Q: I am an unmarried, 25 years old female. I have polycystic ovarian disease. I took familon for 3 months, then I had regular periods, but I do have pain in my right side of the abdomen. My FSH level on third day has come to 16.88 mIU/ml. According to my gynaecologist I have risk of premature menopause and I should get married as soon as possible so that complications in conceiving can be avoided. How is premature menopause related to polycystic ovarian disease?

A:You have used a lot of technical and semi-technical terms in your letter. I am not sure how much of each term you understand. From what you have written I get the impression that you are very worried that you have a serious disease called PCOS. Let me assure you that PCOS (even if you have it) is one of the commonest condition and occurs in as many as 20% of all women. Indeed it is so common that it can no longer be called a disease or a disorder. It is only a variant of normal. PCOS represents a wide spectrum of clinical problems and I do not know which end of the spectrum you will fit in. Most women with PCOS have a fairly normal life. Since you are not married, infertility is not an issue with you. The future fertility cannot be predicted at this stage as PCOS can present in many ways. You may have 5 children and have PCOS and no children at all and no PCOS. It is true that this condition gets worse in late twenties and early thirties and early pregnancy is generally prescribed on this assumption that if you have one or two kids before PCOS takes its full course you may never have an infertility problem. As we know marriage and children cannot be ordered on demand. You should plan your married and family life, along with your career and other responsibilities like the rest of women of your age. The discovery that you have PCOS should not change that. Even if you do get infertility due to PCOS, I can assure you that this is one of the most treatable forms of infertility. Once we think you do have a problem conceiving, I am confident that with modern methods or reproductive technologies and with the current knowledge of reproductive medicine it would be managed. What is more important at this stage is what you have right now. Why did you go to a gynaecologist in the first place? Whatever symptoms you have should be treated like facial hair overweight or menstrual irregularities. If you do have PCOS you may need to take Familon or a similar pill for a very long time (not three months only). If you have facial hair you may be better off with a pill like Dianne 35 which also reduces facial hair. Either way these decisions will have to be taken by your treating physician. If you have other problems like overweight and insulin resistance you may require Metformin or similar agents. You need to be under the supervision of a gynaecological endocrinologist but more importantly try and understand the whole condition. There are literally hundreds of sites that talk about PCOS on the internet including the Royal college of obstetricians and Gynaecologists (www.rcog.org.uk) and the American College of Obstetricians and Gynaecologists sites. There are many self help groups on PCOS which supply information free on the net about this condition. Please find time and read about all these. Your question regarding Premature Menopause (Premature Ovarian Failure) is difficult to answer. Premature ovarian failure as opposed to PCOS is an uncommon disease and is more serious. PCOS per se does not make you prone to premature ovarian failure which is a completely different disease. I think you need to review your diagnosis. Please see an endocrinologist / Gynaecologist and clarify. FSH of 16 is high (LH is high in PCOS and not always FSH) which suggests premature ovarian failure. The diagnosis of PCOS depends on a typical ultrasound picture and Day 3 or 5 hormonal profile. Please get your diagnosis reviewed.