January 08, 2016

Polycystic Ovary Syndrome (PCOS)

Question: What is a Polycystic Ovary Syndrome?

Short Answer:

This is what a Polycystic Ovary looks like. And yes, that is mine.

Fig 1. A transvaginal ultrasound image of a polycystic ovary.

Long Answer:


Allow me to share my background story, complete with (potentially embarrassing) pictures.

Circa 2004 (?). A groupfie attempt using a film point-and-shoot camera.

My adolescent years were fairly acne-free, as far as I can remember. Save for the occasional zit during "that time of the month," most days my face was clear and blemish-free.

Office teambuilding, circa 2010.

Everything was fine up to my first few years in the corporate world. I work in the IT industry, where workload varies depending on project deadline. Work was slow on some days, toxic on others. Work-related stress has caused some pimples to pop up on my face, but thankfully they clear up within the same week.

Family reunion, circa 2011.

It may be because of my lifestyle change (sweldo = luho = means to buy kikay stuff), or perhaps because I was going on through some stuff in my life (I was in a long-distance relationship for three years), or a combination of both, but some time during my late twenties, acne started to take over my face.

It wasn't the whole face, just at the area around the jawline. My forehead and nose were still blemish-free, but my chin, under my cheeks, and even my neck, were filled with red and painful cystic acne.

Korea, circa 2011. Me trying to cover up my blemishes by doing the 'V' sign.

At first, I consulted a dermatologist, who gave me the 'usual' acne regimen: Clindamycin lotion to kill the acne-causing bacteria, and Tretinoin cream to induce peeling. In addition to that, I had monthly pricking + diamond peeling sessions to further remove the acne and its marks. My skin responded positively to the treatment, however got overly sensitive in the process.

Europe, circa 2011. An active lifestyle (because of all the walking due to travelling)
did improve my skin's complexion. Also, the climate. 

Because of the peeling, my face easily got red at the slightest pressure; there was a point when I cannot bear the pain of the pricking and peeling process anymore. I also became dependent on BB creams, foundation and sunscreen, to mask the marks on my face.

Circa 2014. I was wearing BB cream to cover the acne marks,
but look closer and you'll see the bumps on the skin because of the whiteheads. Eww.

After I got married and moved away, I wasn't able to visit my dermatologist as often as I should. Little by little, my acne started to come back. Not as worse, but equally annoying nonetheless.

It was then when my mother-in-law suggested that I consult an obstetrician, to test if my acne may be caused by abnormal hormones.

Now here comes the educational part of my story.

May 2015: The Diagnosis

The OB requested for a transvaginal ultrasound to check my ovaries. 

How is it done, you ask? During a transvaginal ultrasound, the lab technician inserts a toothbrush-shaped device into your vagina, pressing the end of the device to the walls of your inner lady parts so that the ultrasound can get a good 'look' of the other inner lady parts that are separated by tissues and stuff.

How does the procedure feel, you ask? Intrusive as heck. The pressure you feel while the technician is prodding your insides is an uncomfortable sensation that you have to patiently endure for 10-15 mins.

What does it look for, you ask? A transvaginal ultrasound generally checks the health of your cervix, uterus, endometrium (i.e. uterine lining) and ovaries. It can determine the position of your cervix (if it is leaning forward i.e. anteverted or leaning backwards i.e. retroverted), the phase of your menstrual cycle based on the thickness of the endometrium, and the status of the follicles (i.e. premature egg) in your ovaries.

My test results showed that I my cervix, uterus, and endometrium are fairly normal, but determined that I have polycystic ovaries.

Fig 2. Right ovary. The black masses in the image to the right show the ovarian follicles.

So, what exactly are polycystic ovaries?

As supplement to my explanation, I would like to share a VERY insightful video about the female reproductive system. Going forward, any terms that I will use are based on this video.

During a normal ovarian cycle, the hormones secreted by the glands are balanced enough to ripen an egg into maturation. However, there are some cases where there is an imbalance of hormones--too little estrogen, too much androgen--, which hinders the ovaries from ovulating.

As a result, follicles start to build up in the ovaries instead of being released (as a mature egg) into the Fallopian tube. This is the Polycystic Ovary Syndrome.

Fig 3. Left ovary. The black masses aren't that prominent, but it is still diagnosed as polycystic.

What are the symptoms of PCOS?

There are three main symptoms, and not everybody diagnosed with PCOS experience them. These are:
  1. Irregular period. The ovarian cycle is what drives the menstrual cycle, and since there is no egg being released, it is possible that there will be missed periods. I did not experience this, as I was having my period regularly for every 28-32 days or so. But then I learned that there is such a thing as an anovulatory bleeding, where menstrual-like bleeding occurs but no ovulation takes place (more on this later).
  2. Weight gain. Hormonal imbalance also affects the metabolism, hence women suffering from PCOS tend to be on the heavier side. I did not experience this either, as I was rather slim during the time I had acne. Last year I was admittedly heavier than before, but I suppose it was because of my slowed metabolism due to aging.
  3. Acne breakouts. Hormonal-related acne usually form around the jawline and into the neck. I definitely experienced this, and this was the main reason why I consulted an OB.
Minor symptoms include excessive facial hair, mood swings (anxiety and depression), and in extreme cases, infertility.

June 2015 to November 2015: The Treatment

There are two types of treatment for PCOS, both aim to regulate the hormones. One is by using contraceptive pills, and the other is by using feritility pills. As I had no plans to get pregnant then, I chose contraceptive pills.

How do you take contraceptive pills?

The brand that was given to me by the OB was Yaz, which according to the OB, had the lowest dosage of hormones. There are 28 pills in a pack: 26 pink (with hormones) pills and 4 white (placebo) pills. The first pill should be taken on the first day of the menstrual cycle, and 24 hours after that. After finishing the 28th pill, bleeding will occur, but this is anovulatory bleeding because contraceptive pills prevent you from ovulating.

These pills contain a synthetic version of estrogen so it will cause some changes to your body. To ensure a most comfortable experience while taking the pills, it is recommended that you take the pills at a consistent hour each day.

I will not discuss its contraceptive effects on this post as it is not the topic of my blog.

What to watch out for while taking the pill

  • On the first pack, there will be significant spotting for the first three weeks. This may be a way for the body to adjust to the synthetic hormones going into the system.
  • If the pills aren't taken on schedule, there will be spotting as well.
  • There will be weight gain, or at the very least, bloating. This is because estrogen is a type of steroid hormone, wherein puffiness or bloating are a few side effects.
  • A number of studies show that there may be a risk of developing breast cancer while on the pill. This is why, during the first month, breast ultrasound must be done to check if there are any masses on the breast that may be at risk of growing while under the pill.
Check-ups were done every three months to see if my acne is responding to the pill. All in all, I was given six months' worth of pills before my acne completely cleared up.

December 2015: Off the Pill

It's been two months since I was off the pill, and so far it seems that my acne is still under control. I get the occasional breakouts, one--maybe two--on my chin, but it isn't as worse as before.

Fig 4. My face right now: oily, but relatively clear.

Just this month I started another treatment, but this time I'm taking fertility pills as I am ready to get pregnant. But I guess this is a story to be told later on.

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