Introduction
Martine knew that she had an infertility problem. She wanted a baby, she said, but she didn’t want twins—and certainly not triplets. She’d heard that fertility treatments often led to more than one baby at a time, and she knew that wasn’t for her. “My doctor told me you were the specialist I should see,” she said to me.
In her mid-thirties and a vice president at a well-known commercial bank, Martine was direct and to the point in a businesslike way.
“I don’t want a high risk for multiple births,” she said. “What can you do for me?”
She clearly expected me to write a prescription and she’d be on her way. I knew her doctor well and understood why she had referred Martine to me.
“It’s true that a woman taking the popular fertility drug Clomid has a one-in-ten chance of having twins,” I said. “But I assume you’ve been told that I don’t run a fertility clinic.”
“What can you give me?” she asked.
“It all depends on what’s causing your infertility,” I replied.
“Doctor, we’re both busy people,” she said. “I don’t have time for a medical investigation. My husband and I want a baby. The problem is mine, not his. Help me.”
“Are your periods regular?” I asked.
“I run in the marathon every November,” she said. “The rest of the year I train for it—my periods aren’t all that regular.”
“You don’t look like a runner,” I commented. She was about fifteen pounds overweight, mostly around the waistline.
“I know.” She sighed. “I’m always snacking. When I don’t eat, I get dizzy.”
Our brief conversation had already been quite revealing. Martine’s menstrual cycles were not regular. She was beginning to develop an apple shape, carrying her excess weight in her middle. This is often a sign of insulin resistance, a condition in which greater amounts of insulin than normal are needed to regulate the blood sugar level. Her snacking and dizziness also suggested unstable blood-sugar levels, probably aggravated by a diet rich in carbohydrates.
Martine noticed me examining her hair. It was auburn and cut fairly short, in a style that suited the shape of her face. There was no sign of any thinning scalp hair, which would have been an indicative symptom of PCOS. She shot me an impatient look. Obviously the last thing she expected from a specialist in my field was my apparent interest in her hairstyle!
“When did you last have acne?” I asked, having noticed very faint scar traces on both her cheeks, not quite fully concealed by makeup.
“About a year ago,” she said, becoming curious about whatever game I was playing. “You’re seeing me at a good time. When I get it, it takes forever to clear up. I think it’s all the chocolate I eat.”
Contrary to popular myth, chocolate does not cause acne. The cause of persistent acne in adult women is often a higher than normal blood level of male hormones.
“Do you have much unwanted facial and body hair?” I asked next.
“More than most women, I suppose,” she answered somewhat defensively. “I use electrolysis to get rid of it.”
“One more question. Have you ever heard of polycystic ovary syndrome, often called PCOS?”
She nodded. “I’ve read a little about it on the Internet.”
I told her she had some signs of the condition, but I couldn’t be sure she had it until after a physical examination and some lab tests on a blood sample. We discussed PCOS for a while. I explained that she might not always be ovulating when she had periods, something that happens commonly in women with PCOS.
“If PCOS is the cause of your infertility, I may be able to help you,” I said.
The lab tests confirmed my suspicions that Martine had PCOS. With lifestyle changes and medication, she was soon pregnant and delivered a healthy baby. I also prescribed remedies for her acne and unwanted hair.
My guess is that Martine’s year-round training for the New York City Marathon helped keep her PCOS symptoms from becoming more troublesome. Not all women with PCOS are as fortunate in this respect as Martine. In addition to having more severe symptoms, many never discover what is really wrong with them. Instead, they bounce from doctor to doctor without ever receiving an accurate diagnosis or effective treatment.
If you’ve done any online research into PCOS, you may well have come across personal accounts that describe experiences very similar to your own. Keep in mind that not everyone who thinks she has PCOS actually does. Other hormonal illnesses can cause very similar symptoms. You can get a proper diagnosis only from a trained professional, ideally from an endocrinologist familiar with PCOS or perhaps from a reproductive endocrinologist, although a number of well-trained gynecologists and internists have the experience to diagnose PCOS. As one of the doctors who is considered to have helped pioneer PCOS diagnosis and the development of effective treatments, I have a personal stake in getting word out to women affected by this sometimes baffling syndrome. I want women to know that once they reach out to seek help in the right place, help is at hand.
If someone were to ask me what I have done with my life as a doctor, I would say that I have devoted more than twenty-five years of it to treating women with PCOS. Today the majority of patients in my New York City practice are women who know or suspect that they have PCOS. In addition to my private practice, I teach, do PCOS-related research at The Mount Sinai Medical Center and School of Medicine, and am active in numerous organizations that spread awareness of the condition. If you don’t want to hear about PCOS, don’t ask me what I do as a doctor.
As knowledge about PCOS and its treatment has increased, it has been my good fortune to have been involved in important developments and events. Although doctors still have much to learn about this syndrome, we have developed effective treatments for the various symptoms as well as the syndrome itself. The purpose of this book is, very simply, to tell you what these treatments are and how to best take advantage of them.
If you suspect that you have PCOS, the first thing you need to do is make a self-assessment. I help you do this in the first chapter. Take the PCOS Quiz—your score will indicate the likelihood of your having the condition.
Most American women with PCOS have weight problems, and conversely, losing weight can alleviate their PCOS symptoms. A woman’s weight may have much to do with insulin resistance. Excess weight and insulin resistance are often accompanied by PCOS, and in chapter 2 we look at the complicated interaction between them.
High LDL (“bad”) and low HDL (“good”) cholesterol levels, high triglycerides, high blood pressure, and insulin resistance can interact in the insulin resistance syndrome (IRS), a condition to which women with PCOS are unfortunately vulnerable. We will look at this syndrome in chapter 3, and at the possible serious health consequences of PCOS in chapter 4, which include diabetes and heart disease.
Part II is titled Getting Well Again, and if you haven’t heard this from your doctor, let me be the first to assure you that you can feel good again. The chapters in Part II all focus on managing the symptoms with the best treatments available.
Treating PCOS symptoms often requires the attention of an endocrinologist—a specialist in hormonal medicine, like me. In chapter 5, I show you how to go about find a knowledgeable, experienced specialist and how to establish good communication with her or him so that you can work together to address your most pressing problems quickly and effectively.
Your treatment will work on two levels—you and your doctor will tackle the symptoms that you suffer from, such as infertility or skin and hair symptoms, as well as the underlying condition itself. Let’s first consider the underlying condition. You can’t cure PCOS, but you can render it almost inactive by losing weight through healthful eating and moderate exercise. In chapter 6, we look at PCOS-friendly foods, namely, foods with a relatively low glycemic index. In chapter 7, Let’s Eat, we put those principles into action with healthful meal plans to jump-start your weight loss. Some of my patients balk at my exercise prescriptions in chapter 8, but there’s no need. Even moderate exercise will make a big difference in the way you feel, and the Level 1 plan in chapter 8 is designed for the absolutely sedentary woman. You only move on to more physically demanding routines when you’re ready, so your progress is gradual and completely under your control.
Weight loss may be the answer to your fertility problems, because as your weight comes down, so do your insulin levels and, voilà—your menstrual cycles become more regular. But are you ovulating? If you’re, not, nothing much can happen. In chapter 9, we show how you can tell. If weight loss doesn’t reverse your infertility, we look at two drugs that almost certainly will: metformin (Glucophage) and clomiphene citrate (Clomid). Separately and in combination, these two fertility drugs have a more than 80 percent rate of success in women with PCOS.
More good news: Women with PCOS can and do have healthy babies. When they get pregnant, however, women with PCOS have greater difficulty staying pregnant than other women. They need to monitor their blood sugar and insulin levels to avoid gestational diabetes. They also need to keep their blood pressure down. If they have previously lost a pregnancy, the drug metformin can help prevent that from happening a...
