DEAR DR. DONOHUE: I am 30 and have been married for five years. My husband and I are trying to start a family, but we have had no luck so far. My family doctor didn’t know what was wrong. He sent me and my husband to an OB-GYN doctor. She thinks I might have polycystic ovary syndrome. What is it, and how is it treated? Does it cause infertility? Incidentally, I have gained 40 pounds since I’ve been married. – J.L.

The weight gain isn’t incidental. It may well be a sign of polycystic ovary syndrome, a condition whose main features include irregular and fewer menstrual periods, an overproduction of male hormones and an ovary whose surface is studded with many cysts. The irregular periods indicate that an ovum isn’t released every month, and that’s one of the causes of infertility, a prominent consequence of the syndrome. An indication of the overproduction of male hormone is hair growth in the mustache area and on the chin, breasts and inner thighs. Acne is another polycystic ovary sign. One of the newer discoveries is that polycystic ovary syndrome produces insensitivity to insulin. Insulin doesn’t work like it should. It doesn’t efficiently usher sugar into cells. Blood sugar rises.

Sometimes, with overweight women, weight loss corrects many of the hormonal problems of the syndrome and restores fertility. If it doesn’t or if the woman is not overweight, birth control pills can often restore the body’s normal hormonal environment. If they don’t work, medicines that blunt the action of male hormones are useful. In light of the insulin insensitivity, treatment with an oral diabetes medicine, metformin, can re-establish body chemistry and can correct many of the problems brought about by this syndrome.

This is only a sample of the treatments available to you. You and your husband have a good chance of having a family.

DEAR DR. DONOHUE: As a practicing dentist, I appreciate your recent column citing the dental implications of ice-chewing. I have seen my share of tooth fractures from this habit.

The craving for ice is referred to as pagophagia. At times, this craving is associated with iron-deficiency anemia. I have made of number of referrals of ice-chewers to physicians for follow-up for the diagnosis of iron deficiency anemia. The mouth is a good barometer of overall health. – G.F., DDS

DEAR DR. DONOHUE: I had the problem of chewing ice constantly. It turns out I had an iron deficiency. After the deficiency was corrected, the problem went away. – M.H.

Thank you both for your comments. The mail on pica was overwhelming. Pica is eating things not considered to be food, such as ice, dirt, starch and on and on. Each of the various picas has a specific name, like pagophagia for ice-eating.

I had a letter from a reader who claimed to have eaten ice all her life and had not suffered the slightest damage to her teeth. She is a definite exception to the rule. Many writers mentioned they were iron-deficient when they had the habit.

DEAR DR. DONOHUE: My husband has iron deficiency anemia. Can it lead to leukemia? I am 80 years old and have been taking thyroid hormone since I was 30. I read recently that it decreases bone density, so I stopped taking it on my own. I don’t feel any different from how I used to feel. What is your opinion? – M.H.

First, the good news: Iron deficiency anemia does not lead to leukemia.

Second, the bad news: It’s most unwise to stop thyroid hormone after taking it for 50 years. Thyroid hormone supplements cause osteoporosis only if they are given in doses in excess of what is needed. Stopping your hormone supplement is very apt to put you into a thyroid hormone deficiency. It doesn’t happen fast, and that’s why you feel fine right now. In time, however, you are very likely to drift into hypothyroidism. Your skin and hair will dry. You will become constipated. You’ll gain weight without increasing the calories you eat. Your energy level will drop. Call your doctor, and tell him or her what you have done.

DEAR DR. DONOHUE: How do people know when it’s time to replace a joint? I have been treated for hip pain for more than 10 years. They say I have osteoarthritis. In the beginning, I could get by with painkillers. Now I have reached a point where it is near impossible for me to do common house chores. I hardly get out of the house because of my hip. My doctor is reluctant to send me to a surgeon. He thinks I should “bite the bullet,” as he says. I am 72. I don’t want to waste the years I have left sitting in a chair, knitting. I don’t know how to knit. – B.H.

: The doctor isn’t the one who makes the call for surgery. The patient – i.e., you – is. Replacements of arthritic hips and knees are common surgeries these days. No one views surgery as a picnic, but no one views severe arthritis as a picnic either.

When medicines don’t relieve joint pain, when people limit their lives because a joint forces them to be inactive, and when a person is in good enough health to undergo surgery, then the time for surgery is at hand. “Bite the bullet”? Give me a break.

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