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stressed
I went to the Dr for a CPE and addressed the 9 lb. weight gain I had at my recent post-op appt with Dr Korman. He pressed on my tummy and told me he was concerned. He felt a mass. He ordered an abdominal ultrasound and a pelvic, since I had always suffered with cystic ovaries and had periods rarely. I have gone years without them since I was 12. They disappeared when I was about 19-20, with exception of one or two in a blue moon, and a couple of bouts with excessive bleeding - which had to be stopped by D&C. I had been told by several doctors I would never have kids. I had tried while I was married for two years. I was diagnosed with Polycystic Ovarian Syndrome with Insulin Resistance (that I had to take metformin and birth control for). PCOS is how I became obese. I also have had hypothyroidism since I was 18 years old. To read more on it, I have posted info at the bottom of the page.
I went to have the abdominal u/s done. The techs acted weird and pressed alot of buttons. They were measuring. Not good. The screen was turned away from me. Then, after it was over they asked if I wanted to do my pelvic the same day and cancel the later appt. I had. I agreed and went to drink my 32 oz of water and waited for an hour. This one went longer. I assumed they were measuring my cysts. I had seen my ovaries before on ultrasound. They had previously contained so many cysts that they looked like grapes.
They could not tell me anything. They can get sued, so they turned the screen so I could look for myself... something they weren't really "supposed" to do. But I could figure it out on my own. I almost died.
I'm pregnant. Not early, not three months. Try five. The report for 7/30 said 18 weeks 2 days, approx. due date December 29th. I had my quickening later that evening - the tech messed with my tummy that day so that may be why. Lol, could you imagine having the quickening BEFORE getting the ultrasounds?! That would have scared me to death. They won't do another ultrasound to determine the sex of the baby because I just had one done, which made me upset. At the moment there is no "medical need".
I had no symptoms, no morning sickness, no additional weight gain really... I worked it off going to the gym 4x's a week. I weigh the same or less as I did in March because I lost a few pounds and have cracked down on the diet I was supposed to be following. No junk. I knew my tummy was getting bigger, but I thought I had a hernia or gaining weight in my stomach again. I had dizziness when I stood up too quickly. I thought it was lack of discipline and consistency in taking my vitamin supplements. I guess the weight gain is justified now.
I won't lie, I did consider my options before I knew how far I was along. Anyone would.
...But I'm keeping my baby. I have prayed for someone to come into my life to love me unconditionally and to love unconditionally. And it isn't through a man, or a husband, or a relationship.
I was dumb in being inconsistent with the patch throughout the time I got pregnant, finished a whole pack of birth control in June to bring on a period like I was told to do, and even took a pregnancy test in March-April that came back negative.
Most people are unaware of the complications of PCOS, unfortunately, even the doctors. I am considered a "high risk pregnancy", simply because no one has a clue on what to give me in the way of vitamins due to the malabsorption the gastric bypass causes, and because of past maternal history of gestational diabetes (I was given a 1 hr. GTT), but NOT because of PCOS. The doctor "claimed" it went away when I lost the weight. That is NOT TRUE. There is NO CURE for PCOS. If that was true I would have had 2 1/2 years of normal periods instead of 4 months of normal periods. And PCOS is a main reason for "high risk" about 45% of pregnant women have miscarriages with PCOS.
PCOS
How common is PCOS?
Polycystic Ovary Syndrome affects an estimated 5-10 percent of women of childbearing age and it is a leading cause of infertility. It is the most common endocrinopathy among reproductive age women. As many as 30 percent of women have some characteristics of the syndrome.
What are the symptoms of PCOS?
Women with PCOS may have some of the following symptoms:
- Amenorrhea (no menstrual period), infrequent menses, and/or oligomenorrhea (irregular bleeding) — Cycles are often greater than six weeks in length, with eight or fewer periods in a year. Irregular bleeding may include lengthy bleeding episodes, scant or heavy periods, or frequent spotting.
- Oligo or anovulation (infrequent or absent ovulation) — While women with PCOS produce follicles — which are fluid-filled sacs on the ovary that contain an egg — the follicles often do not mature and release as needed for ovulation. It is these immature follicles that create the cysts.
- Hyperandrogenism — Increased serum levels of male hormones. Specifically, testosterone, androstenedione, and dehydroepiandrosterone sulfate (DHEAS).
- Infertility — Infertility is the inability to get pregnant within six to 12 months of unprotected intercourse, depending on age. With PCOS, infertility is usually due to ovulatory dysfunction.
- Cystic ovaries — Classic PCOS ovaries have a "string of pearls" or "pearl necklace" appearance with many cysts (fluid-filled sacs). It is difficult to diagnose PCOS without the presence of some cysts or ovarian enlargement, but sometimes more subtle alterations may not have been recorded, or are not recognized as abnormal, by the ultrasonographer.
- Enlarged ovaries — Polycystic ovaries are usually 1.5 to 3 times larger than normal.
- Chronic pelvic pain — The exact cause of this pain isn't known, but it may be due to enlarged ovaries leading to pelvic crowding. It is considered chronic when it has been noted for greater than six months.
- Obesity or weight gain — Commonly a woman with PCOS will have what is called an apple figure where excess weight is concentrated heavily in the abdomen, similar to the way men often gain weight, with comparatively narrower arms and legs. The hip:waist ratio is smaller than on a pear-shaped woman — meaning there is less difference between hip and waist measurements. It should be noted that most, but not all, women with PCOS are overweight.
- Insulin resistance, hyperinsulinemia, and diabetes — Insulin resistance is a condition where the body's use of insulin is inefficient. It is usually accompanied by compensatory hyperinsulinemia — an over-production of insulin. Both conditions often occur with normal glucose levels, and may be a precursor to diabetes, in which glucose intolerance is further decreased and blood glucose levels may also be elevated.
- Dyslipidemia (lipid abnormalities) — Some women with PCOS have elevated LDL and reduced HDL cholesterol levels, as well as high triglycerides.
- Hypertension (high blood pressure) — Blood pressure readings over 140/90.
- Hirsutism (excess hair) — Excess hair growth such as on the face, chest, abdomen, thumbs, or toes.
- Alopecia (male-pattern baldness or thinning hair) — The balding is more common on the top of the head than at the temples.
- Acne/Oily Skin/Seborrhea — Oil production is stimulated by overproduction of androgens. Seborrhea is dandruff — flaking skin on the scalp caused by excess oil.
- Acanthosis nigricans (dark patches of skin, tan to dark brown/black) — Most commonly on the back of the neck, but also but also in skin creases under arms, breasts, and between thighs, occasionally on the hands, elbows and knees. The darkened skin is usually velvety or rough to the touch.
- Acrochordons (skin tags) — Tiny flaps (tags) of skin that usually cause no symptoms unless irritated by rubbing.
Is PCOS a Syndrome or a Disease?
PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
Are there are other names for PCOS?
Other names for Polycystic Ovary Syndrome are Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.
What causes PCOS?
The exact cause of PCOS is unknown. There are studies being conducted to see if there may be a genetic link — that PCOS is passed along in families. Just as one might have a genetic predisposition to diabetes, one might also have a disposition to PCOS.
The above analogy to diabetes seems appropriate as many current studies into PCOS are focusing on the body's ability to process insulin. A growing collection of data suggests that elevated insulin levels are unhealthy and contribute to increased androgen production, worsening PCOS symptoms from cosmetic issues to infertility, and eventually increasing the risk of certain cancers, diabetes and heart disease.
It is also possible that PCOS may be caused or worsened by valproate, a medication used to treat seizures, but it is hard to say if it is the epilepsy per se or the agent used to treat it that brings about the PCOS symptoms in some women. The condition may be improved by switching to another medication.
Is there a cure for PCOS?
No, it is a condition that is managed, rather than cured. Treatment of the symptoms of PCOS can help reduce risks of future health problems.
What kind of doctor can diagnose and treat PCOS?
Any type of doctor familiar with PCOS might make the diagnosis, but the disorder is complicated and may be best treated by a specialist. Those having difficulty getting pregnant should see a reproductive endocrinologist, while long-term management by an endocrinologist should be considered. A general practitioner or an OBGYN may treat some women with the syndrome, but someone who specializes in endocrine disorders may be more familiar with treatment options and recent studies on PCOS. A list of fertility specialists is available on INCIID and PCOSupport.org has a list of doctors familiar with PCOS.
Are PCOS and hypothyroid related?
No. It may be that PCOS and thyroid disease are both common, so will sometimes be seen in the same patient.
A good number of PCOS patients have under-active thyroid glands. Since many of the symptoms are the same, evaluation of the thyroid gland with a blood test for thyroid stimulating hormone (TSH) should be a part of the evaluation for PCOS. The TSH is almost always the only test needed to evaluate thyroid function.
Likewise, PCOS should be evaluated in the patient with under-active thyroid gland.
What are the long-term health risks associated with PCOS?
PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart disease.
What is the connection between insulin resistance and PCOS?
At least 30 percent of women with PCOS are insulin resistant, although some investigators claim a much stronger association exists. Hyperinsulinemia produces hyperandrogenism by stimulating ovarian androgen production and by reducing serum sex-hormone binding globulin (SHBG). This can heighten PCOS symptoms. Reducing insulin resistance through the use of insulin-sensitizing medications can restore ovulatory function in many women with PCOS. It appears that even some patients who do not test as being insulin resistant may benefit from these medications.
Do all women with PCOS suffer from infertility?
The answer to this depends on the criteria used to diagnose PCOS. If a main criterion is anovulation, then by definition women with PCOS would have fertility problems. It is possible to have the appearance of polycystic ovaries and be fertile, but having the syndrome usually does impact fertility adversely.
Will losing weight jumpstart fertility in overweight patients with PCOS?
It may, but it doesn't always. There are lean women with PCOS. Weight loss may help reduce insulin resistance, resulting in spontaneous or improved ovulation. Quick weight loss may cause more harm than good, so slow weight loss is best. Losing 10 percent of one's body weight should be enough to show some improvement in symptoms.
Is the miscarriage rate higher in women with PCOS?
There does appear to be a higher miscarriage rate in women with PCOS, but the exact reason is still under investigation. According to some studies, the risk of miscarriage in women with PCOS is 45 percent or more. One possibility is that early loss is associated with elevated levels of luteinizing hormone — and women with PCOS often have elevated LH levels — but the reason why it relates to miscarriage is not understood. Another possibility is that elevated levels of insulin or glucose may impede implantation or cause problems with the embryonic development. There is a clear association between uncontrolled blood sugar and pregnancy loss, but the issue of insulin resistance and elevated insulin levels is relatively new and in need of further study. There is a possibility that insulin resistance reduces egg quality. That leads to another possibility — that late ovulation (after cycle day 16) may be associated with poor follicle development and decreased egg quality.
Does having PCOS make pregnancy high risk?
The answer to this may depend a little on the definition of high risk. Most PCOS patients can see a regular OBGYN, or perinatologist. Anyone who is severely insulin resistant, diabetic, or has high blood pressure may need to see a high-risk OBGYN. This is an issue to be decided by doctor and patient together.
Does a pregnant woman with PCOS require special monitoring?
Some special monitoring may make sense — such as earlier gestational diabetes screening or home glucose monitoring. Beyond that it depends on the PCOS symptoms experienced by the patient before pregnancy. Anyone taking medication may require additional monitoring. Many of the issues one needs to watch for are included in routine pregnancy care. For example, a woman with borderline hypertension before is more likely to have increased blood pressure in pregnancy, but most doctors check all patients for blood pressure issues.
Is someone with PCOS more likely to have gestational diabetes?
Many women with PCOS are insulin resistant, and pregnancy tends to be a time of increased glucose intolerance as well. When one combines the two, there is an increased incidence of gestational diabetes.
What is gestational diabetes and how is it diagnosed?
Gestational diabetes occurs when a woman has impaired glucose/carbohydrate tolerance during pregnancy (usually temporarily, or a temporary worsening). The main concerns are having the baby get too much sugar since the mother is not processing it herself — leading to a large baby, but perhaps with immature lungs, and some birthing difficulties — and the ketone byproduct that may be produced when the body turns to other sources, such as fat-stores, for energy.
It is usually diagnosed based on a reading of 200 mg/dl or higher on a 1-hour oral glucose challenge test where 50 grams of sugar are consumed, or based on having two parameters out of normal range on a 3-hour GTT after consuming 100 grams of glucose.
Will pregnancy cure PCOS?
There is no cure for PCOS, but some women do have a normalization of cycles after a pregnancy. Those who had fertility problems may find it easier to get pregnant again.
What treatments for PCOS symptoms are available?
There are many medications that can be used to control PCOS symptoms, and some may be used in combination with each other. Among the most common is the birth control pill, discussed directly below. Other anti-androgens such as spironolactone (Aldactone), Flutamide, cyproterone acetate, and Finasteride may be used to help control cosmetic issues. Corticosteroids are sometimes used as well, though their side effects may be intolerable. Women who are not seeking pregnancy can also make use of a wide variety of blood pressure and cholesterol lowering medications, in addition to insulin-sensitizing medications. The best course of action depends on individual needs.
Will removing my ovaries cure my PCOS?
At present, there is no cure for PCOS. The endocrine upset characterized by polycystic ovaries does not go away just because the ovaries are removed. Attention must be focused on why the ovary acted that way, and what signals called it to make 30 pellet-sized follicles at the same instant? It is possible that it might lessen symptoms, but it is a rather extreme approach that will not prove to be a cure.
Does PCOS get worse over time?
It is possible that PCOS will worsen during the prime reproductive years, ages 20-40, especially with weight gain. A healthy lifestyle is probably the best defense. It seems as women approach menopause that the severity of PCOS improves, as judged by hormonal parameters.
Does PCOS cause obesity, or does obesity cause PCOS?
In some ways, this question is akin to asking, "Which came first, the chicken or the egg?" since it isn't completely understood, but it appears more likely that PCOS comes first. Symptoms of PCOS may be lessened by weight loss, or increased by weight gain, but the syndrome is not caused by weight or body mass. There are lean women with PCOS. The insulin resistance that is common to PCOS may play a role in weight gain and the difficulty in losing any extra weight.
How can women with PCOS lose weight?
Usually the key to weight loss with PCOS is improving glucose metabolism and reducing insulin resistance. This may be achieved by reducing carbohydrate intake and increasing exercise level, as well as through the use of insulin-sensitizing medications. Metformin has a stronger link to weight loss than the glitazones (Avandia, Actos). It is preferable to alter eating habits without reducing caloric intake below 1800-2000 calories for long-term results.
Are depression and anxiety common in women with PCOS?
This is an area where more research is needed. It does appear that many women with PCOS suffer some physical or psychological manifestations of depression. There is some medical literature suggesting a link between diabetes and depression, and perhaps that might be extended to early stages of insulin resistance. It may be that the hormone imbalances, including hyperinsulinemia and hyperandrogenism, create a physical source for depression. Medications that help restore proper hormone ratios or antidepressants may help reduce depression and anxiety attacks.
Another possible source of depression is the effect that PCOS symptoms may have on self-esteem. Skin, hair, and weight can each cause discomfort in one's appearance that damage confidence. Infertility may also lead to frustrations with one's body and the feeling it can't do anything right, or perhaps a notion that one is being punished for some past action. Miscarriages are common in women with PCOS, and the grief associated with this type of loss can be far-reaching.
Anyone who feels she is showing signs of depression should consult her doctor as well as consider seeking emotional support. Be sure to find a doctor who is willing to listen to concerns and not dismiss this potential side effect of PCOS.
INCIID has a bulletin board for this called the PCOS Café ..: index.html pcoscafe forums www.inciid.org http:>where women with PCOS can connect, discuss issues, and support each other. Also consider checking PCOSupport.
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