Birth Control and Body Dysmorphia: Living with Polycystic Ovary Syndrome
I remember being fifteen years old, standing on the scale at Physicians for Women of Greensboro. I held my breath and fixed my eyes on the blank wall above the scale, avoiding the sight of the nurse continuing to slide the weights like my life depended on it. I nervously fiddled with a loose thread on my khakis, still in my uniform from my day at school.
The nurse’s manicured hands finally stopped moving. I braced myself for impact and held back the tears that threatened to spill from my eyes.
“156 pounds,” she nonchalantly muttered under her breath as she wrote that godforsaken number on my chart. “Alright sweetheart, time for your height.”
I stood frozen in place for a few seconds. I was reeling, my mind searching for a possible explanation. I didn’t eat much then, having developed disordered eating in middle school. How was that scale correct?
By the time I left my OB-GYN’s office that day, I had my answer: polycystic ovary syndrome. I also had four prescriptions to get filled at the pharmacy.
Polycystic ovary syndrome, PCOS, is a condition that results from an imbalance in sex hormone production characterized by ovulatory dysfunction and hyperandrogenism. PCOS is associated with infertility, decreased fertility, hirsutism, acne and metabolic complications that are linked to an increased risk of obesity, type II diabetes, and insulin resistance, according to research published by Oxford University Press.
My diagnosis came from an anomaly that appeared in the monthly blood work I was subjected to while on Isotretinoin for my cystic acne. My dermatologist pointed out an unusual amount of testosterone and a hormonal imbalance in my test results and advised my mother to make an appointment with a gynecologist.
In all, I was lucky. I was diagnosed at a young age and set on a path to control my symptoms. Not all women are granted the same opportunity. Although symptoms of PCOS can appear in adolescence, many patients aren’t diagnosed until adulthood. Early identification plays a vital role in symptom management, according to research published in the Journal of the American Academy of PAs in October 2021.
An estimated 4-20% of women of reproductive age worldwide are affected by PCOS, according to research published in the Journal of Human Reproductive Sciences. However, many women remain undiagnosed due a lack of awareness about PCOS symptoms.
To be diagnosed with PCOS, patients must meet two of the following criteria: (1) evidence of excess testosterone production either through blood testing or symptoms such as acne or excessive hair growth, (2) irregular or absent periods and (3) the presence of polycystic ovaries on ultrasound, according to research published by Oxford University Press.
However, variation in the severity and prevalence of such symptoms can make it difficult to properly diagnose PCOS. According to a study published in Human Reproduction Open in October 2019, the uncertainty and complexity of diagnosing PCOS has led to both underdiagnosis and overdiagnosis of PCOS.
PCOS was first properly defined and extensively described in a paper published in 1935 by Irving Freiler Stein and Michael Leventhal titled “Amenorrhea associated with polycystic ovaries.” According to a journal article published in the American Journal of Obstetrics and Gynecology, a little over 8,000 publications were released between 1950 and 2000. In the 15 year period between 2001 and 2015, over 20,000 publications about PCOS were published.
Despite the exponential growth in literature on the topic, women potentially living with PCOS remain oblivious to it. In an attempt to soften the blow of my initial diagnosis, my OB-GYN told me there was a good chance I knew another woman who had undiagnosed PCOS. She said many of the women she treats often brush off their symptoms as normal experiences that come with menstruating or just ‘being a woman.’
This was somewhat the case for me. When I got my period for the first time at age 14, I assumed the things I experienced were normal. Everyone loses enough blood to make them nearly pass out every month, right? Don’t we all endure cramps so painful they render you immobile for hours on end? What do you mean you don’t get extremely dizzy every time you move an inch?
I thought the other common symptoms of PCOS were simply part of puberty and growing up. However, when I noticed my friends weren’t dealing with stubborn severe cystic acne or wrestling with ever-fluctuating numbers on their scales like I was, I felt jealousy burn inside me.
After my diagnosis, I felt a little better knowing I had something to point to as the root cause of the issues I struggled with. Still, I was somewhat alienated from my friends. I suddenly had a million things to worry about to stay on track and make my symptoms more manageable. They could just be normal teenage girls.
Every morning before school, I would pop open my weekly pill case and swallow the multicolored prescriptions inside with a gulp of water.
There were four of them; metformin, a drug normally used by patients with type 2 diabetes to control my blood sugar and insulin; phentermine, an amphetamine-like anorectic to suppress my appetite; famotidine to ease my acid reflux; and Lo Loestrin Fe, a low-dose birth control to stop my period and decrease the risk of developing cysts on my ovaries.
As I swallowed each pill, I sometimes wondered about my friends’ morning routines. They probably didn’t even have a pill case. Maybe they just took a Flintstone gummy vitamin and called it a day. They didn’t know how lucky they were.
I was put on all of those prescriptions at age 15. Six years later, I still take all of them every morning without fail. I wish I didn’t have to, but staying on a treatment plan is the only way to control PCOS symptoms. There is no cure.
According to a journal article published in the National Library of Medicine, the costs to the United States healthcare system for diagnosing and managing PCOS are around $4 billion each year. PCOS patients are normally put on a course to manage most of their symptoms through medications and lifestyle changes, though treatment plans vary depending on the symptoms that are present in each patient. Metformin is one of the most commonly prescribed medications for PCOS patients, according to the same journal article. For patients who wish to improve their fertility, drugs such as Clomiphene can help induce ovulation, especially when combined with antidiabetics.
The prescriptions I take have helped me dramatically over the past few years. My energy levels are more regulated. My birth control stopped my period, letting me live free of stabbing cramps and migraine-inducing dizziness. I finally shed the weight that once caused me to tip the scale close to 160 pounds. Despite an improvement in my physical condition, my mental health has worsened.
PCOS has been found to directly result in psychological problems. According to a study published in Archives of Women’s Mental Health in February 2021, physical and metabolic changes caused by PCOS can lead to depression, anxiety, eating disorders, low self-esteem and decreased physical satisfaction.
The same study found that the issue of infertility can cause patients to feel a loss of womanhood and therefore develop long-term depression and an altered feminine identity. These mental effects of PCOS result in a lower quality of life, which can lead to diminished sexual satisfaction and issues in personal and professional environments.
Even before I knew I had PCOS, I grappled with self-esteem and body-image issues. Having to worry about my weight at such a young age took a toll on my mental health.
My mother has PCOS too, though she didn’t know it until much later in her life. When I was younger, she would tell me stories about how she used to come home after school and cry into her pillow over her weight as a way to scare me into eating healthily. I found it hard to believe because I’ve only known the version of my mother who is stick thin and eats like a bird, but she told me that losing the weight took her years and she refuses to do anything that might jeopardize her progress.
Seeing me suffer through the same symptoms of PCOS she battled in her youth probably made her want to keep me from experiencing the pain she felt for so long. She meant well, but she also caused me to fret over everything I ate in order to keep my weight in check. She took me to a dietitian who made me write down every single calorie I consumed. If you ask me, that sounds like a recipe for disordered eating.
I worried constantly about my appearance. I stole glances in every reflective surface I came across and actively avoided events that required me to wear clothing that exposed my insecurities. It wasn’t until my junior year of high school that I was formally diagnosed with body dysmorphic disorder.
PCOS affects me physically, but the mental consequences are arguably worse than any somatic side effect. It hangs over my head constantly like a dark cloud. Knowing that it has crept into all areas of my life is frustrating and frightening. I wonder what my life would be like had I been one of the lucky ones who dodged PCOS entirely.
Unfortunately, I wasn’t so lucky, but at least it’s not like I’m alone in dealing with PCOS. As previously stated, PCOS affects a considerable percentage of women of reproductive age around the world. PCOS is one of the most common endocrine disorders, meaning there’s a very good chance that you know someone who has it. The only issue is that no one talks about it.
Even to this day, I still feel a flush of embarrassment whenever I tell someone I have PCOS. I usually get bombarded with questions, usually concerning whether or not I actually have cysts on my ovaries. Maybe one day I won’t feel so self-conscious about it. Better yet, maybe one day I’ll be given a magic cure for PCOS. I can only hope.
Cover Photo by Thought Catalog. Edited by Madison Case.