Tag Archives: treatments

PCOS and Eating Disorders

10 Aug

Aside from the fact that PCOS seems to predispose our bodies to hang onto calories, there is a connection between PCOS and disordered eating (binge eating disorder, bulimia, or compulsive overeating, for example). It’s not clear whether PCOS might cause the eating disorder or whether the eating disorder can change hormones enough to encourage PCOS to develop, as this article by Angela Grassi points out. The only thing that is clear is that the PCOS population has a higher rate of disordered eating than the rest of the female population.

But if you have PCOS and struggle with disordered eating, it doesn’t really matter which problem came first, does it? You just need to find the solution.

So what to do? Your first stop needs to be a counselor or health care professional. This treatment finder from the National Eating Disorder Association has some good resources. You could also go to your primary care doctor and ask for suggestions or a referral, or ask your counselor, psychiatrist, or other mental health care professional, if you have one.

Diagnosis

Your doctor or therapist can help you determine whether you have an eating disorder. In some cases, it’s very clear, and you already know that you have one, but some sufferers don’t realize that their eating is unusual or problematic. Each specific disorder has a separate set of diagnostic criteria, but in general, any of the following behaviors or experiences suggests that you should consult a professional. (I have focused on binge eating disorder and bulimia, as these seem to be the most closely linked to PCOS–anorexia may be the most publicized ED, but it is not the most common among PCOS ladies.)

Symptoms:

* You routinely eat when you are not hungry;

* You overeat large amounts of food, even to the point of making yourself feel ill or uncomfortable (and not just on Thanksgiving!);

* You feel as though your eating is out of control;

* You eat secretly and hide your eating habits from others;

* You feel ashamed or guilty over the things you eat;

* You purge after eating–for example, vomiting, abusing laxatives or diet pills, fasting, or exercising obsessively;

* You eat in response to non-physiological factors: stress, emotion, boredom, etc.

Keep in mind that some of these are behaviors that can be normal and fairly functional if they’re minor. After all, most of us would consider it reasonable for a woman who just broke up with her boyfriend to hunker down on the couch with a pint of Ben & Jerry’s, and most of us eat more than we need to in certain social situations. It’s a matter of degree. It’s a disorder if your eating habits interfere with your life (that is, if they’re harming your health, causing you anguish, interfering with your job or school, or compromising your family life). Ultimately, a trained professional is the person who will be able to help you figure out whether you have an eating disorder or just a few bad habits.

While you’re setting up treatment, check out this page from the PCOS Network–it has good suggestions for curbing binge eating, most of which apply to compulsive overeating or bulimia as well. Don’t assume that you can handle this problem on your own, however. Any eating disorder can wreak havoc on your health over time, and they are very difficult to manage.

Treatments

There are no shortcuts on this one: you have to do the hard work of figuring out why you eat the way you do and how to achieve healthier habits. Some of the things you might try, in the treatment process, include:

  • Cognitive-behavioral therapy (or other psychotherapy). In many cases, therapy can help. CBT is most often suggested, because it concentrates on revising your own self-talk–the things that you say to yourself inside your own head–and that can be very effective at changing behavior. But really, any kind of therapy that can help you be more conscious and mindful in your eating choices will help.
  • Group therapy. You can consider a group run by a mental health professional and/or something like Overeaters Anonymous.
  • Medication. Sometimes certain antidepressants can help. Your doctor can help you make decisions about this.
  • Nutritional counseling. While this is not really a problem that can be solved by a nutritionist–it’s a mental health issue, not a lack of education about nutrition–sometimes a good nutritionist can help you figure out what is reasonable, what kinds of things you will find satisfying that would also be good for you, and what you might do to avoid foods that trigger your binge behavior.
  • Treating your PCOS symptoms. This is only my opinion, and I haven’t seen it said anywhere, but if there is a link between the two problems, it would seem likely that treating the PCOS may also help.  Some researchers feel that the prevalence of binge eating disorder among PCOS patients may be due to the body’s response to insulin, and if so, treatments for insulin resistance–such as Metformin–could also help.
Summing Up
If you have an eating disorder, it will be very hard for you to treat your other health issues until it is under control. And it is very difficult indeed to manage it alone. While I think that self-care is often a good option for some problems (mild depression, for example), an eating disorder always requires treatment. If you need it, get it; if you can’t figure out where to find help or how to pay for it, ask your primary care doctor for suggestions.

alternative remedies: a few thoughts

5 Jun

PCOS patients–or perhaps I could more generally say “patients with chronic conditions”–often get frustrated with the difficulties of treating the syndrome. Treatment protocols for PCOS can be very simple (more exercise, for example) or very complicated (an array of medications, lifestyle modifications, even invasive fertility treatments or weight loss surgeries). Often, “alternative” remedies start to look pretty good, especially if you struggle with bad side effects from your medications.

There are a few things I’d like to say here about some of the most commonly suggested alternative treatments for PCOS. I have not tried all of these things, by the way, so I am basing my recommendations and thoughts on scientific research, not personal experience.

Herbs
From what I have read, some herbs may be helpful for some of the symptoms of PCOS, but none have shown consistent results in clinical trials. That doesn’t mean they’re definitely not useful (especially because there are not a ton of researchers rushing to do large blind trials of products without a lot of profit potential), but it does mean that there are no solid recommendations for what to take, or how much to take. The other concern with herbs of any kind is that they are not regulated products in the way that pharmaceuticals are. You don’t know for sure what’s in your capsules, whether it’s a consistent strength, etc. For this reason, I recommend a lot of care if you use herbal supplements. And I recommend that you research the supplement and the company to make sure you’re buying from a company you trust.

Specifically, many women use vitex, and anecdotally, a lot of them seem to have some results for cycle regulation. Keep in mind, however, that these self-reported results are usually also the result of lifestyle changes, so it may or may not reflect an effect from the herbs.

The bottom line on this one is: use caution. Even if an herb has genuine use for a particular condition, it’s hard to know you’re getting what you pay for, and difficult to know what dose to take. Final caveat: TELL YOUR DOCTOR if you are using any herbal supplement. If there’s an interaction between the herbs and your drugs, your doctor will need to warn you about that, and in any case that is information your doctor needs in order to treat you most effectively.

Yoga

Yoga may be very helpful for PCOS patients. It’s good exercise, although probably not enough of an exercise regimen on its own; it can reduce stress in the same way that meditation might. As long as you are using good form and not pushing yourself too far, it is very unlikely that you’ll see any adverse effects from yoga (except maybe on your budget, if you’re doing classes). For that reason, it’s a great choice for an activity that might complement your other exercise. The worst that can happen is that you don’t find it useful. There are several different kinds of yoga, some more active than others, so you can get a pretty good workout if you choose the right variety.

Acupuncture

Acupuncture is the stimulation of certain points on the body–most of the time, when people talk about acupuncture, they’re talking about the kind that uses needles to stimulate those points. There has been clinical research about acupuncture, but most of the studies have been fairly small. The studies all seem to agree, though, that there is no clear benefit. Acupuncture also carries some risks, though not common ones: infections from contaminated needles, punctured organs. If you want to give acupuncture a try, make sure you choose a reputable, careful establishment that uses single-use, new needles.

Although a lot of people cringe at the idea of acupuncture, the needles are very, very thin and most patients report that they do not hurt.

Insulite Labs Program
Finally, I wanted to discuss the program for insulin resistance sold by Insulite Labs. It is a popular program, and a lot of ladies have had good results from it. In my opinion, however, it is a very expensive program for what you get, and it is likely that the good results are coming from the fact that the program includes healthy eating and exercise in addition to weekly support and the “nutraceuticals” that patients take. I’m not knocking those things–if it helps you eat better and exercise, more power to you!–but I am very skeptical about the supplements themselves as a treatment for PCOS.

Summary
In sum, the trouble with alternative treatments is that there just is not enough evidence. While you might try some of these things, I recommend that you not give up on traditional medicine in the meantime. Some of these approaches–especially yoga or similar types of physical practice (tai chi, etc.)–can be great adjuncts to your PCOS treatment regimen. If you do have good luck with any of the alternative treatments, let your doctor know!

Straight talk about antidepressants

19 Apr

Women with PCOS have a higher rate of depression than the rest of the population. (And, according to the National Institute of Mental Health, 6.7% of adults suffer depression in a given year–that’s a huge proportion!) I have talked about how to identify depression and how to manage it, but I haven’t talked about antidepressants specifically.

Most people who suffer depression over a long period of time will consider antidepressants, even though some people still feel uncomfortable about taking these kinds of drugs. They can help a lot. But it’s important to know what you’re getting; there can be side effects and withdrawal problems, too.

Personally, I’ve tried a number of different antidepressants. Some were awful for me; some worked well. I’m not going to discuss which ones might be best for you, beyond a couple of general statements, because one of the biggest challenges for doctors who treat depression is that every sufferer responds to these drugs differently.

I am discussing newer types of antidepressants–SSRIs, NDRIs, and SNRIs–because these are the drugs of choice today. There are some others, but chances are that your doctor will consider these first. Most of the drugs you hear about (Prozac, Zoloft, Paxil, Effexor, Wellbutrin, Lexapro, etc.) fall into these categories. Tricyclic antidepressants and MAOIs are not used very often because of the higher likelihood of serious or dangerous side effects.

TIPS AND HINTS
1. These drugs are life-saving and medically useful. If you are resisting trying them, even though you’re miserable, because you think you should be able to “just snap out of it,” or because you think that antidepressants are for wimps, rethink it. At least consider it. There are good reasons that some people may not want to take them, but this particular reason is silly.

2. Be aware that the first one you try may not help you. Finding the right medication for you takes trial and error. Work with your doctor and be prepared for the possibility that it will take time.

3. In a related vein, don’t expect these medications to help overnight. It can take up to six or even eight weeks to feel better, in some cases. (Some people do see a lot of improvement very quickly. It varies.)

4. Take them conscientiously. These are not drugs that you want to take “when you need them” or forget to take. A missed dose now and then is not a crisis, but they really do work best–and have the fewest side effects–when you take them every day, exactly as directed.

5. Antidepressants can also be extremely helpful for anxiety problems or make anxiety worse. Again, it varies. Be aware that if you suffer anxiety as well, you may have to adjust your medication based on that.

6. Tell your doctor about ANYTHING else that you take–other prescription drugs, over-the-counter drugs, supplements.

SIDE EFFECTS
Some common side effects of antidepressants include:
* drowsiness
* dry mouth
* nervousness, anxiety
* insomnia or hypersomnia (that is, too much or too little sleeping)
* decreased or increased appetite
* weight gain (this is long-term–not immediate–but it’s a big problem for some women and something to remember if you already struggle with your weight because of PCOS symptoms)
* sexual dysfunction, including anorgasmia (aka the inability to have an orgasm)

WHAT TO DO ABOUT SIDE EFFECTS
In some cases, if you can ride it out for a week or two, the side effects will go away. In other cases, not. In particular, weight gain and sexual dysfunction tend to be the ones that cause long-term problems. If the side effects are untenable, don’t give up. A different drug might be better for you. Wellbutrin might be something to ask about; for most people, it actually produces a small increase in libido, and it doesn’t contribute to weight gain (indeed, some people find it easier to control their weight or lose weight while they’re taking Wellbutrin). Some people also take Wellbutrin with their other antidepressant to help ameliorate the side effects.

DISCONTINUATION SYNDROME
When you stop taking an antidepressant, you can suffer symptoms. (People sometimes call these “withdrawals” but the technical term is “discontinuation”–that’s because these drugs are not addictive in the sense that animals–or people–given free access to them are not driven to take them. They do, however, cause symptoms when you stop taking them.)

These symptoms can be very, very unpleasant, although not everyone experiences them. The most notorious antidepressant for causing these symptoms is Effexor (and I can attest that it can be extremely unpleasant indeed to stop taking it!), but any of them can cause these problems:
* depression
* irritability or agitation
* aggressiveness
* dizziness
* sensory disturbances (e.g., paresthesias such as electric shock sensations–a lot of sufferers call these “brain zaps,” and all I can say is, if you experience them, you’ll recognize the description)
* anxiety
* confusion
* headache
* lethargy
* nausea
* vertigo
* bizarre and vivid dreams
* seizures (rare)

Some of the specifics here depend on your specific drug. The half-life of your medication (that is, how long it stays in your body) affects the severity and duration of the symptoms. If you are on a med that has a short half-life, you may see these more quickly and they may be worse. (Effexor, which has a very short half-life, can produce these symptoms even if you miss a dose.) It is a good idea to cut your dose down gradually, as your doctor directs. Some doctors also prescribe Prozac, which has a long half-life, while you are discontinuing your other medication. Sometimes taking a short course of Prozac can make the symptoms less severe.

BOTTOM LINE
Antidepressants may be very useful to you. While the big lists of scary side effects can be intimidating, these drugs have changed the lives of a lot of depression sufferers. The most important thing is that you have a good care provider: one who listens to you, will help you tweak your regimen, and has a lot of experience dealing with antidepressants. I recommend, if you can, that you visit a psychiatrist. They do nothing but psychiatric medication management (mostly–a few of them also provide therapy), and they’re very good at it. If you can find a doctor who knows a lot about these drugs, it will make the process a lot easier and you might see some excellent results.

THREE MORE NOTES
1. If you are pregnant, breastfeeding, or planning to get pregnant, be sure to discuss this with your doctor. There is considerable evidence that the advantage of treating depression in a pregnant or nursing mother may outweigh the risks, but it should be an educated decision–and there are some drugs that are much better-tested in pregnancy than others.

2. If your medication tells you not to drink alcohol, don’t. Talk to your doctor if you want more information. I have a glass of wine often even though I take Wellbutrin, but I would not drink more than one drink while I’m taking it. It’s very important because alcohol can affect you more when you’re on an antidepressant, which means both that you may end up more intoxicated than you had planned or expected, and that any side effects of your medication may get worse. Plus, in a more general sense, alcohol is a depressant, which is not what you want if you suffer from depression!

3. Sometimes, an antidepressant that works well for you might stop working. This just happens occasionally. For example, I found that after my pregnancy, when I went back to my old antidepressant, it no longer worked well for me. That can happen even if you don’t stop taking it or have an obvious physical change such as pregnancy and birth. If it happens to you, don’t panic–talk to your doctor, and try something else.

new study: Metformin safer than other diabetes drugs

16 Apr

A new study in the European Heart Journal, by Tina Ken Schramm et al, found that metformin had the best outcomes out of a group of diabetes drugs: metformin, tolbutamide (Orinase), glipizide (Glucatrol), glibenclamide (Diabeta, Micronase, or Glynase), and glimepiride (Amaryl or GLIMY). The other drugs are known as sulfonylureas, whereas metformin is a biguanide.

The study, which compared metformin against available insulin secretogogues (ISs) found that the risks of “monotherapy with the most used ISs, including glimepiride, glibenclamide, glipizide, and tolbutamide, seems to be associated with increased mortality and cardiovascular risk compared with metformin. Gliclazide and repaglinide appear to be associated with a lower risk than other ISs.”

In other words, Met is safer. The American Diabetes Association recommends that sulfonylureas be used as a second-step treatment.

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!

Metformin: basic information

18 Mar

Many PCOS patients are prescribed Metformin for the treatment of their condition. It can be a bit confusing, because it is only FDA approved for treatment of diabetes; however, there are a lot of good reasons for using this drug to treat PCOS. Here’s a general overview of some things you should know.

How It Works

Metformin improves your body’s sensitivity to insulin. If you read my post about insulin resistance, you’ll remember that an insulin resistant person produces a lot of insulin, and her body is not very good at recognizing and using it to control blood sugar. Metformin improves the body’s ability to do this; it resensitizes the cells to insulin, so that your body doesn’t have to produce as much.

What It Does
From your perspective, you might see the following results from Metformin:
* Lower risk of developing diabetes.
* Easier weight loss (this varies from woman to woman, but many feel that Metformin makes it easier to drop pounds).
* Drop in testosterone production–this is directly related to the drop in insulin production. This can also mean less hirsutism, acne, and hair loss.
* Improved menstrual cycle regularity. Many women on Metformin have more consistent or frequent cycles. That is why it is often prescribed for women who are trying to get pregnant. (I took Met when I was trying to conceive my second child, and it did regulate my cycle very well.)
* Reduced risk of miscarriage. This is why many reproductive endocrinologists recommend that PCOS patients continue to take Metformin through the 12th week of pregnancy or later.

Side Effects
Metformin can have some major side effects for some women. These include GI symptoms (nausea, diarrhea), which can be bothersome, but not usually dangerous, at least in the short term (see below for suggestions on minimizing these problems). However, Metformin is also associated with liver and kidney problems; usually, this won’t be an issue for you unless you have a liver or kidney function problem already.

Metformin can also cause (or contribute to) a problem called lactic acidosis. This is rare (3 in 100,000 Metformin users), but it is a serious problem, so you should be aware of the symptoms: weakness, slow pulse, muscle pain, deeper and more labored breathing, and sleepiness. This is more common if you have liver/kidney problems, dehydration, diabetes, or a great deal of chronic stress. It is very important that you NOT take Metformin while fasting (for example, before a medical procedure) or if you are dehydrated, for this reason.

How to Minimize Side Effects
If you do have unpleasant GI symptoms while taking this medicine, there are a few things you can do to try to make them less severe. Make sure that you eat when you take your medication; break up your dose over the course of the day; and, at least at first, avoid very fibrous foods such as salads. Some people also find that the name brand (Glucophage) causes them fewer side effects.

The Bottom Line
Should you take Metformin? That’s a question you’ll want to discuss with your doctor. It’s worth considering, though, if you have many symptoms of insulin resistance. The side effects (which, by the way, I never experienced) are manageable for most people who use it, and it may be protective against diabetes over the long term.

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?