cyproterone is available locally as part of the oral contraceptive pills: Diane and Althea.

Irregular menstruation may be treated with hormonal therapy in the form of oral contraceptive pills or cyclic progesterone tablets like Duphaston or Provera. These medications are taken once a day for 10 days of every month to allow regular menstrual flow.

Polycystic ovary syndrome as the name implies is a syndrome. It involves a group of symptoms affecting several organs in the body. There is not one drug to cure all problems. The doctor and the patient have to agree and prioritize what is most important for the patient to address at the moment.

If you suspect that you have PCOS, do a vaginal ultrasound even before you go to a doctor. This will save you one consultation visit and one day less absence from work.

 

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14 Comments

  1. filipinamd says:

    Question from Ms. Hopping:

    Doc I’ve been married for almost 7 years but we still don’t have a baby, 2 years of our married life ng widrawal kmi ng husband ko kc he wants dw muna to enjoy, after 2 years I had experience abnormalities s menstration ko minsan sobrang hina at minsan sobrang lakas ng p check ako s ob ang sbi my hormonal inbalance dw ako at ipa take ako ng pills gracial kpg nagtake me ng pills normal po ang mens ko, pero pg hnd mhina, so lumipat po ako ng ob kc we want to have a baby n po ng n ultra sound ako my ob said n my polysistic ovary nga po ako and give me another pills ovamit ung left ovary ko dw po ng re2sponds s ovamit dhil ng ovulate but the right polysistic p din, possible p po b akong mbuntis? Maari po bang s mga n take kong pills dti kya ako nging polysistic or my effect din ang 2 years nming ppg wiwidrawal ng husband ko. I hope u can advice what do to best or what to take to get pregnant.
    Thank you doctora!! God bless you more!
    Ms. Hopping

    Dear Ms. Hopping,

    Polycystic Cystic Syndrome is a genetic problem. It is not caused by taking pills or practicing withdrawal. But, honestly, it is really a stubborn disease to treat. Sometimes you have to do a “trial-and-error” of different drug combinations before you can achieve pregnancy. I suggest that you visit an infertility specialist since 7 years is already a very long time to wait.

    Good luck!

    Doc D

  2. Letlet Casado says:

    Hi Doc. Thank you very much for maintaining this website. It is really very informative and helpful. I bookmarked your blogsite as I constantly check it for informative articles. :)

    I just want to inquire about PCOS. My lastest TVS shows that I have polycystic ovaries, with developing follicles on both ovaries; with trilaminar endomerium with thickness of 1.2cm.

    I am wondering if I already have PCOS kahit na I don’t have excessive hair growth and had been on ideal body weight, all my life. I just remember that when I was in college (I am 29 y/o now), there were years that I would have period for just 10months (nag skip twice in one year ng tig-one month).

    It this a syndrome already or just polycystic ovaries?

    Hoping for your response. Kasi my husband and I are really praying to have a baby soon.

    More power to you, Dra. D! :)

    • filipinamd says:

      It seems that you don’t have the syndrome yet but your ovaries are starting to show signs of PCO. I suggest that you try to get pregnant asap while it is early because as you get older, it is harder to get pregnant and with a background of PCO it might even be harder.

      An endometrial thickness of 1.2 cm is normal if you are about to get your period. The thickness is best assessed on Day 5-7 of your cycle (Day 1 being the first day of menses). The thickness on this day should be only 0.5 cms.

      Discuss everything with your husband and if you are both ready, try to get pregnnant on your own for 3 months. If you have not been blessed by the 4th month, then please see a doctor for advice on fertility tablets.

      Doc D

      • Letlet Casado says:

        Doc D, Thank you very much for your prompt response. Your reply was very helpful and clarified a lot of questions I had in mind. :) More power! :)

  3. DS says:

    Hi Doc!

    I just gave birth 2 mos. ago via cesarean to a healthy baby girl. I too was diagnosed with PCOS upon ultrasound. My OB-gyne suspected PCOS because I often experience vaginal infection due to my period. From the two pap smears and 3-4 gram stains I had over the past 3 years, results show changes in flora and mild to moderate fungal infection respectively. After treatment of suppositories, I would be okay at first then symptoms (foul odor, whitish discharge, vaginal itching) increase as months go by usually after my period. Not really because of sex (I make sure to wash right after and besides I dont do it often. hehe) When I had TVS to finally check whats going on, my doc said I had PCOS as she suspected. Also have slightly irregular menses. Usually they come around every 38-40+ days, sometimes delayed by a week or two. I cannot really pinpoint the exact day it would come. I even do PT sometimes when Im delayed just to relieve the paranoia. She said explained that the egg doesnt really mature every month. That its not severe, just a level 1-2 from the scale of 1 to 10. She prescribed Yaz which I took for a month. Im not good at taking meds. After six months of that, I got preggy. Anyway, I too have no symptoms of being hairy (though I have little hair in my upper lip, they’re not bothersome), I have very fair and smooth skin, I’m not really fat too, but i never got really thin like others (mabusok ako). My boyfriend then (now husband) and I are not really that careful (I extend my counting period for safe days to up to 10 days thinking I dont get pregnant easily. Yes I know its wrong. :D). I got pregnant after 4 years of being in a relationship (im 22 now BTW). Do you agree that I have PCOS? The meds I was able to try so far are Neopenotran forte (usual prescription), Funzella, VAFF (first suppository I’ve tried from my previous OB), metronidazole tabs. Do you have any other recommendations? Maybe something that I can take regularly when things go wrong again down there (my doc actually suggested this but im not a fan of neopenotran). do you have a preventive treatment in mind for my case? Thank you so much doc. Great to have found your site. :)

    • filipinamd says:

      PCOS has no effect on the vaginal discharge. You have 2 separate problems.
      #1 If you are forgetful in taking pills daily, try injectable. You are too young to keep on getting pregnant by accident.
      #2 Frequent vaginal odor and discharge is not an STD, it is simply because some women like you are not acidic enough in the vagina. I suggest Mithra Intim vaginal gel. Insert 1 inch gel inside vagina 2x a week as maintenance. You will notice the smell and discharge will disappear.

      • DS says:

        Doc, I bought Mithra Intim today. You mentioned that I should insert 1 inch of the gel. In the instructions, it said to fill half of the applicator. Should I fill the applicator with only an inch of the gel?

  4. Gomm says:

    Hello Doctora. First of all, thank you for having this site and for helping a lot women. I already bookmarked this site. Right now, i’m quite worried about my thinning hair. I have been diagnosed with PCOS and i took Diane birth control pills for about 1 year and a half. The pill helped me a lot, nawala yung bigote ko, and nag normalized ang priod ko, though medyo bawas and sex drive, ok lang. Btw, i already have 2 kids, and i don’t want to have anymore, so Diane was really a fit for me. Then i got concerned about breast cancer naman. Some say that the pill “might” contribute in developing breast cancer (is this true?). Though we don’t have a history of breast cancer in the family, and my annual mammo was always normal, i decided to stop Diane last March.

    I still got my period (April)after 3 days of taking my last batch of Diane pills, pero thids May wala na. I noticed also na parang kumakapal na naman yung upper lip hair ko, nag increase ang weight ko, and worst, i feel/know that my hair is thinning!! (sabi kasi ng hubby ko my thinning hair could just be because of getting old)

    Now i am thinking of taking Diane again. When is the best time to take the pill again Doctora, kasi, diba you have to start when your period starts too?? Kaso hindi pa ko nagkaka priod ulit.

    Thank you very much in advance Doctora.

    • filipinamd says:

      Pills do not cause breast cancer.

      Breast cancer is due to the presence of a gene called BRCA1 and BRCA2.

      Some women who have this gene and they are exposed to carcinogens like pollution, cigarette smoke, fertilizers and insecticides used on vegetables, chemicals from plastic containers and, YES, pills will have a higher risk of breast cancer.

      Meaning it is not the pill that caused your cancer. It is your genetic make-up. If you are afraid that you might have that gene then don’t take the pill and huwag ka na ring lumabas ng bahay and huwag ka na ring kakain or iinom ng anything na hindi ikaw and naghanda.

      Sorry, napahaba ang explanation ko but my point is…the pill has many good effects on the body. It helps regulate your cycle, it decreases the male hormone effect if you have PCOS and you are able to plan your family’s future.

      If you are taking the pill, be a responsible patient. See your doctor once a year for a pap smear, mammogram and blood tests.

      By all means, take the pill. I have been on the pill for 9 years STRAIGHT. No breaks. And I do a mammogram once a year because my grandmother died of breast cancer. But I don’t want to live in fear of an unplanned pregnant. I fear breast cancer too but that fear should not stop me and my family from enjoying a full and happy life.

      Don’t get me wrong. Women with many kids are also very happy. Nakakinggit nga ang big families but I have no financial, psychological and emotional capacity to take care of more than my 3 wonderful kids right now. I have so many plans for them and they have so many dreams of their own too. I pray that God will grant them their good wishes and they live in His light always.

      Ano nga ang tanong mo? When to take the pill? Do a pregnancy test now, kung negative, take the pill TODAY.

      Enough said.

  5. yhanhie says:

    hi doc. ask q lang about progesterone hormones kung paano iincrese..

    last year i have a PCOS and now im normal. im done in papsmear. and my ob said na ok na q. pwede na qng magbaby khit na mejo my maliliit pa. nagttake aq ng metformin and folic acid. but until now la padin aqng baby. month of may,na delayed aq ng 7 days i thought preggy na q pero ndi parin kc nagkamens aq. anu puh kayang problema??. iniisip q baka mababa ung progesterone hormones q. di puh kaya?? salamat puh..

    • filipinamd says:

      Mukhang effect pa run yan ng PCOS.
      Keep taking Metformin 500 mg 3x a day and take your Clomid 150 mg once day for 5 days on Day 2-6 of your cycle. Hanggang 1 year ka mag try with this regimen. Kung wall pa run, see an Infertility doctor.

  6. Kaye says:

    Hi dra. i am diagnosed to have pcos a month ago. a transvaginal utz is done as a confirmatory test for d initial diagnosis. my ob gave me duphaston for 10days and take diane on my 1st day of menstruation. im now on my 3rd day to take d pill. i am planning to switch diane to althea eventhough i dont experience any sideeffect with it, and i want to take metformin to treat pcos. but i dont knw d right dosage for me. im 24yr old, wt 68kgs.

    • filipinamd says:

      You may shift to Althea on your next cycle. Finish the current box of Diane then NO PILLS for 7 days then start Althea.
      Take metformin 500 mg 3 x a day.
      Mag start ka na rin ng Xenical 1 capsule after each meal for 2 weeks.
      Excess body weight makes it harder to treat PCOS.