– what you need to know about this hormonal disorder

MARIA* had been married for three years and was unable to conceive when she sought medical intervention at age 24. An ultrasound showed small ovarian cysts and a local gynecologist eventually diagnosed her with Polycystic Ovarian Syndrome (PCOS), a hormonal disorder that affects one in every 15 women worldwide.

Over the last six years since then, Maria has received a series of treatment to manage her PCOS and primarily help her become pregnant. However, despite several rounds of clomiofene and metformin, medications that are used to treat infertility, a laparoscopic surgery to remove the cysts and a session of intrauterine insemination (IUI), Maria is still longing to become a mother.

PCOS is a condition in which a woman’s level of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can affect a woman’s menstrual cycle, fertility, cardiac function and physical appearance. According to the United States Department of Health and Human Services, between one in 10 and one in 20 women of childbearing age has PCOS. The condition currently affects up to five million women in the United States

Aside from infertility, Maria is confronted with irregular periods, weight gain and facial hair which are all symptoms associated with PCOS. However, she said she had these issues since her teen years and did not know she had hormonal imbalance and a complaint that would affect her life so dramatically.

“I had the laparoscopic surgery first, in 2015 and it was very painful afterwards. Plus I was low on blood and before the surgery, I had to get two pints of blood…During the metformin course, I used to get upset feelings and then I even did IUI but no positive result yet,” the young woman said. She is currently considering In Vitro Fertilisation (IVF), an assisted reproduction technology where the embryos are fertilised outside of the body and introduced directly into the uterus. Guyana’s first IVF baby was birthed two years ago at a private hospital in Georgetown.

While the exact cause of PCOS is unknown, doctors believe that hormonal imbalances and genetics play a role. It is believed that women are more likely to develop PCOS if their mother or sister also has the condition. Overproduction of the hormone androgen may be another contributing factor, according to research. Androgen is a male sex hormone that women’s bodies also produce. Women with PCOS often produce higher-than-normal levels of androgen, doctors have observed.

Treatment
Like Maria, there are many other Guyanese women who suffer from hormonal disorders such as PCOS, according to Dr Judy Hung, a final-year resident doctor who specialises in gynecology at the Georgetown Public Hospital (GPHC).
She said though that while some PCOS patients display clinical symptoms such as heavy menstrual bleeding, irregular periods or none at all, obesity, acne, rapid facial and hand hair growth and/or darkening of the skin behind the neck, other women are asymptomatic meaning that they show no indication of the disorder. In most cases, PCOS is diagnosed when the women seek fertility treatment. She explained that an ultra sound can help too with diagnosis if there are cysts on the ovaries.

Once diagnosed, Dr Hung noted that medical practitioners work with the women to deliver an individual treatment plan based on the patient’s particular situation/needs.
“In some cases, women come to us because they are having heavy periods or irregular periods or had never had a period before, so we can use contraceptives to help regularise their ovulation. However, if it is a woman who is trying to get pregnant, we can’t use that same treatment strategy, we have to put them on other hormonal drugs to boost fertility,” she outlined.

In addition to medicinal treatment, she encouraged women suffering with PCOS to exercise regularly to control weight gain and reduce body fat which usually impact hormone imbalance. She also urged women to eat healthy. The doctor further observed that women between 18 -35 are mostly affected by PCOS and hail from various ethnicities, locations and genetics.
Anna* is another young Guyanese woman battling infertility due to PCOS. Diagnosed at age 28, Anna is now 31 and has since turned to herbal medicine to treat her condition after several rounds of clomiofene and metformin did not yield her a pregnancy. She, too, is struggling to control her weight as well as excess facial hair and irregular periods. The whole situation, she related is very frustrating not only for herself but her spouse and other relatives who are eager for the young couple to expand their family.

“We were placed on several rounds of clomid, which seemed to be the ideal fertility treatment but after it didn’t work, we were advised to try all sorts of remedies, and we tried a lot. However, after a while it became very tiring because every time we tried something new our hopes would be renewed that this would work and this would be our time, but it always ended in disappointment,” the woman said.

Dr Juliet Skinner, Founder of the Barbados Fertility Clinic, has been quoted in the Caribbean press as saying, “The sooner the condition (PCOS) is diagnosed, the sooner women can be advised on their options for medication and in extreme cases, assisted reproduction. It is also important to note that maternal age plays a big part in successful treatment and therefore I urge women who may be suffering to seek help sooner rather than later.”
*Name changed for protection of identity