Dealing with Hirsutism

Synopsis: If your extra hair due to PCOS bothers you, here are some things you can try.

Women with PCOS often have excess hair growth (hirsutism) due to an overproduction of androgens. This results in sometimes dark, coarse hair growth, most commonly on the upper lip, chin/beard area, breasts, lower abdomen, inner thighs, and lower back, and less commonly on the chest, upper abdomen, and upper back. I know from personal experience that this hair growth can negatively impact one's self-confidence and body image! It can be challenging to look and feel feminine.

If your hirsutism bothers you, there are various solutions you might like to try.

Accept Your Body

While hirsutism can be annoying, it is not harmful in itself. It is certainly possible to love and accept your body and its appearance! Your hair growth may make you look different than some people's standards of beauty; however, the natural variance of human bodies lends to beauty! Do not be afraid to be different. Social pressure is not necessarily a reason to alter your appearance, and if you like the way you look, you will be confident, which is always an attractive feature. Hold your head high, be generous with your smile, and you will look and feel great!

Treat The Cause

Birth control pills can alter the hormonal balance in your body, slowing the growth of unwanted hair. Obviously this is not a good solution if you are trying to conceive.

Spironolactone is an anti-adrogenic prescription drug that can help treat hirsutism. It can take several months to see a noticeable difference in hair growth. It should not be used in pregnancy or breastfeeding. See the ASRM guide on Hirsutism and PCOS for other drugs that serve a similar purpose. 

Remove The Hair

Plucking unwanted hair is an option; however, in my experience, it often results in infection, causing acne. Waxing is a similar option with the same downside. 

Depilatories, which dissolve hair, may also be an option; however, they may irritate sensitive skin. 

You can bleach hair; this is most effective for small areas, such as the upper lip. The hair is not actually removed, but is less visible as a lighter color.

Shaving is another option; it may cause stubble, but is "probably the simplest and safest way to temporarily remove hair," according to the ASRM guide.  

Electrolysis permanently destroys hair follicles; however, this is done one hair follicle at a time, so may not be practical, and is fairly expensive.  

Laser hair removal is another option. I was told by a doctor that it was not a good option, because it is expensive and not permanent; however, the ASRM guide claims that it is effective (but not necessarily over the long-term). 

Ultimately, the best remedy for hirsutism is a combination of the three methods above: accepting your body, treating the cause, and removing unwanted hair. It may take some experimenting to figure out the right combination for you, but if you do not want to be a "bearded lady," you have options!

Choosing a Fertility Specialist

Synopsis: Choose a doctor with good credentials, with success rates near the national average, and, most importantly, that you like!

Before we went to a fertility specialist, I had seen three different gynecologists and had had both positive and negative experiences with them. I knew I wanted a fertility specialist who would take my case seriously and treat me with respect; I did not want my treatment to be delayed or impeded any further!

Luckily, I found a wonderful doctor that was recommended by my gynecologist AND whose clinic was in-network on my insurance plan. She also listened to my concerns and made me feel like I mattered!

If I were in the process of finding a new fertility doctor, here is what I would do:

1. Check my insurance network. I would see if there were any fertility specialists in-network for my insurance plan. Not all insurance policies offer coverage for infertility, but if yours does, it may be worthwhile to choose an in-network doctor.
2. Get a recommendation from my primary care physician/family doctor/gynecologist. If you have been seeing a doctor for fertility-related issues, or for anything else, ask if they have a recommendation for a fertility specialist. Chances are, they will know of a good specialist in your area.
3. Check the SART website. The Society for Assisted Reproductive Technology is a professional organization of doctors who perform IVF. Clinics that belong to this society meet high "meet the highest standards for quality, safety and patient care." You can compare the IVF outcomes of different clinics on their website. It is advisable to seek out a clinic with outcomes near the national average. 
4. Seek out reviews and ratings for the clinics and doctors I am interested in. If nobody has anything nice to say about a particular doctor, that might be an indication that there is a problem! However, keep in mind that "you can't please everyone" -- even a doctor that might be perfect for you has probably not been a good fit for someone else. 
5. Meet the doctor. I think it is extremely valuable to consult with your doctor face-to-face. Do you feel that he or she is concerned about your situation? Is the doctor willing to answer your questions in a way that you understand? Do you feel comfortable with the doctor and the staff? Do your personalities clash? This doctor and staff will be intimately involved in the creation of your family. It is worth finding someone that you like!

Healing Cracked Nipples

Synopsis: You don't have to endure a cracked nipple when you are breastfeeding!

Unrelated to my PCOS, I dealt with a cracked nipple for a time when I was beginning to nurse my baby. It was so painful when the baby would latch on that side that I avoided nursing on that side. Ultimately it was the reason I went to a lactation consultant.

What finally helped was:

Taking a few days off of nursing on that side, and instead solely pumping
Rinsing the nipple with salt water a few times a day
Applying breast milk to the nipple
Newman's Ointment
Lanolin

As long as the baby was still nursing on the damaged side, the nipple would not heal. Pumping allowed me to relieve engorgement and maintain my milk supply. It also helped me avoid further damaging my wound. Once it healed, we were able to recommence breastfeeding on both sides.

Breastfeeding with PCOS

Synopsis: PCOS can affect how much milk your body produces after your baby is born! Who knew?!

Before my baby was born, I had no idea having PCOS could impact breastfeeding!

Two weeks post-partum, I went to a lactation consultant for help with an injured nipple. I left devastated after learning my supply was not adequate to sustain my child (who was still half a pound shy of birth-weight).

Estimating my supply with a rented pump, I found I was producing about half the quantity of milk that my baby probably required. I was given instructions to nurse my baby every 2 hours, pump afterward, and supplement with formula and whatever I was able to pump. (As a new mom, this was completely overwhelming. Nursing my baby took an hour and pumping took probably half an hour altogether -- when was I expected to sleep?! Not a great solution!)

The lactation consultant suggested, and my own research confirmed, that taking Metformin could help my supply. Prior to my pregnancy I had been prescribed Metformin, so with the green light from my doctor, I recommenced taking it.

Although I still supplemented with formula, my supply seemed to improve. My nursing routine looked like this:

• Nurse on one side and simultaneously pump on the other
• Burp the baby & switch
• Bottle-feed the baby the pumped milk
• Bottle-feed the baby additional formula if she still seems hungry

I found that I was able to pump more if simultaneously nursing. Additionally, this resolved any pain from engorgement and limited possible leakage from a let-down.

While I was very disheartened to not be able to exclusively breastfeed, I continued to nurse my baby and supplement with formula until weaning at 10 months. My original goals had been much loftier, but I am glad I was able to provide immunity and at least some of her nutrition in this way!

What I will do differently next time:

• Go on Metformin right away after the baby is born
• Allow the baby to nurse longer at birth
• Start pumping in the hospital
• Weigh the baby more often the first couple of weeks to chart weight loss and re-gain
• Not give the baby a pacifier
• Just accept that a newborn wants to nurse ALL the time!

Intrauterine Insemination (IUI)

Synopsis: An IUI can be a viable treatment for infertility if you have PCOS!

After two years of trying to get pregnant, we made an appointment with a fertility clinic. The doctor confirmed my diagnosis of PCOS after looking through my medical records (especially blood test results) and recommended we try an Intrauterine Insemination (IUI).

I took Letrozole (Femara) for 5 days at the beginning of my menstrual cycle. This drug is used off-label in treating infertility; it is a breast cancer drug but can stimulate the ovaries just like Clomiphene (Clomid).

I went in for a baseline ultrasound early in my cycle. The following week I had a second ultrasound to confirm that my follicles looked good. I gave myself a shot of HCG (to stimulate ovulation), and then, two days later, went in for the actual IUI procedure. I was sent home with instructions to follow-up with intercourse that day, and to begin progesterone suppositories (progesterone is a hormone that supports pregnancy) the following day.

The procedure itself is much like a gynecological exam. You lie on the exam table, with your feet in stirrups, and the medical professional inserts a specula. The washed & prepared sperm are in a syringe attached to a catheter that is threaded through the cervix. Once inserted, the sperm are injected into the uterus. At the time of this writing, I have experienced 4 IUIs, and there can be some painful cramping! Fortunately, the process is fairly quick & straightforward. Following the IUI, the patient's pelvis is elevated slightly and the patient rests for 10-15 minutes.

My Infertility Timeline (#1)

Synopsis: It took two years to get pregnant, in spite of trying various medical interventions to help the process!

After two years of marriage, we decided we wanted to try for a baby! I stopped taking hormonal birth control and started reading Taking Charge of Your Fertility. I like to plan, and I was going to plan this baby, that's for sure. I began charting my basal body temperatures to figure out my cycles so we could have the best chances of pregnancy.

And then, my menstrual cycles went haywire. Like, 4 months without menstruation, then a month of spotting, and no rhyme nor reason to my temperature charts. Prior to using hormonal birth control, my cycles had been pretty regular, so at first, I attributed all of this to the hormonal changes of going off of birth control.

After six months of this, though, I decided to see a doctor. Blood tests revealed elevated prolactin and testosterone levels, and this combined with obvious anovulatory cycles landed me the PCOS diagnosis. I was prescribed Metformin and encouraged to lose weight.

Eight more months passed, and in spite of losing 30 lbs and having my cycles regulate, my doctor's advice was always, "Keep doing what you're doing, and call when you get pregnant!" At this point, at least, an HSG test was ordered, and a semen analysis was ordered for my husband.

My fallopian tubes were normal and there were no blockages. And my husband's semen analysis was "above average" -- no problems there. This was good news, but also confusing news, as my temperature charting indicated that ovulation was occurring each cycle, and now we knew that the tubes were fine as well. My doctor's advice was still, "Keep doing what you're doing, and call when you get pregnant!"

I decided to switch doctors, as it was obvious to me that the original doctor was not taking this as seriously as I thought she should.

After an unfruitful 17 months of trying to conceive, my new doctor had a new game plan for us. I was prescribed Femara and instructed to start using ovulation predictors in addition to charting my temperatures. When the test strips indicated impending ovulation, we were to abstain the day of the test and then have intercourse the next day.

Six cycles (=6 months) on increasing levels of Femara, and with charting and ovulation tests clearly indicating ovulation, and we still had had no success! I was understandably disheartened.

Almost two years to the day of when we had started trying to conceive, we met with our fertility specialist for the first time. She was impressed with my thorough documentation of everything, and that I had already had all of the pertinent testing done and had brought my medical records along for the appointment. Based on all of the factors, she decided that at this point, the cause of my infertility was unexplained by PCOS or anything else. Her recommendation was to try intra-uterine insemination (IUI) for the next few cycles, and potentially move on to in-vitro fertilization (IVF) if I still wasn't pregnant after that.

I was so thrilled & grateful that, because I was early in my cycle at that point, we would begin immediately! I had a baseline ultrasound the same day as our consultation and began an additional round of Femara.

I took Femara for CD5-9, had an ultrasound mid-cycle to check follicles, triggered ovulation with an HCG shot, and went in for the IUI. The next day, I began progesterone suppositories. Blessedly, 13 days later, my blood HCG test came back positive. I could hardly believe our first IUI had been a success!!