PCOS with normal labwork?

Question

This is a long question, for which I apologize.
Some background: My OB/Gyn diagnosed me with PCOS, but my primary care doctor is skeptical of that diagnosis because although I have several of the symptoms (slight hirsutism, moderate acne, polycystic ovaries) my hormonal levels were all normal, I’m thin and I’m not insulin-resistant. My charted cycles are all over the place. One month is a textbook example with a BBT rise of 0.4 degrees and a luteal phase of 14 days (a 34-day cycle). Other cycles are only 24-26 days long, and if any BBT rise is present, it’s a very weak rise, and the luteal phases are much shorter–as short as five days. My last few cycles have been up and down like a yo-yo. Last month my cycle was 37 days long, with no discernible rise in BBT. This month, I’m on day 40 of my cycle — and my chart looks nearly like a sine wave. Temperature up to 98.1 one day, then down to 96.9 the next. Up and down, up and down. Aside from my cycles becoming more irregular, over the last few months my menses have also changed — from five days of bleeding to two days of normal bleeding, one day of light bleeding and two days of brown spotting. Are there any reasons for this? I’m not so much worried about interpreting my charts for family planning purposes as I am worried about whether my crazy charts might indicate some sort of problem…

Thank you so much.

Answer

Last Updated: July 23, 2013
One would need to review all your hormone levels to see what was tested and make sure the workup is thorough, as well as reviewing your charts. Fifteen percent of PCOS women are thin. Fasting insulin should really be very low – below 10 or lower if you are thin. You cannot just rely on the lab’s norms. My local lab states that fasting insulins up to 29 are normal, but this is not true for young, reproductive age women. You should have a 2 hour 75 gram glucose challenge test. Any abnormality whatsoever would go along with PCOS. FSH should be greater than LH. If LH is greater than FSH, sometimes this is the only indicator of PCOS. If your BMI (body mass index) is low, you could be having abnormal menses on the basis of low estrogen. You fail to state your age. Even in the early 30’s, a pattern of some normal cycles mixed with short luteal phase can indicate premenopause. Did you have 17-hydroxyprogesterone checked? Maybe you have an adrenal problem. If you think something may be abnormal, get a second opinion from a physcian who specializes in treating NFP patients, such as a medical consultant trained in the FertilityCare method.

Dr. Davenport

Answered By:

Mary Davenport, MD, MS
Mary Davenport, MD, FACOG, an obstetrician/gynecologist from the Oakland Region of California, offers telehealth services over MyCatholicDoctor.com She graduated from Tufts University School of Medicine and completed her residency at UC San Diego. Dr. Davenport is a Fellow of the American College of Obstetrics and Gynecology, and serves on the Advisory Board of the California Association of Natural Family Planning.

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