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Re: pcos but not insulin resistant- lots of questions!From: jodi (anonymous@obgyn.net)Wed, 27 Nov 2002 15:28:01 -0600 (CST)
Hi there and welcome to our club :-)
At Wed, 27 Nov 2002, ksbdca wrote:
> I will try to answer them. I will warn you first that I am a self-proclaimed windbag...
>1. Should I still push to go on met/glucophage? I understand that it Okay. What tests did your doc run to see ir you are/are not insulin resistant? Being overweight is a pretty good indication that you are, at least slightly. The catch with blood tests is that they are judged according to what a given lab concludes is acceptable and healthy, based on many people's averages. These values may not be best for your body. So, yeah, they now think PCOS is related to insulin resistance. They find that many of us test for it - I had really high fasting insulin, perfectly normal fasting glucose. BUT, not all of us test out to be IR. So either something else is causing those women's PCOS... or their level of hormones are not right for them, even though they may be right for most other people. Maybe, an insulin rating of 6 is OK for most people, not OK for you. Just to pick a random number here. So. Yeah, you should push to try glucophage. If you really are IR and it's just not showing, it might help. If it's true that it helps women even if they really aren't IR - which some studies do suggest - it might help. Chances are, it won't hurt, aside from the slightly gross side effects some of us have early on.
> Yes. It happens quite a lot, not always with weight loss. It happens sometimes when women have tried years and years of conventional fertility treatments to no avail. Glucophage, if it works for you, works to address the issue of WHY you aren't ovulating, rather than just the fact that you aren't ovulating. This is a totally different action than conventional fertility meds. Glucophage allows you to ovulate on your own, rather than forcing you to ovulate. In the process, it not only increases your chance of getting pregnant, but decreases your chance of miscarrying due to hormonal pandamonium. Sometimes the gluc alone isn't enough. In these cases, the addition of clomid - one of the simpler, cheaper conventional fertility meds - can prove very beneficial. Glucophage increases the chance of clomid working. Benefits of glucophage long term. Well, it can really aid in weight management for _some_ of us. It can normalize your hormones, and regulating your periods will reduce your risk of endometrial cancer. If testosterone is reduced, you could see a reduction in acne, hair loss, excess body hair... It can really improve your self esteem to make you feel more like a woman and less like a side show freak. They think it can significantly lower our risk of developing diabetes, which they think we are prone to. ("They" being doctors and researchers who actually think of PCOS as a noteworthy subject... such rare and saintly creatures...)
>I'm not looking to get pregnant right now, but I am very freaked out by I am right there with you. I learned I had PCOS when I was 23. Until that point in my life, kids were like, oh, a nice something or other to think of in the future. Of course, with my wacky periods, I didn't know how easy that would be, but I didn't dwell on it. Having a definitive diagnosis of PCOS with a definitive diagnosis of impaired fertility was like... oh my god. I WANT kids. How DARE this disease take away my ability to have children? It's very difficult. I am now 25 and unofficially married. I mean, I am legally married, but our wedding is not until next October, and that is when we're gonna start trying. I am going absolutely insane worrying over what I may or may not be up against here. I now want kids more than anything and it is infuriating to feel that while any crack addict can go out and get pregnant, but here I am, college educated, married to a great guy, living comfortably... and I can't even have a PERIOD! Part of me wants to start trying NOW to see what will happen... but part of me wants to fit into my wedding dress... So, I think the sooner you can start addressing this, the better. It is really my hope that addressing the PCOS and attacking it years before trying to concieve can ward off the need for years and years of infertility treatments, for some of us. Of course, taking glucophage is by no means the only thing you can do. You may to make diet and lifestyle changes as well. (I say may because, really, a lot of us DO try, before diagnosis, to lose weight the conventional way... and fail! BUt I want to say that by no means is the glucophage all you need to do.) I feel like it is hard to stay hopeful about this when it seems so many stories you read involve years of failure, trying to get pregnant with PCOS. For every "It happened naturally" story you read, there seem to be three "We just failed our 4th round of IVF" stories. I try to tell myself, OK, be rational. PCOS affects a lot of women. It's likely that the ones who are really suffering from infertility are the ones most likely to be going to support groups, posting on the web... We don't read ALL the easy success stories because those women may not feel the need to dwell on PCOS. I try to tell myself that. :-) I will also tell you that my new doctor told me, not to worry too much when it's time to get pregnant. They treat so many infertility patients with so many different problems, when they hear someone has PCOS they are happy, since it is one of the easiest problems to overcome. It COULD be a lot worse. You COULD be lacking, say, a uterus... A hormone imbalance is fathoms more surmountable...
> It really depends on the doctor's interests. I have had nothing but bad experiences with ob/gyns. But some women have had good luck with them. In general, I think an endocrinologist is the way to go, be it a regular endo or a reproductive endo. To screen your doctor, when you make an appointment, ask: Does Dr. SoAndSo treat Polycystic Ovarian Syndrome? Does he/she use insulin sensitizers to treat it? Those are the two most important questions. Even if you are not prescribed insulin meds, you will know he/she is at least up on the current news on PCOS. You may get answers such as "What is that?" or "Why would he?" If so, hang up and move on. If you are having trouble finding a good doctor, you can A. post here where you live and maybe someone can help B. go to http://www.soulcysters.com where there is a doctor locater or C. try what I did when I was at the end of my rope. I looked for a research study on PCOS in my town, and asked the director for some recomendations. It worked, I got a great doctor I never would have heard of otherwise.
> Very. BUT, as I said, taking measures to address the PCOS, not just the lack of ovulation, can help a LOT. Glucophage significantly reduces the miscarriage rate.
> There are different kinds of ovarian cysts. The type associated with PCOS are NOT the type that grow really big and can rupture (although there are women with PCOS who have these from time to time.) The kind we have are small. This is actually something that I can't spit out all the answers on, but my understanding is something like this. We are born with millions of little immature eggs in our ovaries. In a normal woman with a normal body, FSH works on the ovaries "stimulating follicles(sp)" (hence FSH) to feed and nurture the little immature eggies inside. Around two weeks after a cycle begins, LH surges upwards. Then, ovulation: one of these developing eggs wins the race and is spit out to travel along the fallopian highway towards the uterus. For some reason, with PCOS, this ovulation never occurs, and our follicles simply hang around as cysts. The follicle is sort of arrested at an early stage of development, and since these follicles produce more androgens in the early stage of development... well, basically what we end up with are a bunch of androgen-producing unable-to-ovulate follicles/eggs (cysts). I think this becomes a viscious cycle since, the higher your androgens, the less likely you are to ovulate, and the more your body attempts to ovulate and can't, the higher your androgens go. So the eggs in their follicular home become cysts. The result to your health is annovulation and all the effects of excess male hormones we suffer from. The cysts do not need to be removed. I don't think all the ovum become cysts... any ovum you actually manage to ovualte, at least, should not!
> The only way to learn is to ask. I know how overwhelming and horrifying this disorder is when you first learn of it, but look on the bright side. It's a good time to have PCOS. At least now we can get better treatment than birth control pill bandaid cures, or doctors who tell us it's nothing to worry about. Do some internet searching and get a copy of Samuel Thatcher's PCOS: The Hidden Epidemic. It's like the PCOS bible and should answer just about anything you could ask... - jodi
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