I have PCOS with endometriosis
Dear Dr Mitchell,
I would like to ask, what are the treatments that I would be eligible for? I have PCOS with endometriosis and I am desperate to become pregnant.
Polycystic Ovary Syndrome (PCOS) is a condition that is associated with infrequent ovulation and in extreme cases, a failure to ovulate, excessive weight gain, excessive facial and body hair growth in a male pattern type of hair distribution, temporal baldness (male pattern type of hair loss), acne, enlargement of the clitoris in some women, deepening of the voice, and an increased tendency to develop diabetes mellitus. The diagnosis can be confirmed by doing a pelvic ultrasound.
The usual finding is enlarged ovaries with multiple immature ovarian follicles. A blood test can be done to check the hormone levels. This includes checking the testosterone levels; follicle stimulating hormone and the luteinizing hormone levels. The blood glucose is usually done to rule out diabetes mellitus, especially in women who have excessive weight gain.
Weight loss utilising an appropriate diet with reduced calorie intake and a regular exercise programme will definitely help the regulation of the menstrual cycle and improve fertility. The use of Metformin and Clomiphene (CLOMID) will also help to induce ovulation and significantly improve your chances of becoming pregnant.
Endometriosis is a condition that is associated with chronic pelvic pain and infertility. In endometriosis, tissues that are similar to the tissues lining the cavity of the uterus are present outside of the uterine lining. These tissues bleed with the onset of the menstrual period. In a lot of women these deposits are present around the ovaries and Fallopian tubes. This results in scarring or adhesion formation which interferes with ovulation and the function of the Fallopian tubes which are sometimes severely bound down.
The management of endometriosis usually involves the use of drugs to suppress the menstrual period, thus allowing the deposits to shrink and improve fertility. In severe cases, surgery has to be done to burn or remove the deposits and the pelvic adhesions. In some women the use of drugs and surgery to treat the endometriosis still does not result in an increased fertility outcome. In these cases, invitro fertilisation has to be done to achieve a pregnancy. This involves removing the egg from the ovaries under ultrasound guidance after giving medication to stimulate the ovaries to produce several eggs in one cycle. The semen is collected from the spouse or a donor and this is used to fertilise the egg which is then put into the uterine cavity where it develops. The outcome with this treatment is good. Invitro fertilisation is available in Jamaica at the Hugh Wynter Fertility Management Unit at the University Hospital of the West Indies.
You need to discuss all the options with your doctor who will advise you further.
In the interim, you should take daily folic acid supplements to decrease your risk of birth defects in the brain and spinal cord of the foetus.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Avenue, Kingston 5; or fax to 876-968-2025. All responses are published. Dr Mitchell cannot provide personal responses.
DISCLAIMER:
The contents of this article are for informational purposes only, and must not be relied upon as an alternative to medical advice or treatment from your own doctor.
September is globally observed as Polycystic Ovary Syndrome (PCOS) Awareness Month. In this, the second of a two-part series, we share the stories of some of our sisters, details of the condition, and available treatment options.
T“The first step in the treatment of patients is lifestyle, or modification of diet and exercise,” he says. “This is directed at achieving weight loss. Patients who respond to lifestyle modification may not need any other form of intervention.”
He adds: “Women who have menstrual irregularities and associated infertility may be started on Metformin, a medication that increases insulin sensitivity and can lead to regular ovulatory cycles. Women who have irregular cycles or heavy periods, but do not desire fertility at this time, may be offered the oral contraceptive pill in addition to the Metformin.”
Oral contraceptive pills with an anti-androgenic component, he says, can help manage other symptoms of PCOS such as acne and malepattern hair growth, but patients may need to see a dermatologist for additional treatment and monitoring.
“Any woman who thinks she may have PCOS should see her gynaecologist, who will do a full consultation to assess her symptoms clinically,” Dr Hardie recommends.
These PCOS ‘cysters’ share their symptoms with All Woman, and tell us how they have been managing them since their diagnosis.
Annecia Barrett, 26, teacher:
I didn’t really know what it was until I was much older, but ever since I hit puberty I started to develop coarse chest hair and facial hair on the side of my face and under my chin. I would have extremely painful periods and pain on either side of my abdomen during ovulation. I thought that it was normal so I treated the pain with multiple doses of painkillers. During university I started to research the symptoms of PCOS and I matched the profile. I then
I found out that I suffered from PCOS at 20, after a very bad experience in a clinic that I went to, based on my symptoms. Even though the ultrasound showed that both my ovaries were swollen with multiple cysts, with suspected endometrial polyps, the doctor maintained that I did not have PCOS, and said I should come back when I was ready to have a baby. So I did my own research, and now I manage my symptoms with natural remedies and other medications. I am currently taking folic acid and prenatals to improve my chances of fertility. I also drink the dog blood bush and other bush remedies to help with the symptoms.
Sabriena Simpson, 28, communications officer: The symptoms I experience with PCOS are irregular periods, bleeding between periods, excessive weight gain, hirsutism (male distribution of hair), and insulin resistance (which makes me prone to diabetes, anxiety and mood swings).
After a pelvic ultrasound exam revealed that my ovaries are polycystic, my gynaecologist prescribed a contraceptive called Diane 35 to help with the irregular periods and Metformin to control the sugar levels and assist with ovulation. I was also recommended to a nutritionist to assist me with losing weight. I lost 23 pounds and my periods became regular, but the other symptoms persist. It is sometimes worrying to think that I can easily get diabetes and, most of all, experience challenges in having a child.
Sheena Lee, 27, teacher:
I found out I had PCOS when I was pregnant a few years ago. Luckily for me, it doesn’t seem to be that severe of a case. I have my regular periods, no weight issues, and no pain. However, recently I have been experiencing a change in the texture of my hair, I have hair on my chin (which I hate), and I now have acne. I’ve never ever had that so that was a bit hard to adjust to. Birth control helps, so I went and got some from the doctor. I specifically take Lindynette, and I see the difference when I do. I don’t take it consistently though, because birth control comes with its own side effects.
WCondoms, according to Medical
Internist Dr Samantha Nicholson-spence, when used consistently and correctly, can effectively reduce the chances of unplanned pregnancy and the spread of STDS.
But even as condoms offer reliable protection against the transmission of many STDS, Dr Nicholson-spence said that not only do they not provide absolute protection, but there are some diseases, transmitted sexually, that the condom is not physically or otherwise capable of protecting you from.
“Some STDS such as herpes, HPV [Human papillomavirus] and crabs, for example, can be passed on by way of skinto-skin contact. In some cases, these STDS present with lesions that are not always on the shaft of the penis or the vulva and are not necessarily transmitted through vaginal intercourse. Condoms might not help much with preventing infection,” Dr Nicholsonspence explained.
So how exactly do you get these STDS, and what can be done to reduce the likelihood of contracting them or passing them on to sexual partners?
Herpes
Unfortunately, herpes lesions might not only be on the shaft of the penis or the vulva, but they can also be inside the vagina, on the cervix, on the mouth and throat as well as on the general pubic area or in the pelvic region. Since these areas are not covered by the condom, skin-to-skin contact with the lesions could result in transmission. This is why medical professionals generally recommend that you abstain from sex when having a herpes outbreak to reduce the chances of transmitting the STD.
Crabs
Commonly called crabs, pubic lice is not as common as it once was, because of an increase in the number of people taking time to groom their pubic areas. Pubic lice generally live and lay their eggs in pubic hair and are passed to a person on contact.
“While most people usually get crabs by way of sexual contact, you don’t even need sexual contact for crabs. You can get it even by way of using the same sheets, or having contact with certain items of clothing from the infected person,” Dr Nicholson-spence underscored.
HPV
There are over 100 strains of this virus. And while some strains do not present with symptoms, HPV can be passed through skin-to-skin contact.
“In herpes, for example, the lesions are not always on the shaft of the penis, sometimes they are not even visible, but that does not mean they are not contagious. The issue of HPV transmission is also further fuelled by a habit of not putting on the condom before the start of any type of genital contact,” Dr Nicholsonspence shared.
She explained that some HPVS present with warts, while others are believed to trigger the development of various types of cancers. Some strains of the virus can be prevented with the HPV vaccine.
Syphilis
In most instances, the risk of transmitting syphilis to someone while wearing a condom correctly is very low. However, some medical experts argue that the firm sores that often present in areas that are not covered by the condom, means if the sores are present in an area that is exposed, the highly contagious disease may be transmitted.
Dr Nicholson-spence said that the best way to stay Std-free is to abstain, or commit to a monogamous relationship, and even then, she recommends the continued use of condoms.
If you decide to engage in sexual relations with multiple partners, she said that not only should you use a condom every time, but it is important that you get tested for STDS regularly.