Possible infertility isn’t a conversation topic anyone wants to have in general, let alone during an ambush. But she was talking about it and I couldn’t stop her. Up until this moment, my other doctors in Brisbane had skirted around this aspect of my Polycystic Ovary Syndrome (PCOS). Back home, sitting in the gynaecologist’s office with my mother, there had been an unspoken understanding, a let’s-cross-that-bridge-when-we-come-to-it understanding. But now, during an appointment that was meant to be spent talking about condoms and contraception, my new Melbourne doctor was talking about the elephant in the uterine room – no period means no babies, at least not easily for me. Well shit, I thought as I left the building and started to make my way back to college, maybe I don’t want to have children anyways? I was 19 and only just figuring out how to find pleasure in sex, let alone get results from it.
Although not wholly understood, PCOS occurs when a woman’s ovaries receive mixed hormone messages on the factory floor and in effect, halt ovulation. Ovaries, as I hope you know, are responsible for making eggs. The egg is the female half of the zygote, and the zygote is what can eventually be considered a baby. Simple, right? Wrong. There’s a lot more to it but we ain’t got time for that here. In order to do anything, our bodies need hormones. Acting as little chemical messengers, they’re the ones that tell the body when to function and how. In the case of PCOS, however, a complex imbalance of certain hormones confuses the ovaries before their egg-making job is done. Failing to produce the right amount of oestrogen, the ovaries, disheartened, abandon the would-be egg and leave it as an immature follicle – a mutant follicle, if you will.
Now, here’s the kicker: instead of just moving on from this mix-up on the production line, the body and its hormones become even more confused. If this is not an egg, says the ovary, what is it? Not wanting to move out of home and take up the quest to find a sperm and settle down in the uterus kingdom, the follicle suddenly becomes an issue that the body needs to ‘deal’ with. The follicle is a bit of a fuck-up. And so, instead of producing the right ‘female’ hormones, the body – for god knows what reason – begins to produce androgens, ‘male’ hormones. Houston, we have a problem.
Now don’t get me wrong, all women have a bit of testosterone floating around in their ovaries, but for women with PCOS, it’s a lot more. From weight gain to acne to hirsutism (male-pattern hair growth), the symptoms of PCOS vary wildly and are by no means synonymous with infertility. While one cyster (see what I did there?) may exhibit all of these symptoms, others can go their entire lives without knowing. For me, PCOS all came down to one thing: Aunt Flo – or rather, her absence. When I first had my period, I was 14. It wasn’t late or particularly unusual, but I had read enough Judy Blume to know that it was bloody-well about time. But then something unexpected happened: the periods stopped coming. While everything else on the puberty checklist was making its way onto my body, my initiation into ‘womanhood’ had faltered, and with it, my identity. While adolescence wasn’t going to script in a number of ways, it was always the unopened packet of pads in my school backpack that felt like a kick in the shins.
Flash forward four more years and an ultrasound technician is pressing hard into my bladder. It could be anything, the doctors have all told me. But watching the technician, I know, just by the way she is pointedly clicking the screen that anything is definitely something – targets found. The kinder voices on the internet will tell you an ultrasound of PCOS looks like a string of pearls floating in space. Trust me when I tell you, it doesn’t.
So, there’s something you need to know. Affecting roughly 12 to 18 per cent of women of reproductive age in Australia, PCOS is pretty darn common. And I’m not just saying that to make myself feel better. The maths sits that this particular combination of raving hormones and very confused ovaries affects nearly one in five women. That is to say, PCOS is out there, and unless you’re averse to people with lady-organs, you’ve probably come across it without realising. Heck, you might have even come across me. But even if we have crossed paths, chances are, I haven’t mentioned this to you before. As a subject, it’s just not something that can be worked into the conversation easily. You’ll never guess what my hormones did last month, I imagine telling an unsuspecting innocent over brunch, they are such pesky little fuckers!
At the time of my diagnosis, I was weeks away from moving to Melbourne. With more than a few things to tie up on the ranch before my departure, I decided on my own volition not to think about my PCOS. I was given a prescription to the pill and voila, periods galore. I packed my bags, upgraded from the kitten heel and gave a final finger to puberty. Today, however, the hush-hush surrounding PCOS and other similar conditions has started to build up in my mind. My thoughts, for once, have snagged and stayed on ovaries.
Standing in a room full of people, I will sometimes catch myself looking for the elusive one in five, knowing full well that my own silence hasn’t helped to bring the condition out into the public discourse. All these years after my diagnosis, I still look at the body shapes of other women and for the signs of unwanted facial hair. I wonder about hormones and the bigger things that I cannot see. Are there any cysters here tonight? I want to ask.