PCOS - Diagnosis and Treatment

PCOS and Indian Women - PCOS affects nearly 35% of Indian Women

2009-09-01T14:14:00.001+10:00

As some of you might know, I come from an Indian background. I was shocked to find out nearly 35% of women in India have PCOS. It is a no brainer why we would have got this as health awareness is very less in India. Our diet is full of refined foods and sugar and there is no sign of this epidemic slowing down. Though we have one of the largest PCOS population in the world, we don’t have any support groups to share our experiences.

When I was thinking about the reasons for our PCOS epidemic, our lifestyle comes to my mind. Typical of Indian families, many of us are not encouraged to do exercise or instructed to follow healthy food habits. The worst part is Indian doctors don’t think of PCOS as an issue, because it is so common. Even after I came to Australia, I was following typical Indian diet. My diet mainly consisted of parboiled rice, maida and refines wheat flour etc. The symptoms I had related to PCOS were acne and irregular periods. I never did exercise and don’t feel like doing it anyways. Luckily, I became aware of PCOS as one of my colleague’s girlfriend had it. As I had acne, I pretty much concluded even before getting my blood tests that I have PCOS.

For anyone reading this, please be aware that getting diagnosed with PCOS is not an easy thing. i.e. When you go to a doctor for irregular periods , they might just prescribe you BCP’s. Though 70% of women with irregular periods have PCOS, you might not get diagnosed for that in your first consultation. Most women get diagnosed with PCOS, only after they consult the doctor for infertility.

If you have adult acne or anyone you know has it, get diagnosed for PCOS. It is vital to get diagnosed and treat it appropriately to avoid the risks of diabetes and cardiovascular diseases. If you have family history of PCOS or diabetes, then your risks of getting PCOS is higher. Regarding diet, try to consume as much whole grains a possible.

I was able to change my diet and get rid of my PCOS symptoms such as acne and irregular periods. It tried cutting rice from my diet and it helped with my cravings. My diet typically contains Low GI bread and whole wheat flour rotis as my staple. Whole wheat flour is full of fibre. It releases energy slowly into your body and thus helps Insulin Resistance.

The rest of my diet consists of items such as avocado, which are easily available in Australia. To help with irregular periods, I consumed carrot and beetroot juice. Your body must be capable of detoxifying the toxins, beetroot being a blood purifier helps heavily with it. Carrot juice helps your liver in eliminating those toxins.

Try consuming lot of legumes and pulses, as they are high source of protein. Try consuming hot water whenever possible, as the fat deposits get released with hot water. Avoid deep fried foods from restaurants.

Exercise regularly. If you can’t join a gym try to do skipping at home. Start doing it for 5 minutes and slowly increase it to half an hour. You can do it while watching TV, so you don’t have to allocate a special time for it.:)

Also, d-chiro-inositol can be used to treat women with PCOS. As it is quite expensive to buy it online, you can try having buckwheat. Buckwheat is a rich source of DCI and it helps with the PCOS symptoms greatly. Buckwheat is also know as kuttu in Hindi and Papparai in Tamil.

I am a big fan of Buckwheat flour dosa..I will post the recipes soon....:)

In addition to making lifestyle changes I also took the Insulite PCOS system and False Unicorn Root in the month I got pregnant naturally. Both are bit costly supplements but it worked in my case.

If you have been told by doctors that getting pregnant is harder and suggested the IVF path start making these lifestyle changes I see whether it makes any improvement in your symptoms(i.e. regular periods, less acne etc..) . If your PCOS symptoms improve with proper diet and eating habits, then there is a real possibility you can get pregnant naturally.

Healty Eating Guide while TTC

2009-08-31T18:24:00.035+10:00

As you might know, for women with PCOS healthy eating means everything. We don't have the luxury to follow a strict diet and then get back to junk. Once diagnosed with PCOS, we should adopt a diet which suits our lifestyle and also our PCOS. For most of the women with PCOS, eating Low GI foods instead of Low Carb foods has been the key to success. Learn more about PCOS and Low GI here.

Below is a healthy eating guide for all of us. You can tailor it to suit your lifestyle. This might not help you with loosing weight, but once you had lost weight, food habits below will provide you the necessary nutrients for a sustainable well being.

Try to consume fresh and organically grown foods whenever possible. If you can't get hold of organically grown vegetables try washing the veggies and fruits with diluted vinegar to get rid of chemicals and toxins.
Try having 2 serves at least a day. This should come from a primary protein: an animal source, which is a complete protein(that means it contains all the amino-acids) or
A combination of secondary proteins, which comes from a plant source and are incomplete proteins (they don not contain all the amino-acids), therefore will need to be combined to make a complete protein. By combining 2 of the food groups below, you will make a complete protein: Nuts, Grains/Seeds, Legumes/Pulses

Below is the list of protein providing foods:

· Fish - 3 times a week. Low in saturated fats, high in essential fatty acids, especially deep ocean fish, cold water fish such as herrings, mackerel, salmon, trevally, ocean trout, pilchards, luderick, rainbow trout, sardines, blue grenadier, king George whiting, redfish, golden perch. Avoid large fish as they may be high in mercury.

· Chicken - Free Range or Organic only and avoid all fats

· Eggs - An excellent source of protein unless you are sensitive/allergic. Buy organic or good quality free range which are fed chemical free food.

· Dairy - Use low fat; use little as it creates mucus in tubes and mal absorption. Natural low fat organic non-flavoured organic is good or use goats milk or soy.

· Red Meat in moderation

· Legumes/Pulses/Grains - Good protein source and good detoxifiers.

· Nuts/Seeds - Fresh, store in fridge, away from heat and light. Nuts should not taste bitter. Use on breakfast cereals, in stir-fries, salads, pasta dishes or a snack.

Fats -Avoid all saturated fats, which can upset your prostaglandin, hormone and mineral balance.
Fried Foods - No fried foods except stir-fry. Cook with extra virgin, cold-pressed olive oil.
Cold-Pressed oils on Salads - Extra virgin olive oil, flaxseed, safflower, sunflower oils are high in essential fatty acids if not heated.
Avoid Margarine - Margarine is a saturated in the processing and contains chemicals. Can use butter sparingly. Try avocado instead of butter.
Veggies - Lots of veggies everyday. Should make up to 40% of the food intake.
Grains/carbs - Eat in moderate levels and choose low GI cards whenever possible.
Sugar - Avoid all sweet things including sugar, sugar substitutes, processed foods with sugar, undiluted fruit juices, cakes, biscuits, soft drinks.
Fruits - 2-3 serves a day
Drink plenty of purified water

This is just a generic eating guide for anyone and it is especially helpful for women who are trying to conceive. Above eating guide will give you and your baby a healthy environment to grow in, especially because our hormones are messed up due to PCOS.

Preparing for your TTC Journey

2009-08-27T23:10:00.001+10:00

Preconception care is a time of preparation to optimise your health and thus ensure the best possible start for your child. Therefore areas to be addressed are nutrition, environment, lifestyle and detoxification.

Here are some things u might consider following before and during your TTC journey.

1. To provide your body with the building blocks necessary to create a healthy baby, you need to eat healthy, nutritious, whole foods. This means buying fresh, unrefined foods that have been grown organically and therefore have plenty of nutrients.

2. To avoid the toxins that come through your water and food supply, such as agri-chemicals and heavy metals, you need to use water purifier and buy organic whenever possible. This is especially important when buying animal products as animals might have been fed hormones or antibiotics, or been exposed to polluting chemical, as these products collect in the animals fatty tissues and organs.

3. Avoid sugar and all forms of sugar substitutes, coffee and alcohol as these contributes to nutrient loss. Eat plenty of veggies, whole grains and protein rich foods. Avoid saturated fat and processed foods. Buy and consume fresh produce whenever possible.

4. Drink roasted dandelion tea , which is an excellent detoxifying herb through its action on the liver. Eat plenty of garlic and onions which will also help to eliminate toxins.

5. Avoid chemical estrogens which can contribute to reproductive issues and fertility problems with both sexes. To protect nutritional content of your food you should avoid using processed, pre-prepared and packaged foods or foods that have been microwaved.

6. Take a comprehensive nutritional supplement, including the complete range of vitamins, minerals and essential fatty acids. These are required for proper fertility and healthy embryonic growth. The anti-oxidant nutrients (Vitamin A,C,E , Zinc and Selenium) can help you detoxify and eliminate heavy metals and chemicals.

7. Avoid all drugs. This includes social drugs such as alcohol, caffeine and nicotine, which have all been linked to reproductive and fetal ill health.

8. Avoid breathing in petrol fumes, or using household cleaning materials that are based on ammonia or any other solvents. Studies have shown that oven cleaners, mould treatments, paint, glues, and all types of solvent can affect the health of sperm or eggs.

9. To avoid the effects of non-ionizing radiation use your mobile phone and microwave as little as possible.
10. To avoid the most toxic, ionizing form of radiation, which can affect eggs and sperm for up to 3 years, avoid X-rays for as long as possible before conception.

11. Exercise for at least 2 hrs per week, three 45 minutes walk or four 30 minutes walk a week or join a gym. This will help u normalise your weight in conjunction with eating a wide variety of healthy foods.

12. Stress can be problem for those who are trying for a while. One approach is to try some visualisation. Lie down in a quiet place, with no interruptions, and direct your breath to each part of your body in turn. If stress is an ongoing problem then it can affect your nutritional status and fertility. Seek professional help if needed.

PCOS and Low GI

2009-08-27T17:03:00.000+10:00

GI – Glycemic Index is the measure of carbohydrates based on their effect on our blood glucose levels.

Carbohydrates that easily breakdown, increasing the blood glucose levels rapidly are said to have high GI. Carbohydrates that breakdown slowly, releasing glucose gradually into the blood stream are said to have low GI.

Several scientific studies have shown that individuals following low GI diet over several years are at significantly low risk of developing Type 2 Diabetes and coronary heart diseases.

How does high GI food affect PCOS?

Insulin is a hormone that performs various functions in a body. One of its function is to maintain the blood glucose levels. As high GI food increases the blood glucose levels rapidly, more insulin is secreted to maintain the blood glucose levels. Releasing high levels of Insulin over prolonged period of time will cause your Pancreas (gland which secretes hormone Insulin) to wear out. Since, optimum levels of Insulin is necessary to maintain your blood glucose levels, eating high GI foods will increase your risk of Type 2 Diabetes.

PCOS and Low GI Diet

As most of the PCOS women have insulin resistance, it is advised to follow low GI diets which will gradually releases energy into your blood stream. This will not create Insulin spikes and hence your pancreas will not overwork.

Following a Low GI diet is not that hard as it sounds. Being an Indian, all I need to do was cut down on my rice intake and increased my wheat intake. Instead of getting the soft atta flour, I purchased the whole wheat flour and to my surprise it tasted better. I started having Green Tea twice as day as the antioxidants in the green tea is supposed to get rid of toxins in our body.
Purchased a juicer and started having vegetable juices after my exercise routine. I am not overweight, so following a low GI diet resulted in some weight loss for me as well. But, the good thing I felt a lot more energetic than I used to.

As the name suggests, it is not diet that you follow for a while and forget about it. It is kind of a lifestyle change.
If insulin resistance is the primary cause of your PCOS, then it might be necessary for you to make this lifestyle changes. This will not only reduce your PCOS symptoms, but prevents your from future diabetes and heart diseases risk.

Choosing foods for your Low GI change

If you live in any of the developed countries, it might be easy for you to the get the low GI breads. You can see the cover of the bread and in most of the low GI ones they specify the GI index.

But, if you are not lucky enough to get GI details from the food you purchase in your country, then the best thing to do is to increase your whole grain intake. You can start to have brown rice instead of white rice. Also, you can purchase fibre supplements such as Metamucil to complement your daily fibre intake.

Fibre is a natural source for detoxifying your body. The good source for learning about the GI value of variety of food and meals is: http://www.glycemicindex.com/

You can safely follow a low GI meal while taking other medications such as Metformin. You can make your whole family follow a low GI diet as it is beneficial for everybody. This way you don’t have to prepare a separate meal for yourself.

There are many low GI diets available on the internet. For obese women with PCOS, following a traditional low fat high Card diet will make the situation worse. This is especially true if the carbohydrate you are consuming is of high GI.

Take time to do your research on the internet regarding the GI values of food. This website provides a GI database which contains the GI values of various food items across different continents. Use that as your basic source before investing in costly low GI diet books available over the internet.

Don’t forget to send your success stories to me. Please remember it provides inspiration and confidence to lot of PCOS sufferers out there!!

Disclaimer

2009-08-25T16:55:00.001+10:00

All information in this blog is for information purposes only. It is by no means a replacement for formal consultation with your doctor or MP.Options discussed here are not meant to cure any disease as such. It is merely just a journey of a PCOS individual just like you.:)

PCOS Research Papers

2009-08-25T12:12:00.003+10:00

Preparing for your TTC journey: - Some simple steps that can be followed to increase your chance of conception.
PCOS and Indian Women - PCOS affects nearly 35% of Indian women indicating the ethnicity as a factor in PCOS

PCOS Alternate Remedies

2009-08-25T12:11:00.005+10:00

PCOS Conventional Treatments

2009-08-25T12:11:00.001+10:00

PCOS and Clomid
PCOS and Metformin(or Glucophage)

PCOS Stories

2009-08-25T12:10:00.001+10:00

My PCOS Story

About this Blog

2009-08-25T11:53:00.000+10:00

Just diagonised with PCOS or suspect you have PCOS. There are lots of articles available here which will guide you through your journey to beat PCOS. I too have PCOS and approximately 5-10% of women have it. So, you are not alone in this journey.

Even if you have PCOS symptoms it is important not to assume you have PCOS. Everyone with PCOS have different symptoms and the symptoms overlap with may other syndromes out there.

Good thing about PCOS is, it is not a life threatening situation, but it does increase the risk of some diseases out there. Now you know that you have PCOS, you can prevent yourself from being at increased risk of those diseases.

How is this blog different?

When I was diagnosed with PCOS I was looking for a solution to cure PCOS. Unfortunately, nothing out there will cure PCOS. They basically say we will mask the symptoms but not cure the problem. But, I believe I can cure it or atleast minimise the symptoms naturally. My belief is based on the based concept in our life reverse engineering. So, if you too believe you can beat PCOS or want to have a buddy who believe in it I am there for you...

I will be glad to hear your PCOS story. If you are interested in sharing one with the PCOS world, let me know. I will be glad to publish it.

Whats more to come?

First few posts will discuss how to go about diagnosing PCOS .....And then I will write about treating PCOS..Both conventional and traditional solutions will be discussed. So that we can get the best of both worlds.

PCOS Diets

2009-08-25T11:40:00.002+10:00

PCOS and Low GI Diet

Diagnosing PCOS

2009-08-25T11:39:00.007+10:00

As you might know, many doctors use different methods to diagnose PCOS. Though it is impossible to predict the tests your doctor will suggest you to have, as a general rule of thumb the following tests will be performed. I had provided information based on the tests my doctor asked me to do. It is by no means the complete list.

Ultrasound:

The first and foremost test that you might need to perform is a ultrasound scan. If you are diagonised with a PCO it is important not to assume that you have PCOS. As per statistics, around 25% of women have PCO yet only 5-10% of them PCOS.

Others blood tests suggested by my doctor:

HARMONES(Serum) :

SHBG
FAI
FSH
LH
Progesterone
Prolactin
Oest-17 Beta
Testosterone

Tests in Conjuctions:

BIOCHEMISTRY:

Leptin
Insulin
Glucose

Note that all the above are after 12 hrs fasting. Glucose and Insulin levels are taken after consuming a sugar concentrated juice in addition to fasting levels.

LIPID STUDIES:

Cholesterol
Triglycerides
HDL-Chol
LDL-Chol

CHOLESTEROL RATIOS:

LDL/HDL
Chol/HDL

VITAMINS :

Vitamin D

Below is the normal reference range for all the above tests. Please note that reference range might sometimes vary depending on which country you reside in.

HARMONES - Reference Ranges :

1. Prolactin 2.8-29.2 ng/L

2. Testosterone 0.7-2.8 nmol/L

3. FSH - 1.0-6.0(Follicular), 6.0-12.0(Midcycle), 1.0-6.0(Luteal), >20.0(Menopausal)

4. LH - 3.0-10.0(Follicular), 20.0-40.0(Midcycle), 3.0-10.0(Luteal), >35.0 (Menopausal)

5. Progesterone - 0.6-2.6(Follicular), NA,13.0-75.0(Luteal), <2.0 (Menopausal)

6. Oestradiol - 100-630(Follicular), 550-1650(Midcycle), 200-900(Luteal), 40-300 (Menopausal)

7. SHBG(Female Range-nmol/L ) - 24-230(Follicular), 48-185(Luteal), 89-379(Contraceptives), 46-277 (PostMenopausal )

8. SHBG (Pregnant Range-nmol/L) - 59-1162(First Trimester), 324-956(Second Trimester), 312-1363 (Third Trimester)

VITAMINS

1. Vitamin D - 48-144

LIPID STUDIES –Fasting

1. Cholesterol - 3.0-5.5 mmol/L

2. Triglycerides - 0.6-2.0 mmol/L

3. LDL - 0.8-2.0 mmol/L

4. HDL - 1.6-3.0 mmol/L

LP- RATIOS

1. LDL/HDL - <3.0

2. Chol/HDL - <4.0

BIOCHEMISTRY

1. Glucose -3.0-5.5.mmol/L (Fasting)

2. Insulin -0-20 mIU/L (Fasting)

3. Leptin - 3.7-11.1 ng/mL

Not many you might be aware that PCOS women are deficient in Calcium and Vitamin D. So, most doctors nowadays recommend Vitamin D test to figure out your levels. If you plan to get pregnant, it is better to test your Vitamin D levels so that you can start taking supplements.

Leptin is another hormone that might be linked to PCOS. My naturopath recommended me to test my leptin levels as I am thin cyster and she suspected that I might have been anorexic in the past( which I am not). Surprisingly, my Insulin levels are very good and I had slightly high leptin levels. So, that might be the contributing factor to my PCOS. Unfortunately, there is not much study done to establish the link between PCOS and leptin.

Based on your hormone tests, generally doctors conclude that you have PCOS, if you have 2 of the following symptoms:

1. Anovulation - Irregular or absent periods

2. PCO - Polycystic Ovary in ultrasound

3. Elevated Androgen Levels( basically testosterone level)

If you had any other tests to diagnose PCOS, feel free to post it here.

PCOS Symptoms

2009-08-25T11:39:00.004+10:00

PCOS and Acne
PCOS and Insulin Resistance

PCOS and Clomid

2009-08-24T18:41:00.000+10:00

The first and foremost treatment while treating women with anovulation is prescription of Clomid. Little is known about the fact that Clomid was initially manufactured as BCP. And the fertility outcome was an added advantage. Clomid is supposed to make infertile women fertile by making them ovulate regularly. Each woman will respond to different doses of Clomid. The common prescribed dose is 50 mg. I responded to 25 mg of Clomid. It is better to start with a low dose of Clomid and gradually increase it. Starting with high doses straight away can result in ovarian hyper stimulation in women.

Your doctor might be able to prescribe the correct dose of Clomid and see how you respond using an ultrasound scan. As the main risk with Clomid is ovarian hyper simulation, your doctor will be the monitoring the number of mature follicles around your ovulation time. Usually Clomid is taken from Day 5 to Day 9 of your cycle. But, some doctors might prescribe you to take it on different dates depending on your situation.

Regular ovulation is required to increase your chances of getting pregnant. As most of the women with PCOS, don’t ovulate regularly the chances of getting pregnant is greatly reduced.

Women not ovulating regularly don’t secrete enough LH and FSH in correct amount for the egg to mature. This results in an immature egg that is not released from the ovary.

How Clomid works

Clomid is a drug available upon prescription and should be taken with a doctor’s supervision.

Clomid works by binding itself to the estrogens receptor sites in the brain. This disallows the estrogens receptor sites from binding with the naturally circulating estrogens.

In response to this, the hypothalamus releases more Gonadotropin releasing hormone (GnRH), stimulating the pituitary to release more FSH and LH. The FSH will cause the ovary to produce more eggs and follicles.

Once the Clomid intake is stopped at Day 9 (or Day 10) of the cycle, the follicles in the ovary will produce oestrogen. The oestrogen will bind with the estrogens receptor sites in the body. As the follicles mature towards the mid-cycle, oestrogen (oestradiol) level peaks resulting in LH surge. The LH surge will cause the ovaries to release the egg resulting in ovulation.

Clomid is an effective fertility drug that doesn’t require any hormone injections. As Clomid works by binding with the oestrogen receptor sites, brain is fooled to think that there is not enough oestrogen in the body and will start producing more oestrogen.

Hence, women in a Clomid cycle might have high levels of oestrogen when compared to a normal cycle.

Side effects of Clomid

Most of the side effects associated with Clomid or minor and usually disappears when the drug is stopped. The most common side effects of Clomid are discussed here:
 Nausea
 Tiredness
 Headaches
 Moodiness
 decrease in cervical mucous
 A thinner uterine lining ( sometimes too thin for conception to occur)
 hot flushes
 ovarian hyper stimulation
 Abdominal bloating
 Blurred Vision

What is PCOS

2009-08-24T16:04:00.000+10:00

What is PCOS?

Often misunderstood and under diagnosed symptom found in women of reproductive age.
If you have been diagnosed with PCOS, don’t panic. It is not such a worst thing in the world as the name sounds. You are one of those people who are lucky enough to get diagnosed with PCOS, for most women it is left undiagnosed. It is good that you identified this in your body so you can make wise decisions about your life style.
The causes of PCOS are not understood completely and nor it is the same for all women. While some women might have it at the time of their birth, for most women it is believed to have developed at a later stage due to their lifestyle. This kind of implies that though there is no specific cure for this syndrome, it is completely reversible. Which means you might have to drastically change the life style factors that cause it.

Please be mindful that most general practitioners don’t have much insight into PCOS. So, you might be better off consulting a gynaecologist or a reproductive endocrinologist if you suspect PCOS or have any of the symptoms. The most common symptoms of PCOS includes:

• Obesity
• Irregular periods
• Prolonged mensuration
• Frequent Abdomen pain
• Ovarian pain
• Acne
• Hair Loss
• Hirsutism
• Anovulation(Absence or lack of ovulation)

It is very important to understand the difference between PCO and PCOS. PCO just means polycystic ovaries. It doesn’t necessarily mean that you have the syndrome. PCOS is diagnosed by a series of blood testes that your endo/gyno would suggest based on your circumstances.

The diagnosis of PCOS typically includes the following:

• Testing the level of male hormones(androgens) in your body
• Diagnosing polycystic ovaries in ultrasound
• Anovulation - Blood tests to diagnose whether you have infrequent or no ovulation at all

Before we jump into possible solutions it is important to understand how your body functions in relation to this situation.

Every woman develops eggs in her ovaries after puberty. Egg development in ovaries is controlled by two hormones produced by the pituitary gland namely the Follicle Stimulating Hormone (FSH) and the Luteinizing hormone (LH).
The pituitary glad is situated behind the eyes and it is of the same size as peanut. The pituitary gland is connected by a stalk to the base of the brain. There is a control is base of the brain just above the pituitary glad which determines the level of production if FSH and LH hormones in pituitary gland. This is also knows as the brain's fertility centre. This centre works in a continuous fashion in men whereas in women it works in a cyclic fashion.

If the women's body starts producing more than average levels of male hormones then it starts to work in a continuous fashion like men rather than the monthly cyclic fashion resulting on anovulation ( infrequent or no ovulation).
Anovulation can also be caused by high levels of a pituitary hormone prolactin. But, this is an uncommon cause of the polycystic ovary syndrome.

Ovulation Cycle

Early in a woman’s cycle the pituitary gland secrete a large amount of follicle stimulating hormone (FSH). FSH stimulates growth of the egg and the cells lining the follicle, the tiny bubble that holds the egg, so that the follicle enlarges and moves out towards the surface of the ovaries. At this stage, the follicle does not respond to stimulation by luteinising hormones (LH).

Around days 10, 11 or 12 of the cycle, the fertility centre stimulates the pituitary gland to make a very large amount of LH. By this time the follicle is 9.5 millimetres in diameter and has become sensitive to LH stimulation. The surge in LH from the pituitary gland always stimulates the final step of maturation of the follicle after which no further growth is possible. At this stage the follicle and egg are mature and the follicle will rupture, releasing the egg. This will result in proper ovulation.

Early in the cycle, the ovary and the developing follicle produce a female hormone called oestradiol or oestrogen. Oestrogen stimulates the lining of the womb to grow and thicken. After the follicle ruptures and releases the egg in the middle of the cycle, the ruptured follicle changes its function and produces the second female hormone, progesterone. Progesterone changes the lining of the womb so that it no longer grows thicker but becomes receptive to the implantation of a fertilised egg. This change also allows the lining of the womb to separate from the womb promptly and evenly after blood oestrogen levels fall if fertilisation and implantation have not occurred that cycle. This will result in a normal menstrual period that lasts from four to six days.

The consequences of lack of ovulation:

If ovulation does not occur, the follicle continues to produce oestrogen for some time, causing the lining of the womb to grow thicker than usual. The situation is made worse because the ovary does not produce progesterone if ovulation has not occurred. The lining of the womb then breaks away in an erratic fashion. This causes the menstrual bleeding to be long, often with large quantities of blood and tissue, causing menstruation that can be heavy, painful and prolonged. This free floating oestrogen is converted to testosterone making the situation worse. High level of testosterone is responsible for causing the typical symptoms such as acne, hair loss and hirsutism. The other obvious consequence of lack of ovulation is reduced fertility.

PCOS and Metformin (Or Glucophage)

2008-02-07T16:26:00.000+11:00

Metformin or Glucophage is the most popular anti-diabetic drug taken by people all over the world. It has been shown to lower insulin levels in the blood. In other words, it increases the insulin sensitivity of a person and hence and your insulin secretion will be reduced. As the insulin starts to perform its job effectively, carbohydrates and fats are effectively converted into energy.

Metformin works by lowering the insulin levels, so it works only for PCOS patients with Insulin Resistance. People having PCOS due to other lifestyle issues need not have to use Metformin. Personally, I didn’t have Insulin Resistance and hence did not take this drug.

It is important to test for Insulin Resistance before you are prescribed this drug. If your doctor prescribes the drug without testing you for Insulin Resistance, I would recommend you to go for a second opinion.

If your family has as history of Diabetes, it is better to check for Insulin Resistance as Type2 diabetes is associated with early symptoms of Insulin Resistance.

The use of metformin in the treatment of PCOS is yet to be examined in large scale trials but a number of small scale studies have demonstrated a reduction of androgen and insulin levels and improvements in menstrual regularity and ovulation rates. Hence the drug should always be taken under the supervision of a gynaecologist or endocrinologist.

How Metformin Works

The exact action of Metformin is unknown though it has been proven to be beneficial for people with Insulin Resistance. It increases the insulin sensitivity by increasing the peripheral utilization of glucose. In a 2001 study, Metformin showed to stimulate the hepatic enzyme APMK, which plays an important role in the metabolism of fats and glucose. Your fats and carbohydrates are burnt effectively while you are on Metformin.

Side Effects

The most common side effect of Metformin is diarrhoea, cramps, nausea and vomiting. Metformin is more commonly associated with gastrointestinal side effects than other anti-diabetic drugs.

Side effects can cause severe discomfort for patients. It is most common when Metformin is first taken or when the dosage is significantly increased.

Who should take Metformin?

Because Metformin is primarily an anti-diabetic drug it can be taken by people who have Insulin Resistance. This will reduce the risk of acquiring Type 2 Diabetes in the future and will also reduce the symptoms associated with Insulin Resistance and PCOS.

PCOS Women trying to conceive are also treated with Metformin and in many cases Metformin along with food and life styles changes is shown to reduce the symptoms and bring back regular ovulation.

You can take Clomid along with Metformin if you are actively trying to conceive. But, it is better to start one medication and wait for at least 3 months to start on the other medication. This will help you to identify which medication actually works.

Women suspecting Insulin Resistance or women diagnosed with Insulin Resistance should talk to their doctor about Metformin and its possible use for you case.

Supplement with lifestyles Changes

If you have Insulin Resistance, following a healthy diet with regular exercise may benefit you. Healthy diet usually means with food with low Glycemic Index.

PCOS and Insulin Resistance

2008-01-23T14:14:00.000+11:00

Though 70% of PCOS sufferers have insulin resistance, I don’t have this myself. If you are one of those typical PCOS persons who are obese then you are most likely to have this. It is important to test for insulin resistance and glucose tolerance if you have symptoms of PCOS or if you are undergoing a blood test to diagnose PCOS. Most of the PCOS patients are obese and the major contributor of obesity in PCOS patients is Insulin Resistance.

What is Insulin Resistance?

As the name suggests, it means the inability of body to use insulin effectively. This will result in high blood insulin levels causing PCOS. Insulin is a hormone secreted by the pancreas gland. It is produced in large amounts after a meal and in smaller amounts between meals.

The main function if Insulin is to convert and control the energy from foods in the body after a meal. The food we consume comes in 2 major forms namely fats and carbohydrates. Carbohydrates comes in 2 major forms starch ( rice, potato, pasta..) and sucrose from carbonated drinks. Both are digested into glucose and then absorbed into the blood stream. In the same way, fats are digested into smaller fats and absorbed into the blood.

After glucose is absorbed into the blood, hormone insulin stimulates muscles and liver to absorb glucose and store it for later energy use. If you have insulin resistance, your body doesn’t absorb glucose from your blood effectively. You might think this will lead to high levels of glucose in the blood stream. But, what actually happens is your pancreas will start producing higher levels of insulin to control your glucose levels. Thus your pancreas starts working 3-5 times the normal rate and the insulin producing cells in pancreas will eventually wear out. Though the wear out period differs for each and every person, it is important to treat this condition as this might potentially result in Type 2 diabetes in the future. It is definitely preventable if treated promptly.

Fat breakdown usually occurs at a lower level of insulin (i.e. It occurs few hours after a meal). As the insulin levels are usually higher for a person with insulin resistance fat breakdown is eventually switched off resulting in weight gain. Without fat breakdown enlarged fat cells gets stored in your body which will cause variety of other problems.

Enlarged fat cells secrete a variety of other hormones which will act on the muscles and the muscles become more resistant to insulin. This will cause the pancreas gland to secrete larger further larger amounts of insulin in order to maintain the normal blood glucose level. Thus it becomes harder to achieve fat breakdown due to higher insulin levels.
For PCOS women it is easy to gain weight because the process of fat breakdown is halted and very difficult to lose weight despite diet and exercise.

How does insulin resistance cause PCOS?

The ovarian follicles are lined by two types of cells, theca cells and granulosa cells. Theca cells absorbs cholesterol out of the blood stream and, after a series of steps, turns it into androstenedione, a weak male hormone. Theca cells pass the androstenedione on to the adjacent granulosa cells where it is converted into oestrone, a weak oestrogen or female hormone and then into oestradiol, a strong oestrogen or female hormone.

In women with a genetic susceptibility, high levels of insulin in the blood stimulate an enzyme called cytochrome P450c 17-α in both the ovaries and the adrenal glands to produce increased amounts of male hormones. Yes, the increased levels of male hormones come from both the ovaries and the adrenal glands and hence ovarian removal will not fix your problem completely.

The high levels of insulin in the blood stream also stimulate the pituitary gland to produce increased amounts of LH. It does not, however, stimulate a surge in LH secretion. The higher baseline levels of LH stimulate the same enzyme, cytochrome P450c 17-alpha to produce even more male hormones, but only in the ovaries not the adrenal glands.
The developing follicle and egg do not become sensitive to stimulation by LH until the follicle has grown to a diameter of 9.5 mm.

High levels of insulin, however, cause the developing follicle and egg to respond to stimulation by LH at an earlier stage of development, at 4mm. diameter rather than at 9.5 mm. As no further development of the follicle is possible after LH stimulation, the growth of the follicle is therefore stopped at a diameter of 8 mm and the follicle is left too immature to ovulate. These immature follicles do not rupture as in normal ovulation and hence left as cysts.

When ovulation does not occur for some reason, both the theca cells and the granulosa cells lining the follicle should self-destruct by a process of "programmed cell death", known medically as apoptosis. This causes the follicle to collapse and disappear. In the polycystic ovary syndrome the granulosa cells self-destruct normally after failure of ovulation but the theca cells do not die because they are kept alive by high levels of insulin, preventing the follicle from collapsing, resulting in a cyst.

After failure of ovulation and after death of the granulosa cells, the theca cells that should have died continue to produce androstenedione. As there are no longer any adjacent granulosa cells to convert the androstenedione into estrogens, the theca cells convert the androstenedione into testosterone. In other words, for whatever reason a woman may have an ovarian cyst, the lining of the cyst will produce testosterone in most cases.

If you have PCOS due to high levels of insulin then it can be reversed by following proper diet and also by a medication named a metformin. It is vital to treat this insulin resistance to prevent yourself from the risk of cardiovascular diseases and diabetes.

PCOS and Acne

2008-01-03T17:09:00.000+11:00

Acne is one of the prominent symptoms of PCOS. Adult acne in many cases has been proved to be related to PCOS. PCOS acne may appear in face, neck, back, chest or other areas. The acne problem in PCOS is related to the hormonal changes in your body and hence the topical or conventional acne treatments will not work effectively for you. Acne is caused by the excess oil that gets trapped into your skin pores.

If you have any digestive problems like constipation you are more likely to get acne. Your body tries to get rid of excess hormones by all means. If it couldn't do it then it tries its last resort to get rid of acne i.e. through your skin.

In women with PCOS, androgen levels are often high and elevated. This results in the overproduction of DHT (Dihydrotestosterone). DHT promotes more oil production which gets clogged in your skin pores. Following are the common types of acne that can be caused by PCOS.

If you are experiencing acne in your adulthood it is advisable to check for PCOS. It is one of the early symptoms of PCOS if you are not Insulin Resistant.

Blackheads: This type of acne results when oil and bacteria rise to the top of pores that are partially blocked. When the oil mixes with your skin melanin, the pimple takes on a darker appearance, making it look "black," hence the name blackhead.

Whiteheads: A whitehead is the result of oil and skin cells completely blocking your pores. This debris gathers beneath the surface of your skin, resulting in a pimple that appears to have a white head

Cystic Acne: This type of acne can be very painful might be of four or five millimetres or more in diameter. They occur when oil, dead skin cells, and bacteria are pushed far down into your pores leading to hard bumps that you can feel underneath your skin and that may swell and remain for weeks.

Causes of Acne

There are variety of reasons why a person might be suffering from acne. But, hormonal imbalances are the most common reason for PCOS people to suffer from acne. Women with PCOS have high level if androgens, which in turn increases the DHT levels which results in more sebum production causing acne. Also, 70% of women with PCOS have insulin resistance. Insulin resistance prevents you from ovulation which also increases your androgen levels thereby making the condition worse.

Treating your Acne

There are many over the counter medications available for the treatment of acne. They might be able to reduce the acne but might not actually cure it. Elevated androgen levels are the main cause of acne in women with PCOS, you need to treat this underlying problem to treat acne in women with PCOS. Most of the doctors prescribe spironolactone or Birth Control Pills for PCOS related acne. They require prescription from your gyno. or dermatologist. Spironolactone is primarily a blood pressure medication. It is designed to suppress the adult hormone that causes blood pressure. The adult hormones suppressed by Spironolactone are similar to DHT in women with PCOS, it lowers the androgen levels and helps to treat the acne. Similarly, birth control pills also lower the androgen levels in you blood and help with acne symptoms.

As you might notice, the solutions for PCOS sufferers are generally aimed at masking the symptoms rather than curing. So, if you want to really get rid of the underlying symptoms of PCOS then you might have to go for some natural remedies that could regulate your hormone levels.

My PCOS Story

2008-01-02T22:30:00.002+11:00

Hi, I am Priya. Here is my story about PCOS. I know there are lot of you out there either struggling with PCOS or trying to beat the symptoms associated with it. This blog is dedicated for such people and I will be reviewing and discussing the variuos treatment options available for us.Below is my stroy in brief :) Just kidding, it is quite long...So, make sure you are ready for it....

I used to get regular period till my marriage since puberty. I got married to a Software Engineer and went as a happy housewife to USA.

US weather made me the laziest person in the world. I used to sleep for 12 hrs a day and have cornflakes for breakfast and some form of rice for lunch and dinner. We used to live in a single bedroom apartment and the only physical activity I did was cleaning the house.

All I did there was eating and sleeping without any kind of physical activity apart from the occasional shopping and library trips.

Problem Starts Here – First Meeting with the Gyno

After I went to US, I didn’t get my period for the first 3 months. Then the next period was delayed for more than 3 months and decided to meet a gyno. Now I feel really angry on the gyno.

All she did was a pregnancy test and charged me $140 and explained that it might be due to the change in climate. She prescribed me Provera (progesterone pill to induce periods) and asked me to take it for 2 weeks. I got my induced periods. I didn’t continue with Provera after that.

During the meeting she also asked me whether I am taking any contraceptive pills. As I always had an aversion towards it, I didn't take it. Now, this is another thing that makes me frustrated. Why does everyone promote using contraceptive pills if it had been proven to induce PCOS?

Even though only a small percentage of women are affected I feel it is really bad because none of the women at the time of taking it knows it might cause a syndrome like this.

Second Meeting with the Gyno

O.K. next phase. We came back from US to India in Jul 2003 and fixed an appt. with a doctor over here. I went to her, to consult about my main concern - irregular periods. She touched my lower abdomen and said I have retroverted (tilted backwards) uterus. She also explained that there is nothing wrong in having irregular periods and went on saying that some women will have a cycle of 28 days and for some women it is 60 days etc…
She also did manual repositioning of my uterus and made it normal(anteverted position).

She put me on a drug called regesterone(I think Indian version of Provera) and it induced my periods for about 6 months and then I stopped taking it.

Until now, I didn’t have any other symptom of PCOS apart from irregular periods.

Symptoms start here

In the meanwhile we came to Australia for his work in Apr 2004. I stayed at home for a while and started looking for work once my visa things are sorted out. I got a job in in Aug 2004 and then lead a happy living for nearly one year. After one year, I went back to India for vacation for 4 weeks and came back.

This is when I started getting severe acne. I tried lots and lots of products, went to a dermatologists and nothing seemed to work. She put me on Benzoyl peroxide and I hoped it would work. But, it started to get worse and worse.

I was really feeling helpless at this stage. My self confidence is at an all time low and as didn’t know the cause of it. I was trying so many things from avoiding dairy products to avoiding eating at some stage.

Meeting the GP

We thought of having a family since then and went to the GP for general check up. He prescribed a lot of test like Hep A, Hep B and Rubella ….

We went to the GP to get the blood test results and found I wasn’t vaccinated for Hep B and Rubella. So, he asked be to get vaccinated for Rubella and also suggested me to get my Pap smear done.

I got vaccinated for Rubella in Jan 2006 and had to wait for 3 months before ttc. My Pap smear results were ok by the way. In Apr 2006 I had to travel regarding my work for 3 months and again we postponed the ttc phase.

Starting the TTC journey

We have been TTC from August 2006.
I used to get stomach pain now and then and I decided to meet a GP to know the cause for it in Oct. 2006. When I went to the GP she analysed my stomach and asked me where the pain was. I had always felt the pain in the upper abdomen and that's what I told her. She ordered a pelvic ultrasound for me and found no issues with the ultrasound. After trying for nearly 4 months we went to the GP again for check up related to infertility. She convinced us by saying that it is normal for ordinary couple to take up to 1 year to be able to conceive.

No one knows the cause

Ok. What next. Still I am having severe acne and because I got acne at the age of 23 I read a lot on the internet and figured out it might be related to my hormones.

The weird thing I do get regular periods now and then and now I feel that I get regular periods when I do some physical exercise. During the 4 months of trying we tried the ovulation test now and then and got positive results for 3 months in 5. Not sure whether I got ovulated the other 3 months as I didn't test regularly and purely tested on my symptoms (pain in the ovaries).

I myself tried to figure out the cause

Though I had the symptoms of acne, irregular periods, pelvic pain etc. . .none of the doctors suggested ultrasound for my ovary. I read PCOS as being one of the reasons for adult acne; I started to do some research on it. Then I found these whole heaps of information in the internet and got terrified.

I rushed to my GP and requested ultrasound for my ovaries. My request seemed like fun to him and he said irregular periods and acne are common problem. It seemed to me that he kind of reacted as if I am overreacting. But, I was stubborn and requested the u/s referral from him.

Finally Diagnosed

Finally I got the appt. for ultrasound on Jan 18th 2007. I got the results from my GP and on 21st Jan 2007, I was found to have PCO. After reading the results from my ultrasound, my GP suggested me to meet a gynaecologist.

(PCO "Polycystic Ovaries" is a condition in which your ovary consists of multiple small cysts forming a pearl necklace shape - this definition makes my stress worse). When I was diagnosed with PCO the first thing I did was came and searched Google. Reading all the information from the internet, I was really worried. One other thing that bothered me was information such as infertility, no cure for PCOS etc…

First Meeting with Gyno after PCOS Diagnosis

Got appointment to meet a male gyno on 31st Jan. Though I was not convenient meeting a male gyno, I went to him because I got the appt. with female gyno only on 2 weeks later. I believed it was mainly due to laziness in US and I could really see a link b/w my exercise and regular periods. To confirm my theory, I started walking 1 km a day and went to gym for half an hour.

I was eating only low GI bread and gave away white rice. I got positive ovulation test on 1st Feb 2007 (got my period on Jan 13th 2007-So think it was OK). In the meanwhile I met the male gyno on Jan 31st 2007 and he did an ultrasound and Pap Smear. From the u/s he told me my right ovary is enlarged. Started adding that, if we are ttc he would like to put me on fertility drugs.

I was bit upset because without even doing the blood tests and seeing which hormone levels are high/low… he was trying to put me on fertility drugs?. I do ovulate as per my kit.

Normal Blood Test Results

Pap smear was negative ( Thank God!!) and waited for by blood tests till 6th Feb 2007(to correctly measure my hormone levels). All my blood test results came out normal. I didn’t have Insulin Resistance- typical symptom of PCOS. The only issue I have now is PCO, acne and retroverted uterus.

Lifestyle Change

I continued my lifestyle changes in the form of exercise and the type of food I choose to eat. I started ovulating regularly and currently having a 30-38 day cycle. Not so perfect, but atleast I am happy that I am moving in the right direction.

Continuing TTC

In the meanwhile, we are continuing with our TTC journey and started taking Clomid 25 mg as per my gyno from Oct 07. This will help me predict my exact ovulation day and help me have a 30 day cycle. BTW, I am meeting a female gyno these days. I am taking Metamucil fibre supplement as it is supposed to naturally detoxify your body. If you are having digestion problem in the beginning of the cycle, I would suggest you to take fibre supplement. As most PCOS women are oestrogen dominant (few of them have oestrogen deficiency, so it is better to understand your situation), detoxifying your body will get rid of the excess hormones from your body. So, it might help you to ovulate regularly. I am also taking folic acid supplements.

Result Oct’07

I ovulated on 26th October and got my periods on 13th November (17 days after ovulation)

I am continuing with my ttc journey and will post my progress each month and the treatments and symptoms I am undergoing.

I feel like I had reached the end of the world sometimes. But, I believe, I can reach there one day and I am just waiting for that day.

Result Nov’07

This month as well I took Clomid and monitored the follicle growth through ultrasound. Had an IUI but got a BFN and periods after 21 days post ovulation.

Result Dec’07

Not taking Clomid this month and seeing what would happen with natural way…
Mainly because my gyno. is on a holiday. Will see what 2008 has in store for me...

Result Jan'08

Ok, I got my periods on 15th Jan. So, it is all regular and I am not planning to take Clomid next cycle as well. Meeting the gyno on Feb 5th as I couldn't get an appointment earlier.

Baby dust to all who are TTC!!

I am editing this post(in Aug'09) after a long time to post my progress...

Well, I didn't get pregnant in the natural cycles I tried from Jan'08 to Mar'08. My gyno categorised us as unexplained infertility, as I do ovulate regularly these days and my DH sperm count is in normal range as well.

Result Apr'08

I took Clomid this month. My gyno increased the dosage to 50 mg(God knows why?). To be frank, I hate Clomid cycles as it gets me on the nerve. The side effects are mostly emotional and psychological than physical which is the worst part. My acne was ok in the first half of the cycle, but during the midcycle it got worse. Forgot to mention, that I did IUI this month. My DH sperm count was 10 mil with 99% motility. Not great but not worse either. I was not hoping for much to happen these days. Just started the two week waiting game as usual only to find out after 17 days that I have my period.

Result May'08

Probably not worth writing about it as the story is pretty much same as the previous month. Only difference is DH Sperm count was far less than last month. Not sure why..It was around the 3 mil range this month with good motility.

Result June'08

I decided to go the natural way again. But, not completely natural. I started taking False Unicorn Root(also known as FUR) after I heard from one of my friend that it helped her get pregnant. I am not sure whether she had PCOS though.
Good thing about FUR is it made me ovulate slight earlier than usual(15days, usually it is in the 20 days range). Bad thing is I had severe breast pain while I was on FUR. It was more like someone pulling my breast from inside. The pain was really sharp and it was quite difficult to manage at work in front of others. I decided not to take FUR again even though it slightly made by cycle length better.
Needless to say I didn't get pregnant this cycle as well....

Jul'08
I am tired and hopeless. I feel like I want to get pregnant in no time. Pressure from families is mounting, and quite frankly I am sick of hearing their opinions and suggestions. I was depressed and wanted to try some treatments but my mind was not prepared for that yet. So, I decided to postpone my TTC for few months and decided to take a break. I didn't get pregnant this cycle as well. I was religiously doing exercise and eating healthy as usual. I got my period on day 35 as usual.
Aug'08

I was a bit relaxed and preparing to ask about IVF to my gyno this month. I didn't bother much to track my temperatures. This cycle I didn't do any pregnancy test for 15 days since I ovulated. On 15 th day of my luteal phase, i did my pregnancy test(just in case) and it came back positive. I couldn't believe my eyes. We were so excited and went to do the formal blood tests. It was all good and now as I am writing this I am the mother of my 3 months old son one year later in Aug'09.

Aug'09

I am currently BF so haven't got my periods back yet. I am very aware of the fact that I had to manage my PCOS symptoms after I stop BF'ing. Also, I am planning to have another bub in coming years. Will definitely try the natural path for atleast a 3 years before opting for any treatments.
I will be updating my TTC plan once I start it.