PCOS

PCOS is a condition that affects women, often during teenage or young adult years.  This condition is associated with increased weight, acne, irregular periods, or unwanted hair growth.  The symptoms of this condition are related to hormone function.

People with PCOS should have a menstrual abnormality for 2 years or more.  This may be irregular frequency of periods, such as no period for 90 or more days, or a later age of the first period, for example.  Many people with PCOS have increased body weight, male pattern hair growth, high blood sugar or difficult to control acne symptoms.

There are several conditions that are similar to PCOS.  These are normally related to other hormone conditions, such as those that affect the thyroid, cortisol, growth hormone, or prolactin hormone functions.

PCOS can be diagnosed with a clinical exam and history, an ultrasound test of the ovaries, and tests for hormone levels such as testosterone, hCG, TSH, and FSH.  When the diagnosis is made, evaluation of sleep disorders, glucose level, cholesterol and heart function are often considered.

Infertility management

Women may have problems having a pregnancy for a variety of reasons.  These include:

Body weight far above or below the ideal level

Women who are very thin or very overweight may observe irregularity of their menstrual cycle.  This has an effect on the success of pregnancy, since differences in weight may affect hormone production.  Women who exercise a lot may have similar symptoms.  Some women who are overweight have polycystic ovarian syndrome, a condition that affects egg production and influences body weight.

Changes in hormones that are needed to regulate the monthly cycle

Some women with infertility may have problems making hormones necessary for pregnancy, such as prolactin, FSH or LH.  These hormones can be measured by blood tests, and treatments to replace or influence these hormones levels may be helpful.

Changes in the structures of the fallopian tubes or uterus

A variety of factors can affect the structure of the uterus or the fallopian tubes.  The fallopian tubes are necessary to deliver eggs from the ovary to the uterus, where fertilization and implantation occur.  Fallopian tubes can be affected by conditions like endometriosis or pelvic inflammatory disease.  The uterus can be affected by these causes as well as fibroids, the uterus structure, or other factors.

Treatments for infertility depend on the cause.  Sometimes specialized treatments are helpful for infertility.  These may be stimulation of egg production with a medicine like clomid, in vitro fertilization, or selection of eggs and sperm with normal genetic material to facilitate a healthy pregnancy.

Hyperparathyroidism

Hyperparathyroidism is a condition when the parathyroid hormone is elevated.  This may be the cause of kidney stones, but most cases of hyperparathyroidism cause an elevated blood calcium level without symptoms.  Elevated calcium can be related to symptoms of fatigue, depression, muscle pain, bone pain, or changes in the bones also.  People with fibromyalgia symptoms have symptoms similar to those with hyperparathyroidism. 

Testing for hyperparathyroidism

People with hyperparathyroidism may have an elevated parathyroid hormone or ionized calcium level in the blood.  Sometimes urinary calcium levels are elevated.  At the same time, tests for creatinine, vitamin D, alkaline phosphatase, phosphate, and magnesium should be normal.

Causes of hyperparathyroidism

Elevated parathyroid hormone can be caused by side effects of medicines, changes in the parathyroid gland, certain kinds of cancer, and changes in calcium metabolism.

Treatment of hyperparathyroidism

Clinical observation is an important part of caring for this condition.  This may include lab tests or bone density monitoring.  Some patients use a medicine to protect the bone density in this condition. Others use a medicine to help keep calcium levels low.  Surgery of the parathyroid gland is also sometimes helpful.

References:

Marx SJ, N Engl J Med 2000 Dec 21: 343(25) 1863-75, Hyperparathyroid and hypoparathyroid disorders

Ferrari and Russell, Clin Rheum 2015 Jul 34(7): 1279-83, Prevalence of primary hyperparathyroidism in a referred sample of fibromyalgia patients

Hypothyroidism

Low levels of thyroid hormone interfere with metabolism.  Sometimes the thyroid gland does not make enough hormone, especially in older women.   Symptoms of hypothyroidism can include fatigue, a puffy face, weight gain, irregular periods, depression, muscle aches, weakness, memory dysfunction, or dry skin.

Hypothyroidism if diagnosed by blood tests.  People who have a high TSH and a low T4 are hypothyroid. Sometimes people may also have a low T4 and an inappropriately low TSH.
Treatment of hypothyroidism is usually done with a thyroid hormone supplement.

hyperthyroidism

When the thyroid hormone is elevated, the symptoms may be a tremor, weakness, fatigue, weight loss, a faster heart rate, changes with emotions, or a feeling of anxiety.   Sometimes people with this condition notice a change in the size of the thyroid gland (which is in the front of the neck).

Thyroid function can be measured by laboratory testing.  Blood tests for TSH, T4 and T3 are often used to measure thyroid function.  There are also other tests which can help to measure the structure of the thyroid gland (ultrasound) or its hormone-making function (radio-iodine uptake).

Graves disease is a common cause of hyperthyroidism.  In this condition, the body’s immune system stimulates the thyroid gland to make thyroid hormone.  Other causes of hyperthyroidism include inflammation of the gland and overactive thyroid nodules.