Hi Judie,

I have a question that I was wondering if you could answer. If not, could you please forward this to a specific doctor or have a specific doctor contact this email?

My fiancee has polycystic ovarian syndrome and struggles with higher testosterone levels. This has caused her to have irregular cycles. She is diabetic and currently take the drug metformin, which is generally considered one treatment for irregular cycles. We are now a few months from marriage, and her cycles have begun to become irregular again.

In marriage, we know the birth control pill is absolutely not an option. That seems to be all that doctors want to prescribe to regulate it though. There is the option of taking clomid in order to help with getting pregnant, but what options are there to help regulate her cycle and avoid the symptoms involved with high testosterone levels? I love her very much Judie, and I know she's been hurting a lot with this. Seeing how worried this has made her is very tough and sad. Any help and any prayers offered for her with this would be greatly appreciated. Thank you and God bless you for all that you do.

Dear Scott

Here is a response to your question from Anthony Dardano, M.D.

Polycystic ovary syndrome is the condition where the ovaries are filled with tiny cysts and a hypertrophic exterior which secretes an elevated level of the male hormone testosterone. The result is ususally irregular menses and fertility problems. Metformin is a common therapy and it's good you are already on it. The diuretic spironolactone is also used to help reduce the testosterone. This in turn helps regulate the cycle by allowing the estrogen which is also being produced, to now become the dominant hormone. Strict diabetic control as well as ruling out any thyroid imbalance is crucial as well. When and IF fertility becomes an issue, clomid can be used. Clomid alone is given for 5 days or so to induce ovulation. This drug merely helps your pituitary gland release it's own natural hormone which in turn will act on your ovary to release your own egg. There have been no harmful effects as it is gone from the body by the time conception were to occur. Usually the most effective therapy is a "wedge resection" which is a procedure which re-arranges the anatomy of the ovary such that the monthly follicles containing the eggs are now on the surface of the ovary where they belong instead of being buried in this thickened capsule. This is a time honored procedure which has been very effective. Today it's even easier because of the minimally invasive surgery offered by laparoscopy which can make this an out patient procedure. As a side comment, I see no place for the pill. The pill supresses ovulation. Ovulation is already surpressed by the condition. All the pill does is mask the symptoms. The regularization of the cycle is artificial so that one might appear to be "normal" but of course is not. I should mention that frequently, natural progesterone taken from day 16-25 of the cycle will also regulate the flow without artificially altering the reproductive physiology. I realize this is a complex subject but you seem to be well informed and what's more important, willing to live according to God's Will. He in turn will help you through this.

Anthony N Dardano, MD, FACOG, FACS

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