KatCarney

PCOS: Medical Enigma or All in Our Heads?
source: http://www.expositorymagazine.com/womantowoman_v1i2.htm

Goosebumps on her arms, scratchy paper gown rustling while she awkwardly tried to make herself comfortable, Eliza perched on the exam table and perfunctorily thumbed through several well-worn magazines. She couldn't help but feel bored and anxious; this was the fifth doctor she'd seen in as many years, and she'd just about given up hope on getting treatment (or even an explanation) for the symptoms she'd been experiencing for over 10 years.

Her first doctor blamed her lack of periods on her weight, putting her on a diet so restricted that it caused dizziness from low blood sugar. The diet was impossible to maintain and whatever small loss she achieved was quickly overshadowed by regaining not only what she'd lost, but another 30 pounds as well.

The next doctor prescribed birth control pills, which, while they gave her regular periods, also gave her headaches and high blood pressure. When she complained, he had no other suggestions for her and referred her to a colleague. The next two specialists just threw up their hands and shrugged, offering no insight or advice, but charging a hefty fee -- one her insurance didn't cover because they could make no diagnosis. She had the final question memorized after having been through it so many times: "That'll be $150. Will that be VISA or Master Card?"

Finally she gave up, figuring it was just one of the many quirks her body had, like her widow's peak or that cute mole on her ankle. Since she wasn't planning on having children any time soon, she wasn't too concerned about her periods, and in fact rather welcomed their absence. She used about five different cleansers to combat her acne, volumizing shampoos to mask her thinning hair, and depilatory cream on her arms, chin, and legs to keep the hair growth to a minimum. Other than that, it was just a matter of finding clothes that fit and keeping granola bars around for the low blood sugar attacks that seemed to be plaguing her. Admittedly, not a lot of fun, but she didn't seem to have too many alternatives and was, in fact, starting to get used to it after such a long time.

What was really odd, though, was a dark patch of skin on the back of her neck that just would not -- no matter how hard she scrubbed -- go away. She tried bleaching it with lemon juice and scrubbing it with facial scrub, but nothing seemed to work. She always looked like she had a dirty neck, and she knew that wasn't the case. Between that and the skin tags, she had to admit it wasn't a pretty picture. She made a mental note to discuss the skin tags and dark skin with the doctor. She figured she'd need to see a dermatologist about them, but it never hurt to ask. Besides, Dr. Rodrigues seemed to know her stuff.

Long after Eliza had given up and stopped even asking for help or -- guiltily, she remembered -- having yearly pap smears, she read about Dr. Rodrigues in the newspaper and decided to try to get some help. Just this one last time.

A reproductive endocrinologist, Dr. Rodrugues had a strong reputation in the community for being able to unravel the tangled web of women's hormones. Even though it took several weeks to schedule an appointment, Eliza finally got in to see her. "If this doesn't work," she said to herself, "I give up. For real, this time."

Dr. Rodrigues breezed in, apologizing for being late. Her warm brown eyes and friendly smile immediately put Eliza at ease. After examining her and carefully taking down her history, Dr. Rodrigues said, "Well, Eliza, I think I might know what's wrong with you." She handed Eliza a pamphlet about PCOS and said, "I won't know for sure until I do some blood work and an ultrasound, but this is what I think you have: Polycystic Ovarian Syndrome. The unfortunate news is that there is no cure; however, the good news is that we can treat your symptoms and hopefully get you back on track."

'Polycystic Ovarian Syndrome,' Eliza read. Hmmm. Seems like she'd read something about that in a woman's magazine once but didn't pay much attention, since she never experienced ovarian cysts like some of her friends. The symptoms listed, however, were many she'd had: abnormal menstrual cycles, thinning hair, acne, dark patches on the skin, and a large tummy. Lifting her hair, she showed Dr. Rodrigues the dark skin on the back of her neck, and Dr. Rodrigues pointed out the dark patches on the backs of her knees as well. "This is me," she said, looking up at Dr. Rodrigues. "I have nearly all of those symptoms." "Yes, I think this may answer some questions," Dr. Rodrigues answered. "So let's get you tested."

In the weeks that followed, Eliza was scheduled for a transvaginal ultrasound, which, though rather embarrassing, wasn't painful. A probe was inserted into her vagina allowing the best possible view of her ovaries. It wasn't uncomfortable - in fact it reminded her of having a pap smear because it had about that much dignity -- and she was fascinated by the fuzzy pictures of her ovaries and uterus. The radiology tech pointed out the tiny strings of follicles on the surface of her ovary. "See those?" she asked. "Uh huh," Eliza said, not sure that she could really differentiate one shadow from another. At least she had her first clue, now. She remembered her doctor mentioning "strings of pearl-like cysts" as being one sign of PCOS.

Probably the worst part of the whole testing procedure was taking hormones to stimulate a menstrual cycle. The hormones made her weepy, and her breasts hurt, but at least they worked. She was rewarded just a few days after starting to take them with the first signs of her long overdue period. A few days after that, and then at different intervals, she had to return to the laboratory and have more blood taken, each test evaluating different hormones. She also had a fasting insulin test done, as well as some other general blood panels to evaluate her overall health.

After all of her testing was done, she was scheduled for another visit with Dr. Rodrigues to discuss the results and further treatment. This time the doctor met Eliza in her office, not an exam room. "Well, your pap smear came back normal, which is good. But let's talk about the rest of your tests."

Eliza gave a sigh of relief, but was eager to hear what the doctor had to say. Good or bad, at least someone - finally - knew what was going on with her.

To be continued….

In the next issue, we'll be discussing Eliza's test results, how they influence the diagnosis of PCOS and the treatment plan outlined for her by her physician. We'll also examine what she can expect long term and the successes of different treatment modalities.

In the meantime, I'd like to encourage you to do some of your own reading about PCOS. I've included several website URL's below, and if they stimulate any questions you may have that you'd like me to address in Part 2 of the article, please feel free to email me. This column is for you, and for every other woman out there who wants to take control of her health care. It's my pleasure to do what I can to help facilitate that.

Until then, happy reading!

--Vickie

"I am a woman giving birth to myself." - Adrienne Rich

http://www.soulcysters.com

http://www.inciid.org/

http://www.pcosupport.org/

Copyright © 2001 - 2002 Vickie Miller

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