A blog dedicated for PCOS sufferers from India
Tuesday, August 25, 2009
Blog moved to a different address
Dear All,

I had moved all the contents of this blog to http://treating-pcos.blogspot.com. I will reply to all your comments there...Make sure you check it out!!!
posted by Priya @ 12:10 AM   0 comments
Tuesday, January 22, 2008
PCOS and Insulin Resistance
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.

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posted by Priya @ 7:14 PM   5 comments
Wednesday, January 2, 2008
PCOS and Acne
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.

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posted by Priya @ 10:09 PM   1 comments
My PCOS Story
Here is my story about PCOS.

I used to get regular period till my marriage since puberty. As most of the Indian women 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!!

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posted by Priya @ 3:30 AM   13 comments
Wednesday, December 12, 2007
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posted by Priya @ 6:49 AM   0 comments
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