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Re: New - lot of questionsFrom: jodi (anonymous@obgyn.net)Mon, 12 Nov 2001 14:49:12 -0600 (CST)
Hello Stefanie Welcome to the group. If you stick around you should soon find your head spinning from the wealth of information available here. :-) You need not apologize for asking too many question. However, I will apologize in advance for possibly giving you too many answers. Your gyn. might or might not be a good place to start with this problem. My personal experience has been that gynocologists are idiots when it comes to PCOS. They look at PCOS from the period angle, or lack of period angle, and treat the easiest way they know how to treat irregular periods - birth control pills. There are both pros and cons to treating PCOS with birth control pills. The pros include a lowering of the LH hormone, a lowering of testosterone, a reduction of cysts formation, less ovarian activity and less risk of ovarian cancer,an improvement in skin conditions (acne is most easily corrected with BCPs, some women have success treating the excess hair problem with BCPs), and regular shedding of the uterine lining, which reduces the risk of endometrial cancer. (On BCPs you do not have periods, technically... you have withdrawl bleeding. Saying "period" is easier, and the health benefit of the bleed is for all intents and purposes the same.) Basically, BCPs put the ovaries into hibernation. For a long time, this was the only treatment available for PCOS. The reason we have cysts on our ovaries with PCOS is because the ovulatory process is flawed - the egg sort of starts to ripen, but doesn't quite finish the job, and instead of popping out from the ovary it simpky forms a cyst. These cysts build up over time, further inhibiting ovulation and thickening the wall of the ovary itself. As I understand it, either this thickening itself or the failed ovulatory process leads to a sort of ovarian irritation/scarring, and this is why the increased risk of ovarian cancer... ANYWAY, the above are all the good points of BCPs. The bad points are, well, BCPs don't do anything to fix the real cause of PCOS, they merely make it better for a little well. I liken it to treating a brain tumor with tylenol... you are only doing away with the pain. The tumor is still there, wreaking havoc... In addition to BCPs being a temporary fix, they are thought to worsen insulin resistance, which is thought to be the real cause of PCOS. PCOS is not a gynocological disorder - it is an endocrine disorder. Ob/gyns tend to treat the gynecological aspects of it, but that's all. So, you see, it is arguable that BCPs not only do not fix the underlying problem... they might even make it worse! Many women report a worsening or even initial appearance of symptoms after use of the pill. In all liklihood, the pill itself does not cause PCOS - these women probably had an underlying predisposition to develop the disorder. Some women first develop signs of PCOS after a pregnancy. Pregnancy is also something that can worsen insulin resisitance/glucose tolerance... think of gestational diabetes. So, the pill has good and bad points. Better to know these points before you go on it, if the doc reccomends it. (I was put on the pill at age 16 or 17 by a ob/gyn to "regulate" my periods, and I spent the next 4 years going on and off the pill to see if my periods had in fact been regulated yet!!! i did not know that the pill only fixes things while you take the pill...) So, as to how you ask your doctor about this... well, that's a tough one. The best advice is to read up on this as much as you can before you go. Push for blood work for insulin levels, sugar levels, testosterone (total and free), LH and FSH levels... an LH:FSH ration that is greater than 3 is indicative of PCOS. Samuel Thatcher's book PCOS the Hidden Epidemic is probab;y a great place to start to understand which tests to push for and why. Buy this book. Read this book. Highlight this book and dog-ear the pages. Take this book to the doctor! There are lots of questions in the back of this book you might want to asnwer so you can give your doc info you might not have thought was important before. really, buy this book! Your doctor might order a sonogram of your ovaries. This is a good way to check what's going on in there but ovarian cysts are not the end-all and be-all of a PCOS diagnosis. Some women have cysts, some do not. PCOS is called a syndrome because it is a weird collection of weird symptoms and not all of us have all the symptoms. I have excess hair which you would never notice from a speeding train and irregular periods. I have always been "slightly overweight" though since going on met I am now pretty normal weight wise. I have some pimples on my forehead. Some cysters have no hair problems to speak of but terrible acne. Some women have regular periods and full beards. Some cysters are 300 pounds and got that way on a low fat diet. It goes on and on... I would suggest telling your doctor what problems you have, and see what he/she says. If PCOS is not mentioned, then say you wonder if you could have it, say why, bring out the stuff in Thatcher's book. You might find your doc is willing to listen. You might find he/she will prescribe BCPs and pat you on the head. You might need to find a good endocrinologist... They are treating PCOS with insulin sensitizers these days, which is thought to get to the root of the problem. That sort of leads to your diet question. As I said, PCOS is thought to stem from insulin resistance. What this means if your body is not able to use its own insulin effectively, so the pancreas pumps out more and more to compensate. This excess insulin leads to the weight gain and hormonal problems of PCOS. (Or that is the school of thought now...) It also puts us at a higher risk of diabtetes and certain other medical problems... PCOS is NOT a cosmetic problem! Ok, it is a cosmetic problem, but it is not ONLY a cosmetic problem... The insulin resistance component is thought to be genetic. Look at your family members. Anyone overweight? Any bald men who began balding young? Any fertility problems in the womenfolk? There are a few ways to treat this insulin problem. One is insulin medications. Some of these work by inhibiting how much glucose is released into the blood stream after a meal. This in turn inhibits insulin release. This is how metformin works, and this may be why a lot of women report gastric distubance on met. At least, this is how Thatcher describes it! Since met limits how much blood sugar can be released, if you eat more than that, your body has to do SOMETHING with the extra.... and what it does with the extra is poop it out. Sorry to be gross, heh. This explains why women who take met and eat a high carb meal end up spending the night on the toilet. This doesn't quite explain why some women have more gastric problems when they take met and low carb... so i don't really know how true this is. For what it's worth, I have not had any gastric problems with the Met other than when I've eaten macaroni and cheese. I don't know why, this is the one food I can't eat now. Unfortunately, every now and then I get a craving for it and forget that i can't eat it... I made this mistake just last night. Bottom line, do not let fears of gastric distubances keep you from trying met if it is offered! Some of these meds work by directly inhibiting how much insulin is released into the body. Actos and Avandia work that way. I have no experience with either of these, met is the most popular insulin med for PCOS at this point. Another way to lower insulin levels is through diet. Some women choose to low-carb. By limiting carb intake, insulin production is lowered. Some women choose to eat foods with a low glycemic index. Low glycemic index foods do not raise blood sugars much, and this also keeps insulin down. For a good read on this, try Sugar Busters. Oh! Insulin meds and/or low carbing might be a good way around the worsening of insulin resistance that BCPs cause. If you decide to go the BCP route, it's something to consider. Which diet and which meds you use is highly personal... what works for one might not work for all... what works for me might not work for you... what works for you might make me sick! Some women try treating PCOS with herbs... I don't have much experience here. i took vitex for two days, did some reading, decided it was a bad idea. A lot of women have success with it... but I was uncomfortable with the idea. Exercise is good for us no matter which treatment route you try to take. As for how to tell your family... well, i guess it depends on why you feel they should know. I have told my mother and my brother about my PCOS, but I have not told my father. I feel I SHOULD tell my father, as the IR is undoubtably passed on from him... but I am not sure how to broach the subject. i think I might broach it with my brother, who really needs to lose a few pounds... and see if my father learns by example. (My brother lives with my father... ) I don't know why but I am uncomfortable talking about this with my father. I have also told my boyfriend because of the reproductive issues... ANYWAY I will shut up now. Hope some of this was helpful. Good luck with your doctor and getting this under control! - jodi
At Mon, 12 Nov 2001, Stef wrote:
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