Question:
Hi, thank you very much for your help in advance. I am 22 years old and not sexually active. I had my first period may be at about 16 yrs. of age. My period was always relatively irregular and it was normal for me to miss 2 to 4 months (4 months usually happened once a year in the spring). I have gone to a gynecologist several times and after the exams all have told me that I have irregular hormonal levels and should take birth control pills. As I have heard many times that such pills are bad for my health, I refused to follow that advice. The problem which greatly concerns me is that I now have not had a period for about 6 months (last time was in March).
I am very worried and will go to the doctor, however, I would appreciate your opinion as well. I have a good figure, good eating habits, no excessive stress. What could this be? If this is PCOS would it have significant negative effects on my ability to get pregnant? Are hormonal pills really bad (weight gain, hair growth, adaptation of the body to constant supplements)? Could this be due to my lack of sexual experience/activity? If so, is this a problem? Is there a "body cleansing" pill that I could take to induce a period and see how things go without significant negative effects? Do you think that traditional Chinese medicine could be of help? In short, what is you opinion on this? I would appreciate as much detail as possible.
Thank you for taking the time to answer my questions.
Answer:
From your history, it sounds like you have PCOD (polycystic ovarian disease). This has not become the syndrome (PCOS) yet because the disease eventually turns into PCOS (polycystic ovarian syndrome) when it manifests by increased weight gain (obesity), excessive hair growth, increased male hormone, decreased voice, hair loss (male pattern loss), diabetes. This disorder is due to a dysfunction of the ovary, whereby the ovary does not process the FSH and LH from the brain appropriately so that ovulation does not occur. If the ovulatory process does not occur, the hormone precursors do not go down the estrogen/progesterone pathway to make those hormones and instead go down the testosterone pathway, leading to excess testosterone. This leads to the manifestations explained above. These are long term changes and occur slowly. They are not reversible, so you don't want to go down that road.
The other problem with not having a period regularly is that the endometrial lining can thicken leading to several problems: hemorrhagic bleeding when you do have a period requiring hospitalization and transfusion, a precancerous state and endometrial cancer. You also don't want to go down that road. Another problem is that with the lack of estrogen in your body, you can suffer other long-term consequences such as a very dry vagina, vaginal shrinkage, inadequate lubrication with intercourse, shrinking of the breasts, increased heart disease, bone loss, dryness of the skin.
If you are not intending to become pregnant, then the treatment of choice is to use the birth control pill. This is the recommendation that medical doctors in my field will give you. That is mainly because the pill/patch/ring are made of estrogen and progesterone and override your ovaries. It basically puts your ovaries at rest and gives you the hormones your body needs. Several studies have shown long term benefits from the pill including a significant decrease in ovarian cancer if used for greater than 7 years. I also believe that it helps to preserve your fertility longer because the ovary is quiescent. The things you heard that are "bad" about the pill are wives tales and not true. The one truth is that you may not be able to become pregnant after stopping the pill, but that is because you will go back to the way you were prior, which is not conducive to pregnancy because you are not ovulatory. So, my recommendation is to go on the pill.
In terms of sexual activity. The value of sex, if you are not trying to get pregnant, is for recreation. Because it feels good or gives other good feelings. It is not a physiologic requirement, so don't feel compelled to have sex just because you have to. It should be fun.
I cannot comment regarding Chinese medicine, as I have no knowledge of this subject. I have recommended acupuncture for my infertility IVF patients as a complimentary part of my protocol and have seen improved pregnancy results.
I hope this gives you the information that you were looking for.
Follow-up question:
I wonder if I can take up a bit more of your time by asking a follow-up question.
From what I understand, birth control pills do not treat the problem, they simply override it, for lack of a better term. At this stage in my life, I am not looking to become pregnant; however, this is a natural progression in life. As such the question is as follows: If I can't become pregnant without taking the pill due to the absence or scarcity of the ovulation process, and the pill while restoring that process, will be acting as a contraceptive, what are my options?
One of my concerns about the pill is that by taking it I will be decreasing the possibility of having natural period, as my body will become used to constant supplements. Consequently, my chances of ever becoming pregnant suddenly become almost null. As for sexual activity, I certainly understand the value thereof, I have been told, however, that sexually activity will stimulate the production of the hormones which are missing in my body. This was the assertion the validity of which I was looking to confirm. From what I understand, that belief is erroneous. Is that correct?
Furthermore, I was a bit unclear as to why you believe that I have not yet developed a "syndrome". You also mentioned that the pill will prolong my fertility. Are you then suggesting that I will likely lose fertility at some point due to PCOD?
Again, thank you for your time and assistance!
Follow-up answer:
Hello Again,
The answer to your first question is that the pill will not inhibit your ability to become pregnant in the future. As you said, it overrides the ovary and puts it into a quiescent state. The active state returns after stopping the pill and you will return to where you were previously. That is, if you are not ovulating prior to the pill, you will still not ovulate after stopping the pill. Your body will not "become used to constant supplements" so you don't need to worry about that.
Sometimes, being on the pill causes the ovary to straighten itself out and I have had patients get pregnant immediately upon stopping the pill (the opposite reaction to what you are thinking.)Sexual activity has no influence on the regular hormones in your body. You can have many sexual encounters per day and your hormones and ovaries would still be abnormal from the PCOD. Of course, you will be exhausted every day too. :) Just kidding!
From how you described yourself in your first question, you do not seem to be exhibiting the "classic" symptoms of hirsuitism, weight gain etc. that manifest themselves with PCOS. That is why I am assuming that you have PCOD. I have had many patients that are PCOD with no symptoms whatsoever. To diagnose latent PCO you need to see an infertility specialist who will ultrasound you during your cycle to determine whether you are overproducing follicles.
Lastly, you will lose your fertility potential with increasing age, not because of PCOD. At age 30 the pregnancy rate is 85% per year, 35 PR is 30% per year, 40 yo PR is 10% per year.
Hope all this makes sense and answers your questions.
Sincerely,
Edward J. Ramirez, M.D.
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
