Ask The Expert

This month's topicsInsulin Sensitizing Agents (ISA)TreatmentsPCOS and Fertility

Insulin Sensitizers

Q. I was wondering the effect on ISA'S just to control the symptoms of PCOS. I am 45 years old ,in good health and not overweight (which I work very hard at). I had a tubal ligation 17 years ago so fertility is not an issue, but I'm still plagued by many of the symptoms. thank you.

A. In general, ISAs have not been studied for long term use. The only studies in women with PCOS have related to helping those women ovulate (i.e. short term use). As such, I can't really endorse the long-term use of ISAs at the current time. However, a screen for diabetes or glucose intolerance would probably be wise for you. ISAs are approved for use by type II diabetics.

Treatments

Q. I have been told that there are no treatments for PCOS. Is this because these  drug treatments have only been approved in the States or can they be  used in Canada? Do you know of any Doctors in the Toronto Ontario area  who treat this disease?

A. Thank you for your inquiry. While there are no "cures" for PCOS, there are different treatment options available, depending on the specific problems that you have. While I don't have specific names of physicians, there are likely to be ob/gyns or reproductive endocrinologists in the Toronto area who are knowledgeable about PCOS.

Q. I am a 38 yr old with PCOS/Insulin Resistance. My hair loss is worsening, and now, it won't even grow.. same chin length for months now. Hirsutism on breast area worsening. Testosterone...69, serum; estrogen quotient (.18 LOW!), estriol and estrone needs to be raised some how according to my doctor who is an MD and Naturopath. He gave me the 24 urine fractionated estrogen test. I went to him because after six years of know help from a regular doctor, I developed very serious consequences that I will not get into.

According to different tests that were done at the doctor's, I am now on Pancreatic enzyme after meals (could not digest meat), I am taking 450mg Licorice root extract to help adrenals hang on to cortisone, and 4,000IU Cod liver oil capsules daily prevent the heavy bleeding. He also feels I should go and see another specialist since I was diagnosed from his Insulin Tolerance test with Hyperinsulinemia.

To make this short for you. I first noticed an Insulin problem after taking a Kenalog shot for allergies (I had generalized edema...and weight gain that wouldn't come off in my mid section; I had always been thin). The following year I was exposed to high levels of Benzene, etc. from illegal dumping of dirt piles within a couple yards of where I worked in an office. I bled under the skin, the dumps was eventually removed...after three months of exposure and my refusal to come to work after the bleeding. Apparently these last two situations did some damage to possibly the liver and/or pancreatic pathways that regulate hormone.

So, I thought maybe Propecia for hair loss an option (however, if Italian studies show it INCREASES tesosterone by 40%) is this going to make my baldness worse? And I read that PCOS patients make NO progesterone...is this rue, and should I take some natural progesterone cream, bearing in mind that if I use too much it may go the pathway of estradiol or some other androgen and cause worsening of hair loss and hirsutism. I've got my weight down to normal again by avoiding all sugar, breads, pastas and other high carbs, etc. But the hair loss is really producing balding on crown....any ideas on what to do or who I should see that would understand this syndrome (PCOS/IR) in the Seattle area?

A. I believe there are specialists at the University of Washington Medical Center who deal with insulin resistance and weight management. You may wish to try there. It would be very difficult for me to make specific comments about your case via e-mail.

PCOS and Fertility

Q. I am writing you to ask you a few questions about the disease PCOS. I have always had a problem with my hormones, also I have always had a problem with hair growth on my face, and arms, and back above my pants line. I have been married for 3 years, and for some reason I have not got pregnant yet. I have just recently heard about the disease I really do not know much about it, so I am wondering do you think I may have this disease.

I also need to know who should I see about this problem? Someone had told me to see a endocrinologists, so should I see them or my gyn? Please let me know more. Also what kind of tests are done to show if I have this disease?

A. It is difficult to address all of your questions about PCOS via e-mail. Irregular cycles, a lack of ovulation, and infertility are common features of PCOS in reproductive age women.

You may wish to address your questions to your gynecologist, or initiate a referral to a reproductive endocrinologist. A lot of information about PCOS can be found on obgyn.net and www.pcosupport.org.

Q. I was wondering if you could shed some light on my PCOS case. I am 35 years of age and have had PCO since my early 20's when coming off bcps. Did a 60 pound weight gain in 4 months (devastating to a newly married woman) and continued to stay at 225 pounds for almost 8 years. After doing a short stint on Atkins Diet, I lost 45 pounds and my cycles returned (as long as I stayed on Atkins). Got bored with the Diet, went off it and gained all the weight back in 2 years. Now am back on Atkins, and doing Metformin (1500 mg a day). Periods have been 28 days like clock work for 3 months and then last month came on day 19 with a vengeance. Lots of clotting and very heavy. I am sure I was not pregnant due to no intercourse during that month. I am charting my temps and checking my cervical mucous but not sure if I am ovulating.

Would it be worthwhile to start doing the ovukits again? Any other suggestions? I did clomid and pergonal 4-5 years ago and hyperstimulated on the combination almost killing me. My hubby said no more drugs. He is willing to try clomid again if I can get back to 150 pounds (I am 5'11 inches tall). He thinks this may help normalize my hormones. What do you think?

Any help you could provide would be appreciated.

A. There is little doubt that your fluctuations in weight will likely affect your insulin levels and ovarian function. At age 35, the ovaries also start to feel the effects of age, along with the metabolic/insulin issues. I advise my patients to consider more aggressive treatments when age starts to become a factor.

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