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Every once in a while someone will stop and ask me whether I have come out with my next book. I will respond “It is coming, I just do not know when.” Writing a quality book is not easy. You complete a manuscript, send it to the editor after which you respond to the editor’s comments and re-write some parts of the book before sending it off again to the editor. I am now in the process of the second review of the second set of comments by the editor.  The new book is similar to Letters to My Sisters, Plain Truths and Straightforward Advice from a Gynecologist in that it will be in letter format; but this time each letter is followed by health statistics. We are not alone when dealing with health issues. As with the first book, the aim is to continue what we started with the original book in educating ourselves about health issues and conditions affecting women of all ages. The approach in writing the book is deliberate and meant to foster conversations that are intergenerational allowing nieces to freely discuss issues with aunties, granddaughters with grandmothers, and vice versa.

Below is an excerpt from the book that does not yet have a title.

Polycystic Ovary Syndrome (PCOS)

Dear Ms. Fenning,

You came to me for a second opinion because you did not want to be labeled with a diagnosis. You had never heard of polycystic ovary syndrome. You had moved here about two years ago and prior to this you had been seeing a gynecologist for five years and they never said anything. The first gynecologist you saw when you moved here made the diagnosis and you were rather upset. I finally reviewed your lab work and based on the history I obtained from you and the physical exam at your last visit, I agree with your new gynecologist—you have polycystic ovary syndrome. The short name for this is PCOS.

I know that this may come as a surprise, and you might be wondering why your other gynecologist never said anything. It can take years and sometimes requires seeing multiple gynecologists before the diagnosis is made.

The diagnosis of PCOS is usually one of exclusion, meaning we have to rule out all other possible reasons for your current symptoms. Typically the symptoms include irregular menstrual cycle, or for some women no menstrual cycle, abnormal hair growth, and at least one polycystic ovary (one with multiple small cysts inside) confirmed by ultrasound. You need at least two of these symptoms to be diagnosed with PCOS and we have to make sure nothing else can explain these symptoms.

I recall that you also mentioned that you were not “fat” and that according to your research, people with PCOS tend to be overweight. All women have the possibility of being diagnosed with PCOS regardless of their weight. Although majority of women who have PCOS tend to be overweight or obese, thin people can have PCOS.

Based on your history and physical exam, you actually have all three symptoms. You mentioned that your periods have been irregular for the past five years, and although you liked not having a period every month, you cannot predict when you will have one so you always have to carry a pad. You also mentioned that you have had an increase in facial hair that is requiring you to shave most mornings. You did not worry about that because all the women in your family are hairy. Lastly, the ultrasound revealed that one of your ovaries is polycystic. It has what we call in the medical field “a ring of pearls.” This is when we see follicles (little small cysts) around the ovary on the ultrasound image.

My recommendation is that you return to your gynecologist and discuss further management. I do not want you to go more than three months without a period, because that will put you at risk for precancer or cancer of the lining of the uterus. You will need to be screened for diabetes and high cholesterol. People with PCOS are at increased risk of chronic diseases in the future, and we want to catch things early. Finally, although it is true that you are not obese, based on your body mass index, you are overweight and would benefit from exercising and being mindful of your diet.

Although it increases your risk of developing certain serious health conditions, PCOS is not a death sentence. It is a chronic disease and can be managed. And yes, you will be able to have children; you just might require medication to help with ovulation. You will need to work with your gynecologist.

I hope I have explained everything in a way that is helpful to you. If you have any further questions for me, please do not hesitate to schedule an appointment.

Take care and all the best,

Ngozi Osuagwu, MD, FACOG

The incidence of PCOS varies according to the diagnostic criteria used.¹

Using the National Institutes of Health Criteria, the incidence of PCOS is approximately 7% of reproductive-aged women.¹

Obesity is not a diagnostic criterion for PCOS, and approximately 20% of women with PCOS are not obese.¹

Polycystic ovaries appear to be inherited as an autosomal dominant trait: Among women who have PCOS, 3% to 35% of their mothers have PCOS.²

Sources: ¹American College of Obstetricians and Gynecologists. Polycystic ovary syndrome. ACOG Practice Bulletin No. 194. Obstet Gynecol 2018;131:e157–e171; ²Rosenfield RL. The Diagnosis of Polycystic Ovary Syndrome in Adolescents. Pediatrics 2015;136:1154–1165.