Fit and feeling good, Lori Rufrano, then 32, thought it was the right time to get pregnant. So did everyone else. "People asked me, 'When are you going to have kids? What's taking so long?'" she says. Soon she found herself asking the same question. Months after taking her last birth control pill, Rufrano, a physician in Long Island, New York, specializing in geriatric medicine, still hadn't had a period.
Worried, she made an appointment with Avner Hershlag, M.D., a reproductive endocrinologist and chief of the Center for Human Reproduction at the North Shore-Long Island Jewish Health System. After a series of blood tests and an ultrasound, Rufrano got a diagnosis she had never suspected: polycystic ovary syndrome (PCOS), a hormone imbalance that affects up to 1 in 10 women of childbearing age.
Rufrano was shocked by the diagnosis because she hadn't had any symptoms—or so she thought. Turns out the Pill, which Rufrano had taken since her teens to help with painful ovarian cysts, had been masking the condition, temporarily resolving her cysts and regulating her period. By treating the symptoms, Rufrano thought she was fine, not realizing that she was dealing with a larger threat to her fertility and her health.
Women with PCOS may have elevated levels of male hormones, including testosterone, which prevent eggs from maturing and being released from the ovaries, Dr. Hershlag explains. Instead, eggs linger and form cysts. No healthy eggs means no periods and no babies. It may also quadruple the risk for uterine cancer, a study in Cancer Causes Control notes. If you don't ovulate, your endometrial lining thickens, allowing cancer cells to thrive.
Up to 70 percent of women with PCOS are also insulin-resistant, which can scramble your mix of sex hormones even more. Plus, insulin resistance may increase the risk for type 2 diabetes, heart disease and—if you do manage to get pregnant— complications such as gestational diabetes and preterm labor.
More than three million women take the Pill to regulate their cycle, and many of them start in their teens. According to a recent survey by the Guttmacher Institute, one third of teens ages 15 to 19 are on the Pill solely for noncontraceptive reasons, such as cysts and missed periods. Both of these can be crucial signs of PCOS, yet doctors often fail to check for the underlying problem, says Debra Minjarez, M.D., a reproductive endocrinologist at the Colorado Center for Reproductive Medicine.
"There are so many hormonal changes during adolescence that many doctors consider these a part of normal development," Dr. Minjarez says. "They prescribe birth control to regulate the cycle, assuming it will eventually regulate itself. But with PCOS, it doesn't."
This means that although PCOS usually develops during teen years, doctors often don't spot it until women want to start a family. By then, many are racing against their biological clock. "If PCOS were caught earlier, women could be helped before their fertility becomes an issue," Dr. Minjarez says. She would like to see doctors test teens with irregular cycles and urges women who take the Pill for cysts or skipped periods to get screened.
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