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Re: How did I get this?From: jodi (anonymous@obgyn.net)Sun, 1 Apr 2001 14:22:04 -0500 (CDT)
I don't know if anyone can answer for sure what you "did" to get PCOS. many feel this disease is genetic - i can certainly see signs of insulin resistance (thought to be the cause of PCOS) on my father's side of the family. some feel that exposure to high levels of androgens and/or insulin while in utero is responsible... i am not sure if i buy this one. my mother claims her legs were as hairy as mine when she was younger, but she had no period irregularities and she had no trouble getting pregnant with my brother or me, and she has none of the facial hairiness, etc.. so i don't think her hormones have been screwed up nearly as bad as mine, if at all. i have a confounding factor in my PCOS in that i was bulimic for several years of my adolescence... i am not sure if the insulin resistance could have caused this (i see many cases of evidence that it did) or if my crazy eating habits could have caused the PCOS (i see many cases of evidence that it did... leading me to conclude that the IR lead to my bulimia which lead to a worsening of my IR and in turn my PCOS...) regardless of how we got this way, many feel that insulin is the key. our bodies, for whatever reason, seem to produce too much insulin and our bodies also, for whatever reason, aren't very good at using that insulin. that is why weight is often an issue with PCOS - insulin is a big old fat storing drug. this makes the presence of fat another chick or egg factor in PCOS - fat worsens IR, but IR makes fat storage more possible. so one problem seems to essentially feed into the other. "just lose weight" has long been heard by women presenting with PCOS. losing weight can help with the problem... but the very problem can make such weight loss difficult! in addition to making weight loss difficult and/or weight gain easy, this excess insulin is thought to confuse our little ovaries into producing FAR too much testosterone than is good for us. this in turn makes it hard for those little ovaries to ovulate normally, which is what leads to the formation of ovarian cysts. the egg follicales (sp) start to develop more or less normally, but they are unable to complete the job, and rather than bursting and releasing eggs, they just hang around in the form of cysts, pumping out even more excess androgens and making us hairy and even less able to ovulate. (in time, our little ovaries are also often not so little any more.. all this cyst-forming often leads to enlarged, thick skinned ovaries...) that's my understanding of PCOS in a simplified, laymen's terms nutshell. if anyone has a different understanding and would like to correct me, feel free. :) now, as for the birth control pills. there are several schools of thought on this. when girls go to the doc with irregular periods, they are almost always given the pill to "regulate their periods." i *loathe* this term. i was told that the pill would regulate my periods when i first presented with PCOS at the age of 17. i had symptoms since i was 14 or 15, but never went to a doc. when i did go to a doc, i was not told i had PCOS. i was told that it is common for some women to be hairier than others, and that many girls my age have irregular periods. well, i went on the birth control pill, firmly believing that it would a. cure my hairiness and b. regulate my periods. so, like a dimwit, i spent the next few years going on and off the pill trying to see if it had, in fact, regulated my periods. what docs somehow often fail to mention is that regulating your periods with the pill only regulates your periods so long as you are ON the pill. it does nothing to fix what's really wrong. i was only officially diagnosed with PCOS last fall. since that time i have been adamately opposed to the birth control pill. i want to know what is going on with my body - i do not want chemical regulation giving me the impression that all is well under the surface, when in fact everything is about as screwed up as it can possibly be. many PCOS'ers seem to feeel this way. HOWEVER, i can also fully understand the arguments for why the pill is good for PCOS. it effectively shuts your ovaries off. once they are shut off, testosterone production drops. since ovulation is shut off from the pill, those little cysts stop forming. eventually, they might be reabsorbed. for many women, this is enough to get menstruation going normally again, and many women are supposedly able to conceive immediately after stopping the pill since their uncysted, well rested ovaries are able to go through the whole egg-releasing process normally for a while. this has never been the case with me. when i stop the pill, i am right back to my irregular self. but i can still see how, for some women, being on the pill might actually restore or preserve fertility. to take or not take the pill is a very personal choice. many women have great success. what is important is that you have a doc who knows about PCOS and therefore will give you a pill that will make your PCOS symptoms BETTER, not worse. some pills actually increase our insulin resistance, which is why many women find going on the pill makes them worse, not better. so the bottom line is, you need to find a good doctor, probably an endocrinologist, who understands PCOS. you should have fasting insulin/glucose levels done and see if insulin resistance might be your problem. (some doctors perform a insulin-glucose tolerance test to measure this. there are supporters for both methods.) the only thing is, many women find that their lab work indicates that insulin is not the problem. some feel that if PCOS is present, IR is present, even if their blood work appears normal. what's "normal" by the standards might actualyl not be normal for your body. so it's good to find a doc who understands this, and will treat you accordingly. once you accept the insulin issue... here are some ways to treat PCOS. insulin can be controlled by insulin sensitizing/lowering drugs, diet, and exercise. many women find low-carbing works for them. others find that the quality of the carbs is what matters (look up Sugerbusters of glycemic index to get an idea of what carbs are good and what ones are bad.) some find that insulin sensitizing drugs are all they need, and low-carbing doesn't make a difference. some find the meds work only if they also low-carb or otherwise modify their diets. exercise is a good idea for everyone, regardless of where they fall with the diet aspect of things. fat is more prone to insulin resistance than muscle, so building muscle and losing fat is good for PCOS. in addition, exercise uses up free, curculating insulin. so, meds, diet, and/or exercise are good places to start with PCOS. if insulin is lowered, it is thought (and some have found) that testosterone levels will fall as well, and menstruation will resume. some find that hairiness will be reduced as well through such mechanisms. other ways to deal with PCOS - not the best ways, in my opinion - are birth control pills and anti-androgen medicines, such as aldactone. the rationale for BCPs appears above. anti-androgens simply block the effects of testosterone on the body, redcuing unwanted hair. aldactone isa very effective drug. however, it also has some side effects, such as irregular (frequent and/or heavy) bleeding (i'm talking menstrual here) and birth defects. for this reason, many take BCPs along with the aldactone. i have no first hand experience with other anti-androgens, but they are out there as well if aldactone doesn't seem to be the drug for you. using BCPs and aldactone has been the standard of treatment for PCOS for some time. however, many now realize that they really treat only the cosmetic aspects of this disease. for this reason, insulin sensitizers (which adress the root cause) are being used more and more, sometimes alone and sometimes in addition to anti-androgens and BCPs which do address the cosmetic issues faster and/or better. i hope that this has helped you somewhat. if i recall correctly, dianette is one of the pills that is GOOD for PCOS. can anyone vouch for that? that would mean staying on the Dianette is OK. but, you should really find a doc who will address the insulin issues with you, and with or without medications (such as glucophage, actos, and avandia), you might want to look into changing your diet and exercise patterns. good luck! - jodi
At Sun, 1 Apr 2001, Alaniya wrote:
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