So, I had my consult with The Special GYN yesterday. After it was over, I managed to contain my fury at the uselessness of it all only by telling myself that I could have my real consult with you Internets when I got home—because you’re all licensed medical professionals, right?
First though, a word about the waiting room. I was prepared for the rows of pregnant women rubbing their bellies as if expecting genies to float suddenly from their uteri, but not for this:
Pregnant: (One hand rubbing belly, one hand holding squirming toddler/baby) I don’t know how you do it…
Other Woman: (One hand hushing crying newborn, one hand holding squirming toddler/baby) Hahaha! Some days are better than others…
Pregnant: Did you plan to have them so close together?
Other Woman: Hahaha! Well, I’m Irish…
Excuse me? I’m Swiss, so why aren’t my cycles more like clockwork? I have yet to see a mechanical bird come shooting out of my vagina at precisely timed intervals to tell me when I’m ovulating. But never mind all that.
I waited in the exam room for the doctor for what seemed like at least an entire menstrual cycle but was actually 35 minutes, by which time I had:
1. Gone over my notes
2. Taken off my gown and put it on again with the opening in the back
3. Rifled through all the file folders containing instructions/information about various procedures, and read their contents
4. Written part of a song about gynecological exams to the tune of “It’s only a Paper Moon,” that started “Its only a Paper Gown”
5. Taken off my gown and put it on again with the opening in the front
I hope to Jesus they don’t have cameras in those rooms. When the doctor arrived I flipped through my notebook, cleared my throat, and gave her everything I had–A reproductive history in bullet points, a list of tests I thought might be useful, questions I hoped to have answered, etc. When I finished I gave her a moment to catch up with her frantic note-taking.
“Wow,” she said finally, “You’re really organized.”
I hopped onto the table and she did a lightning-speed pelvic. Just before it was over, she asked, “Do you think you could tolerate a finger in your rectum?” and as I was mulling over my answer to this delicate question, OH! Gracious! There it was.
She snapped off her gloves and I sat up flustered, wondering if I’d at least get flowers the next day.
“Your exam does not impress me as indicative of a woman riddled with endometriosis.”
Ok…good, right?
“I see a couple of women like you in here every month…”
Less good…
“…And I think you produce an excess of prostaglandins.”
I jumped in.
“Yes, I figured I probably did…isn’t that one of the effects of Endometriosis?”
Flip of hand.
“Like I said, I see at least two women exactly like you every month, and when I do the Lap, I find something in 50% of cases. So we can do the surgery, if you want it, but there is only a 50% chance of finding anything. I think you have primary dysmennorhea. But I would be happy to do the Lap if you want to have one done.”
“Well, if you don’t think…”
“The sudden weight gain suggests other possibilities.”
“I’m not hairy.”
“I see you know where I’m going with this.”
“You’re thinking PCOS.”
“Yes, although you don’t impress me as a PCOS patient either–as you said, you aren’t hirsute.”
What do I have to do to impress this woman? I am exceedingly blond, and ethnicity plays a large part in hirsutism with PCOS—for instance, Asian PCOS patients are almost never hirsute.
“If it is PCOS, we can put you on continuous birth control pills and take you off them the month before you want to get pregnant, which would increase your fertility.”
….And my migraines…
“So, if I don’t have PCOS, and it’s just the prostaglandins…how would you explain the anovulation?”
“Oh…(actually scratches head) “Good question…I don’t know.”
“And the fact that I have miscarried both of my pregnancies?”
“Just Bad Luck, maybe.”
Too bad I’m not Irish like the woman in the waiting room. I hear they’re very lucky.
So I went in this morning after fasting to have the following tests:
FSH, Glucose, Insulin, LH, Prolactin, Rubella, TSH, Testosterone, DHEAS, 17OHP
Apparently the results won’t be in for 10 days—does that seem long to anyone else?
Also, Special GYN had no explanation for the phenomenon I noticed while I was charting wherein I would get positive opks around days 15 and 26, separated by negative opks, and each followed a few days later by a modest temp rise. After four or five days my temp would go back down, and when this happened the second time, my cycle ended.
Now, I want to stress that The Special GYN was very polite and listened to my long spiel at the beginning, taking notes and asking questions–she wasn’t evil, or unconcerned. Maybe I don’t have endometriosis. Maybe there is nothing wrong with me at all, except for the horrible luck of the Swiss. But I was hoping for something more definitive. And she has left the lap decision completely up to me, and of course I don’t want to have one, so if she doesn’t think it’s likely to find anything…I don’t know what to do. I agree with her about the prostaglandins—they could explain the pain, and possibly the miscarriages. But what would be causing the elevated prostaglandins? For treatment of the excess prostaglandins, she suggested Advil during my period. Well, I get pain all sorts of times, not just during my period, and Advil doesn’t touch it, so…I wasn’t “impressed” with her, on that one. In addition, for the past three days I have been having very sharp pains in my left ovary, which is unusual for me. The Special GYN wrote “cyst?” in her notes when I told her about it, and then said it was “probably nothing.”
And what about the anovulation?
I am beginning to think it would be faster for me to go to medical school in order to treat myself.

{ 4 comments… read them below or add one }
“I have yet to see a mechanical bird come shooting out of my vagina at precisely timed intervals to tell me when I’m ovulating.”
Okay. This made me laugh so hard I had to get up and walk it off. Even now I’m snickering. (Did you know that if you have two babies – from separate pregnancies – within a year they’re called Irish Twins?)
Okay. Now I can go back and read the rest of it.
Wow, she’s really hard to impress! My apologies for the long (very long!) response, but I’m in writing (and not editing) mode these days…
Yes, 10 days seems long for results, but I guess if the tests are being sent off to central processing labs it can easily take that long. Annoying, but true. My old RE offered to do a lap even though I have no definitive symptoms of Endo – she figured it could be worth checking if we could find no other causes for things. I turned her down, because so far I really think it’s unlikely, but I’ll reconsider all my options if my upcoming IVF doesn’t do the trick. Endo isn’t my area of expertise, but I think I’ve heard some statistic about increased fertility following a lap that removed some endo, so you may want to put it off on those grounds if nothing else. Though pain is always an important factor.
Did she do (or have you ever had) a vaginal ultrasound to actually look at your ovaries? Not all PCOSers actually have polycystic ovaries, but it would be good to know, wouldn’t it? Depending on your other symptoms, I’d pay attention to that TSH result – sometimes thyroid issues have symptomatic overlap with PCOS and other endocrine issues. (If nothing else pops up from these tests and you match the symptom profile of a thyroid condition, there are other thyroid tests they can run.) And BCPs are not a treatment for PCOS. If you have it, they should look into Glucophage or one of the other insulin sensitizing drugs.
Once you get the results back from the bloodwork I’m happy to share what I know about those in terms of PCOS at least. If you haven’t already, you might look at http://www.fertilityplus.org/faq/hormonelevels.html for some of the basic info. And of course, you’ll want the actual numbers, not just whether the lab says it’s “normal” or not. But then, you’re really organized (Why are doctors so impressed with patients that care about their own medical details? Shouldn’t that be the norm?) so I’m sure you’ve got that covered.
I was diagnosed with “excess prostaglandins” by a very well respected RE back in college. When I came to him to see if he could tinker around with my birth control pills and improve my bizarre and painful irregular episodes of bleeding of all sorts, he immediately suggested a lap to rule out endo. There wasn’t any (though there were extensive adhesions pulling my ovary up into my rib cage, so he chalked the pain up to excess prostaglandins. When I went back to see him years later for infertility, he said the prostaglandin thing wouldn’t have caused infertility, the HSG showed clear tubes, and the u/s showed the ovary back in place, so he diagnosed me as “unexplained.”
If I were in your position, I’d wait and do a lap when you’re ready to try to get pregnant. Otherwise, if you do have endo, you’ll just end up doing another one when you’re ready to try to conceive.
Ugh. Doctors suck.
I was very glad I did the lap when it was suggested as it turned out I had extensive endo, even though I had no symptoms. Best thing for you is to wait for those results, as cass said, then figure out a next step.