Tag Archives: fertility

research: Metformin useful even for non-obese PCOS patients

14 Apr

A recent meta-analysis (which, for those of you who don’t read a lot of academic jargon, means that it’s a piece that examines a bunch of clinical studies and draws conclusions) has concluded that Metformin is a good first-line treatment for women with PCOS, regardless of whether or not they are obese. The studies–which looked for successful pregnancy and live births–found that both Met and clomiphene (Clomid) were good treatments for anovulation.

This is interesting because Metformin is usually used for women in the “obese” category on the BMI chart. In my view, this is further evidence that PCOS is associated with insulin problems, regardless of how heavy the patient is.

This could affect you if you are a relatively thin PCOS patient and you’re trying to induce ovulation: Metformin is worth a try!

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some notes about birth control pills as PCOS treatment

2 Jun

One of the first lines of treatment for PCOS for women who are NOT trying to get pregnant [and for a few who are] is usually hormonal contraceptives. This has the superficial result of regulating your period, though it doesn’t actually improve your cycle in a meaningful way; you have an artificially-induced period, called a “withdrawal bleed,” when you switch to the week of placebo or iron pills in your pack. [In this post, I am discussing “birth control pills”–but this info applies also to the NuvaRing and the birth control patch.]

There are benefits to this for some women:

1) Obviously, it is more convenient to have a regular period instead of the erratic cycles or spotting that some PCOS ladies get.

2) Birth control pills can also improve bone density if you are otherwise not having cycles [estrogen is important for bone density, and most birth control pills provide it].

3) They also reduce testosterone, which can, in some cases, reduce other symptoms of PCOS–hirsutism [that would be the unwanted hair] and acne. If this is important to you, you might ask your doctor about Yaz, which also contains drospirinone, a drug that can help with those problems.

4) Some women find that hormonal birth control reduces PMS.

5) Having a period can decrease your risk of endometrial problems, including endometriosis, which can be painful and may reduce fertility.

6) Birth control pills can also increase fertility–yes, INCREASE. They are sometimes used as part of a program for treating infertility, as especially the first month after you stop using them, you may experience increased fertility. If your doctor recommends this line of treatment, there is probably more benefit to using them than there is reason to avoid them.

That said, there are also some compelling reasons to avoid hormonal birth control as a first-line treatment for PCOS. They carry risks: not just the standard “increased risk of stroke and blood clots” and less-serious side effects such as nausea or headache, which you always hear about and will see on the monograph that accompanies your prescription, but also the possibility of weight gain, which can make PCOS worse.

In addition–and this is my completely non-medical opinion–using hormonal contraceptives falsely regulates your cycle, which means that it masks one of the most significant measures of your health. At least for me, my menstrual cycle is a sort of litmus test for how well my lifestyle is working to control PCOS. When I eat well and exercise, my cycle is quite regular. If I don’t–well, my body will remind me, through irregular cycles, that it needs better care. This is a valuable way that my body reflects the success or failure of management, and I don’t want to obscure it. It would be a bit like taking ibuprofen every day because you have been prone to headaches: you wouldn’t know whether the headache was still there if you took it every time your dose was up! I would rather commit to treatments that are really treating my insulin resistance problem.

Finally–and let me emphasize that this is only my experience and that many women have excellent experiences with birth control pills–I no longer use hormonal contraceptives because they contribute a great deal to the depression that I have always suffered. Depression and anxiety are common adjuncts to PCOS. If you suffer either of these disorders, it’s important that you track your response to ANY drug you take, including contraceptives, to see whether they contribute to your problem. For me, it’s not worth it.

One final note about hormonal contraceptives AS contraceptives: I had a great experience with NuvaRing and used it for years, and I felt good while I was using it; however, I also got pregnant while I was using it. My doctor at the time said that women with PCOS often seem to have failures of hormonal contraceptives; in retrospect, I believe this to be true because many women with PCOS are overweight, and women over about 150-175 pounds in weight have decreased rates of effectiveness with hormonal birth control. Food for thought, eh?

some facts about your menstrual cycle

29 May

Warning: Graphic!

I know a lot of women don’t want to spend a ton of time worrying about their menstrual cycles, and that’s fine for a lot of them–but PCOS sufferers have more incentive than average to pay attention to the details of their cycles. Often, a wacky menstrual cycle is a primary reason that PCOS sufferers seek medical attention. It can also contribute to infertility, which is another common reason a woman with PCOS might see a doctor.

A common symptom of PCOS is oligomenorrhea [infrequent periods: a longer-than-usual cycle] or amenorrhea [no periods]. “Infrequent” periods are cycles of more than 35 days, between four and nine periods in a year; amenorrhea refers to the total lack of menstruation.

The normal menstrual cycle consists of the follicular phase [day 1 of your period, up to ovulation]; ovulation; and the luteal phase. Let’s look at each one so you can see what is happening–or, at any rate, what should be happening! Keep in mind that the cycle days here are AVERAGES–many women ovulate earlier or later, or have a longer or shorter cycle.

DAY 1-ABOUT DAY 13-14: THE FOLLICULAR PHASE
Your period begins. If you are charting your cycle–which I encourage you to do [more on this later]–you should count as day 1 the first day on which true bleeding [not spotting] begins by 5 p.m. [At least, this is what most doctors will ask you to do. You can really do whatever works for you as long as it’s consistent.]

Estrogen gradually increases, causing the lining of your uterus to thicken. Follicles in the ovaries ripen and eventually one per ovary becomes dominant.

AROUND DAY 14: OVULATION
The dominant follicle of one ovary releases an egg. The egg only lives a day or two. That is why, if you are trying to conceive, you want the sperm to be there, ready and waiting–the days leading up to ovulation are key to success on that front! You can obviously conceive via intercourse on the day you ovulate, but since pegging that day accurately is tricky, it’s important to know when you are ABOUT to ovulate.

DAYS 15-28: THE LUTEAL PHASE
The other follicle becomes a corpus luteum. It releases lots of progesterone–a hormone that makes your body hospitable to pregnancy. The progesterone causes a lot of the things that you might feel varying over the course of your cycle–breast tenderness, etc.

In the event of pregnancy, the fertilized egg implants within about a week of ovulation–sometimes as quickly as 4 days or so, sometimes up to 10 days after ovulation. That is one reason that it takes so long [if you are TTC, at least, it feels long!] to begin to experience pregnancy symptoms or get a positive pregnancy test: your body does not begin producing hcg, the pregnancy hormone, until implantation. You may, if you become pregnant, experience cramping or spotting during implantation.

If you are not pregnant, the corpus luteum will involute after about two weeks. Production of estrogen and progesterone will drop, which will cause your uterus to shed its lining–that is, bring on your period. Menstruation is not just blood; it’s the tissue of your thickened uterus, shedding all of that material that’s not needed unless you are supporting a pregnancy.

LENGTH OF CYCLE

The average menstrual cycle is 28 days. Variation is normal from woman to woman! If your cycles are very long or short, you may have trouble conceiving; in the case of a short cycle, this can be caused by a shortened luteal phase that does not allow enough time for a fertilized egg to implant. In the case of a long cycle, if you are ovulating but not predictably, the issue may be that you are not sure when to expect ovulation and so you might miss your window of opportunity.

Q & A:


AM I OVULATING?

If you are not menstruating, you are not ovulating. That means that your reproductive system is not releasing an egg at all. If you are menstruating, you are PROBABLY ovulating; however, there are some women who have anovulatory cycles and still have a period. Your doctor can check this using ultrasound, but that’s not really necessary–charting will usually reveal it.

WHAT IS CHARTING?
Charting your menstrual cycle is a complex but not difficult practice that will tell you a lot about your body. I recommend it for all women, whether they are TTC or trying to avoid pregnancy [or just going with the flow!]. It is important to learn the basics, and since I don’t have the credentials to teach you this, I will recommend a couple of resources instead at the bottom of this post.

Basic things that you record when you chart can include your menstrual flow, cervical mucus [yes, I said cervical mucus…I warned you that this post was graphic!], basal body temperature [that is, waking temperature, before you get out of bed], and menstrual symptoms such as cramps or breast tenderness. Different models record different things. The sympto-thermal method, in which you combine temperature readings with other fertility signs, tends to be very reliable. You may also be interested in the Creighton or Billings methods, which are symptom-based. In any case, especially if you are using Natural Family Planning to avoid a pregnancy and you really really don’t want to get pregnant, it is a good idea to take a class or find a teacher.

WHY CHART, IF YOU ARE NOT TRYING TO GET PREGNANT?
Charting tells you a lot of valuable things about your body that will help you and your doctor sort out your health issues. If you have PCOS, your charts are incredible useful diagnostic and statistical tools that can tell you whether you are ovulating, what your cycles look like, and whether you might want to consider birth control pills or another method of inducing a period.

WHY WOULD YOU WANT TO INDUCE A PERIOD?
While amenorrhea is not a problem in any immediate sense [unless you are trying to have a baby!], there is some evidence–fairly strong evidence–that there are long-term effects of amenorrhea. If you are not menstruating over time, your body is not producing estrogen; that can put you at higher risk for osteoporosis.

There is also the possibility that your amenorrhea is caused by endometrial hyperplasia: overgrowth of the lining of the uterus. That’s a risk factor for endometrial cancer. So it is key, if you are not menstruating at all, to see an OB/GYN and find out why. If it is a hormonal imbalance, such as PCOS, without other complications, and you’re not trying to get pregnant, you and your doctor may choose not to treat it. In that case, however, you should be aware of the osteoporosis risk and be vigilant about bone density testing.

If you do treat it, there are some different options: birth control pills, progesterone, etc. Your doctor can give you more information about your choices!

GREAT RESOURCES FOR LEARNING MORE:
Toni Weschler, Taking Charge of your Fertility. This book is the reproductive Bible. It will teach you about charting, about birth control options, about increasing chances of conception when you are trying to conceive, and a whole lot more.

FertilityFriend.com is a free online charting service. The course of tutorials they offer are designed to help you achieve pregnancy. If you are trying to conceive, great! If you’re trying not to, you’ll need to get your information elsewhere, but you can still use their charting interface. There are bells and whistles if you pay for a membership, but all the basic stuff you need is free.