PCOS after tubal

stacymarie01

I'm 37, three kids, have had a tubal and an ablation, and have just been diagnosed with PCOS. The Dr. prescribed Metformin, which I can't start taking until Friday after my insulin resistance test. From my reading I know that BCPs are commonly prescribed to help regulate hormones for those suffering from PCOS, so I'm wondering if Metformin alone is enough, or if BCP would be helpful too.

Clearly after 3 kids and a tubal I have no desire to have more kids, and because of the uterine ablation I have only a few days of very light spotting a month, so I don't have annoying bleeding that needs to be controlled anymore. Is there any added benefit to BCP for someone in my situation?

KnitOrMiss

@stacymarie01 BCP is a bandaid at best, and often worsens the underlying issue. The best ways to regulate hormones are through diet, exercise, insulin management (Metformin, incorporating fasting, etc.), removing toxins from your environment, and supplements.

BCP adds more hormones into an already tangled mess rather than straightening it out, but like a bandaid on a wound, it covers up the true issue just enough for us to ignore it and not treat it.

I personally would switch doctors if yours recommended BCP strongly. And endocrinologist is who you should see if you have ongoing concerns.

There are others here with much more technical knowledge than me. Maybe @stacicali @Dragonwolf @aSearch4Me and others have more specific guidance. There have been discussion on this topic in the last year, but I'd have to dig to find the topics.

stacymarie01

Thanks, my Dr. did not recommend, but she was in and out very quickly, just prescribing the Met and I didn't get a chance to ask.

KnitOrMiss

I think BCP do work for a very rare few people. Just not in average. Most folks with PCOS tend to have more estrogen dominance than too low estrogen, so adding more in the mix, or trying to "low pills" just tends to wreak more havoc, particularly since from what you said you're pretty comfortable with your cycles now, @stacymarie01

Metformin and I were not friends. It caused me to have chronic diarrhea, but that was mainly due to me continuing to eat dairy and sugar (couldn't have any 2-3 hours either side of a Met dose). If your glucose levels are not out of control, even if your insulin is raging out of control (my glucose numbers are normal, and my insulin levels are high, showing resistance), you might be better served by incorporating dietary, exercise, and meal timing changes, if you can stick with it. Metformin mimics this combination in our bodies, and works extremely well for some folks.

The brand name medication Glucophage is often better tolerated (less side effects).

You might need to try the extended release and immediate release formulas to try out what will work better for you, as that's always very individual.

I think PCOS Diva has a site that @stacicali loves... I know @Dragonwolf has some blog writings she's done.

Once you have your tests and know which aspects of PCOS are your highest concerns, we can then offer advice for how to proceed best. Just remember, PCOS, insulin resistance, and any of the co-morbid conditions, they aren't the end of the world, and the sooner you treat for them, the more quality of life you can retake!

stacicali

Amen to everything KnitOrMiss said. I am on Metformin and am a big fan. Also, I was told by an endocrinologist that metformin is used as a preventative measure to try to stop the slide into Type 2 diabetes that we are greatly more at risk for than the average population. Sounds like you have a pretty good doctor if they are testing your insulin.

Regarding the birth control pill, the latest info I've seen says don't do it. Here's a good synopsis of why not with supporting expert interviews: http://pcosdiva.com/category/pill/

If you and your dr do decide it is what's best for you individually, make sure you ask questions about the progesterone component of the pill. It was probably at least 6 years ago when I last discussed it with an endo, but she was adamant that only Yaz and Yasmin were appropriate for PCOS because all the others contained progesterones that aggravate our androgen issues.

Best of luck and keep us posted!

KnitOrMiss

@stacicali - I thought PCOS needed progesterone only pills, that it was estrogen that messed up the androgen issues/hormonal estrogen dominance? Or do I have it backwards? Yaz and Yasmin were supposed to be the low estrogen ones, if I recall?? Am I totally lost?

stacicali

@KnitOrMiss that's a really great point. I'm not sure why that endo was so adamant about the progestin in most birth control pills. Perhaps she meant to say that the progestin in Yaz is the most appropriate because it is the most anti - androgenic? She was pretty firm in saying that my PCOS symptoms would be worse with other progestins though. Maybe that's why I've always felt like hell on any birth control pill or progesterone therapy? It still begs the question how (or if) we treat estrogen dominance that many of us struggle with. My integrative md swears that there is a big difference between synthetic progesterone (progestin in bcp) and natural bioidentical progesterone, so perhaps therein lies the difference. For anyone who wants to have their eyes crossed or be put to sleep tonight, here's a study on why the docs are pushing Yaz (if recommending bcp): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504056/

KnitOrMiss

I also feel a million and 12 times better on a higher estrogen pill and felt like total crap on progesterone supps... I got terrified of all the warnings, even after paying $50 for Yaz, I think it was, and tossed it in the garbage, unused.

I know my doc has tried to get be back on spirolactone, but that stuff massively worsened my dehydration. It was insane. I'm at a loss, @stacicali - I've not heard of docs not wanting to supp Prog...but that would make sense that it was when my PCOS took a turn for the worst after 2-3 year supplementing it, if that's the case!

KnitOrMiss

I do know that my endo said that the estradiol test the run would NOT show the estrogen from my BCP on the test, as I'd said I'd taken it before the test. So the standard test shows "natural" estrogens.

The progesterone I was using was bio-identical, and it put me through heck and back.

I was on a low dose pill at first, and it was awful. Full on PMS and psycho mood swings... Switched to the estrogen pill, then up a strength - most level I've been in a decade!

stacymarie01

Interesting, for years I went on and off of the pill when I was not diagnosed with PCOS to help control acne and irregular/long periods. Yaz was the only one that worked well for me.

So I got my results back from the IR test and I am not insulin resistant. So that is good news. They are having me continue with the Met anyway, because it is supposed to help with PCOS symptoms even when you don't have IR. I did find a study that confirmed this so I am okay with staying on it. Right now I am only taking 1 dose a day and easing my way up to 3x a day, so hopefully I don't have too many stomach issues.

A few other things I've been thinking about:

My hair is falling out like crazy and I REALLY want it to stop, is the Met going to help with that? I started taking Saw Palmetto last week to try and help with that as well. Anything else I should be taking or doing?

I am so tired all the time, from the reading I had done I was thinking it must be from IR, but now my results are back and I don't have IR, so now I can't blame that...any advice on how to deal with/or improve the fatigue?

I have been working out regularly since August with no weight loss, I've added more cardio in the last few weeks and have been cutting back on carbs. The though of giving up bread and dairy makes me want to cry. UGH.

KnitOrMiss

stacymarie01 wrote: »

Interesting, for years I went on and off of the pill when I was not diagnosed with PCOS to help control acne and irregular/long periods. Yaz was the only one that worked well for me.

So I got my results back from the IR test and I am not insulin resistant. So that is good news. They are having me continue with the Met anyway, because it is supposed to help with PCOS symptoms even when you don't have IR. I did find a study that confirmed this so I am okay with staying on it. Right now I am only taking 1 dose a day and easing my way up to 3x a day, so hopefully I don't have too many stomach issues.

A few other things I've been thinking about:

My hair is falling out like crazy and I REALLY want it to stop, is the Met going to help with that? I started taking Saw Palmetto last week to try and help with that as well. Anything else I should be taking or doing?

I am so tired all the time, from the reading I had done I was thinking it must be from IR, but now my results are back and I don't have IR, so now I can't blame that...any advice on how to deal with/or improve the fatigue?

I have been working out regularly since August with no weight loss, I've added more cardio in the last few weeks and have been cutting back on carbs. The though of giving up bread and dairy makes me want to cry. UGH.

@stacymarie01 - my first thought with all this is thyroid. It practically jumped off the page to me. What number was your last TSH? And Free T4 and Free T3, if you have them.

And what number was your insulin level? Because there's a wide variety of what is supposed to be okay, and what isn't.

I've added in a number of support supplements for my hair loss, and they're all cofactors with thyroid and adrenal dysfunction.

Personally, I have mostly dropped bread and grains, but being on a lower carb diet, dairy is a crucial success staple for me, so unless under threat of death, I'm unlikely to ever give it up myself... LOL

stacymarie01

TSH was 1.87 they didn't do t3 t4 this time but did last summer and all were in range. I don't have those numbers in front of me right now. I need to request the IR results, they just called and said they were good.

stacymarie01

Also can anyone refer me to a good reference for what levels of various hormones should be. I see such a variation between different websites and the normal ranges listed on my lab paperwork.

KnitOrMiss

@stacymarie01 - I know that my Endocrinologist wants me below 2 for sure, and would prefer me be below 1.5. My understanding is that most folks feel best at between 0.5-1.5 for TSH. I'll have to look up the numbers, but Free T3 and T4 were both a 2.??? if I remember right. I know my Free T3 by itself didn't show a problem with a neon flag, but having the Reverse T3 number being high indicated that my body was trying to protect me from running out, as T4 converts to T3, and T3 is the active usable form.

And yes, on the insulin levels, I think anything over a 5 is considered "take preventative steps" and anything over 10 freaks most doctors out (even though labs say up to 19 is okay)...and anything over 15 gives them heart issues. I think mine was a 9 and they wanted to put me on metformin.

Maria Emmerich has some good info on it: mariamindbodyhealth.com/thyroid-madness/

mariamindbodyhealth.com/zinc-hair-loss/ - and this is the one that got me started on hair loss stuff...

This is another site: stopthethyroidmadness.com/recommended-labwork/

I haven't used this specific site, but @stacicali is a huge proponent, so: pcosdiva.com/category/blog/treatment/thyroid/ and specifically I like this one: pcosdiva.com/2016/05/hormone-link-thyroid-and-iodine-pcos/.

Hopefully these will give you some starting points. I think it is Dr. Hymen and another functional doc that listed the first numbers. I will dig through my notes to see what I can find.

stacicali

From all the studies I've seen lately, scientists are beginning to suspect inflammation and insulin resistance at the heart of all PCOS cases. Here are some tests you can discuss with your dr: http://insulinnation.com/treatment/medicine-drugs/beyond-bmi-and-a1c-measuring-insulin-resistance/

I too struggle with the hair thinning and suspect it is more PCOS than my hypothyroidism. The wretched part is that even if we don't score abnormally high on free testosterone, our follicles can simply be more sensitive to DHT. Here's a good synopsis of things you can do:
http://pcosdiva.com/2010/11/pcos-and-hairloss-what-works-for-me/

I personally just started Rogaine and am rubbing 5 drops of Rosemary oil cut with a carrier oil in my scalp 30 minutes before every shampoo.

Here's Dr. Mercola's two cents on tests and what their ideal results should be:

http://fitness.mercola.com/sites/fitness/archive/2012/04/27/vitamin-d-and-blood-test-health-factors.aspx