Interesting Pcos case study

Click polycystic ovary syndrome (PCOS) to read more about PCOS, its symptoms, treatment and management. This is a post discussing a pcos case study.

Pcos case study

The nurse’s initial review read “G3, P0+2, A0.” It was a form of medical shorthand used to summarize parity– a woman’s “reproductive career”. In this case it meant that the woman was pregnant for the third time [“G3”– gravida 3], did not carry the first two pregnancies beyond the age of viability haven miscarried them [ “P0+ 2”– para zero, plus 2 miscarriages], and as such she has no living child [“A0”– alive zero].

And she was complaining again of abdominal cramps, associated with vaginal bleeding, barely 3 months into the recent “pregnancy”. So, the nurse at the ANC suspecting a “Threatened miscarriage” [ more like “threatening” in the real sense; that is a miscarriage threatening to occur], had sent the patient to me for a review.

We are trained to be skeptics, not to accept anything hook,line, and sinker; to always reverify every piece of information. Because? Because like the fictional character Doctor House would say, “every patient lies”. Knowingly, or sincerely unknowingly [ that is without knowing that they are actually “lying”].

So after empathizing with them for 2 years of childless marriage, punctuated with 2 “miscarriages”, and another one threatening to happen, I put on my “game face” and started the history proper.

First things first. Was any of those “pregnancies” confirmed with a pregnancy test, or an ultrasound scan, before the “miscarriages”, I asked. No, they both answered.

So how did they know they were pregnant, I asked wide-eyed. She had missed her period for three consecutive months in each of the cases, and by virtue of that they assumed she was pregnant. Then in each of the cases, she had heavy vaginal bleeding afterwards,each associated with clots[clumps of blood] — the probable “miscarriages”.

Once again, I asked if they had confirmed the index pregnancy, and they said no.

Then for the first time I noticed that her voice sounded like a man’s, and a wild line of thought started tiptoeing its way into the back of my mind. And I decided to pursue it.

My argus eye caught the acne scattered all over her face, the coarse facial hairs and her obvious plus body size.

I wasn’t surprised when she said she’d been having irregular periods, neither was I surprised to find out that she had male pattern of pubic hair distribution during examination, nor was I surprised much later when pregnancy test done was negative, and ultrasound showed an empty womb and ovaries with multiple cysts.

And the diagnosis changed to “Primary Infertility, possibly due to PCOS”.

Fact is that she had never been pregnant and had never had any miscarriage. But of course, she did not lie about all that as she genuinely thought she was pregnant.

She had a condition called Polycystic Ovarian Syndrome [PCOS] which was messing up with her hormones and her periods, giving her a false hope of being pregnant when in essence she was not.

The deep voice, coarse facial hairs, male pattern of pubic hair distribution, and acne, together all points towards “masculinization” due to an increase in level of androgens [male hormones]. The irregular cycles with long periods of cessation of menstruation points towards a possible ovulation dysfunction with either oligo-ovulatory or anovulatory cycles, that is bleeding without ovulating. And then there was the multiple cysts in the ovaries.

All three [hyperandrogenism; anovulation or oligo-ovulation leading to amenorrhea or oligomenorrhoea; and polycystic ovaries] are part of the diagnostic criteria for PCOS.

The first part of solving any problem is identifying it. That I have done. The next step is the solution to the problem. To that end, I have referred them to a gynaecologist. And hopefully, they will be pregnant soon and have their own child.

This story does not in any way suggest that any person who missed her period for some months, who also didn’t do a pregnancy test to confirm it, and then had vaginal bleeding thereafter was never pregnant and therefore didn’t have a miscarriage.

Also, it does not in any way suggest that any female who has a deep voice, or coarse facial hairs, or facial acne, or male pattern of pubic hair distribution, has hyperandrogenism. And even if the person has hyperandrogenism, please note that it is not all cases that is associated with PCOS! Medical syndromes are constellation of specific findings, and one of such finding is not enough for a diagnosis.

PCOS is not tantamount to infertility; while it is a cause, a great number of women with PCOS may have babies even without any medical intervention. The ones that cannot, most of them would still be able to have children with medical intervention.