Polycystic Ovary Syndrome: Symptoms, Diagnosis, and Management

Polycystic Ovary Syndrome (PCOS)

Hello Doctor, I have been married for over a year without any news.
However, I was pregnant a few years ago and had a medical abortion, but it wasn't completely cleared out.
The doctor advised me to wait for three menstrual cycles with medication before confirming it was clean.
After that, my menstrual cycles became a bit irregular and took longer to arrive.
However, for the past six months, my cycles have been regular, coming every 35 days.
Last December, I had my LH/FSH levels checked, but when I reviewed the report with the doctor, he didn't say much and prescribed ovulation medication for me to take and return for follicle tracking, but I did not follow up.
I took the medication during my December and January cycles, and my period came normally in January.

In February, however, my period was over 40 days late, so I went back for testing and had my AMH levels checked, and I took medication to regulate my cycle.
After finishing the medication, my period finally came after two months.
The doctor reviewed the results and diagnosed me with polycystic ovary syndrome (PCOS) and prescribed ovulation medication.
On the 14th day of taking the ovulation medication, I returned for an ultrasound, which confirmed the diagnosis of polycystic ovaries.
The ultrasound showed eight follicles on one ovary, all measuring 0.6 mm, and the endometrial thickness was 0.4 mm.
The doctor mentioned that I was already on a medium dose of the ovulation medication (50 mg) and also prescribed PREMARIN 0.625 mg.
He advised me to consider injections next time.
On the third day of my menstrual cycle, my lab results were as follows: FSH: 6.0, LH: 14.7, AMH: 18.7 (this value was not tested on the third day of my cycle), TSH: 0.891, E2: 25.0, PRL: 12.25.
My weight is 45 kg, height 160 cm, body fat approximately 20%.
I am quite thin, have acne, and do not have excessive hair growth.
My body temperature tends to be low, usually around 35.x, and my high temperature phase does not exceed 14 days, which led my traditional Chinese medicine doctor to suspect I am not ovulating, prompting further tests.
Since I have been pregnant before, I prefer not to pursue artificial methods, and I am only 30 years old.
Am I experiencing mild PCOS? Is my insulin level a concern, and is my ovarian function normal, with the main issue being related to the pituitary gland? My usual lifestyle includes infrequent exercise, poor sleep at night, difficulty falling asleep, light sleep, and I often wake up late without having breakfast.
Would regular exercise, a normal routine, and proper diet help improve my condition? Thank you.
I hope to hear your advice.
I appreciate it!

Lin Youzi, 30~39 year old female. Ask Date: 2017/04/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Since I have been pregnant before, I prefer not to use artificial methods, and I am only 30 years old.
Could I have mild polycystic ovary syndrome (PCOS)? Is the issue related to insulin, or is it primarily a problem with the pituitary gland, given that my ovarian function seems normal? My menstrual cycle has been regular at 35 days for the past six months.
In December of last year, I had my LH and FSH levels checked.
When I reviewed the report with the doctor in December, he didn't mention much.
On day three of my menstrual cycle, my values were: FSH: 6.0, LH: 14.7, AMH: 18.7 (this value was not tested on day three of my cycle), TSH: 0.891, E2: 25.0, PRL: 12.25.
The assessment suggests mild PCOS, and it is reasonable to prescribe a moderate dose of ovulation medication (50 mg) along with PREMARIN 0.625 mg as a treatment.
2.
My weight is 45 kg, height is 160 cm, and body fat is approximately 20%.
I am quite thin, experience acne, have no excessive hair growth, and my body temperature tends to be low, often around 35 degrees Celsius.
My luteal phase does not exceed 14 days.
In terms of my daily life, I do not exercise regularly, have poor sleep quality, struggle with insomnia, and often wake up late without having breakfast.
Would regular exercise, a normal routine, and a balanced diet improve my condition? The answer is yes.

Reply Date: 2017/04/13

More Info

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder that affects women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, excess androgen levels, and polycystic ovaries. Understanding your condition is crucial for effective management and improving your chances of conception.

Symptoms of PCOS
The symptoms you described, such as irregular menstrual cycles and the presence of multiple follicles in your ovaries, are indeed indicative of PCOS. Other common symptoms include:
- Irregular periods: This can manifest as infrequent, prolonged, or absent menstrual cycles.

- Excess androgen levels: This may lead to symptoms such as acne, hirsutism (excess hair growth), and scalp hair thinning.

- Polycystic ovaries: As seen in your ultrasound, the presence of multiple small follicles can be a sign of PCOS.

- Weight issues: While you mentioned being on the thinner side, many women with PCOS struggle with weight gain or obesity.

Diagnosis
Your diagnosis of PCOS seems to be supported by your hormonal profile and ultrasound findings. The elevated LH (Luteinizing Hormone) relative to FSH (Follicle Stimulating Hormone) is a common finding in PCOS. Additionally, your AMH (Anti-Müllerian Hormone) level is elevated, which is often associated with polycystic ovaries.

Management
Management of PCOS typically involves lifestyle modifications and, if necessary, medication. Here are some recommendations based on your situation:
1. Lifestyle Changes:
- Diet: A balanced diet rich in whole foods, fruits, vegetables, lean proteins, and healthy fats can help manage insulin levels and weight. Consider reducing refined carbohydrates and sugars, which can exacerbate insulin resistance.

- Exercise: Regular physical activity can help improve insulin sensitivity and promote weight management. Aim for at least 150 minutes of moderate-intensity exercise each week.

- Sleep Hygiene: Improving your sleep quality is essential. Establish a regular sleep schedule, create a restful environment, and consider relaxation techniques to help with sleep onset and maintenance.

2. Medical Management:
- Medications: Your doctor has prescribed ovulation induction medications, which can help regulate your menstrual cycle and promote ovulation. If you are not responding to oral medications, injectable medications may be considered.

- Hormonal Treatments: If you experience symptoms like acne or hirsutism, hormonal contraceptives (like birth control pills) can help regulate your menstrual cycle and reduce androgen levels.

3. Monitoring: Regular follow-ups with your healthcare provider are essential to monitor your condition, adjust treatments as necessary, and assess your overall reproductive health.

Insulin Resistance
While your weight is on the lower side, PCOS is often associated with insulin resistance, which can occur regardless of body weight. It might be beneficial to have your fasting insulin levels checked, as managing insulin resistance can significantly improve symptoms and fertility outcomes.

Conclusion
You are not alone in your journey with PCOS, and many women successfully manage their symptoms and achieve their reproductive goals. Regular communication with your healthcare provider is key to tailoring a management plan that suits your individual needs. Lifestyle changes, along with appropriate medical interventions, can lead to improved menstrual regularity and fertility. If you have concerns about your treatment plan or symptoms, do not hesitate to discuss them with your doctor. Your proactive approach to understanding and managing your health is commendable, and with the right support, you can navigate this condition effectively.

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