When it comes to taking care of your health, asking questions never hurts. But is it always worth a visit to your doctor? We’re asking experts to weigh in on your burning questions—from feminine to general health and everything in between—so you can get advice from a pro before you go. The doctor will see you now.
Polycystic ovary syndrome is a hormonal imbalance that is notoriously hard to diagnose. PCOS affects up to 10 percent of women, causing irregular periods, obesity, hirsutism (excessive hair growth), and infertility, and it has been linked to an increased risk of developing insulin resistance, type 2 diabetes, high cholesterol, high blood pressure, and heart disease. Patients can present with any number of symptoms, and there is no definitive laboratory test to yield a straight answer.
According to the PCOS Foundation, true PCOS has been recognized and diagnosed by doctors for seventy-five years. But a new kind of PCOS diagnosis has been coming on the scene: temporary PCOS. What is it? According to Dr. A. Nicky Hjort, M.D., OB-GYN, temporary PCOS, also known as “pill-induced PCOS,” is essentially “post–oral contraceptive pill cycle irregularity,” which means that women who are coming off the pill have symptoms similar to PCOS. Dr. Hjort gave us the 411 on this emerging condition.
Q. How is the pill related to temporary PCOS?
Dr. Hjort notes, “What is commonly seen as a clinical picture consistent with PCOS can be described in patients that have just recently come off of birth control pills.” Hormonal birth control “suppresses communication hormonally between the ovaries, the uterus, and the brain.” When the average woman comes off of the pill, that communication should resume in a “cyclic, hormonal, appropriate fashion, and the woman goes right back to having regular cycles,” Dr. Hjort says.
Sometimes a woman’s cycle resumes so intensely that there is a “slight spike in the rate of twins, or double ovulation, in the cycle coming off long-term birth control use.” Other women, especially those who may be particularly sensitive to hormonal contraception or who have used hormonal birth control for a long time, may have had ovulation suppression for years, Dr. Hjort says. She cites the timespan after coming off of the long-term use of the pill as a “very common time for women to be diagnosed—or misdiagnosed—with PCOS.”
Q. How common is temporary PCOS?
Any woman who had regular periods before taking the pill and doesn’t experience periods for at least three months after coming off of it may be diagnosed with pill-induced PCOS. But in her practice, Dr. Hjort only hears patients complain about temporary PCOS “maybe one or two times a year.” She says the condition is rarely serious, although it can be. When a woman comes off of the pill and her cycle doesn't resume with regularity, she should see her doctor to investigate the causes.
Q. Why else might a woman’s cycle not resume post-pill?
The first test Dr. Hjort orders in this situation is a pregnancy test. If that’s negative, the next possibility is that “the patient might have always had PCOS,” but the pill was masking it. After all, hormonal birth control is often prescribed to regulate irregular cycles.
If a patient didn’t have a PCOS diagnosis before starting on the pill, but her periods don’t resume after she comes off of it, Dr. Hjort looks for other classic PCOS symptoms, including acne, hirsutism, insulin resistance, and “polycystic appearance of the ovaries, which is sometimes seen [via ultrasound], but not always.”
A third possible cause of an absent period post-pill that is unrelated to either true or temporary PCOS is hypothalamic amenorrhea, a malfunction of the hypothalamus gland that causes a lack of ovulation. It’s commonly seen in “underweight, super thin patients, patients that are anorexic,” and those under “extreme psychological or physical stress, which would include marathon runners,” says Dr. Hjort. These patients’ bodies aren’t able to produce enough hormones—particularly estrogen— because they don’t have enough body fat.
Q. How can I know if my PCOS is temporary or chronic?
Women with true PCOS and temporary PCOS may present symptoms in very similar ways—acne, insulin resistance, and hormone levels in lab testing, namely a higher ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH), both necessary for a regular reproductive cycle.
Dr. Hjort says one of the main differences to note is whether or not the patient had regular cycles before starting the Pill. If she did, she says the condition may “spontaneously resolve” anywhere between a month and a year after Pill use lapses. Dr. Hjort gives a patient at least ninety days to see what her body does on its own before introducing intervention such as hormone and nutrition supplements.
As with so many issues related to our menstrual cycles, temporary PCOS may be your body’s way of telling you that something isn’t quite right. With careful attention (a feminine health habit you should be doing anyway!) and regular check-ins with your doctor, you can use that knowledge to resolve problems or catch them before they even begin.
Photo Credit: Eleanor Rask