PCOS: Symptoms, Weight Gain, and Hair Loss Concerns

Polycystic Ovary Syndrome (PCOS) Menstrual Issues

I would like to ask the doctor, I am 32 years old this year.
Three years ago, my menstrual cycle was often delayed and the flow was light.
I inexplicably gained 20 kilograms, going from 55 kg to 75 kg.
I have been experiencing hair loss, with thinning hair on the top of my head, almost leading to baldness.
I consulted a dermatologist regarding my hair and had blood tests done, which showed no iron or zinc deficiency; all my levels were normal! Initially, I visited a general clinic for gynecological issues, where the doctor performed an ultrasound and noted the presence of follicles.
Based on my description and the observation of excessive hair growth on my arms and legs, the doctor diagnosed me with polycystic ovary syndrome (PCOS), but did not conduct any blood tests.
Instead, they prescribed progesterone and birth control pills (I forgot the name of the medication).
After taking them for six months, my menstrual cycle became regular, and the doctor advised me to stop the medication.
After my periods normalized, my weight gradually decreased to 60 kg, which I maintained through exercise and dietary control.
However, I have not been able to lose more weight, nor have I gained any, but my hair remains sparse.

Over the past three years, there have been occasional months where my period was delayed again, but it would return to normal afterward.
I did not return for follow-up visits or medication.
However, in the last six months, my weight has started to increase again, nearing 70 kg, and my menstrual cycle has become increasingly delayed, with lighter flow.
My hair is thinning even more, and I have started to notice a significant amount of gray hair! Recently, I went to Chang Gung Memorial Hospital to see a gynecologist and explained my situation from three years ago.
The doctor suggested blood tests to get a more accurate assessment (all tests related to PCOS were conducted), but today I received the report, and all my levels were normal, including male hormones, and my thyroid function was also normal...

So, doctor, are my symptoms indicative of polycystic ovary syndrome or not? Why is my weight continuously increasing, and why am I experiencing hair loss to the point of near baldness, along with the emergence of gray hair, without any identifiable cause? What is wrong with me? Why do some doctors say it is PCOS while others do not? Is it possible that the blood tests are inaccurate, and should I seek a second opinion? Lastly, the doctor prescribed medication again, this time progesterone (Norethisterone) and birth control pills (Chlormadinone).
Will these medications have side effects? Will I gain weight or experience more hair loss? I am already overweight and balding, so I am quite anxious! (I forgot the name of the medication from three years ago, but I did not experience side effects or weight gain then.)

Li, 30~39 year old female. Ask Date: 2017/06/13

Dr. Huang Jianzhong reply Obstetrics and Gynecology

I am 32 years old this year.
Three years ago, my menstrual cycle became irregular, often arriving late and with lighter flow.
I inexplicably gained 20 kilograms, going from 55 kg to 75 kg.
I have also experienced significant hair loss, with thinning hair on the top of my head, almost leading to baldness.
I consulted a dermatologist regarding my hair loss and had blood tests done, which showed no iron or zinc deficiencies; all my levels were normal.
Initially, I visited a general clinic for gynecological issues, where the doctor performed an ultrasound and noted the presence of follicles.
Based on my description and the observation of excessive hair growth on my arms and legs, the doctor diagnosed me with polycystic ovary syndrome (PCOS) but did not perform any blood tests.
Instead, I was prescribed progesterone and birth control pills (I forgot the names of the medications).
After taking them for six months, my menstrual cycle became regular, and the doctor advised me to stop the medication.
After my periods normalized, I gradually lost weight down to 60 kg, aided by exercise and dietary control.
However, I have since maintained this weight and have not lost more, but I also have not gained further weight.
My hair remains sparse.
Over the past three years, I occasionally experienced delays in my menstrual cycle for one or two months, but it would return to normal afterward.
I did not return for follow-up appointments or continue medication.

Recently, in the past six months, my weight has started to increase again, approaching 70 kg, and my menstrual cycle has become increasingly delayed, with lighter flow.
My hair is very sparse, and I have started to develop white hair! This time, I went to a large hospital, Chang Gung Memorial Hospital, and consulted a gynecologist, explaining my situation from three years ago.
The doctor suggested blood tests to check my hormone levels more accurately (all tests for PCOS were conducted), but today I received the report showing that all my levels are normal, including male hormones, and my thyroid function is also normal.
1.
Doctor, are my symptoms indicative of polycystic ovary syndrome?
Answer: No, it is not polycystic ovary syndrome.
2.
Why do I keep gaining weight, and what is causing my hair loss, which is leading to near baldness and the growth of white hair, yet no cause can be identified? What is wrong with me?
Answer: You should consult a dermatologist or a metabolic specialist.
3.
Why do some doctors say it is polycystic ovary syndrome while others say it is not? Is the blood test inaccurate, and should I seek another opinion?
Answer: Polycystic ovary syndrome requires blood tests for diagnosis; specific hormone levels must be checked.
4.
Finally, the doctor prescribed me medications again, this time progesterone (Norethisterone) and birth control pills (Chlormadinone).
Will these medications have side effects?
Answer: There should be no significant side effects, but they may cause weight gain (water retention).

Reply Date: 2017/06/13

More Info

Polycystic Ovary Syndrome (PCOS) is a complex endocrine disorder that affects many women of reproductive age. It is characterized by a combination of symptoms, including irregular menstrual cycles, weight gain, and hair loss, which can be distressing and challenging to manage. Your experience reflects a common scenario among women with PCOS, and I will address your concerns regarding symptoms, weight gain, hair loss, and the medications you have been prescribed.

Firstly, it is important to understand that PCOS can manifest in various ways, and not all women will experience the same symptoms. The irregular menstrual cycles you mentioned are a hallmark of PCOS, often due to hormonal imbalances, particularly elevated levels of androgens (male hormones). This hormonal imbalance can lead to weight gain, as you have experienced, and can also contribute to hair loss, particularly in a pattern similar to male-pattern baldness.

Regarding your weight gain, it is not uncommon for women with PCOS to struggle with obesity or weight fluctuations. Insulin resistance is a common feature of PCOS, which can lead to increased fat storage and difficulty losing weight. It is encouraging to hear that you have made efforts to maintain a healthy diet and exercise routine, as these lifestyle changes can significantly improve insulin sensitivity and help manage weight.

As for your hair loss, it is possible that the thinning hair on your scalp is related to the hormonal changes associated with PCOS. The condition known as androgenic alopecia can occur in women with elevated androgen levels, leading to thinning hair and a receding hairline. While you have had blood tests that showed normal hormone levels, it is important to note that PCOS can still be present even if some hormone levels appear normal. The diagnosis often relies on a combination of symptoms, ultrasound findings, and sometimes additional hormonal assessments.

You mentioned that some doctors have diagnosed you with PCOS while others have not. This inconsistency can be frustrating, but it highlights the complexity of the condition. A definitive diagnosis of PCOS typically requires the presence of at least two of the following criteria: irregular ovulation, clinical or biochemical signs of hyperandrogenism (such as excess hair growth or elevated testosterone levels), and polycystic ovaries observed on ultrasound. If your recent tests did not indicate elevated male hormones, it may be worth discussing further evaluations or seeking a second opinion from a specialist in reproductive endocrinology.

Regarding the medications you have been prescribed, including progesterone and birth control pills, these are commonly used to help regulate menstrual cycles and manage symptoms of PCOS. While some women may experience weight gain or other side effects from hormonal medications, many find that these treatments can help restore regular cycles and improve overall symptoms. It is essential to monitor how your body responds to these medications and communicate any concerns with your healthcare provider.

In conclusion, managing PCOS often requires a multifaceted approach, including lifestyle modifications, medication, and regular monitoring of symptoms. If you continue to experience significant weight gain, hair loss, or irregular menstrual cycles, it may be beneficial to work closely with a healthcare provider who specializes in PCOS. They can help tailor a treatment plan that addresses your specific symptoms and concerns, ensuring you receive the most effective care for your situation. Remember, you are not alone in this journey, and there are resources and support available to help you navigate the challenges of PCOS.

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