1- General PCOS Information
NOTE: I am not an OB/health professional, this is just what I have learned from years of dealing with my own PCOS, trying to conceive with PCOS and obesity related to PCOS. If you have PCOS, think you may have PCOS or suspect a sister, daughter or niece may have PCOS you should seek the advice of a knowledgeable and up to date OB who specializes in PCOS. Treatment started at a younger age makes a big difference in preventing the complications related to PCOS. That said:
Polycystic Ovarian Syndrome is the most common reproductive disorder, it is the source of 70% of fertility problems, at least 1 in 10 women are diagnosed with PCOS and more than 50% are un-diagnosed or misdiagnosed. Many women who are overweight or obese are ignored. There are OB's who assume their weight is to blame and the underlying issue is not addressed.
PCOS was first named in the 30's but has increased over the years. In my opinion, BPA is to blame. BPA started being used in plastics and food packaging in the 50's. Up to 93% of Americans now have testable levels of BPA in their bodies. Though many products (especially baby/child related products) claim to be "BPA Free" the substitute chemicals are also hormone disruptive chemicals and cause the same or similar symptoms as BPA.
Despite its commonality there is still very little known about PCOS and exactly why women being diagnosed with it are increasing in huge numbers.
PCOS is a chain reaction where are several factors are at play:
Hormonal Imbalances:
FSH (follicle stimulating hormone) & LH (luteinizing hormone): FSH is the hormone that tells the eggs in our ovaries to get to work maturing a follicle and a large LH surge combined with a smaller elevation of FSH signal the release of the mature egg from the ovary.
Women with PCOS have highly elevated levels of LH and also an elevation of FSH.
LH is the hormone that ovulation test kits detect to signal ovulation, it you have PCOS and take these tests it seems like you're always ovulating even when you're not.
*Interesting Fact: OPK's do detect pregnancy! When I became pregnant I was terrified of miscarriage. I had severe cramping and spotting but the clinic's OB's wouldn't see me until I was 3 months pregnant. I explained that after 10+yrs of infertility, obesity and PCOS I had a VERY high risk pregnancy. Nope, wouldn't see me. I lied and said I had a yeast infection to get in;) But during those scary first 3 months I took hundreds of pregnancy tests, one day I ran out and took one of my left over OPK's and yup, two bold lines.
Women with PCOS have high levels of FSH and even higher levels of LH, but we don't produce the LH surge that produces ovulation since our LH is already so high. This causes irregular menstrual cycles, no menstruation, light bleeding, excessive bleeding and no ovulation or irragular ovulation.
Overweight or obese women are usually more at risk or are simply more often diagnosed with PCOS but thin women can have PCOS too. I bet that many thin women are misdiagnosed or diagnosed later simply because the stereotype for PCOS is the overweight, inactive, Snickers bar munching beaded lady.
Research about PCOS and how it affects thin/average women suggests that LH is the main issue for them but that is still unclear. A thin woman can have the extra muscle mass, unwanted hair and acne too.
The Disastrous Duo- Tag Team Testosterone & Insulin Resistance:
Insulin resistance (IR) occurs when our body's ability to respond to normal levels of insulin produced by the pancreas is impaired, forcing the pancreas to make more and more. *My OB said I was basically a diabetic in the making. Eventually my pancreas won't be able to produce enough insulin and I will develop Type 2 diabetes. Women with PCOS have excess/high insulin levels but our bodies don't use it to process sugar and carbs, leading to *obesity.
Now, IR and LH, both already elevated, cause the ovaries to produce too much testosterone and that androgen (male hormone) disrupts the development of eggs and they are never released, turning into fluid filled cysts.
All women produce testosterone but women with PCOS produce more. This is why woman with PCOS may have:
-Hirsutism (male-like facial hair, *chest hair, *hair on breasts/*around nipples, *upper thighs, buttocks, *belly and back), may experience male pattern baldness or Alopecia
-*Higher than average muscle mass, increasing BMI
-*Adult acne
-May lower or *raise libido
-Both increased testosterone & IR may cause depression and anxiety since both have a correlation with serotonin. More research is needed but from my own experience this rings true. *I showed signs of depression (noticed by looking over poetry written as a child) at around age 9-10 or sooner and it has steadily worsened since then. I have never had an antidepressant help me at all.
- *Darker skin (acanthosis nigricans) in areas where skin moves/bunches like the neck, crease of groin and underarms and skin tags (like a small flap of extra skin) may be an indicator of IR.
Obesity: The Chicken or The Egg?
Weight is a major issue for the majority of PCOS sufferers. We gain weight easily and have a very difficult time losing weight. Our fat cells are are larger and our ability to break down fat and regulate insulin are significantly impaired.
This is caused by hormonal imbalances/high testosterone and IR.
*I have seen 5 different OBGYN's and all told me to lose weight. Well, I have tried everything and nothing ever worked, every pound I lost was gained and doubled.
So, if you are *morbidly obese, have tried diet and exorcise programs . . . and never saw any significant results, what are you supposed to do?
It took me 14 years to learn this and it was suggested 5 months ago by my weight loss specialist (Figure Weight Loss in Edgewood, KY) who knows more about PCOS and obesity than any OB I've EVER seen.
1- Eat like a diabetic! We need low sugar/low carbs and high protein diets. Healthy fats (monounsaturated and polyunsaturated fats) like avocado, olive oil and almond butter, soluble fiber like oat bran and psyllium powder improve glucose release and insulin response. Cashews are amazing! I fill a bowl with 1/2 cup lightly salted cashews and snack throughout the day on them and don't get overly hungry or crave sweets. The protein is filling, they're low sugar and low card. String cheese is great too, good source of protein, no sugar and no carbs.
2- There are supplements that help regulate our hormones and promote weight loss and you can take ALL of them.
-Chromium 100-600mg/daily
-Alpha Lipoic Acid (ALA) 100-500mg/daily
-Green Tea Extract (ECGC) 100-2,000mg/daily
-Cinnamon Compounds 500mg/daily
-EPA-DHA 2-4 grams/daily
-Inositol 500-1,000mg/daily
-Prenatal Vitamin. Most Americans are all low on D/Calcium and PNV have what we need in case we end up pregnant. 10-20% loss in body fat can regulate cycles.
3- We must treat the problem, not just mask it with birth control pills. BCP cause weight gain, which is counter productive for women with PCOS. If you are not trying to conceive you would likely be better off with the "mini" pill, spermicide and condoms. Some OB's say that not having regular cycles puts us at risk for uterine cancer. The risk is so slight that BCP's are more risky than going without regular cycles. We don't build up endometrial tissue monthly since we don't have the hormonal flux and sometimes we don't build any at all. *I given a uterine biopsy (quite painful) after going 6 months without a period. The OB said my results resembled someone who had already gone through menopause, my lining was not overgrown as she had expected but my FSH/LS were both up proving I had not gone into early menopause.
We must have the insulin resistance treated or weight loss will be short-lived and very hard to attain.
*My weight loss specialist just (yesterday) put me on Metformin. It's actually an incredibly safe drug, far safer than birth control pills. Right now my panaceas is keeping my blood sugar low-normal and I was worried that Metformin would bottom me out. I've been monitoring my fasting and after meal finger sticks and my fasting was 80, and after meals 120-130. Perfect. Metformin will take care of the IR. I also take Adipex. Adipex is meant for MORBIDLY OBESE people who cannot lose weight through regular programs. Adipex is a type of stimulant/appetite suppressant, comparable to amphetamines (it even comes up as one in a drug test) it increases heart rate, decreases hunger. It can be VERY dangerous and must only be used by those who truly need it, can use it responsibly, as prescribed and only under the care of a specialist. Thanks to Adipex I lost over 100lbs 4yrs ago and became pregnant. Now I have been back on the program for 5 months and have lost 56lbs, BMI started at 62.3 (30 is morbidly obese), my BMI is down to 43.2. I am hoping that adding Metformin will help make my weight loss permanent by treating the hormonal imbalances causing the weight gain.
*I believe my PCOS was caused by BPA exposure. I was born 7lbs, I was a normal weight until about age 5. I started to get bigger and bigger. I went through puberty very young, started my 1st period at age 9. I likely had high androgen levels even then because of my muscle mass. I hope there will eventually be a solid link between PCOS and BPA so that all of those who have suffered with PCOS can someday sue.
I'll be adding more sections on PCOS, so bookmark or follow me on Twitter.
* my personal experience
Interesting Websites:
http://www.environmentalhealthnews.org/ehs/newscience/early-life-bpa-exposed-rats-develop-polycystic-ovarian-syndrome
http://www.medicalnewstoday.com/articles/221205.php
http://www.baumhedlundlaw.com/bpa/what_is_bpa.php
http://www.lef.org/Protocols/Female-Reproductive/Polycystic-Ovary-Syndrome/Page-01
http://youngwomenshealth.org/clinicians/pcos-nurse/
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/womens-health/polycystic-ovary-syndrome/Default.htm
http://www.pcosfoundation.org/pcos-info-1
http://scholars.unh.edu/c
