Dear Dr. G,

I am hoping to get some help from you about my hormonal complaint.

My husband and I have been happily married for three years.

Like most couples, our initial sex life was active.

However, the passion seems to have dwindled a bit in recent months.

Strangely enough this also coincided with me putting on weight and having issues with irregular periods.

As we are reaching certain stages of our lives to start a family, we are trying hard to conceive a baby.

Sadly, it is simply impossible to catch the fertile window, as the menstrual cycles are really chaotic.

We went to the fertility specialist for help. To our surprise, I was diagnosed with Polycystic Ovarian Syndrome (PCOS).

The doctor also explained this is related to problems of excessive acne and facial hair.

Perhaps, that explains why I am growing hair on my face, and yet losing hair on my head.

I understand the theme this month is sexual health and testosterone.

I am hoping to put Dr. G on the spot about PCOS.

Firstly, what is PCOS and why is PCOS happening to me?

Is the elevated testosterone responsible for all my hairy and skin complaints?

Is the testosterone also causing me to have deranged menstrual cycles?

I hear testosterone is responsible for enhanced sexual desires in women, which does not seem to happen to me?

With all the hormone chaos, am I really turning into a man?

Chaotic Cathy

Polycystic Ovarian Syndrome or PCOS is a common hormonal disorder in women, which was documented in Italian medical literature as early as 1721. The disorder is characterised by multiple cystic formations in the ovaries or unknown trigger. Around three-quarters of PCOS sufferers have elevated levels of male hormones (hyperandrogenism) resulting in the derangement menstrual cycle. The prevalence ranges from 2%-26% of the adult female population, with varying prevalence across countries. The World Health Organization (WHO) estimates 116 million women worldwide suffer from PCOS with the manifestation of symptoms in women of reproductive years between the ages of 18 and 44.

The exact cause of PCOS is largely unknown, however the etiology is generally associated with the combination of genetic and environmental factors. Obesity and lack of exercise are well recognised to induce the onset of PCOS, especially in individuals with such family history. The manifestation of the disorder can range from mild symptoms of irregular periods to excessive bodily and facial hair, acne, male pattern baldness, mood disorder, diabetes and obstructive sleep apnea. In severe cases, elevated testosterone in PCOS sufferers can even result in heart diseases and endometrial cancer.

PCOS is generally considered to be a chronic disease that has no cure. Lifestyle changes, such as weight loss and regular exercise are known to minimize the overall symptoms. As hormonal derangement can affect women in various forms and different degree of severity, targeted measures aiming to treat specific symptoms suffered by the patients, plus disciplined healthy life, are key for a successful outcome.

Oral contraceptive pills and diabetic medications such as metformin are utilized to improve the regularity of period. On the other hand, issues of hirsutism can be treated with laser esthetic hair removal technology. Apart from hair removal treatment, many patients would also accept medications such as anti-androgen to reduce acne, facial hair growth and the progression of male pattern baldness.

Not all women with PCOS encounter the problem of infertility. Weight loss and dietary adjustment, especially the reduction of carbohydrate, are known to be associated with the resumption of natural ovulation. For women not responsive to such lifestyle changes, medications such as clomiphene and assisted reproductive technology can often overcome PCOS-induced infertility.

The correlation between circulating testosterone and sexual desire in women is often a subject of debate but remains inconclusive. On one hand, testosterone supplementation at physiological levels in menopausal women or age-related decline in androgen is known to improve sexual desires. On the other hand, the excessive levels of testosterone in women in PCOS has no significant impact on enhancing libido. On the contrary, sexual dysfunction is documented in up to 50% of women suffering from PCOS. Most studies demonstrated the impact of adverse bodily image of obesity and hirsutism, resulting in poor rates of sexual arousal, lubrication and orgasm.

The intricate set-up of the female hormonal system is the fine balance of estrogen and testosterone, which is crucial for the bodily order of sexual functions, reproduction health and secondary female characteristics. Although the onset and progression of PCOS are largely unknown, unhealthy lifestyle and obesity are well-recognised triggers that tip the balance.

Clearly, the excessive supply of androgen is associated with adverse outcomes of irregular period, skin complaint and overall health chaos in women. The American Historian, Henry Adams once said: “Chaos was the law of nature; Order was the dream of a man”. When women with the chaotic hormonal issues of PCOS is putting Dr. G on the spot. His view is “keeping a healthy lifestyle can restore the law of nature, without the nightmare disorderly chaos of turning into a man!”

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