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Ask Jerilynn |
Androgen Excess
My background: I started menstruating when I was 15 years old and had really heavy week long periods, but they were irregular and did not come very often. When I was about 17 I started getting big pimples on my face, my Doctor at the time told me that it was because my periods were irregular and prescribed me Diane 35. It worked. I was on Diane for 5 years.
The problem now: I am now almost 22. I went off Diane at the end of February and not including the initial period, I haven’t had one since (about 6 months!). I went off Diane because of fear of long term side effects, especially considering my mother’s history of estrogen dependent cancers (atypia cells in her breasts, and ovarian cancer). Since I went off the Diane, however, my skin has gotten extremely bad and I have severe acne concentrated on my chin.
I am concerned for many reasons including that I am petite and worry about osteoporosis. I am tempted to go back on Diane 35 because it helped in so many respects, but again am apprehensive... Any suggestions you might have for me would be greatly appreciated.
It is not good to skip periods. And acne is painful, embarrassing and difficult
to live with. I agree with you about being careful about the birth control pill,
Diane, because it now one of the higher dose estrogen pills.
Your story, which you told very clearly is absolutely typical of something called
Anovulatory Androgen Excess (often also called PCOS). Two good news aspects of
that—it’s very treatable, and low bone density is not a risk with it.
Let me explain. Anovulatory androgen excess is a partially genetic condition
in which the ovary is pushed by the brain and pituitary hormones to make more
estrogen and androgen (male hormones). These interfere with ovulation and making
progesterone. The constant rather than changing estrogen levels is usually what
causes delayed periods. The higher male hormones cause the acne and sometimes
hair where you don’t want it like on the face and less hair on the sides of the
forehead. Like with you, it often starts druring the teen years with periods
that are far apart (typically six weeks to two months). It is worse if a woman
becomes heavy (this hormone situation makes it difficult to keep from gaining
weight) and doesn’t exercise.
I’d suggest going to our website and starting to keep the daily
Menstrual Cycle Diary you can download
from there. I’d also suggest that you print the Cyclic
Progesterone Therapy handout, study it and take it to your family
doctor. Finally, there is an article called “Ovulatory
Disturbances—They
Do Matter.” I’d read that, especially the table that describes two kinds
of ovulation problems—Turned On and Turned Off. You have the Turned On
kind, it sounds like.
I’d suggest that you take cyclic progesterone therapy. You will probably get
a period. If you don’t, take progesterone for two weeks, stop for two weeks and
then take it again. If you need contraception, use barrier methods.
Once you’re onto the cyclic progesterone I’d add a medicine called spironolactone
(in a dose of 100 mg a day). Your family doctor can prescribe it. Spironolactone
blocks the action of male hormones at the cell and also helps to lower testosterone
levels. That will allow you to begin to ovulate for yourself! Spironolactone
is similar to cyproterone acetate, the progestin, in Diane 35 pills. It is equally
effective and safer. Your acne should be mostly better within 3 months on the
combined progesterone and spironolactone therapy.
We will soon have an article about Anovulatory Androgen Excess on the CeMCOR
website.
Hope this is helpful to you.
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