Dear Dr Mitchell,
I am writing in response to your article dated May 21, 2012. The topic was “What’s the possibility of pregnancy with an erratic cycle?” I am 24 years old as well and I’ve experienced very similar symptoms of PCOS and especially as it pertains to irregular menstrual cycle. When I began reading this article I was a bit taken a back and wondered if the young lady was writing about me. Like her, I started having my periods when I was 11 years old. At that time my period came every month. By the time I reached in my early teenage years I missed one month every year. I thought it was normal to miss a month every year. However, when I reached 17 years old it got worse in irregularity. I wasn’t worried but I was always concerned and when I asked my friends about their cycles, mine was never the same. When I reached about 19 years old I would miss three months in a row and that’s when I visited the doctor who prescribed Minigynon pills to regulate my cycle. The pills worked but as soon as I stopped taking them, my cycle was irregular again. When I was 20 years old I did several tests which included a pelvic ultrasound and I was diagnosed with PCOS. I started to see hair under my chin and I was gaining weight very quickly. I just couldn’t understand why I was gaining weight. I made an appointment to see the gynaecologist. He had my medical file so he knew that I had PCOS. All he gave me was another dose of Minigynon pills to take to regulate my cycle. I recently visited a different doctor. I told him about my history of irregular menstrual cycle and he gave me Metformin to take for three months. He told me that I wasn’t being treated all along for PCOS. I am 5 feet 7.5 and weigh 169lbs. I am aware that I am overweight and I would love to get to 145lbs. Could you please tell me if the Metformin will increase my chances of getting pregnant and possibly help with weight loss? Since I’ve been on the Metformin I no longer feel hungry often. I eat a lot of whole grain cereals and fruits every day. I hardly eat fried foods but I do little or no exercise. I don’t eat a lot in large portions but I’ll snack a lot in small portions.
It would definitely seem as if you have polycystic ovarian disease with the history of irregular menstrual cycles, excessive weight gain and excessive hair growth on the body in a male pattern type. Polycystic ovarian disease is also associated with difficulty in becoming pregnant because of infrequent ovulation or sometimes failure to ovulate.
Weight loss works in helping to restore regular cycles and improve fertility. The condition is also associated with an increased risk for diabetes mellitus and achieving your ideal weight for height helps to reduce the risk for diabetes mellitus.
The use of Metformin helps in improving fertility by restoring ovulation and regular cycles. It also reduces the risk of developing diabetes mellitus. Metformin sometimes causes a bit of nausea and diarrhoea but these symptoms eventually settle down in a short time and the medication usually works well in improving your fertility.
Clomid (Celomiphene Citrate) is a medication that is commonly used in conjunction with the Metformin to help to establish ovulation and improve your chances of becoming pregnant. A regular exercise programme will help in achieving your ideal weight for height and improve your fertility. Walking helps in this regard if you are not able to have a structured programme in a fitness centre. Brisk walking at least three times per week will help. Eating frequent small meals and avoiding excessive carbohydrates especially refined sugars (ice cream, cakes and pastries) will definitely help in your attempt to lose weight.
You should consult your doctor and have a baseline progesterone test done on day four, counting every day from the first day of the last menstrual period. This will establish whenever you are ovulating. The dose of Clomid can be increased until you achieve the desired effect. If you are trying to conceive, you should take daily folic acid supplements to help to prevent birth defect in your baby.
Dr Sharmaine Mitchell is an obstetrician and gynaecologist. Send questions via e-mail to allwoman@ jamaicaobserver.com; write to All Woman, 40-42 1/2 Beechwood Ave, Kingston 5; or fax to 968-2025. Dr Mitchell cannot provide personal responses.