Metformin question and a few general questions (plus a bit of venting)
bdawso88
Posts: 13 Member
So, I just started taking Metformin on the 13th of December (1000 mg split into two doses each day...starting 12/22 will be on 1500 mg/3 times a day). I was wondering if anyone can identify how long it took for you to start ovulating again while taking the Metformin? Or if it even did...
My husband and I are trying to have a baby, and I don't feel like my doctor is really doing everything they can based on some of the information that I'm reading. The first doctor I talked to when I suspected I had PCOS was my endocrinologist (I also have an underactive thryoid) and she said, "That's really more of a GYN problem so you'll have to talk to them." Did any one else find that their endocrinologist wouldn't treat/test them for PCOS?
Then, I go to the gyno who says, "I don't think you have it but monitor your cycles for 6 months and then come back if they aren't regular." Then, I go back and she started talking to me as if I already had been diagnosed with PCOS ("Women with PCOS...")...um...hello? You said that I probably didn't have it and would have to come back. So she asks me some symptom-style questions and then says, "Based on that you probably have PCOS. I could run a bunch of tests but when they all come back negative it'll just confirm PCOS anyway." At this point, I had read a bunch of stuff online about PCOS and knew that there were tests that could confirm it. The only way I finally got it diagnosed was that Dr gave me Clomid which requires an ultrasound. My normal gyno wasn't working the day I had to have the us done so I ended up following up with a different gyno who ran bloodwork since the u/s showed polycystic ovaries.
After all this, the newest gyno that had ordered the bloodwork confirmed my diagnosis of PCOS and put me on the metformin to see if that gets me ovulating again. In a prevous post, some people mentioned Vitex. I was just wondering (especially those of you trying to conceive) what your doctor's have put you on because it's becoming clear that I am going to have to manage my own medical care.
I also was wondering who deals with a fertility doctor instead of just a regular gyno for their PCOS.
I am so happy to have found this group! Thank you all in advance for reading my long post!
My husband and I are trying to have a baby, and I don't feel like my doctor is really doing everything they can based on some of the information that I'm reading. The first doctor I talked to when I suspected I had PCOS was my endocrinologist (I also have an underactive thryoid) and she said, "That's really more of a GYN problem so you'll have to talk to them." Did any one else find that their endocrinologist wouldn't treat/test them for PCOS?
Then, I go to the gyno who says, "I don't think you have it but monitor your cycles for 6 months and then come back if they aren't regular." Then, I go back and she started talking to me as if I already had been diagnosed with PCOS ("Women with PCOS...")...um...hello? You said that I probably didn't have it and would have to come back. So she asks me some symptom-style questions and then says, "Based on that you probably have PCOS. I could run a bunch of tests but when they all come back negative it'll just confirm PCOS anyway." At this point, I had read a bunch of stuff online about PCOS and knew that there were tests that could confirm it. The only way I finally got it diagnosed was that Dr gave me Clomid which requires an ultrasound. My normal gyno wasn't working the day I had to have the us done so I ended up following up with a different gyno who ran bloodwork since the u/s showed polycystic ovaries.
After all this, the newest gyno that had ordered the bloodwork confirmed my diagnosis of PCOS and put me on the metformin to see if that gets me ovulating again. In a prevous post, some people mentioned Vitex. I was just wondering (especially those of you trying to conceive) what your doctor's have put you on because it's becoming clear that I am going to have to manage my own medical care.
I also was wondering who deals with a fertility doctor instead of just a regular gyno for their PCOS.
I am so happy to have found this group! Thank you all in advance for reading my long post!
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Replies
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First, I'd say switch to that other gyno, or find a new one. The way your usual one is acting is horrid. If you're not ovulating, and you are not, or were not on birth control that has stopped your ovulating, then odds are, some of the tests done would show abnormalities (there is no "yes, you have it/no, you don't" tests a la strep tests, but you do get your hormones tested and certain ranges are consistent with PCOS).
Second, it's usually the endocrinologist that does and is better at helping you treat PCOS, but some may need a diagnosis from an OB/GYN before they can do anything (insurance, liability, regulation, etc issues may prevent them from diagnosing or some such; makes no sense, but this is healthcare we're talking about).
That said, Metformin is neither a fertility nor a weight loss drug. It is a drug that improves insulin sensitivity of the liver, reducing overall blood sugar levels in the body. If your anovulation is due to excess blood sugar or insulin, then you will start ovulating again as soon as those levels drop below your personal tolerance level. That could be a week, that could be a month, that could be three months from now. It all depends on how you react. The first time I went on Metformin, about six years ago, I was ovulating again within about two months and was pregnant a couple months after that. The last time I went back on it, I had two periods in roughly a year and a half's time. Check your bloodwork results and make sure that they got a fasting insulin test done. Glucose only is next to meaningless unless you have high glucose, too, but it's possible for your insulin to run high and your glucose to be normal. Since Metformin works by improving insulin resistance (and thus, lowering insulin levels), you can't really tell, objectively, whether the Metformin is working for you without it, nor can you tell whether you actually need it (it's pointless, at best, to be taking it if you're not insulin resistant).
Vitex is also known as chasteberry. Doctors in Europe will prescribe this, but it's an herbal "supplement" that isn't generally prescribed by American doctors, but can be obtained over the counter from health food stores or other places that sell such supplements (ie - Kroger, etc). It can help improve fertility and stimulation ovulation, because it directly affects some of the hormones involved in ovulation. Specifically, it stimulated lutenizing hormone (LH) production, which in turn prompts more progesterone production, reducing estrogen dominance.
Additionally, Inositol (in the easy-to-find Myo-Inositol, and harder-to-find C-Chiro Inositol forms) is another supplement that can help you ovulate. It has also been found to improve egg quality in women with PCOS, as well as improve insulin sensitivity in anyone with insulin resistance. It works differently than Vitex, because Inositol is actually a B-complex vitamin (now classified as a pseudo-vitamin, because we can make what we usually need; but it's specifically B8), and like the other B-vitamins, it helps support the nervous system, which improves the body's communication pathways, helping the body help itself, basically. I've had my period regularly every month, starting a week after I started taking it, though the studies have shown upwards of about 6 weeks before it took full effect, though most people saw some effects within a week or two. Like Vitex, it's available over the counter in the United States (I use Inositol, and get mine from Amazon).0 -
I second the switching doctors bit. I had ZERO problems getting my endocrinologist to address my issues. Given the fact that you have low thyroid in addition to everything else, I would also suggest making sure you get your thyroid levels back up to normal with medication. If you still have no ease to your symptoms, talk to your endo about adding a thyroid support supplement for thyroid support. I was on meds that got my levels back into range, but I didn't feel better. Added this supplement (which must be monitored due to potential allergies and over-doses), and literally on the 8th day it hit me like a brick wall that while I was still tired, I wasn't literally having to fight myself to get out of bed every day anymore...with four snooze alarms and still sleeping through it sometimes... So that was a shocking change for me... Good luck, C0
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Dragonwolf, thank you for your reply! The doctor did a fasting insulin test and my levels were actually normal, but he said that could have been affected by my having been on the Clomid so he did start me on the Metformin. Due to my ultrasound results and abnormally high levels of androgens in my blood, he diagnosed me with PCOS even though my insulin test appeared to be normal.
I will definitely look into the Inositol. It sounds like a product that may help. Thanks again!0 -
Dragonwolf, thank you for your reply! The doctor did a fasting insulin test and my levels were actually normal, but he said that could have been affected by my having been on the Clomid so he did start me on the Metformin. Due to my ultrasound results and abnormally high levels of androgens in my blood, he diagnosed me with PCOS even though my insulin test appeared to be normal.
I will definitely look into the Inositol. It sounds like a product that may help. Thanks again!
You can have PCOS without insulin resistance. Metformin wont do much for you if you dont have insulin resistance except make your stomach hurt, a lot. There are many women without IR but have PCOS with crazy hormone levels but the insulin is fine.
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My insulin levels were okay, but my symptoms indicated otherwise, and I have an alternate wonky condition the metformin helps LOADS with, so I'm in the middle of that weird vortex above...0
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Dragonwolf, thank you for your reply! The doctor did a fasting insulin test and my levels were actually normal, but he said that could have been affected by my having been on the Clomid so he did start me on the Metformin. Due to my ultrasound results and abnormally high levels of androgens in my blood, he diagnosed me with PCOS even though my insulin test appeared to be normal.
I will definitely look into the Inositol. It sounds like a product that may help. Thanks again!
You can have PCOS without insulin resistance. Metformin wont do much for you if you dont have insulin resistance except make your stomach hurt, a lot. There are many women without IR but have PCOS with crazy hormone levels but the insulin is fine.
My doctor (the one that ran the blood tests to check my insulin levels) said that my insulin levels may have been reading normally due to a recent bout of clomid i had been on. At the time, I took that as truth but now I'm wondering. Does anyone know if this is true?0 -
Dragonwolf, thank you for your reply! The doctor did a fasting insulin test and my levels were actually normal, but he said that could have been affected by my having been on the Clomid so he did start me on the Metformin. Due to my ultrasound results and abnormally high levels of androgens in my blood, he diagnosed me with PCOS even though my insulin test appeared to be normal.
I will definitely look into the Inositol. It sounds like a product that may help. Thanks again!
You can have PCOS without insulin resistance. Metformin wont do much for you if you dont have insulin resistance except make your stomach hurt, a lot. There are many women without IR but have PCOS with crazy hormone levels but the insulin is fine.
My doctor (the one that ran the blood tests to check my insulin levels) said that my insulin levels may have been reading normally due to a recent bout of clomid i had been on. At the time, I took that as truth but now I'm wondering. Does anyone know if this is true?
A quick search doesn't show an indication that Clomid would reduce insulin levels directly, but it's hard to tell. All of our hormones are intrinsically linked to one another. When one changes, the others often follow suit, so if the Clomid increased your LH and/or Progesterone, it's possible it was enough to prompt a drop in insulin. Additionally, it seems Clomid may increase IGF-1, which is similar enough to insulin to bind to insulin receptors, which could also prompt the body to produce less insulin. The only way to be sure, though, is to retest after you've been off the Clomid for a sufficient length of time and see if there is any noticeable change (I don't know how long that is, as I don't know much about the details of Clomid, but I'd presume it'd be around 3-6 weeks).0 -
Dragonwolf always has the best info lol, so not much to add. I just wanted to add a comment about vitex. Many people report increased fertility with it, but I wouldn't take it at the same time as clomid. The research seems a little spotty, but general consensus is that there is a property that causes them to sort of cancel each other out.0
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I am in a similar situation. My doc told me to take 1000mg metformin in the evening and cut carbs. I can eat brown rice and fruits so the diet is doable for me. My husband and I are hoping to conceive asap and my gyno said the low carb/metformin combo works wonders with some women.0
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So, I have a couple questions about metformin, too...
I went to my dr. with a handful of concerns (constant fatigue/low energy, trouble losing weight, adult acne, hirsutism, severe periods). He ordered some bloodwork - a comprehensive metabolic panel, he tested testosterone and thyroid because I showed high T in the past and I have a family history of thyroid issues (my mom ordered a bunch of tests for everyone in the family when my dad was diagnosed with thyroid cancer but we never did anything with the results for whatever reason
).
He said he thought we'd end up treating me for SOME sort of thyroid problem but wasn't sure what. His 'plan of action' was to treat for whatever thyroid issue might be present and if that didn't fix things then assume I had PCOS as well and treat for that.
He said my tests came back all normal, he didn't think thyroid was an issue after all (TSH was 3.47, lab says 'normal' is between 0.40-4.50). He said that while my testosterone was normal, maybe more of it was actually available than should be - something about not enough of it being bound up to proteins or something? I don't know how that's related to PCOS though, I'm pretty lost. Anyway, given that he's not concerned about my thyroid he wanted to treat for PCOS. He told me that PCOS isn't really something you can test for, it's just a collection of symptoms you can work to treat. He wanted to either put me on birth control or metformin, saying that either one I chose had a low risk of side effects. I prefer to not go on hormonal BC so I said I'd try metformin after he assured me that it really didn't matter which I took and that worst case scenario I might get slightly queasy/looser stools, but probably not even that because he gave me a slow-release version. I'm supposed to follow up in 3 months.
So I'm on day 2 of metformin and I seem to be handling it ok, no upset stomach etc. I am just confused. He sounded pretty self-assured when I left the office but thinking about it after I feel like I don't quite get why metformin is a good choice for me in this instance. I'm also not sure if I trust this dude, he kept assuring me that PCOS is pretty common and no big deal. Maybe it's common but I've come across plenty of women dealing with it who definitely don't think it's no big deal. He said a couple times that simply not doing anything would be fine, I'm not harming my body by not doing anything.... but I feel like not being able to lose weight that I need to lose - a BMI teetering between 28-30 doesn't seem like something my dr should be like 'no big deal' about - and while painful periods and hirsutism aren't dangerous or whatever, they're not normal and I feel they effect my quality of life, so I don't get why he's so nonchalant about this.
I am pretty lost right now. I don't know if he's just telling me that maybe it's PCOS and giving me a relatively harmless prescriptions just so he can say he tried and be rid of me for three months, or if this is a valid course of action given the information we have. Any thoughts?
Edit: I keep seeing people with PCOS say that they're doing better keeping carbs low, cutting out bread/pasta/etc. My dr. didn't give me any guidance as to what I should be doing diet-wise if his suggestion of PCOS is accurate, I'm trying to get 'back on the wagon' diet-wise and I'm just wondering if in addition to eating cleaner, adding activity, and counting calories, I should try to lower carb intake as well?
Sorry to ramble, I'm frustrated and uninformed. Thanks for reading/any help you can give!
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Hello Serenity! I was recently diagnosed with PCOS by my gyn. He ran all sorts of bloodwork which all came back normal including tsh, testosterone. The only thing that did not come back 'normal' was my fasting glucose so he determined I was IR and had PCOS. After an ultrasound he determined my ovaries had no cysts and that I had issues because of my insulin resistance. Were you tested for glucose levels? My understanding is that metformin helps with the body's response to sugar intake.0
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I have IR and my glucose is fine, right in the middle of normal every time. You can have insulin issues without glucose issues. The only way to tell if it is IR is to get a 12 hour fasting insulin blood test, or there is a more time consuming every 3 hour blood test. But the 12 hour fasting is the easiest by far and I get one every few months to make sure the metformin is still working for me.
Metformin is good for IR but if you dont have IR, and many women with PCOS dont have IR, then Metformin doesnt do a whole lot of good. Its a medication that helps your body see and use the insulin you already make so you dont end up making more than you need. Granted using our insulin gives us the added benefits of weight loss and often increased fertility but those are really just benefits because we are now using the excess insulin in our bodies.
A low carb diet helps with quite a few things.
1. IR because the fewer carbs we have the less insulin response our body has. Many of us with IR find that if we eat a normal SAD diet, our calories have to be super low to lose weight even with exercise. If we eat LCHF we can eat a lot more calories and still lose weight. LCHF has the added bonus of keeping you fuller longer so you dont eat as much naturally most days and that of course helps weight loss.
2. Fat doesnt trigger insulin issues which help to balance the hormones. Carbs do wonky things sometimes to our hormones, which can already be way out of wack and fat doesnt trigger those responses. It helps settle hormones.
I also use Inositol in addition to my metformin as it is more natural and gently helps you balance your insulin. There are also other herbs out there that can help you balance your hormones if you are into natural remedies and not on fertility drugs. But a LCHF diet seems to be the hands down best way to deal both with insulin and hormone levels.
Finding out if you have and treating IR is important because if you dont, your pancreas will finally decide its had enough of working triple overtime for years and start to give out, which then gives you diabetic issues as you wont be making enough insulin at some point anymore and it will affect your glucose levels. Diabetes is not curable as you cant get your pancreas to start making insulin again but again, it is something that can be managed thru diet, a diet very similar to a LCHF. Which again is why its recommended to start a LCHF with pcos and/or IR anyway.0 -
serenity56 wrote: »So, I have a couple questions about metformin, too...
I went to my dr. with a handful of concerns (constant fatigue/low energy, trouble losing weight, adult acne, hirsutism, severe periods). He ordered some bloodwork - a comprehensive metabolic panel, he tested testosterone and thyroid because I showed high T in the past and I have a family history of thyroid issues (my mom ordered a bunch of tests for everyone in the family when my dad was diagnosed with thyroid cancer but we never did anything with the results for whatever reason ).
He said he thought we'd end up treating me for SOME sort of thyroid problem but wasn't sure what. His 'plan of action' was to treat for whatever thyroid issue might be present and if that didn't fix things then assume I had PCOS as well and treat for that.
He said my tests came back all normal, he didn't think thyroid was an issue after all (TSH was 3.47, lab says 'normal' is between 0.40-4.50). He said that while my testosterone was normal, maybe more of it was actually available than should be - something about not enough of it being bound up to proteins or something? I don't know how that's related to PCOS though, I'm pretty lost. Anyway, given that he's not concerned about my thyroid he wanted to treat for PCOS. He told me that PCOS isn't really something you can test for, it's just a collection of symptoms you can work to treat. He wanted to either put me on birth control or metformin, saying that either one I chose had a low risk of side effects. I prefer to not go on hormonal BC so I said I'd try metformin after he assured me that it really didn't matter which I took and that worst case scenario I might get slightly queasy/looser stools, but probably not even that because he gave me a slow-release version. I'm supposed to follow up in 3 months.
So I'm on day 2 of metformin and I seem to be handling it ok, no upset stomach etc. I am just confused. He sounded pretty self-assured when I left the office but thinking about it after I feel like I don't quite get why metformin is a good choice for me in this instance. I'm also not sure if I trust this dude, he kept assuring me that PCOS is pretty common and no big deal. Maybe it's common but I've come across plenty of women dealing with it who definitely don't think it's no big deal. He said a couple times that simply not doing anything would be fine, I'm not harming my body by not doing anything.... but I feel like not being able to lose weight that I need to lose - a BMI teetering between 28-30 doesn't seem like something my dr should be like 'no big deal' about - and while painful periods and hirsutism aren't dangerous or whatever, they're not normal and I feel they effect my quality of life, so I don't get why he's so nonchalant about this.
I am pretty lost right now. I don't know if he's just telling me that maybe it's PCOS and giving me a relatively harmless prescriptions just so he can say he tried and be rid of me for three months, or if this is a valid course of action given the information we have. Any thoughts?
Edit: I keep seeing people with PCOS say that they're doing better keeping carbs low, cutting out bread/pasta/etc. My dr. didn't give me any guidance as to what I should be doing diet-wise if his suggestion of PCOS is accurate, I'm trying to get 'back on the wagon' diet-wise and I'm just wondering if in addition to eating cleaner, adding activity, and counting calories, I should try to lower carb intake as well?
Sorry to ramble, I'm frustrated and uninformed. Thanks for reading/any help you can give!
Wow, that's the strangest approach I've seen.
He's right in that it's common (the most common cause of fertility issues, in fact, with upwards of 1 in 5 women having it).
His idea that it's "not a big deal" strikes me as the innate ignorance of being male, by and large, especially with regard to the day-to-day quality of life. I'd guess that his PCOS patients have been unable to get it through his head the effect on quality of life (and possibly, may never be able to, since it's often hard to describe the issues and what makes them a problem, and it's even harder to get someone who's incapable of experiencing such things to be able to understand).
Not doing anything isn't really an option, in my opinion. No, it's not like some diseases where if you don't do anything, it will kill you within weeks or months, but the hormonal imbalances caused by PCOS increase your risk for a number of issues, including metabolic syndrome, mineral deficiencies, and cancer.
What bothers me most is the doctor saying what he said about the risks/side effects of either hormonal birth control or Metformin (and "a little queasy/looser stools" does not even begin to describe the side effects that Metformin can cause, including the extended release version). Hormonal birth control has a laundry list of side effects and risks (how many have been recalled for causing blood clots or other potentially deadly side effects, now?), as well. As for Metformin, like any other medication, the risk increases as the dose increases. At the lowest dose, most only get minor GI issues and that's about the extent of it. At the higher doses, however (2000mg), you start risking B12 malabsorption and have higher chances of worse GI issues.
With the thyroid, if he only tested TSH, then he only did a half-assed job of testing thyroid function. TSH is only half of the thyroid functioning equation. It stands for Thyroid Stimulating Hormone, and it's actually a pituitary gland hormone. The better indicator for thyroid function is free T3 and free T4, at least. For more information about thyroid issues and to see how to get better information about whether you have thyroid issues, I recommend checking out Stop The Thyroid Madness. (Similarly, Testosterone testing should also test free and total T, to get a more accurate picture.)
He is right that PCOS is just a collection of symptoms and there's no definitive test for it. That's why you'll find women with it that don't actually have cysts on their ovaries, or some that don't have weight issues, and so on.
I wrote a primer on PCOS that I think would help you get some more information. I've also written a number of (rather long) comments on here that will probably help, as well.0 -
serenity56 wrote: »So, I have a couple questions about metformin, too...
I went to my dr. with a handful of concerns (constant fatigue/low energy, trouble losing weight, adult acne, hirsutism, severe periods). He ordered some bloodwork - a comprehensive metabolic panel, he tested testosterone and thyroid because I showed high T in the past and I have a family history of thyroid issues (my mom ordered a bunch of tests for everyone in the family when my dad was diagnosed with thyroid cancer but we never did anything with the results for whatever reason ).
He said he thought we'd end up treating me for SOME sort of thyroid problem but wasn't sure what. His 'plan of action' was to treat for whatever thyroid issue might be present and if that didn't fix things then assume I had PCOS as well and treat for that.
He said my tests came back all normal, he didn't think thyroid was an issue after all (TSH was 3.47, lab says 'normal' is between 0.40-4.50). He said that while my testosterone was normal, maybe more of it was actually available than should be - something about not enough of it being bound up to proteins or something? I don't know how that's related to PCOS though, I'm pretty lost. Anyway, given that he's not concerned about my thyroid he wanted to treat for PCOS. He told me that PCOS isn't really something you can test for, it's just a collection of symptoms you can work to treat. He wanted to either put me on birth control or metformin, saying that either one I chose had a low risk of side effects. I prefer to not go on hormonal BC so I said I'd try metformin after he assured me that it really didn't matter which I took and that worst case scenario I might get slightly queasy/looser stools, but probably not even that because he gave me a slow-release version. I'm supposed to follow up in 3 months.
So I'm on day 2 of metformin and I seem to be handling it ok, no upset stomach etc. I am just confused. He sounded pretty self-assured when I left the office but thinking about it after I feel like I don't quite get why metformin is a good choice for me in this instance. I'm also not sure if I trust this dude, he kept assuring me that PCOS is pretty common and no big deal. Maybe it's common but I've come across plenty of women dealing with it who definitely don't think it's no big deal. He said a couple times that simply not doing anything would be fine, I'm not harming my body by not doing anything.... but I feel like not being able to lose weight that I need to lose - a BMI teetering between 28-30 doesn't seem like something my dr should be like 'no big deal' about - and while painful periods and hirsutism aren't dangerous or whatever, they're not normal and I feel they effect my quality of life, so I don't get why he's so nonchalant about this.
I am pretty lost right now. I don't know if he's just telling me that maybe it's PCOS and giving me a relatively harmless prescriptions just so he can say he tried and be rid of me for three months, or if this is a valid course of action given the information we have. Any thoughts?
Edit: I keep seeing people with PCOS say that they're doing better keeping carbs low, cutting out bread/pasta/etc. My dr. didn't give me any guidance as to what I should be doing diet-wise if his suggestion of PCOS is accurate, I'm trying to get 'back on the wagon' diet-wise and I'm just wondering if in addition to eating cleaner, adding activity, and counting calories, I should try to lower carb intake as well?
Sorry to ramble, I'm frustrated and uninformed. Thanks for reading/any help you can give!
Hi hun,
Based on what you said, it sounds to me as if you are taking to your regular physician? If so, this is likely part of the problem. A LOT of medical professional are undereducated about PCOS. I would look into visiting a different doctor for a PCOS consultation, either an endocrinologist or a gynecologist.
When I was diagnosed, our family physician didn't even want to touch it. I was having irregular cycles and she simply said, "go see a gynecologist."
Okay, fine. He told me it wasn't anything to worry about until I wanted to have kids (a common response, really, I've heard it from a couple of doctors) and put me on BC.
When I went to college and had no medical insurance I could only see the campus gynecologist who fancied herself an expert on PCOS (and maybe she was). Her treatment response was only having a menstrual cycle every 3 months with the use of BC. It wrecked havoc on my system, and she wouldn't listen to me when I tried to talk to her about it, so I stopped going and stopped taking any kind of medication for it. I gained 100# while in college and my hirsutism got very bad (which is so incredibly annoying, am I right?).
My new health insurance kicked in in September; I went to the gynecologist for an initial exam in November with a consultation in December. This doctor was much more understanding, and thorough in his way of explaining PCOS. He wants to work WITH me (and check in every 3-4 months) to see how I am doing towards our goal of me losing 100# over the course of the year.
He prescribed BC and Metformin to help regulate the metabolic and hormonal issues with PCOS. I should also say with this, almost all my labs were 100% normal, with a slightly elevated androgen count (testosterone hormone). Meaning, I have a very "mild" case of PCOS (since the symptoms and severity vary from person to person.)
His recommendation: absolutely NO sugar, ever. Low carb, under 1500 calories a day, with 5 days of exercise a week, minimum.
That being said, PCOS is more of endocrinology disorder, so a lot of women will work with an endocrinologist to treat it. But they aren't always reliable, either. I had a friend who's first doctor simply said, "you're fat." The second one (her current one) put her on metformin and told her to lose weight, with no other advice/help.
The MOST important part of treating PCOS is finding a doctor who will listen to you and work WITH you to manage it. It can take a while, be annoying, and hard, but it is the most effective way to get it under control medically. (Other than healthy diet, exercise, and weight loss, of course, but even that isn't a guarantee for every woman with PCOS.)0 -
thetragicjoy wrote: »serenity56 wrote: »So, I have a couple questions about metformin, too...
I went to my dr. with a handful of concerns (constant fatigue/low energy, trouble losing weight, adult acne, hirsutism, severe periods). He ordered some bloodwork - a comprehensive metabolic panel, he tested testosterone and thyroid because I showed high T in the past and I have a family history of thyroid issues (my mom ordered a bunch of tests for everyone in the family when my dad was diagnosed with thyroid cancer but we never did anything with the results for whatever reason ).
He said he thought we'd end up treating me for SOME sort of thyroid problem but wasn't sure what. His 'plan of action' was to treat for whatever thyroid issue might be present and if that didn't fix things then assume I had PCOS as well and treat for that.
He said my tests came back all normal, he didn't think thyroid was an issue after all (TSH was 3.47, lab says 'normal' is between 0.40-4.50). He said that while my testosterone was normal, maybe more of it was actually available than should be - something about not enough of it being bound up to proteins or something? I don't know how that's related to PCOS though, I'm pretty lost. Anyway, given that he's not concerned about my thyroid he wanted to treat for PCOS. He told me that PCOS isn't really something you can test for, it's just a collection of symptoms you can work to treat. He wanted to either put me on birth control or metformin, saying that either one I chose had a low risk of side effects. I prefer to not go on hormonal BC so I said I'd try metformin after he assured me that it really didn't matter which I took and that worst case scenario I might get slightly queasy/looser stools, but probably not even that because he gave me a slow-release version. I'm supposed to follow up in 3 months.
So I'm on day 2 of metformin and I seem to be handling it ok, no upset stomach etc. I am just confused. He sounded pretty self-assured when I left the office but thinking about it after I feel like I don't quite get why metformin is a good choice for me in this instance. I'm also not sure if I trust this dude, he kept assuring me that PCOS is pretty common and no big deal. Maybe it's common but I've come across plenty of women dealing with it who definitely don't think it's no big deal. He said a couple times that simply not doing anything would be fine, I'm not harming my body by not doing anything.... but I feel like not being able to lose weight that I need to lose - a BMI teetering between 28-30 doesn't seem like something my dr should be like 'no big deal' about - and while painful periods and hirsutism aren't dangerous or whatever, they're not normal and I feel they effect my quality of life, so I don't get why he's so nonchalant about this.
I am pretty lost right now. I don't know if he's just telling me that maybe it's PCOS and giving me a relatively harmless prescriptions just so he can say he tried and be rid of me for three months, or if this is a valid course of action given the information we have. Any thoughts?
Edit: I keep seeing people with PCOS say that they're doing better keeping carbs low, cutting out bread/pasta/etc. My dr. didn't give me any guidance as to what I should be doing diet-wise if his suggestion of PCOS is accurate, I'm trying to get 'back on the wagon' diet-wise and I'm just wondering if in addition to eating cleaner, adding activity, and counting calories, I should try to lower carb intake as well?
Sorry to ramble, I'm frustrated and uninformed. Thanks for reading/any help you can give!
Hi hun,
Based on what you said, it sounds to me as if you are taking to your regular physician? If so, this is likely part of the problem. A LOT of medical professional are undereducated about PCOS. I would look into visiting a different doctor for a PCOS consultation, either an endocrinologist or a gynecologist.
When I was diagnosed, our family physician didn't even want to touch it. I was having irregular cycles and she simply said, "go see a gynecologist."
Okay, fine. He told me it wasn't anything to worry about until I wanted to have kids (a common response, really, I've heard it from a couple of doctors) and put me on BC.
When I went to college and had no medical insurance I could only see the campus gynecologist who fancied herself an expert on PCOS (and maybe she was). Her treatment response was only having a menstrual cycle every 3 months with the use of BC. It wrecked havoc on my system, and she wouldn't listen to me when I tried to talk to her about it, so I stopped going and stopped taking any kind of medication for it. I gained 100# while in college and my hirsutism got very bad (which is so incredibly annoying, am I right?).
My new health insurance kicked in in September; I went to the gynecologist for an initial exam in November with a consultation in December. This doctor was much more understanding, and thorough in his way of explaining PCOS. He wants to work WITH me (and check in every 3-4 months) to see how I am doing towards our goal of me losing 100# over the course of the year.
He prescribed BC and Metformin to help regulate the metabolic and hormonal issues with PCOS. I should also say with this, almost all my labs were 100% normal, with a slightly elevated androgen count (testosterone hormone). Meaning, I have a very "mild" case of PCOS (since the symptoms and severity vary from person to person.)
His recommendation: absolutely NO sugar, ever. Low carb, under 1500 calories a day, with 5 days of exercise a week, minimum.
That being said, PCOS is more of endocrinology disorder, so a lot of women will work with an endocrinologist to treat it. But they aren't always reliable, either. I had a friend who's first doctor simply said, "you're fat." The second one (her current one) put her on metformin and told her to lose weight, with no other advice/help.
The MOST important part of treating PCOS is finding a doctor who will listen to you and work WITH you to manage it. It can take a while, be annoying, and hard, but it is the most effective way to get it under control medically. (Other than healthy diet, exercise, and weight loss, of course, but even that isn't a guarantee for every woman with PCOS.)
From what I've seen of the reports on here and my own experience, I'd say even a gyno is pretty hit or miss and depending on where you live (and especially if you don't want to get pregnant), it might be better to just skip right to the endo. Getting a doctor in general that understands PCOS beyond "here's Metformin and the pill, now go lose some weight," is sketchy, but the endo seems to be the most reliable.
I'd also make sure to note to get a copy of your bloodwork results. The analyzing lab may say you're within normal range, but being just inside that cutoff should raise red flags with a doctor that knows what they're doing. You may not be out of range at the moment your blood was drawn, but if you're teetering on the edge of the cutoff, then you would very likely benefit from treating whatever's almost out of range.
I second the importance of finding a doctor that will work with you, and would say to try to find that for all of your doctors. You're the one that has to spend every waking moment with your body. You may not have a PhD after your name, but you're going to know if something's going on with your body far better than anyone else on this planet.
This listing might help you in that search. The doctors listed there have to go through a program and demonstrate that they uphold the ideals of that group -- including working with the patients and encouraging patients to be an active participant in their healthcare. Some of the doctors won't accept insurance, but if you can afford it (FSA/HSA accounts can be used to cover costs and you can file the claim with your health insurance yourself), it's very, very much worth it, because then you'll get a doctor that will work with you for more than 10 minutes.0 -
I also have IR and my sugar levels are always normal. I still take metformin however, though they are giving it to me to see if it will help with the weight loss.
You all have so much information. I am glad to be reading this. I never would have heard of the supplements... Question about them though.. do you take them together or separate.0 -
I go to a reproductive endocrinologist (ie, fertility specialist) for my PCOS and help TTC. She prescribed 1500mg of Metformin for me in October. I went through the steps of ramping up to that dosage over 3 weeks, and also went through one cycle of letrozole at two different dosages to stimulate follicle growth. That cycle ended up a bust, and my last cycle timed out so that we couldn't do the letrozole (holiday shutdown of the fertility offices and morning monitoring clinic) so tomorrow I have another appointment with the RE to discuss more aggresive options to help with TTC.
So, my long answer to your question is yes, find a doctor who's invested in helping you. My suggestion would be to research doctors in the fertility department of a large teaching hospital, if you have one near you. They should have a doctor who's interested in and researching PCOS, and they will have the most current info to help give you options.
Best of luck to you!
Steffanie
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My reg Ob put me on Clomid. It took 4 cycles, but now I have beautiful, 8 month old b/g twins!! Good luck!0
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Dragonwolf wrote: »thetragicjoy wrote: »serenity56 wrote: »So, I have a couple questions about metformin, too...
I went to my dr. with a handful of concerns (constant fatigue/low energy, trouble losing weight, adult acne, hirsutism, severe periods). He ordered some bloodwork - a comprehensive metabolic panel, he tested testosterone and thyroid because I showed high T in the past and I have a family history of thyroid issues (my mom ordered a bunch of tests for everyone in the family when my dad was diagnosed with thyroid cancer but we never did anything with the results for whatever reason ).
He said he thought we'd end up treating me for SOME sort of thyroid problem but wasn't sure what. His 'plan of action' was to treat for whatever thyroid issue might be present and if that didn't fix things then assume I had PCOS as well and treat for that.
He said my tests came back all normal, he didn't think thyroid was an issue after all (TSH was 3.47, lab says 'normal' is between 0.40-4.50). He said that while my testosterone was normal, maybe more of it was actually available than should be - something about not enough of it being bound up to proteins or something? I don't know how that's related to PCOS though, I'm pretty lost. Anyway, given that he's not concerned about my thyroid he wanted to treat for PCOS. He told me that PCOS isn't really something you can test for, it's just a collection of symptoms you can work to treat. He wanted to either put me on birth control or metformin, saying that either one I chose had a low risk of side effects. I prefer to not go on hormonal BC so I said I'd try metformin after he assured me that it really didn't matter which I took and that worst case scenario I might get slightly queasy/looser stools, but probably not even that because he gave me a slow-release version. I'm supposed to follow up in 3 months.
So I'm on day 2 of metformin and I seem to be handling it ok, no upset stomach etc. I am just confused. He sounded pretty self-assured when I left the office but thinking about it after I feel like I don't quite get why metformin is a good choice for me in this instance. I'm also not sure if I trust this dude, he kept assuring me that PCOS is pretty common and no big deal. Maybe it's common but I've come across plenty of women dealing with it who definitely don't think it's no big deal. He said a couple times that simply not doing anything would be fine, I'm not harming my body by not doing anything.... but I feel like not being able to lose weight that I need to lose - a BMI teetering between 28-30 doesn't seem like something my dr should be like 'no big deal' about - and while painful periods and hirsutism aren't dangerous or whatever, they're not normal and I feel they effect my quality of life, so I don't get why he's so nonchalant about this.
I am pretty lost right now. I don't know if he's just telling me that maybe it's PCOS and giving me a relatively harmless prescriptions just so he can say he tried and be rid of me for three months, or if this is a valid course of action given the information we have. Any thoughts?
Edit: I keep seeing people with PCOS say that they're doing better keeping carbs low, cutting out bread/pasta/etc. My dr. didn't give me any guidance as to what I should be doing diet-wise if his suggestion of PCOS is accurate, I'm trying to get 'back on the wagon' diet-wise and I'm just wondering if in addition to eating cleaner, adding activity, and counting calories, I should try to lower carb intake as well?
Sorry to ramble, I'm frustrated and uninformed. Thanks for reading/any help you can give!
Hi hun,
Based on what you said, it sounds to me as if you are taking to your regular physician? If so, this is likely part of the problem. A LOT of medical professional are undereducated about PCOS. I would look into visiting a different doctor for a PCOS consultation, either an endocrinologist or a gynecologist.
When I was diagnosed, our family physician didn't even want to touch it. I was having irregular cycles and she simply said, "go see a gynecologist."
Okay, fine. He told me it wasn't anything to worry about until I wanted to have kids (a common response, really, I've heard it from a couple of doctors) and put me on BC.
When I went to college and had no medical insurance I could only see the campus gynecologist who fancied herself an expert on PCOS (and maybe she was). Her treatment response was only having a menstrual cycle every 3 months with the use of BC. It wrecked havoc on my system, and she wouldn't listen to me when I tried to talk to her about it, so I stopped going and stopped taking any kind of medication for it. I gained 100# while in college and my hirsutism got very bad (which is so incredibly annoying, am I right?).
My new health insurance kicked in in September; I went to the gynecologist for an initial exam in November with a consultation in December. This doctor was much more understanding, and thorough in his way of explaining PCOS. He wants to work WITH me (and check in every 3-4 months) to see how I am doing towards our goal of me losing 100# over the course of the year.
He prescribed BC and Metformin to help regulate the metabolic and hormonal issues with PCOS. I should also say with this, almost all my labs were 100% normal, with a slightly elevated androgen count (testosterone hormone). Meaning, I have a very "mild" case of PCOS (since the symptoms and severity vary from person to person.)
His recommendation: absolutely NO sugar, ever. Low carb, under 1500 calories a day, with 5 days of exercise a week, minimum.
That being said, PCOS is more of endocrinology disorder, so a lot of women will work with an endocrinologist to treat it. But they aren't always reliable, either. I had a friend who's first doctor simply said, "you're fat." The second one (her current one) put her on metformin and told her to lose weight, with no other advice/help.
The MOST important part of treating PCOS is finding a doctor who will listen to you and work WITH you to manage it. It can take a while, be annoying, and hard, but it is the most effective way to get it under control medically. (Other than healthy diet, exercise, and weight loss, of course, but even that isn't a guarantee for every woman with PCOS.)
From what I've seen of the reports on here and my own experience, I'd say even a gyno is pretty hit or miss and depending on where you live (and especially if you don't want to get pregnant), it might be better to just skip right to the endo. Getting a doctor in general that understands PCOS beyond "here's Metformin and the pill, now go lose some weight," is sketchy, but the endo seems to be the most reliable.
I'd also make sure to note to get a copy of your bloodwork results. The analyzing lab may say you're within normal range, but being just inside that cutoff should raise red flags with a doctor that knows what they're doing. You may not be out of range at the moment your blood was drawn, but if you're teetering on the edge of the cutoff, then you would very likely benefit from treating whatever's almost out of range.
I second the importance of finding a doctor that will work with you, and would say to try to find that for all of your doctors. You're the one that has to spend every waking moment with your body. You may not have a PhD after your name, but you're going to know if something's going on with your body far better than anyone else on this planet.
This listing might help you in that search. The doctors listed there have to go through a program and demonstrate that they uphold the ideals of that group -- including working with the patients and encouraging patients to be an active participant in their healthcare. Some of the doctors won't accept insurance, but if you can afford it (FSA/HSA accounts can be used to cover costs and you can file the claim with your health insurance yourself), it's very, very much worth it, because then you'll get a doctor that will work with you for more than 10 minutes.
This is a very good point on blood work. I did get a copy, didn't really assess how close I was on some of these factors. I will review again. 0 -
fancycakemaker wrote: »I am in a similar situation. My doc told me to take 1000mg metformin in the evening and cut carbs. I can eat brown rice and fruits so the diet is doable for me. My husband and I are hoping to conceive asap and my gyno said the low carb/metformin combo works wonders with some women.
Your Doctor is completley right, but you REALLY have to make sure you are low carbing it. Im talking less than 100 GRAMS OF CARBS A DAY, AND i WOULDNT EVEN EAT BROWN RICE IF I WERE YOU, i WOULD SUBSTITUE WITH qUINOA OR bEANS INSTEAD.
sorry about the caps lock craziness, just noticed and im too lazy to rewrite everything. Anyhow, I Tried EVERYTHING to Conceive my first baby, metformin, Clomid, Vitex, EPR, Femera, buut ultimitly none of that worked, only thing that helped be conceive my now 1 year old was specifically dedicating myself to a "low amylose diet", I was strictly following this diet for 3 months only when I finally naturally became pregnant, after 6 years of trying other stuff
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I will definitely look into seeing an endocrinologist, and maybe bite the bullet and get a new regular physician, too... he's got a bit of a track record with me when it comes to being dismissive/minimizing issues I bring up, etc. I was ranting to my bf today about him, I completely agree about the dr.'s statement that hormonal bc has minimal side effects... either he's completely clueless and therefor not really qualified to talk about this at all, haha... or he's flat-out lying to me. Either case is reason enough for me to move on.
So, on MFP... if I'm trying low carb/high fat, what should my little fat/carb/protein pie chart look like? And what amount of carbs counts as "low carb"?
Thanks for all the replies!
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Reading this it sounds like
10% carb (30g)
20% protein (60g)
70% fat (70g) is what he is recommending to start, but that you can add in some more carbs down the road if it you do it smartly. Do those sound like acceptable goals?
http://www.ion.ac.uk/information/onarchives/lowcarbeating0 -
Hey everyone, looks like there is some good discussion on here. I myself have PCOS and also work in medicine (I'm a physician assistant). I actually did my masters thesis regarding metformin and myo-inositol as it relates to pregnancy and live birth rates. I have done alot of self-education, and I think that's what it takes to get the best health care for any condition. Let me know if anyone has questions, I'd be happy to talk personally as well. Good luck all!0
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My endocrinologist put me on 25% carbs, 35-55% fat, balance in protein. Adjusting fat to losing, but he wasn't putting me on super low carbs to affect fertility. I am out of the portion of the game. I have not had success sticking to that carb requirement due to financial reasons, but I know when I first started metformin and stuck to lower carbs, I did start losing weight... that low carb stuff there seems extreme to me, but I have not experienced personally successes as the above folk have. I seem to recall that most have found the best success staying below 50 net grams carbs per day, however that works out for your calories...0
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serenity56 wrote: »Reading this it sounds like
10% carb (30g)
20% protein (60g)
70% fat (70g) is what he is recommending to start, but that you can add in some more carbs down the road if it you do it smartly. Do those sound like acceptable goals?
http://www.ion.ac.uk/information/onarchives/lowcarbeating
That looks about the right ratios for what's known as ketosis, which is what the body does when it burns fat as the primary fuel. It may seem extreme at first, but it's actually quite doable.
However, your total calories are extremely low. By my calculations, that comes out to 990g. Unless you're on the short end of 4 feet, you should be eating quite a bit more than that, especially on a low carb, high fat diet.
Recalculate your numbers to bring calories back to something sane. You can keep the carb gram goal where it is (30g). Keep the protein percent goal where it is (20%, which may increase the gram amount). Then fill in the rest with fat. This will very likely push 100g and may even exceed it. That may look scary, but it's perfectly fine.
From there? Eat all the stuff that conventional wisdom says is bad. I'm not joking.
Butter, whole eggs, bacon, red meat, fatty cuts (and the fat on them!), chicken skin, cream, lard, tallow. The more conventional wisdom cringes at it, the better, basically. Yes, that means including the oft-vilified saturated fat and cholesterol. No, it won't clog your arteries.
The only fat that's bad is artificial trans fat. That is, hydrogenated oils, margarine, industrial seed oils, etc.
Get your fats from whole food and minimally processed sources. If you use oils, choose non-GMO and cold or expeller pressed. Favor unrefined versions for the most part, for their health benefits (as many antioxidants and whatnot are lost in the refining process), but don't fret if you can only afford refined (or really, really don't like the taste of the unrefined version). Favor fats with high saturated or monounsaturated content (avocado, olive, coconut, butter, lard, etc) for cooking, and save the polyunsaturated fats (walnut, sunflower, flax, other nut and seed oils) for cold uses, such as salads, because polyunsaturated fats are very heat-sensitive and oxidize easily (which damage the fats and make them bad for you).
Additionally, eat non-starchy vegetables. Leafy greens, broccoli, asparagus, etc. If it grows above ground, it's basically fair game, but be mindful of the fact that some still have more carbs than others. Be careful with root vegetables, such as carrots and parsnips, as they tend to be higher carb, but if you can fit them in, have a some. Minimize intake of starchy vegetables, as that will rack up your carb count real quick, fast, and in a hurry.
If you want fruits, stick to stone fruits (peaches, nectarines, etc) and berries (strawberries, blueberries, avocados, etc) for the most part. Treat fruits in general as dessert. Don't worry, you're not missing out on nutrients, especially if you're including green veggies and a variety of meats and meat cuts.
I think that's a sufficient primer. I also recommend checking out the Low Carber Daily group, which has a ton of resources and a great group of people that can help with the ins and outs of low carbing.0 -
After reading these posts yesterday and speaking to another member more I decided to try inositol myself. I took about 4g this morning and I am shock of how better I feel today then I have been. I've been through the ringer with infertility treatments and I don't even want to think about starting that again. I just want to not feel like crap and have my body fight me. I'm going to stay on it and give see if helps. I'm definitely sticking to clean eating (8 day streak now!!) and drinking 2 liters of water a day. The eating habits haven't been as tough (with the exception of the weekend). I add protein to my cooking and flax seed as well. There are a lot of great clean eating tips and recipes on pinterest.0
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I don't have much to say on the fertility side of things, but I do know that I despise Metformin and the way it messes up my stomach. I've never had stomach cramps like this before. Does anyone have any tips to help with the cramps and diarrhea?0
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How long have you been taking Metformin? When I was on it I also had cramping and diarrhea. It took a while for my body to get used to it then I was fine. Unless I forgot to take it or script ran out before I could get to pharmacy which felt like my body starting over with getting used to it again.0
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It took me a few weeks to balance out on the Metformin. For me, I had to add some carbs to balance it out. My body tolerates grains better than fruits. Fruits make that reaction worse for me unless it is berries. So I suggest you find out which type works better for you and bumping a little when your reaction strikes. Others on here also made me aware that dairy and a few other things trigger the reaction a little more. It is all about balance. For me, NOT EATING will make the reaction very strong...0
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I agree! Not eating when taking Metformin made it so much worse. I was on a pretty high dosage too. My first RE told me to take it all in the morning which made me feel like crap for the rest of the day. Then she told me to take it at night before going to bed which caused me to be very nauseous throughout the night and mornings were very rough. When I switched REs he told me to take one pill per meal which after my body got used to it I felt better. I always carried crackers or snack bar in my purse cause it would help with the nausea.0
This discussion has been closed.