polycystic ovaries questions (child ment)

[thumper]

***WARNING child ment below, sorry, it's relevant***

I have to admit I read all the posts and questions about PCO that get
posted here, but don't keep much track of it because I haven't had to
worry about the details. And, it is pretty confusing, sigh.

But... I went to see my primary care physician on Friday because I
have been putting on a lot of weight that I can't seem to drop and
wanted some advice about sensible diet, etc. He is sending me to a
nutritionist, but wanted to do some b/w for a metabolic profile and a
u/s for polycystic ovaries. So, I figured I'd come to the experts to
see if it makes any sense and what should I ask him about on my follow
up visit?

The dr says that some women get PCO after childbirth (ds is almost 2),
and that my weight gain could be related to that. Shouldn't he be
looking at insulin/blood sugar instead of my ovaries? Or horomone
levels? (He is measuring TSH and T4, but otherwise just cholesterol,
liver enzymes, usual stuff) He thought that my painful periods could
be a symptom too. I don't have the symptoms that I have read about
some women having with PCO, either; I also have pretty darn regular
cycles, although they've been a bit short lately. Does any of this
sound right?

The irony would be that my gyn, who I saw earlier in the week, had no
comments about me gaining 27 pounds since my last annual exam (based
on his scale and records). Why do they bother weighing me anyway???
And he didn't say much about painful periods other than perhaps I
should take bcp (no thanks). So why do they bother asking??? I know,
I know, time for a new gyn. I also hate his lousy scale that has
always weighed me heavier than any other scale I ever use <g>.

Well, thanks for any insight about PCO. I don't want to go to the pco
board until there's some reason to think I have it. Any good
resources to read up on out there?

Take care,
Lisa, probably just fat from eating too much, anyway

[Donna F]

Lisa-
Heavy painful periods and easy weight gain are definite symptoms of
hypothyroidism. And guess what? It is quite common to become hypothryoid
after having a child.

If it does turn out to be hypothyroidism, a good diet to follow is basically
the PCOS diet - low carb, higher protein, low fat. Like lots of salads with
chicken, fish, etc. Minimize processed foods, and for grains use only whole
grains.

I'm curious about your test results. Too bad he didn't do a free T3 too.
Do you know if the T4 is Total T4 or free T4?

I'll look back here to see how you are doing!

-Donna
p.s. if you want to email me with any hypo questions, use hockeydonna at
attbi dot com

"thumper" <thu...@delanet.com> wrote in message
news:65b7a30b.02071...@posting.google.com...

[Kathy C]

If he were looking for PCOS, he might look at quite a spectrum of things:
LH and FSH among them. With PCOS there is often an elevated LH/FSH
ratio. Also TSH, prolactin, testosterone, DHEA and insulin may all be
elevated in a woman with PCOS, but it is a syndrome, so not everyone has
all hormonal issues.

KC

[LittleGiraffe]

Hi incciid.org has a great faq on pcos....here is the link and a some info that is from there...(sorry if it is a bit hard to read...the formatting may change once I post...so check out the faq!)

Lg :)

http://www.inciid.org/faq/pcos.html

1.2 What are the symptoms of PCOS?  Women with PCOS may have some of the following symptoms:

• Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) — Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting.
• Oligo or anovulation (infrequent or absent ovulation) — While women with PCOS produce follicles — which are fluid-filled sacs on the ovary that contain an egg — the follicles often do not mature and release as needed for ovulation. It is these immature follicles that create the cysts.
• Hyperandrogenism — Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
• Infertility — Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction.
• Cystic ovaries — Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs). It is difficult to diagnose PCOS without the presence of some cysts or ovarian enlargement, but sometimes more subtle alterations may not have been recorded, or are not recognized as abnormal, by the ultrasonographer.
• Enlarged ovaries — Polycystic ovaries are usually 1.5 to 3 times larger than normal.
• Chronic pelvic pain — The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding. It is considered chronic when it has been noted for greater than six months.
• Obesity or weight gain — Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen, similar to the way men often gain weight, with comparatively narrower arms and legs. The hip:waist ratio is smaller than on a pear-shaped woman — meaning there is less difference between hip and waist measurements. It should be noted that most, but not all, women with PCOS are overweight.
• Insulin resistance, hyperinsulinemia, and diabetes — Insulin resistance is a condition where the body's use of insulin is inefficient. It is usually accompanied by compensatory hyperinsulinemia — an over-production of insulin. Both conditions often occur with normal glucose levels, and may be a precursor to diabetes, in which glucose intolerance is further decreased and blood glucose levels may also be elevated.
• Dyslipidemia (lipid abnormalities) — Some women with PCOS have elevated LDL and reduced HDL cholesterol levels, as well as high triglycerides.
• Hypertension (high blood pressure) — Blood pressure readings over 140/90.
• Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
• Alopecia (male-pattern baldness or thinning hair) — The balding is more common on the top of the head than at the temples.
• Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
• Acanthosis nigricans (dark patches of skin, tan to dark brown/black) — Most commonly on the back of the neck, but also but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch.
• Acrochordons (skin tags) — Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing.

2.4 Is there one definitive test to diagnosis PCOS? At this time, there is no single definitive test for PCOS. This is because no exact cause of PCOS has been established yet. This is why there is a wide-range of opinion on how to diagnose and treat PCOS.

2.5 How should PCOS be diagnosed? PCOS should be diagnosed based on physical exam, ultrasound of the ovaries, and the results of various blood tests. Diagnosis is made based on having several of the symptoms listed above. There is some disagreement in the medical community about the diagnostic criteria to be used. Some doctors suggest that at least three of the symptoms must be present to diagnose PCOS, others may make the diagnosis on the basis of fewer criteria (often emphasizing lack of ovulation), while others believe that PCOS is a diagnosis of exclusion — meaning if there are hormonal abnormalities for which no other explanation can be found, PCOS is presumed. Since there is no consensus as to how PCOS is defined or diagnosed, there should be little surprise when a variety of opinions emerge on how this problem should be treated!

2.6 How are polycystic ovaries diagnosed by ultrasound? An ultrasound of the ovaries is usually done transvaginally — where a probe is placed into the vagina to gain view of the ovaries. In some cases, an abdominal ultrasound may be needed as well, but this tends not to give as clear a view.

A classic PCOS ovary is enlarged and has a "string of pearls" appearance, where the pearls are the cysts. Usually ultrasound diagnosis of polycystic ovaries is made if there are at least 8-10 cysts that are less than 10mm in size on each ovary. It is not known how long each individual cyst will last, or what caused the arrested development of the follicle leading to the formation of the cyst in the first place. The polycystic ovary tends to be enlarged to 1.5-3 times the size of a normal ovary and often has an increase in the stromal tissue in the center of the ovary and around the follicles. Both the cysts and the stroma produce hormones, so the more cysts and the more stroma, the more likely one is to have other signs and symptoms of PCOS.

2.9 What blood tests should be done to diagnose PCOS? Much of the bloodwork that should be done in diagnosing or ruling out PCOS is the same as a basic fertility workup; however, there are a couple of additional tests for insulin resistance that should be added, as well as some cholesterol screening to evaluate general health status because of the future risks associated with PCOS. A good basic screening would include:

• Fasting comprehensive biochemical and lipid panel;
• 2-hour GTT with insulin levels (also called IGTT);
• LH:FSH ratio;
• Total testosterone;
• DHEAS;
• SHBG;
• Androstenedione;
• Prolactin and
• TSH

2.15 Are PCOS and hypothyroid related? No. It may be that PCOS and thyroid disease are both common, so will sometimes be seen in the same patient.

A good number of PCOS patients have under-active thyroid glands. Since many of the symptoms are the same, evaluation of the thyroid gland with a blood test for thyroid stimulating hormone (TSH) should be a part of the evaluation for PCOS. The TSH is almost always the only test needed to evaluate thyroid function.

Likewise, PCOS should be evaluated in the patient with under-active thyroid gland.

3.1 What are the long-term health risks associated with PCOS? PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart disease.

3.2 What kind of monitoring is recommended? Even if pregnancy is not desired, women with PCOS should be sure to have their blood sugar, insulin, cholesterol and triglycerides checked once per year. Those who are also hypothyroid should also monitor TSH to make sure medications are working properly.

9.1 Does PCOS cause obesity, or does obesity cause PCOS?  In some ways, this question is akin to asking, "Which came first, the chicken or the egg?" since it isn't completely understood, but it appears more likely that PCOS comes first. Symptoms of PCOS may be lessened by weight loss, or increased by weight gain, but the syndrome is not caused by weight or body mass. There are lean women with PCOS. The insulin resistance that is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.

9.3 How can women with PCOS lose weight? Usually the key to weight loss with PCOS is improving glucose metabolism and reducing insulin resistance. This may be achieved by reducing carbohydrate intake and increasing exercise level, as well as through the use of insulin-sensitizing medications. Metformin has a stronger link to weight loss than the glitazones (Avandia, Actos). It is preferable to alter eating habits without reducing caloric intake below 1800-2000 calories for long-term results.