Psoc and hornones

 Pcos diagnosis (sort of) 

Years ago when I was around 19/20 I was diagnosed with PCOS but had not got an explanation or further tests. I was not sure what it really meant for me or if it would effect me. But at the time I had just come out as Bisexual (pre transition.) so wasn't really sure I wanted to carry children myself. I wanted them just wasn't sure how.

Thus I never really presued the pcos further. From what I did know about it I had no symptoms other then cysts on my ovaries, which is how I was diagnosed. I got diagnosed when I was having problems with my back after a dance injury at university. Which caused pain in my front groin area, due to the sciatic nerve. Therefore when I got pains or aches I did not think much of it. Until my physio felt and said it felt like my ovaries not muscular inflammation. So she request an ultrasound scan. I had been on birth control pills and not had any cycles for over 2 years. I did start my period late too at 17 years old and never really had regular ones before starting the pill.

The scan showed cysts and a doctor told me I had PCOS and to go back on birth control which again stop any cycles. I then had the coil fitted, after I transition because it was progresrone only. This is because I was male I did not want extra female hormones in my body. Meanwhile I did not want the dyphoria of menstruation every month.  I then shortly started testosterone so I had the coil removed. Since then I had few bits of spotting which is normal until the T got fully into my system. 

Due to this I have never had regular cycles at all, I had this understanding I had PCOS whilst I knew it could effect my fertility I didn't understand how and as I said at the time I didn't really want to get pregnant. But I also knew people with PCOS, who had gone on to have babies whether it was naturally or with medication to help. So I knew it was possible. 

Since I had no other symptoms I still do not know if I have it, even with another diagnosis again by a gp with another test that found a few cysts on my right ovary. My left is fine and all my bloods are great. Which means I might just have cyst that do nothing. This can be common with people who have been on birth control for a long time or from a young age, plus being on testosterone. 

Definition of pcos:

It is a very common condition which effects many people with ovaries and  reproductive organs. There are three main features:

1. Irregular cycles, meaning ovulation doesn't occur regularly or at all. 
2. Higher testosterone hormones (for average cis- female)
3. Inflamed ovaries which contain fluid filled follicle sac (not always cysts dispute the name) 

These are the main features which will be diagnosed through ultrasound scans and blood work. There are however different types and PCOS effects many people in very different ways. Therefore it is hard to know how many people have pcos by its suspects its every 1 in 10. However people can also have cysts on there ovaries and it not mean anything or have no effect to fertility at all. 

These are some symptoms that people will pcos many experiences but some may not have any at all. Usual displays around early 20's.

Symptoms:

• Irregular periods or none at all
• Difficulty getting pregnant as a result of irregular ovulation or failure to ovulate
• Excessive hair growth - usually on face, chest, back and buttocks. (Cis or pre HRT if trans like me) 
• Weight gain
• Thinning hair or hair loss from the head 
• oily skin or acne

The cause of PCOS is unknown, but believe it can run in families. There is no clear treatment however there are thing that can help to evelate symptoms, plus medications that can help those who struggle to get pregnant due to PCOS. 

Many people find lifestyle diet and losing weigh can alone have a huge positive impact for symptoms and there chance to get pregnant however some still struggle with fertility due to irregular cycles where ovulation does occur naturally therefore medication such a clomid is used to stimulate the current hormonal imbalances to obtain ovulation. Sometimes this is enough, whilst others many need a combination of medication and/or surgery. Others may also have to seek specialist and have IVF in order to conceive. It is a very unique journey for anyone trying to conceive and difficult in individual ways. But if you are trying keep going, hoping and fighting you can do this. 

(see reference link below for more information) 

My personal PCOS journey

So other then cysts on my scan, my blood work taken have all come back normal so never fully had a yes you do or do not have PCOS, so who knows. A friend who is a midwives is monitoring my hormones and telling me when and what bloods to request from the gp. So far they been really good and match what they should be for good fertility at the right points within my cycle. I seem to have longer cycles around 37 days. The average is 28, but again very personlised to everyone. Doctors suggest anywhere between 21-40 is considered normal. I also do get positive ovulation test (I use clear blue digital ones) every 16 days after my period. Again average is 12-14 but everyone is different. I do not get any other symptoms of PCOS at all. Pre testosterone before transitioning I had no excessive hair growth, no weigh gain, no bad acne. I mean everyone has a bit of acne in puberty. But went away quickly. I do not have thinning hair or hair loss. Along with my blood level being good. I just have cysts. 

I will go on to explain what hormones and what they mean or do at different points. 

Hormones 

There are four main hormones that are important it terms of fertility theses are:

1. Fsh 
2. Oestradiol 
3. Progesterone 
4. Lh

These do different things at different points in your cycle. 

So there are four stages of a reproductive cycle. 

Menstruation (period) 

follicular 

Ovulation (Mid cycle) 

Luteal stage. 

In this order as well. The photo shows the stages and level that your hormones rise and fall during a standard 28 day cycle however every bodies cycles are different and can be shorter or or longer with ovulation happening at different times. But it just gives a rough show of the four different hormones and what they do. 

As you can see they all start low after Menstruation then estrogen rises slightly to fall again mid way through the follicular phase. Before rising just before ovulation and dropping again. Then a small rise and fall, if pregnant it will stay risen after implantation occurs. This is very simpler to progression which is the hormone that is most important in pregnancy, this hormone is what makes the egg ready to be fertilised so rises after ovulation and will drop again, however stay risen if pregnancy happens. 

The LH hormone is what ovulation sticks measure this is the hormone that results in an egg being released. Ones released the egg waits to be feritilisted. LH levels drop and progresrone hormones rise to thicken the lining of the womb which helps a feritilisted egg stick. If pregnancy happens the progresrone stays high, Lh can also stay risen. Estrogen and HCG hormones rise as well. The HCG is what pregnancy test pick up on and what they measure in blood to confirm early pregnancy. 

Hope this information helps other understand PCOS and hormonal levels more and what role they have to play in fertility. 

Referances

https://www.fertilityanswers.com/understanding-how-your-monthly-cycle-relates-to-fertility/

https://www.nhs.uk/conditions/polycystic-ovary-syndrome-pcos

(December 2020)