PCOS pain caused Kelly Ripa to pass out during sex

In a future memoir, Live Wire: endless news, daytime talk show host Kelly Ripa shares a story that has many people talking. The story, described in Haute Living, is in a chapter titled “Don’t Let Your Husband Choose Your Clothes of Death.”

As Ripa recounted, in 1997, as a new mother, she passed out during sex with her husband Mark Consuelos. Severe pain from a ruptured ovarian cyst was the culprit. When she got to the ER, she found herself wearing clothes that Mark had quickly put on her – a 1980s French-cut leotard, red Manolo Blahnik shoes, as well as a pair of warm-up pants from her husband with snaps on the sides. .

She wrote: “My eyes move between the blurry images on screen, the remains of my ovarian hangman and Mark munching happily. Sex can be so traumatic I think, and yet one of us is completely fearless. There he is, happily munching on the crackers now and ordering a second apple juice…I’m on my stomach wondering when the other two cysts will burst.”

Ripa added: “Also, here is my husband, who is, dare I say, smart, well dressed at all times, and yet he dressed me like a dime store prostitute when needed. It’s still disconcerting for me to this day that it is the best costume for the day that he could find me, to the point that, when I was on the stretcher, I thought I was dreaming, I was having a nightmare . .”

Ripa is just one of many celebrities who have revealed their struggle with polycystic ovary syndrome (PCOS). Others include Jillian Michaels, Lea Michele, Daisy Ridley and Keke Palmer. Kelly Clarkson, in 2019, had a ruptured ovarian cyst in the middle of recording The voice.

PCOS: the most common hormonal disorder in women of childbearing age

PCOS is the most common hormonal disorder in women of childbearing age, affecting between 4% and 20% of women in this group worldwide (up to 5 million in the United States alone).

According to the American College of Obstetricians and Gynecologists (ACOG), women with PCOS typically have at least two of the following three conditions:

  • Absence of ovulation, resulting in irregular periods or no periods at all
  • High androgen levels or signs of high androgens, such as excess body or facial hair
  • Cysts on one or both ovaries

PCOS is the most common cause of anovulatory infertility. Many women are not diagnosed with PCOS until they have difficulty getting pregnant. PCOS can also cause other problems, such as unwanted hair growth (hirsutism), dark patches on the skin, acne, weight gain, and irregular bleeding.

Women with PCOS are also at higher risk of:

  • Type 2 diabetes: more than half of women with PCOS develop type 2 diabetes before the age of 40
  • Heart disease and high blood pressure
  • Endometrial hyperplasia (a condition in which the lining of the uterus becomes too thick) and endometrial cancer

Etiology and pathophysiology

The etiology of PCOS, although currently unknown, is most likely multifactorial, with contributions from genetic and environmental factors.

Most PCOS symptoms are caused by excessive levels of androgens, as well as high levels of insulin and insulin resistance.

High levels of androgens can:

  • Interfering with brain signals that normally drive ovulation, with the result that ovulation does not occur regularly
  • Enlarge ovarian follicles, forming cysts
  • Produce other PCOS symptoms including excessive hair growth and acne

Too much insulin also increases the production of androgens, which then cause the symptoms of PCOS. High insulin levels can also increase appetite and lead to weight gain. High insulin levels are also linked to a skin condition called acanthosis nigricans, which results in thickened, dark, velvety patches of skin.

Treatments to relieve symptoms

There is no “cure” for PCOS, although there are many things that can be done to relieve symptoms and improve quality of life.

Lifestyle changes

For many women, the first recommendations from health care providers are to follow a low-calorie diet, lose weight, and increase physical activity. According to ACOG, even 5-10% weight loss can result in significant clinical improvement.

An 8-week study from 2015 showed that a low-starch, low-dairy diet led to weight loss, improved insulin sensitivity and reduced testosterone in women with PCOS.

Oral contraceptives

Oral contraceptives can be used long term for women who do not wish to become pregnant. The combination of estrogen and progestin in women with PCOS makes menstruation more regular, reduces the levels of androgens produced by the ovaries, and helps eliminate acne and reduce excessive hair growth.

Insulin sensitizers

These types of drugs make the body more responsive to insulin and keep glucose levels more stable. For women with PCOS, these medications may help:

  • Clear acne and reduce hair growth
  • Make periods more regular
  • Slightly reduce infertility associated with PCOS

The FDA has not approved any insulin-sensitizing drugs, such as metformin, specifically for the treatment of PCOS, although the drug is often prescribed off-label.

Antiandrogens

These drugs prevent the body from making androgens or limit their activities or effects. Anti-androgens are useful in reducing androgen levels, reducing excessive hair growth and eliminating acne. Because anti-androgens can cause birth defects, they are often taken with oral contraceptives to prevent pregnancy.

Remove or hide unwanted hair

There are many ways to remove or hide excess hair. These include:

  • Shaving, bleaching, hair removal, waxing or use of depilatories
  • Electrolysis, laser hair removal and intense pulsed light therapy – although these methods are often expensive and require multiple treatments

Acne treatment

Retinoids, antibacterial agents, and antibiotics can be used to treat acne. Since retinoids can cause birth defects, however, they should not be used in women who wish to become pregnant.

Treatments for PCOS-Related Infertility

Clomiphene

  • Clomiphene is the most common treatment for infertility in women with PCOS. ACOG recommends clomiphene as primary medication for PCOS and infertile patients
  • Clomiphene indirectly causes egg maturation and release
  • Women treated with clomiphene are more likely to have twins or triplets than women who get pregnant naturally

Metformin

  • Although this insulin sensitizing drug is normally used to treat diabetes, it can also be used as a supplement to increase or regulate ovulation in women with PCOS.
  • Metformin can be used alone or with clomiphene when clomiphene alone is not successful
  • Evidence shows that metformin – alone or in combination with clomiphene – increases ovulation, but does not increase pregnancy rate
  • Metformin is not FDA approved for the treatment of PCOS-related infertility

Letrozole

  • This medication temporarily slows estrogen production and causes the body to make more follicle-stimulating hormone, which is needed for ovulation.

Gonadotropins

  • These hormones, given as injections, stimulate ovulation
  • However, the treatment is expensive and has a higher risk of multiple pregnancies than clomiphene treatment.

Ovarian drilling

  • This surgery may increase the chances of ovulation and may be considered if lifestyle changes and medications have already been used without success
  • It is not known if this treatment, which is not recommended by all professional societies, is more effective than drugs for treating PCOS infertility
  • During ovarian drilling, the surgeon makes a small incision in the abdomen, inserts a laparoscope, and uses a needle powered by electric current to puncture and destroy a small portion of the ovary. Surgery results in lower androgen levels, which may improve ovulation
  • This surgery may be less expensive than gonadotropin treatment and does not appear to increase the risk of multiple pregnancies. However, it carries the risk of scarring the ovaries

In Vitro Fertilization (IVF)

For women who do not get pregnant with the treatments listed above, IVF may be suggested. In this procedure, sperm and an egg are placed in a dish outside the body, in which fertilization occurs. A doctor then places the fertilized egg in the uterus.

IVF can offer women with PCOS the best chance of getting pregnant, and it can give healthcare providers better control over the risk of multiple births. But it can be expensive and may not be covered by health insurance.

Michele R. Berman, MD, is a pediatrician turned medical journalist. She trained at Johns Hopkins, Washington University in St. Louis, and St. Louis Children’s Hospital. Its mission is both journalistic and educational: to report on common diseases affecting uncommon people and to summarize the evidence-based medicine behind the headlines.

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