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Old 06-08-2007, 02:45 PM   #1
chibow
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Default FAQ - Newcomers Come Here First!!!

So, What Is This Thing Called PCOS, Anyway?

While there is a bit of discussion about it, for most of us, PCOS is a hormonal imbalance caused by Insulin Resistance (IR). IR can be tricky to diagnose, as the blood work can be read as "normal" while there is still an issue in the "background", so to speak. IR can be diagnosed from symptoms alone, such as excessive hunger (especially when you feel that you "shouldn't" be hungry), dizziness, headache, nausea, irritability, mood swings, the "shakes", exhaustion, especially if you skip a meal. Also, if you look at your neck where it meets your body, and notice that the skin is thicker, creased, and perhaps looks "dirty" even after having a shower, it is highly likely that you do, in fact, have IR.

Other women seem to have a thyroid issue as the main factor for their PCOS. There are also "thin cysters" who do not have a weight issue, but still can benefit from IR treatment.

The other things to keep in mind about PCOS are that it is not "just a fertility issue". It is a whole-body endocrine imbalance that can cause an increased risk of heart disease, diabetes, and certain "female" cancers. This is why it is important to make sure you treat the PCOS beyond just symptoms control such as Birth Control Pills (BCP). Also, if you do not have a menstrual cycle (absence of AF or Aunt Flow), make sure that you get one induced at least every 3 months to reduce your risk of endometrial, uterine, or cervical cancers.


What Is Insulin Resistance (IR)?

Insulin Resistance (IR) occurs when the body's cells do not use insulin effectively. Insulin is the "key" that allows glucose from the blood to enter cells to be used for energy. Think of Insulin Resistance like a slow-running drain - the insulin does get through, it just takes longer to do so, and in the meantime, the body produces more because it thinks that you need more. This over-production can cause Reactive Hypoglycemia (low blood-sugar) in some people, and can eventually wear out the pancreas, leading to Adult Onset Diabetes. In the meantime, as insulin is a hormone, it affects the other hormones in the body, including the sex-hormones, which cause many of the PCOS symptoms such as high testosterone levels (responsible for acne/bacne, hair loss and facial/body hair to name some). IR also causes the body to become very efficient at storing glucose as fat, which leads to the excess body fat which many of us suffer from, as well as the inability to lose weight.

For those who like to know the details: With IR, you produce more insulin than you need. This insulin is not taken up by the cells, so "floats" around in your body. The extra insulin affects your hormone levels directly, but also makes it harder for your folicles to burst allowing ovulation. These folicles become ovarian cysts, and as there is then no corpus luteum (what the folicle becomes after ovulation) to produce progesterone, there is nothing to trigger a proper bleed to shed the endometrium lining. You may still get something resembling a period, as the lining can get thick enough that it can't support itself, and chunks can fall off, but it doesn't clear out properly.

The good news is that if you better manage the IR, you reduce the amount of insulin in your system, and things start to go back to normal. This is one reason why Metformin can work so well for some people.


I've Heard That Women With PCOS Aren't Able To Have Children. Is This True?

While it is true that untreated PCOS is a leading cause of infertility, once it is properly treated, many women go on to become pregnant. In fact, many women find that using Metformin, an insulin re-sensitizing medication, may be enough to stabilize their PCOS symptoms and can return their fertility quite suddenly! Other women require further levels of medication and intervention, but the main thing to keep in mind is that there IS hope!!! Also, if you are not planning to become pregnant currently, keep in mind that you will still need to practice a reliable method of birth control.

You can also track your fertility by tracking your Basal Body Temperature (BBT), Cervical Mucus (CM) and other fertility signs. www.fertilityfriend.com is a great resource, and can also chart it for you online.


So, What Now? What Can I Do?

Firstly, get a thorough check-up from your doctor, that includes hormone levels, cholesterol levels, thyroid, and see if your doctor will do a 2 or 3 hour Glucose Tolerance Test. You should also make sure they take a Fasting Insulin level and Sex Hormone Binding Globulin. These tests are necessary because with PCOS, you have a much higher risk of developing heart disease, bad cholesterol levels, and diabetes. The GTT can also (but not always) reveal Insulin Resistance, the most common cause of PCOS. Quite often, you will have an elevated insulin level, which is a better indicator of IR. Usually, you will also find a lower level of SHBG, which affects how much the testosterone will affect you.

You should start on a low-er/good carb diet with 3 main meals and 2 - 3 healthy snacks/day. Focus on high-fibre, low-starch veggies and protein. You should also get lots of good exercise!!! If you haven't exercised for quite some time, start where you are now, and increase a little more each day. Even walking will do wonders, and will "get the juices flowing"!!!

A good supplement schedule should include Chromium (good for insulin/blood sugar issues), Fish Oil (Omega3, and good for cholesterol, metabolism, heart health, mood swings, heart rate, and overall brain function), and a good multi-vitamin/mineral.

You should also look into taking an insulin re-sensitizer such as Metformin/Glucophage and/or Cinnamon (herbal alternative). Base levels that seem to work for those of us with PCOS are 1,500 - 2,000 mg/day for the Met, and 500 - 1,000 mg/day for the Cinnamon. With both of them, you will want to work your way up to those doses, and allow your body to gradually adjust.

An Endocrinologist (endo) or Reproductive Endocrinologist (RE) are more likely to know and understand PCOS, but as there is a definate issue with finding a doctor who has thorough knowledge of PCOS, ANY doctor who takes you seriously, and is at least willing to do the research is more than worth his (her) weight in gold!!!


So, How Do I Lose Weight And Change My Lifestyle?

There are many ways to make lifestyle changes, but there are some key elements you need to include.

1) You need to limit highly processed, sugars and starchy carbs. Change the carbs that you do eat to a healthier, higher-fiber version - so brown bread, brown rice, whole wheat pasta, etc. Also, try to pair a protein with your carbs - it helps to even out your blood sugar.

2) You NEED to include exercise of some kind. Ideally, it's a combination of both cardio and muscle-building, but as IR is based in the muscle cells, working the muscles helps to improve insulin sensitivity.

3) Take it one step at a time. Don't try to change everything overnight. Take baby steps, and tackle one thing at a time.

4) Track your progress. This means more than just the scales, as your body is made up of muscle (which weighs more than fat), water, fat, and all the other "stuff" (organs, bones, cartiledge, etc.). Learn how to take your measurements, and chart that as well as weight. Celebrate when you go down a size. Keep maybe only one pair of "fat pants" so you have something to compare to - and get rid of the rest!!! Sell them, burn them, give them away - just get rid of them!!!

www.sparkpeople.com has come up with a really good system put together by dieticians, doctors, fitness professionals, etc., and it's naturally geared towards preventing and controlling IR and Diabetes. It also has nutrition and fitness trackers, recipes and recipe calculators, and TONS of info and it's 100% FREE!!!!!!

When you sign up for Sparkpeople, you start out with what your current stats are, and then put in what you want your goals to be. They will go as far as setting up a daily menu/fitness routine for you, or you can do it independently and enter all your info in the nutrition/fitness logs yourself. It really is a great tool for seeing and understanding the way that nutrtion and fitness interact!!!

The Insulite System is also available. They take all of the same elements, but put it together for you in one package, including your supplements. This is a program that is a little bit more specific in treating IR and PCOS. It can get a little pricy, but it is a good system. You can check out their system at pcos.insulitelabs.com, or from the main page of the PCOSA website.


But I Don't Have All The Symptoms!!! Do I Still Have PCOS?

As PCOS is a syndrome, you can have some, all, or only a few of the many symptoms. Classically, it is diagnosed by having 2 out of the following:

1) a history of PCOS, Insulin Resistance, Diabetes or Hypoglycemia in your family, or having these issues yourself.

2) blood work which shows certain hormonal imbalances such as a reversed LH:FSH ratio or elevated testosterone levels.

3) "PCOS-type" symptoms such as: weight gain (especially around the middle) and inability to lose weight, acne/bacne, irregular/absent AF, hair loss, body/facial hair, skin tags, dark skin patches (may look "dirty"), mood swings, lack of energy, elevated cholesterol levels, and also ovarian cysts. By the way, in spite of it's name, not all PCOS women have ovarian cysts.


I Can't/Won't Take Metformin. What Else Can I Do?

While Metformin is the most common insulin resensitizer, there are other options out there. Certainly, if the intestinal side effects (nausea, diarrhea, etc.) are too intense to realistically deal with, you can try the extended version. That helps many women. Always take with a meal, and be aware that eating starchy/sugary/fatty foods tend to make the side effects worse. Lettuce seems to be a bad idea, too, for some reason. Also, there is Cinnamon (an herbal alternative) which, while they are only just beginning to do studies about it, shows some strong promise in terms of treating Insulin Resistance! It has also been successfully used for thousands of years in Traditional Chinese Medicine to treat endocrine issues. Avandia is another medication that will improve insulin sensitivity. It can be used by itself, or in combination with Metformin or Cinnamon. Actose has just come on the market as a Metformin replacement that has fewer side effects. And don't knock the effects of diet and exercise!!!


I Want To Try Cinnamon. What Do I Get, And How Do I Take It?

The Cinnamon you get is powdered Cinnamon bark, like what you buy at the grocery store. The variety is called Caissia Cinnamon. Some people prefer capsules, as it is easier to measure and you don't have to have Cinnamon with everything. If you do get capsules, be sure that it is the powdered bark, or at the very least, a water-soluble product. You want to be careful NOT to use Cinnamon Oil, as it is difficult to process and flush from your body, and it does not have the insulin-sensitizing effect. If you are using regular Cinnamon from the store, a teaspoon is about equivalent to 500 mg. You can take it sprinkled on cereal, in tea, on desserts, mixed in applesauce, and so on. While previously, dosages were recommended up to 4,500 mg/day, due to the discovery of Cumarin (a powerful blood thinner) in Cassia Cinnamon, we no longer recommend this. Now, dosages of 500 - 1,000 mg/day are recommended. It may take a little longer to be effective, but some studies show that a lesser dosage can be just as effective long-term. This also reduces the need to gradually work up to your dosage.

Cinnamon can bring your blood sugar down when first getting used to it, so if at any time you get hypoglycemic symptoms (the "shakes", dizziness, headache, nausea/hunger, confusion, the sweats, irritability), treat it with a sweet drink followed by a healthy snack that is high in fibre and protein. You may need to either reduce your dosage for a week, or adjust your eating/exercise routine to better adjust to it.

Remember to take your Cinnamon with an adequate amount of liquid, as you can get "Cinnamon burps". Some women have even burped up a cloud of Cinnamon!!! While funny, it can burn, so it's a good idea to avoid it!


I'm Interested In Herbal Remedies. What Can I Take?

One important thing to keep in mind is that HERBAL REMEDIES ARE MEDICATIONS, TOO!!! Not all of them are safe to self-medicate with, and not all of them are OK to use while TTC. Some things are fairly simple to use and have few side-effects, such as Cinnamon which is designated as "Generally Considered To Be Safe", while others can be harmful if too much is taken, or if combined with other medications. Always run your supplements list through your doc, and if you can see a licensed Naturopath or herbalist, please do so before taking something new. Also, beware of adds which promise a "miracle cure" or "instant fertility". Many of them are "snake oil", and are not based on science or true herbal knowledge. It's definitely "Buyer Beware" out there!!!

This has recently been reinforced with the discovery of Cumarin (a powerful blood thinner) in Cassia Cinnamon, something that could have caused serious issues in some people. Always get your herbals checked out and approved by someone with appropriate knowledge (NOT the lady at the health-food store!!).


Is There A "Quick List" Of Meds And What They're For?

Things Taken To Control Blood Sugar/IR
Metformin - a medication that reduces IR and directs the liver to not produce as much glycogen.
Cinnamon - an herbal medication used to improve IR. Also has a pseudo-insulin effect and can lower blood sugar suddenly if not used to current dosage.
Chromium - a mineral used to improve IR. Chromium can also lower blood sugar when first taking it.
Alpha Lipoic Acid - very promising supplement to aid in reducing IR.

Others
Fish Oil - heart health, mood, IR, & cholesterol
B-Complex - energy and to combat anemia occasionally caused by metformin
Pre Natal - taken by those Trying To Conceive (TTC) because of the extra folic acid. Can also contain a multivitamin/mineral
Multivitamin/mineral - to fill in nutritional gaps

Fertility Drugs
Clomid - used to induce folicle maturation and growth. Can cause thining of uterine lining with prolonged use
Femara - used to induce folicle maturation and growth. Does not cause thining of uterine lining. Has shorter half-life than Clomid.
Gonal F - injection of Folicle Stimulating Hormone used to induce folicle maturation and growth
(Trigger Shot) - injection used to trigger ovulation

Hormonal Controls
Yaz, Yasmin - are birth control (BC) with aniti androgens
Spiro (Spironolactone) - is an anti-androgen that requires you be on BC
Provera/Prometrium - Progesterone supplements used to trigger a proper bleed. Prometrium is natural, so it can also be used to help support an early pregnancy.


I Want To Research And Get More Information On PCOS. Do You Know Of Some Good Resources?

Books:
- The Savvy Women's Guide to PCOS by Dr. Elizabeth Vliet
- Fertility for Dummies
- New Glucose Revolution Guide to Living Well with PCOS
- The PCOS Diet Book: How You Can Use the Nutritional Approach to Deal with Polycystic Ovary Syndrome
- A Patient's Guide to PCOS, Understanding and Reversing Polycystic Ovary Syndrome by Walter Futterweit
- PCOS: The Hidden Epidemic, by Samuel Thatcher
- PCOS: A Woman's Guide to Dealing with PCOS, by Colette Harris, Dr. Adam Carey

Websites:
- www.pcosupport.org
- www.fertilityfriend.com
- www.tcoyf.com
- www.inciid.org/faq.php?cat=infertility101&id=2
- http://www.nichd.nih.gov/news/releas...l_diabetes.cfm
- www.sparkpeople.com
- www.pcos.insulitelabs.com
- http://www.aace.com/pub/pdf/guidelin...nstatement.pdf
(Position Statement by the American Association of Clinical Endocrinologists)
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Old 05-01-2008, 11:56 AM   #2
pjmccall77
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Default My 17 year old daughter has PCOS

My daughter was recently diagnosed with PCOS and I was wondering if there was any information about PCOS being connected with Bi-Polar Disorder. Since she hit puberty we have been on a roller coaster. Also, I was really suprised by the amount of pornography on this forum. Are there other forums or sites that are serious about this issue?
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Old 05-01-2008, 12:39 PM   #3
sweetsunshine72
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Hi pjmccall77,

I do appologize about the spam!!! We've been struggling to do an upgrade to our systems to help block it out, but it's been causing some problems. There's a thread about that on the General Discussion board - Programming and Administration Notice at the top. There's a team of volunteers (myself included) that delete the spam as soon as we see it, and we do try to "patrol" especially sensitive areas like the teens board as often as we can, but it's been really crazy! Hopefully the upgrades/changes will be completed soon!

As for your question about bi-polar - yes, there is a connection. Many women are actually mis-diagnosed with bi-polar when the main issue is really PCOS. Part of this is because it's Insulin Resistance that is the main cause of PCOS, and IR can cause unstable blood sugar levels, which affect mood. I, myself, have felt "hyped up", followed by a "crash", and have since discovered that my mood swings were caused by Reactive Hypoglycemia - which is caused by IR. The hormonal imbalances caused by the IR can also cause mood swings, as well as a chronic depression.

Certainly, it is possible that your daughter really does have bi-polar, but I would get her thoroughly checked out by a qualified endocrinologist! Keep in mind, too, that IR can be difficult to detect with standard bloodwork as the tests are really not sensitive enough (according to my own endo). It can, however, be diagnosed with symptoms, and treating the IR (lifestyle changes and an insulin-resensitizer such as Metformin) should show improvement within a few months (many times within a few weeks).

Please feel free to PM me if you need further information. Our FAQ's sticky has a lot to offer, too, including a list of resources at the bottom. Certainly, I am going to go through right now and delete any offensive postings in the Teens forum, but if you see something, by all means, PM myself or any one of the Spambusters! If you wish to join the Spambusters, then just PM Chibow, and she can get you set up.

Take care, and HTH!!! 8)
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Old 05-01-2009, 03:51 AM   #4
hayley25
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Exclamation Bi-polar+pcos?

i just joined this support group and its very ironic that the first thing i looked at was this post.
I am 17 and was diagnosed with pcos and insulin resistance 4 years ago, and diagnosed with bipolar disorder 2 years ago.
I am currently being taken off all of my medications for bipolar disorder to be re-evaluated because i felt like my diagnosis was wrong. i had been wondering if there was any connection between pcos and bipolar. thank you so much for posting the information linking pcos with a bipolar diagnosis. This will really help me figure out what is going on and if my insulin is really the cause of my mood swings and irregular sleeping patterns.

Also, i had been told by my last doctor that i didnt need to take my meteformin anymore because my insulin was "under control" so i havent taken it for a couple years.
any opinions?
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Old 05-01-2009, 04:24 AM   #5
MyJourney
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Smile metformin vs. clomiphene

I am also a new member. I have pcos, endo, and was diagnosed bi-polar a few years ago. I deal with severe mood swings and depression but have noticed it directly relating to my blood sugar level. I test it regularly. One of my dr's prescribed metformin but another said clomiphene is more effective.

Oh I also cannot seem to lose weight even with diet and excercise.

Any thoughts on either???
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Old 05-02-2009, 12:19 PM   #6
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It will be interesting to see what happens when you have your re-evaluation done. Keep in mind that you should also have at the very least a Glucose Tolerance Test done (with fasting insulin levels) at the same time to see where your IR stands, and if it is still under control.

Some of us only need to take Metformin for a year or two, then maintain with a low-GI-type diet and exercise. Others will need to continue taking it, but at a lower level. Then, of course, there are those of us who will need to keep taking it at a full dosage of 1,500 mg/day for life. It all varies. You should be able to tell if it's under control or not by how you feel (once the bi-polar meds are out of the way, anyways). The key symptoms are: energy levels, mood swings that seem to be related to what/how often/when you eat, weight gain (and many bi-polar meds encourage weight gain), and your periods.

Another key one that's specific to IR is dark skin patches. The skin can look thicker, and almost like it's "dirty", even after you scrub it. They tend to be in the underarms, the groin, in a ring around the neck, and under the breasts. If you have that, then it's almost guaranteed that your IR is acting up.

Take care, and keep us up to date!!!
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Also:
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Cannot tolerate BCP
No treatment for 12 years
Now, Metformin 1,500 mg/day, Fish Oil, D3, good multi
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Old 05-02-2009, 12:24 PM   #7
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Clomiphene (Clomid) will help with ovulation, and nothing else.

Metformin will tackle the underlying issue with your blood sugar and insulin levels. Re-balancing your body will help with ovulation. In fact, many women find that simply by using Metformin, a low-GI-type diet and exercise helps them re-gain their fertility. Even if it's not enough on it's own, it will help Clomid work better, if you still need to take it. By stabilizing your blood sugar, you should start seeing your mood swings improve, too.

IR can prevent you from losing weight. Metformin helps improve the IR, so you can then use the diet and exercise to actually be successful at it!

Personally, I'd recommend at least a 6-month go at the Met, diet and exercise before even considering using Clomid. You can take both, btw, too.

HTH!!!
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Also:
DS (1992)
Diagnosed PCOS 1994
Cannot tolerate BCP
No treatment for 12 years
Now, Metformin 1,500 mg/day, Fish Oil, D3, good multi
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Old 05-03-2009, 04:11 PM   #8
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Default I'm 15

Hi! I'm 15 and I was wondering that if you do have the dark patches, how can you get rid of them?
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Old 05-03-2009, 05:55 PM   #9
MyJourney
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Smile thanks:)

sweetsunshine72~ thank you for clarifying that. I wasn't sure why he suggested clomid instead because I explained I'm not TTC anytime soon. I had a molar pregnancy last year that resulted in m/c. I've also had a hard time getting him to put me on met even though my fasting glucose tolerance showed abnormal results. He's also the only doctor accepting patients in my area. I'm also a new patient of his though so I'm not sure he realized yet how determined I am and that I rarely take no for an answer:-)

I was also diagnosed hypothyroid years ago and the synthroid really helped for a while but they took me off of it after a while and decided to see how I fared. My levels come back normal everytime although the symptoms are all there. I was 105 6 yrs ago and while I know everyone gains weight after children and age I'm at 215 now and much of that has been in the last 2 yrs. My husband is type 1 diabetic so we eat pretty healthy and I've done the gym thing with no results so I know it's IR. I carry my weight in the belly and look like I'm 6 months preggo. It's humiliating. Thank you for the support and advice it helps to not feel like your crazy among all the smug faces of the
un-pcos community.
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Old 05-04-2009, 07:38 AM   #10
sweetsunshine72
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As your IR gets under control, the dark patches will start to clear up on their own. If they're really bothering you, you could try using something to fade them (like to fade liver spots on older people), but it probably won't get rid of them entirely, and it might irritate your skin.
__________________
Registered Massage Therapist
2200-hour program in Canada
Focus on women's health and managing chronic health issues
www.massageforlifenb.com

Also:
DS (1992)
Diagnosed PCOS 1994
Cannot tolerate BCP
No treatment for 12 years
Now, Metformin 1,500 mg/day, Fish Oil, D3, good multi
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