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Re: Need advice re Ovcon, Synthroid, and Wellbutrin

From: Kimberly (anonymous@obgyn.net)
Sun, 6 Jan 2002 01:31:52 -0600 (CST)

Karin - I'm glad I gave you a few things to think about - but it's all more clear now that you've clarified a bit.

If you've been on the WEllbutrin for 8 months, I see no reason to not stop whenever you want (although find out if you need to taper off of course! :). My dr. said 6 months was the treatment for depression. I was suprised to discover that a 6 month treatment can actually CURE some people's depression and it is not necessary to take it all their lives. Anyway, it sounds as if you weren't even sure if you WERE depressed, so it would most cetainly be interesting to find out how you feel without it.

I would not attribute the headaches to have anything to do with the Wellbutrin. I also have never seen any indication that synthroid causes headaches. but i may be wrong. The Ovcon seems highly suspect, but then again it could simply be stress from the holidays! Or an ongoing low-grade sinus infection, or...

Well, it you've been on the synthroid for four weeks and just started getting energy it sounds as if it really could be responsible. And that's so great! Hypothyroidism can affect such a huge amount of body functions that it's amazing. I think it WOULD be a good idea to go off the Wellbutrin and see what happens with your energy level and emotions. It would probably be a good idea to write down exactly how you are feeling every now and then because sometimes things change with medication so subtly it is hard to remember how we used to feel. It really sounds to me like you probably are not too depressed, because if you would have been you would have been likely to know it. The thyroid problem slows down every function to the point that even if you are not depressed, you wouldn't feel the OPPOSITE of depressed, whatever that is! :) I wouldn't really worry about it too much and would just focus on the synthroid for now. If you feel bad or low on energy in the future, go ahead and deal with it then.

I think I used the wrong terminology when I was discussing mild and serious PCOS. I used those terms because you said your case was mild - and yet I'm not sure if there is really much distinction between mild and serious. I think there is only the way one's body responds to the 'malfunction'. I was talking more about insulin resistance, and that if your case is 'mild' or not - you are still most likely insulin resistant and therefor need to seek treatment because your chance of diabetes is huge - and also your risk of heart disease and stroke goes up quite a few notches. But I was not directly speaking of the symptoms of PCOS - because I don't honestly know if they get worse with age or lack of treatment. My guess is that everyone is different.

Birth control pills are not treatment for PCOS. They do nothing to help correct most of the symptoms (except giving you a timely period - and the PCOS directed ones that I mentioned can help with acne and hair)- and as I also said they often times make the condition worse. Most dr.s who focus primarily on PCOS do not suggest BCP's unless the patient really wants to prevent pregnancy.

I don't know how much you know about insulin resistance - but quite simply over a long period of time of being insulin resistant, the pancreas simply cannot work any longer because it has been pumping out more than it's fair share of insulin for most of it's life. This is what causes diabetes II. BCP's make insulin resistance worse, therefore causing the pancreas to work even harder than it would without them. That is why it really is a personal decision - but it's nice to know what you are deciding about. I was not aware that BCP's made it worse until recently - and I was pretty suprised, but all the evidence I've found has totally pointed in that direction as well. (such as diabetics shouldn't take them!)

If you are not taking them to avoid pregnancy - I would really suggest that you consider talking to your dr. about insulin sensitizers (Glucophage being the most popular, Actos and Avandia being less popular but quite effective when Glucophage side effects cause too much trouble). These alone could regulate your periods, control your insulin/blood sugar levels therefore giving you more energy, and quite possibly help a whole bunch with your cyst discomfort. (Sorry, but I know little about the cysts, as I think it is only a small percentage of women who actually have trouble or discomfort with the cysts - and I'm not one of them, so really I don't know - but you might want to ask some women on the PCOS support board if they have had any luck with that when they are treated for I.resistance. - I recommend that page because it's more active) The meds can also help with whatever other side effects you may be having - some of which you might be so used to you're not even aware of them.

The other option is the low-carb diet (which forgoes the whole insulin process altogether so that the pancreas is never stressed and the horomones that are messed up because of it go back to normal) and regular excercise (which makes the cells accept the insulin better to begin with so that once again the pancreas doesn't have to work so hard). When I first found out about my PCOS I went low-carb and had 3 regular periods for the first time in my life (right off the bat) and got pregnant (unexpectedly!) thereafter. My skin cleared up and I felt so wonderful I was shocked that I had ever felt so bad. But then after I had my baby the low-carb diet did nothing for me at all. But that could have been the thyroid problem I developed from the pregnancy. Just another one of those things I'm sure I'll never understand! Now that I'm on Glucophage (and synthroid)I've lost 40lbs and my skin is almost perfect - I have very few cravings and I all around feel better than I have in a long time. Quite simply, BCP's just can't do much for you when it comes to correcting the imbalances in your body. That is why I was suprised when you seem to be really looking to feel better but that your dr. hadn't put you on anything to help the PCOS. Also, if you really want to be on the BCP's I would really recommend asking your dr. about Jasmin. It blocks the androgens your body is making and is the only BCP available that does so - and it just came out last year, so perhaps your dr. isn't too used to thinking about it. At least if you block the androgens it helps a little bit more than the average pill.

Gee, I'm probably confusing you now. I'm really sorry if I am - but I've been learning about PCOS for so long and watching how dr.s and women are slowly but surely learning more and more about it - yet so many dr.s really aren't up to date - and the woman patient is really suffering because of it. It just frustrates me that women can suffer and suffer when there actually IS treatment available (i.e. any treatment plan that involves controlling insulin resistance). I would love to see your ovarian pain go away - but on your current treatment plan I don't see that there is really much hope of getting regular periods that are normal or seeing the cysts go away or lessen. I just want to share any info I can that will help anyone feel better, so if I have just made you confused with your meds even more I'm sorry, but I hope in the end maybe you can get treatment that will really help you and prevent further disease in the future.

Anyway - the whole point of that tirade is that I don't necessarily think your PCOS is getting worse, because I don't know if the condition as a rule does get worse per say. And I didn't mean to mislead you - but even if your PCOS isn't getting worse, not being treated for insulin resistance can only be bad - and that CAN get worse. Quite simply, insulin control is the ONLY treatment for PCOS (at the moment) - and if your cysts and irregular periods are being caused by the PCOS you might want to look into it.

That's all I can think of! :) 

--
Kimberly


At Sat,  5 Jan 2002, Karin wrote:
>
>Hi Kimberly -
>
>THANK YOU for your reply!!! It certainly sounds like you've done your
>homework on all of this, and you gave me good things to think about.
>
>To clarify things, I started the Wellbutrin in May 2001 and started the
>Synthroid about 4 weeks ago.  I have been on various birth control pills
>for almost 8 years, but just started the Ovcon-50 4 weeks ago also.  I
>have never been on any insulin sensitizing drugs and try to be careful
>about when and what I eat, but follow no specific diet.
>
>When my PCP put me on Wellbutrin, he recommended that I stay on it for 6
>to 9 months to get the full effect (I am now at the 8 month mark).  I
>agree with you that the first couple of months were tough on my stomach,
>but I did lose several pounds (no complaint there).  I did feel
>increased energy after a few weeks, but it was also summertime and I was
>more active.  By the way, I take the Wellbutrin in the morning to
>prevent insomnia.
>
>Being diagnosed with subclinical hypothyroidism is what really has me
>wondering if I am depressed, have a problem with my thyroid, or both.
>That why my thinking was to reduce the number of meds I was on to see if
>Synthroid without Wellbutrin kept my energy level ok.  My RE thought
>this was a reasonable idea, and said that if I still had headaches, she
>would have me just take the Ovcon to see it that is what is causing the
>headaches.  But, you made an excellent point that if the headaches go
>away it could also be because I've gotten used to the Ovcon!!! Aargh! A
>doctor once told me that our bodies are like a big chemistry set, and
>the goal is to find out the right combination that works; like you said
>it's a lot of variables.
>
>Lastly, could you clarify about mild PCOS turning into serious PCOS? I
>am 38 and have never had normal periods whatsoever, and random sonograms
>over the years always showed cysts on my ovaries.  The birth control
>pills sort of helped regulate things, but often my periods seemed more
>like spotting than periods, and my gyn kept saying this was ok, and he
>shrugged off my complaints of fatigue (as I mentioned I got frustrated
>with him, and am seeing a different doc now).  Anyway, for the last year
>or so, the cysts have caused me erratic pain.  The RE that I am seeing
>now, did a laparoscopy (can't say it, can't spell it) last August to
>drain the cysts.  I was on OrthoCyclen from August until December, but
>painful cysts came back and I had breakthough bleeding; hence, the
>attempt at the Ovcon with higher estrogen.  Could the pain be due to the
>PCOS worsening???
>
>Again, thanks for the info.  My PCP will be back in his office on
>Tuesday, and I will get his advice on whether or not to stop the
>Wellbutrin.  The ability to post to this discussion board makes the wait
>to talk with him more bearable.
>
>Take care,
>Karin
>



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