What is PCOS?

[bebe72]

This post (What is PCOS) and the post (More on PCOS) have been merged into this single thread for those looking for both threads. They are now one. ~Mod-Pickles


What is PCOS?

Polycystic ovarian syndrome (also referred to as Stein-Leventhal syndrome, polycystic ovarian disease or hyperandrogenic chronic anovulation) is an endocrine disorder found in 5%-10% women. It can cause a myriad of symptoms that appear, on the surface, to be unrelated, including:

~irregular or absent periods
~lack of ovulation
~weight gain (particularly around the waist - the "apple" shape as opposed to the "pear" or "hourglass" shape which is more typical for women)
~hirsutism (excess body hair) which tends to worsen over time
~insulin resistance (now thought to be a cause rather than a symptom, more on this later). When insulin resistance is found along with high blood pressure, high triclyceride levels, decreased HDL (good cholesterol) and obesity, it is sometimes termed "Syndrome X".
~acne
~male-pattern balding
~multiple small cysts on the ovaries
~acanthosis nigrans (darkening of the skin under the arms and breasts and at the nape of the neck)


What's going on in my body?

In PCOS, a cycle starts wherein the body becomes resistant to insulin, leading to the release of more and more insulin to compensate. This condition is called hyperinsulinemia. The ovaries of PCOS women seem to be particularly sensitive to high blood levels of insulin and respond by overproducing androgens (such as testosterone). This disrupts the "feedback loop" between the ovaries and the pituitary gland, and the pituitary gland produces too much LH (luteinizing hormone), leading to more overproduction of androgens. The immature follicles in the ovaries then fail to convert the excess androgens to estrogen, which inhibits the development of the follicle. Ovulation doesn't take place because the egg couldn't develop properly, and the immature egg, instead of being released from the ovary, becomes a tiny cyst that starts producing its own supply of androgens, which interferes with next month's developing follicle.

What causes it?

In the past it was thought that PCOS was caused entirely by excess androgen production, but recent research has shown that the factor that causes the problem is insulin resistance and hyperinsulinemia, which in turn cause overproduction of androgens. Treatment previously revolved around treating the androgen imbalance, and wasn't necessarily very effective. Newer treatments focus on the insulin problems and are showing great promise. There's an excellent diagram of the process at Polycystic Ovary Syndrome: A New Direction in Treatment. The diagram is about halfway down the page, under the heading "Insulin Resistance in the Polycystic Ovary Syndrome." The whole article is good and gives a great explanation of the process.

How is it diagnosed?

PCOS is often overlooked by doctors, though awareness of it is increasing. It is generally diagnosed through various blood tests and ultrasound. It shouldn't be diagnosed by ultrasound alone, though, because about 20% of women have polycystic-appearing ovaries - it's a symptom of chronic anovulation, which can be caused by other things. Blood tests can be done to test a number of different hormone levels - high androgen levels (particularly free testosterone), high levels of LH or elevated LH to FSH (follicle stimulating hormone) ratio are often the basis for diagnosis.

Problems and risks associated with PCOS

Women with PCOS have an increased risk of developing a number of other health conditions. This does not mean that by having PCOS you are destined to develop any of these problems, just that you have a higher risk than the general population.

Type II (adult-onset) diabetes.
~By controlling the production of insulin and with changes in diet, this risk can be reduced. If it isn't treated, there is up to a 40% risk of developing diabetes by age 40.

High cholesterol and triglyceride levels
Cardiovascular disease.
~Again, by controlling the production of insulin, this risk can also be greatly lowered. During treatment cholesterol levels have often been seen to drop down to normal levels as well.

Endometrial cancer (cancer of the uterine lining).
~This risk comes from lack of menstruation - if you haven't reached menopause and aren't having periods on your own on a semi-regular basis, you need to be treated or you may risk developing endometrial cancer.

Credits for this infromation goes to http://www.pcos.freeservers.com/general.html

[bebe72]

Chart that goes with the article. (Credits to http://www.pcos.freeservers.com/general.html)

[bebe72]

Glucose tolerance testing and lipid measurements

Most women with polycystic ovary syndrome should have an oral glucose tolerance test at diagnosis and at five-yearly intervals thereafter, and measurement of fasting lipids at diagnosis and at two- to three-yearly intervals. The exception would be a woman aged less than 20 who is not overweight and who does not have a family history of diabetes mellitus, gestational diabetes or large birth weight.

A considerable number will be found to have impaired glucose tolerance or mild type 2 diabetes. The measurement of serum insulin in the fasting state and at one and two hours will detect most insulin-resistant women.

The parents of the woman with polycystic ovary syndrome should also have glucose tolerance tests. Her siblings' glucose tolerance should be assessed if a parent is shown to be diabetic.

Credits to http://www.pcos.freeservers.com/general.html

[bebe72]

There are many factors about PCOS and it only takes one symptom (sx) to be diagnosed (dx) PCOS. PCOS is a
disorder, the "Daughter of Diabetes". Left untreated, it can turn out to be just like "mom".

PCOS is hereditary which stems from Diabetes/Insulin Resistance. PCOS can be passable to your children by 50% of a chance. While PCOS is only in females, Syndrome X is in both females and males. This should by no means stop you from having children. We can never guarantee the health of our children. Also, there are many medical advances that can help PCOS. If you are aware of the possibilities, then you will be that much better at detecting it and curbing it before it gets worse. Who knows, there may be a cure for Diabetes soon. When that happens, PCOS and Syndrome X will also be cured. Whatever happens in the news with Diabetes, pertains to us as well. So keep your eyes and ears open!


PCOS/Syndrome X has several risk factors that only become worse when it is left untreated.

~ Heart Disease
~ Heart Attacks
~ Strokes
~ Uterine Cancer
~ Ovarian Cancer (Rare)
~ Diabetes and more.

Symptoms of PCOS include (not all necessary to be PCOS):

~ Irregular Cycles or amenorhea
~ Alopecia (Thinning of scalp hair)
~ Insulin Resistant (IR - all PCOSers are somewhat IR or wouldn't have PCOS to begin with)
~ Hirsutism (Extra facial and body hair normal only to men)
~ Infertility, pregnancy complications, frequent miscarriages (m/c)
~ Persistent/Chronic: Pelvic Pain, Headaches/Migraines,
~ Anemia, Dandruff, "Arthritic" Pain, Sleep Disorders,
~ Restless Limb/Hands/Feet Syndrome,
~ Bloating/Water Retention,
~ Swelling of hands/feet,
~ Heartburn,
~ Depression
~ Forgetfulness, "Fog Brained", Lack of concentration
~ Frequent Mood Swings/PMS in a month
~ Shakes, uncontrollable hunger, faintish or frequent fainting spells
~ Skin problems, acne, brown spots on neck or armpits,
~ Skin tags, hidradenitis suppurativa
~ Hypertension
~ Hyper/Hypoinsulinemia
~ Diabetes (usually Type II)
~ Ovarian Cysts

Some PCOS facts:

6 to 10% of all females have PCOS (reportedly: as young as 5 to as old as 76)
30% of all PCOSers do not have cysts.
50% of all PCOSers are overweight.
40% of all "Unexplained" infertility later get dx PCOS
20% of all Infertility patients have Ovulation problems

Common LH:FSH ratio in PCOSers: 2:1, 3:1. Normal is 1:1

Many PCOSers hormone levels are "within normal ranges" but are usually on the higher spectrum PCOS gets worse with age.

PCOS gets worse if left untreated and can be dangerous.

BCP only help shed lining, prevent pregnancy, reduce cyst size while hibernating PCOS which still is aging and getting worse in its "sleep".

It is important to know that everyone that has PCOS has some level of IR - even if slightest amount - in fact you may not even register as IR in a Glucose Fasting Test or a 5 hour GTT. The 5 hour GTT is the most important one to dx IRPCOS. If you are a strong IR patient, then a Glucose Fasting Test will most likely show that. However, if you are showing as non-IR in the GFT, that does not rule out IR completely. It takes the 5 hour GTT to completely rule
out IR. Anything less then 5 hours may miss it. Many PCOSers do not register IR until the 4th hour.


Treatments (tx) for PCOS include drug therapy: Such as
~Glucophage/Metformin - considered a "miracle" drug to all those it works.
~Avandia/Actos/Other Glitazone category drugs - alternative or addition to Gluc.
~Clomid - induces ovulation. (Do not take more than 6 months consecutive. )
~Provera - Induces menses. (Should be taken at least once every 3 months of no menses on your own to reduce risk of uterine cancer).

Surgery/Internal: Such as
~Ovarian Drilling (even performed on noncystic ovaries),
~HSG,
~D&C (to rid lining)

Diet and Exercise:
The only diet that truly benefits us long term is a "Diabetic Type II's" diet or Low Carbing . (See more below for additional information).Many benefit greatly from Glucophage and low carbing combined. Some add Clomid too when ttc. Avandia and Gluc combined also is beneficial. A good way to keep an eye on the sugar levels is with a Gluco Meter.

How Glucophage/Metformin and Avandia work and WHY you should be on it for the rest of your life, regardless of ttc or not: An Insulin particle is in the blood stream in team with a sugar particle. The more sugar particles, the
more insulin particles. The more refined sugars (quick sugars such as sweets and potatoes) we eat, the more in our body and the more insulin in our body because it gets released per particle of sugar.

What's very important is that we get the insulin out of the blood stream and away from the heart. High insulin levels is what causes heart disease, heart attacks, strokes and other problems. Insulin is accepted by Muscle Cells and Fat Cells. These are the only 2 spots it can go to get out of the blood stream.

Glucophage allows your muscle cells to soften to accept the insulin particle better, because right now, your muscle cells shell is too hard to allow the insulin particle inside. In PCOSers/Diabetics, generally, the muscle cells are tougher. This is not necessarily so with those that make too many insulin particles although still likely.

Avandia adds more fat cells for the insulin to go. They come in 2mg, 4mg, and 8mg pills. You should start low if you use this medication then work up until you see results shown through blood work. While yes, taking avandia may make you gain some weight, its better then the alternative...heart attacks and more. No one ever died from being fat. They died from the habits and side effects that made them fat to begin with. However, its more beneficial to take both. Larger dose of Gluc and a very small dose of Avandia...to balance the body.

Dieting
The key is less refined carbs, everything else leveled out. Sure, we need to cut out as much as possible but it doesn't mean you can never have these foods. The key to a good diabetic diet is to cut where you can, the amount on your plate (using smaller plates helps), and the amount of times of day you eat.

Eating 5 to 6 small meals a day is advised. This will keep your metabolism running and doing its job and
prevent cravings and over eating. Feed your appetite. Ignoring it and putting it on a time schedule will only
make you gorge and crave.

Eating a handful of nuts once a day gives you nutrients, vitamins, protein and keeps the metabolism
working hard.

Fruits and veggies are necessary. Its ok to eat these, they are healthy after all. Think of it this way, its
better then a candybar. Don't deprive yourself of healthy food simply because the carbs may be higher then desired.

Substitute "white" for "wheat" or "bran".

Avoid anything that says "low fat", "energy", "power", etc. These are all high in sugars. Watch yogurts too.


Decaf coffee or cinnamon are natural sensitizers (glucophage simulator). Drinking one cup of coffee a day,
and 1 tsp of cinnamon per meal can really make a difference in a natural way.

Losing weight takes time. After the first 2 to 4 weeks, you shouldn't lose more then 1 to 2 pounds per
week. This will help you to maintain your weight loss for a lifetime. Quick weight loss is always a cause for
concern.

Lastly, seek out a diabetes center in your area and speak to a Registered Dietician



INFERTILITY
IF Friendly Employers
Men and Infertility Message Board (men only)
Infertility Tutorial
Normal conception rates & causes of infertility
Medline Plus
HPT Detection Levels List
Male Infertility
Infertility in Men
Infertility Blues: Behavioral Management Infertility
Program


YOGA
Yoga and Infertility
Infertility Yoga Resources

PREGNANCY
While pregnant, is it safe to...? see babyc enter.com (Fail load: remove space between "babyc" and "enter")
Meformin during Pregnancy

PCOS/DIABETES/WOMEN'S HEALTH
PCOSA
Superb PCOS info
PCOSA Professional Memberships - a place to find a PCOS-friendly doctor OR look here Fertility Doc Shop
VERITY - The UK PCOS Support Group
Diabetes at MSNBC
Women's Health at MSNBC
PCOS at Anthem
Womens Health at Anthem
PCOS Strategies


PCOS MEDICATIONS
Glucophage/GlucophageXR (generic: Metformin)
Avandia
Avandamet
Actos
Glucovance
Glucotrol XL
PCOS MEDICATIONS ARTICLES
http://diabetes.about.com/library/b...rminPCOS202.htm
http://www.endocrineonline.org/pdf%20box/pcos+met.pd
http://www.asrm.org/Patients/FactSheets/insulin.pdf


DIET
http://www.diabetic-diet-and-recipes.com
http://www.diabetcdiet.com
http://www.diabetes.org/main/health...cipe/071201.jsp
http://www.endocrinologist.com/The-Diabetic-Diet.html
http://www.diabetes-and-diet.com
Diet and Health at MSNBC
Nuts and Seeds

[anxiousfemme]

Hi,

I have just seen you posting and all the information was very helpful.

I had been diagnosed with PCOS a long time ago and have been trying to conceive since the past 4 years.
I am 29 now.
I have been through several clomid cycles and 3 rounds of IUI.
The sad part is that nobody told me that I could be at risk to get diabetes. I had been told to lose weight as I am approximately 10 kgs overweight.

My concern is that I have never followed a low carb, no sugar diet and I am worried sick that I have increased my chances of becoming a full fledged diabetic. To make matters worse my dad has it and there is a history in my mother’s side as well.

Do you have any idea if there is still a good chance of conceiving if I improve my diet. Also can thinning hair be treated in any way?

Thanks and regards,

AT

[pam24]

i was recently diagnosed with PCOS and although i dont know very much about it yet, i was told something by my GP the other day.
i was sleeping with my partner nearly 2 years without contraception and did not fall pregnant, although i wasnt concerned with this at the time ( i was only 19) i decided i should go on the pill, i was put on a progesterone only pill i took it for about a month and 6 weeks later i was pregnant. i had my son who is now 4 and we decided last year to try for another baby, i hadnt been using contraception since 8 months after my son was born so i got worried and went to my GP he did some blood tests and i was told my progesterone level was low it was 15 when it should have been around 45?????? ( i do not understand all these numbers as i didnt know about PCOS till about 6 weeks ago) i had an ultrasound scan 4 weeks ago when it was confirmed that that is the problem. basically i was told that the probable reason why i got pregnant was because of the increased progesterone level maturing the eggs properly. i also know that the doctor will not put me on this pill again because of an increased risk of cervical cancer etc etc. i dont know if this is an option to discuss with your gyn but it at least has given me a bit of hope. i am being referred to the hormone specialist at the local hospital for treatment for the symptoms of this PCOS.
I hope this has helped and good luck

pam

[bebe72]

anxiousfemme ~~

I posted a separate thread to you. I am not sure if you ever saw it or not. I will try to find it and bump it up on the bb for you.

[TNgurl]

Thank you for the information. Alot of useful info that I did not know!

TNgurl

[seed]

Thank you so much BeBe,
I'm about to go for testing for PCOS, and have struggled to find info. Now I want to hear some sucess stories!!!!
Liz

[darkprincess]

Is there a difference between POS and PCOS? Is the same thing, or are they different?

-confused