PCOS and My Battle with the Androgens
Across all of my studies in neuroscience and the health sciences, only now have I really learned the specifics about the female reproductive system and the processes of fertilization and ovulation in detail.
I know, it seems a little odd to be a grown woman of 23 years and have only really learned about these processes now, but what really struck me was that, aside from realizing this was the first in-depth learning experience I’ve had with these systems, I’m lacking a solid understanding of my own medical condition directly involved with this system: polycystic ovarian syndrome, also known as “PCOS.”
All I really knew about PCOS until this point is that I’ve had it since I was about 15, I have little cysts all over my ovary (mainly the left, a few on the right), I have more testosterone than the average lady, it makes me susceptible to infertility (somehow), it made me have my period only like thrice a year (sweet! …or so I thought), and that it causes me a lot of pain once in a while.
For a long time, I’ve indulged my scientific curiosity by analyzing everything in the world that’s available to analyze, ranging from engine mechanics to the clinical pharmacology of my eyedrops, but never have I once thought, “hey, I should probably learn more about this condition that directly affects my life.”
What I learned from my pathophysiology lecture taught me that the ovaries play a pretty important role in reproduction. To simplify the magical process for you: the ovaries essentially house the developing ovarian follicles, which are little sacs that provide the ideal environment for egg maturation, until the egg (within the follicle) is ready to be burst from the ovary and taken up by the fimbriae of one of the fallopian tubes (imagine this little vacuum that reaches out to the egg to grab it suck it up), to then be pushed toward approaching sperm cells within that fallopian tube (imagine literally just this little transport tube) for fertilization. With such a key role in the very beginning stages of fertilization, it’s no wonder that my OBGYN told me that PCOS has a chance of affecting whether or not I could have a child.
Up until now, I’ve brushed that idea off for two reasons: one, I was young, and you don’t think about having children when you’re young, and two, because I didn’t really understand the intricacies of fertilization anyway, so as they say, ignorance is bliss.
However, now it’s time for a little clearer understanding as I move ever so closer to the call of starting a family.
Clinical signs of PCOS include high levels of androgens and/or physical manifestations of these levels (e.g. acne, excessive hair growth), cysts on one or both ovaries (detectable via ultrasound), and absence of ovulation (usually resulting in irregular periods). Symptoms of PCOS include irregular menstrual cycle, weight gain (typically manifested as being overweight since puberty), hirsutism (excessive hair or hair where it’s not common on a woman, such as the upper lip and arms), and acne.
Personally, another symptom I experienced for several months before being diagnosed was aggressiveness. The National Institutes of Health (NIH) document on PCOS does mention “mood swings” as a condition that women with PCOS are susceptible to, but I would have interpreted this as something akin to premenstrual syndrome.
With PCOS, the key sign and characteristic of the syndrome is that a woman possesses an imbalance of hormones; more specifically, that she has an abnormally high level of androgens present, typically testosterone, which not only affects her estrogen levels, thus affecting the effects of estrogen such as ovulation, but also causing her to exhibit traits of a human with high testosterone levels (usually a male). As mentioned, hair growth is the most common, but for me, it was my newfound aggression that told me something was wrong.
In high school, I wasn’t in the greatest of relationships, so being shoved was common during our fights. However, when the aggression started to come around, I shoved back. I would sometimes more than shove back. I yelled. When I pushed him, I felt this surge that made me want to push him more. Pretty soon, I also become more aggressive in sports; I would verbally grunt, try to hit the ball harder than usual, and feel this overwhelming satisfaction of dominance whenever I scored a point. I know what you’re thinking: this girl needed help. However, aside from the social factors in play here, consider the effects of testosterone on the brain: testosterone acts on the amygdala, which is essentially our human emotional center. The amygdala’s attempts to act on our emotions are typically held back by our prefrontal cortex (PFC), which you can think of as our center for social inhibitions and making sure we act appropriately. However, when testosterone acts on the amygdala, it supercharges it in a sense, allowing it to override the inhibitions of the PFC, allowing us to release our emotions through physical muscle movement via the neuroendocrine system. While the actual intricacies of this process are complex, this high-level summary provides pretty clear reasoning as to why males, and women like me, behave the way we do with our testosterone fueling its own manifestations.
Considering a happier ending, what are the treatments for PCOS? While a lot of organizations and websites with information on PCOS list treatment options such as weight loss, symptom management, monitoring yourself for the development of diabetes/cancer, and medicine, there really is no cure. Personally, I went to an endocrinologist and I ended up taking Metformin every day to proactively manage the insulin-related side effects of PCOS, but what ended up helping me was continuing my sports to provide an outlet for my aggression as well as to help me stay fit to keep the other symptoms of PCOS at bay.
Forgive my high word count–I’m just so happy that I actually understand the pathophysiology behind my condition; I’m interested and intrigued instead of afraid, and I feel a sense of control knowing why things have happened and why being a little chubby despite all this physical activity is OK.
I thought that if I learned more about my condition, I would be afraid, but now I’ve conversely found bliss in understanding instead.