Barb's Daily Dose

PCOS & Weight Control

A while back I started a series on PCOS. You can read parts 1,  2 &  3 and the post on treatment if you'd like. Today we'll talk about weight control, which is a challenge for many women with PCOS.

Quick Review

Most women with PCOS also have difficulty losing weight and keeping weight off, which is not their fault and completely unfair. Because of the imbalance of hormones, they also have an underlying Insulin Resistance, in simplified terms means that they are more likely to gain weight.

How this happens:

• Eating starches and carbohydrates makes blood sugar.
• Insulin helps transport blood sugar into muscle, fat and liver cells.
• With Insulin Resistance, there are lots of roadblocks to this transport.
• This leads to higher blood sugar levels.
• It also causes more fat to develop, especially around the waist area.
• This can lead to Type 2 Diabetes.

Nutrition recommendations

It's a good idea to ask your provider to check your fasting glucose level and cholesterol & triglycerides in a Lipid panel. If you can see a nutritionist, that's even better.

Most women with PCOS will be able to lose and maintain their weight if they restrict their carbohydrates with a diet much like South Beach. Some start from the beginning if they want to lose weight, others use the 2nd phase or maintenance plans to control their weight. 

My patients have found that limiting carbohydrates not only helps with their weight loss, but also improves their triglyceride & cholesterol levels.

Dipstick for Bladder Infections

Most women will have at least 1 bladder infection some time during their lifetime. They can occur from the teen years to well past menopause. With the uncomplicated bladder infection or urinary tract infection, the symptoms might be:

• Feeling that you have to get to the bathroom every 10 minutes
• Only having a tiny amount of urine 
• Intense burning
• Pain in the lower abdomen

The Dipstick

When a women with symptoms sees their health care provider, they'll ask for a urine specimen. 

PCOS treatment

A while back I started a series on PCOS. You can read part 1, part 2 & part 3 if you'd like. Today we'll talk about treatment.

Quick Review

Remember with PCOS, in general: 

• A woman doesn't ovulate regularly
• Her periods are irregular or absent
• She's more likely to have acne & unwanted hair growth
• It's more difficult for her to lose weight
• She may have more challenges becoming pregnant
• She has a higher risk of abnormal uterine bleeding and endometrial cancer

Treatments

Are aimed at restoring the balance of hormones in her body (estrogen and progesterone) and decreasing the unwanted side effects of acne and hair growth. It's also essential to prevent abnormal 

Ovarian Cancer & Talcum Powder

A recent report confirmed findings that the use of Talc around the genitals increases the risk of Ovarian Cancer. This is not a new finding, in fact, I remember reading about this over 10 years ago, and counseling patients to avoid talc and talcum powder in the genitals. 

There was a 30% increased likelihood in women who used talc at least once a week or more. There wasn't a problem for women who used talc in other areas or for women who used cornstarch.  It's not known if this is because the talc gets absorbed into the lymph system, or if it's the contaminants such as asbestos and quartz that lead to ovarian cancer in some women. 

One thing is clear, don't use talc or talcum powder around your private girl parts.  For more on Ovarian Cancer see previous posts.

Also here's a great website on Ovarian Cancer

The Pill & Sex Drive

Great Birth Control from Zero interest in Sex

I saw a patient this week who loves her birth control method. Hardly any cramping, light periods, reassurance that she's protected, which are all beneficial. There was one thing that wasn't working and that was her libido. She was wondering if her method of preventing pregnancy was preventing her from having any interest in sex. Could it be? she wondered.

Though this is a normal side effect for some women, thankfully it's less than 10% of those who use the pill or the NuvaRing. Often switching pills will help.

How it Happens
The pill or the ring prevent pregnancy by suppressing the ovary from making Estrogen and Progesterone, which causes ovulation. It can also have the unwanted side effect of decreasing a woman's sex drive. Many of my patients don't notice this for a few months, as they attribute the change to stress, lack of sleep or other interferences.

What to do?
Talk to your Nurse Practitioner, Midwife, PA, or Doctor about:

• Switching pills to a different formulation
• Switching from the pill to NuvaRing or vice-versa
• The IUD, like Mirena is a great option because it is safe and effective

Other side effects
Most women tolerate birth control pills and NuvaRing. Some have minor side effects that improve after 2-3 months of use.

If you're experiencing an unwanted side effect, be sure to call your provider, it's better to switch than to stop and risk an accidental pregnancy.

No Periods?

Yes, that's right, women who are on birth control do not need to have a period every month.

How is this possible, you wonder? Well, as long as there is balance in hormones, then there is no risk of problems. I'll explain a little further.

The menstrual cycle

There are 2 main hormones involved, Estrogen and Progesterone. Estrogen is the hormone that is responsible for many things including building up the lining of the uterus also known as the endometrium. Progesterone is the hormone that causes the endometrium to be thicker and more glandular to help support a fertilized egg.

Every month a woman's ovaries produce levels of Estrogen & Progesterone in a delicate balance that results in ovulation, the release of an egg. The Period happens when the Estrogen and Progesterone levels decrease. If the hormone levels remained higher, and there was no decrease, there would be no period.

The hormone balance
The birth control not only prevents ovulation, it also provides a different balance of Estrogen and Progesterone, which also decreases acne. With this different balance in hormones, the lining of the uterus also doesn't grow as much as it would, so for most women, there is less blood. That's why many women have shorter lighter periods, and much less cramping. What we've found is that by giving the hormones without a break, there is NO decrease in their levels and so no periods.

If you're interested in a more thorough explanation of the menstrual cycle, see my 3 part series on PCOS.

PCOS Part 3

A few weeks ago I posted Part 1 of PCOS.

Last week I posted the 2nd part of our series on PCOS.

Today, we'll talk about how PCOS manifests in women's lives and what they should watch out for.

Quick Review

Women with PCOS often do not ovulate and they have an imbalance in their hormones. Many will have long intervals between periods and some may only have 1 period a year. When this happens, these women are at risk too much estrogen stimulation on the lining of the uterus, without the balance of progesterone.

Heavy Bleeding
With PCOS, because of the imbalance of estrogen and progesterone, the lining of the uterus, known as the (endometrium) may grow too much and a woman may experience heavy and prolonged bleeding. There are many terms for this, and what's important to know is when to be concerned. Check in with your health care provider if:
• You have been bleeding for more than 10 days in a row
• You are soaking through a pad and/or a tampon in less than 1 hour for more than 3-4 hours
• Your periods come more often than every 21 days.

Abnormal bleeding
With PCOS, women are more at risk to have abnormally heavy bleeding that may be a sign of abnormal, pre-cancerous or cancerous cells within the endometrium.

PCOS part 2

This is part 2 in our series on PCOS. Here's a link for Part 1.

Most women with PCOS see a health care provider for a few common reasons. Either they aren't having periods, their periods come infrequently, or they have heavy bleeding.

This is what PCOS looks like with an ultrasound

Poly = Many

Notice that there are many small black areas within the ovary.
Each of these black appearing areas are cysts that are filled with fluid.
It's not unusual to see 10 - 12 cysts on each side.
Each month more cysts begin as others regress.
Most women do not feel these cysts.
These cysts are usually small and rarely burst causing pain.

Is there a cause for PCOS?

Can it be prevented?

Can PCOS ever go away on it's own?

Review
In order to understand what happens with PCOS, let's briefly review what happens in a typical menstrual cycle.

• When a woman starts her period, the ovary is also active. Several follicles, which are where the eggs develop begin to grow under the influence of FSH (follicle stimulating hormone).
• These follicles produce the hormone Estrogen.
• One of the follicles really grows fast, producing the most Estrogen and it becomes known as the dominant follicle, which will ultimately be the one that releases the egg.
• This high level of Estrogen triggers the release of LH (luteinizing hormone).
• About midway through the cycle, there is a surge in LH which causes the egg to be released about 24-36 hours later.

PCOS

Poly Cystic Ovarian Syndrome

This is the first part in a multi-part series on PCOS. I care for many women with PCOS and they've told me that there isn't a lot of information that's easily understood available.

What women with PCOS may notice:

• Too much hair in places you don't want it, like the upper lip, chin, around the breasts and tummy

• Difficulty losing weight

• No periods, irregular periods or 1 -2 each year

• Acne

• Darkened skin around the neck and/or armpits

• Inability to become pregnant

What your provider may notice

• Elevated levels of LH (Luteinizing hormone)

• Lowered FSH (Follicle Stimulating hormone)

• On an ultrasound, 10 or more cysts on one or both ovaries. This is how PCOS got it's name. Poly means many. When there are many cysts, there are Poly Cysts.

Ovarian Cancer Test?

The NY Times recently reported on a new blood test for Ovarian Cancer, OvaSure. What at first seemed promising, may not be, after all, because the testing was done on women who already have Ovarian Cancer, not on women who are being screened for the early signs.

CA – 125

The test measures 6 different proteins in the blood, including CA-125. You’ve probably read a lot about this blood test. It’s really great for women who have already been diagnosed with Ovarian Cancer, been treated, and are in remission. The CA- 125 works by alerting us that the cancer is still in remission or may be returning.