Thin With PCOS: “How can I have PCOS if I’m not overweight?”
by Dr. Sari Cohen
From PCOSA Today, September/October 2007
Are you confused about your diagnosis of PCOS because you are thin? Many people think that everyone with PCOS is overweight, but this is not the case. In fact, at least half of women diagnosed with PCOS are of normal weight or lean. Some women with PCOS are even underweight.
While insulin resistance is generally thought to be the underlying cause of most cases of PCOS, there is disagreement in the medical community about whether thin women with PCOS suffer from the same degree of insulin resistance as their heavier counterparts.
Some studies support the presence of insulin resistance in both lean and obese women with PCOS. Furthermore, lean women with PCOS do seem to struggle with insulin-glucose regulation, even though it is not classified strictly as “insulin resistance.” Thin women with PCOS have higher insulin levels in their blood than thin or normal weight women without PCOS, according to researcher Vrbikova and associates in the 2004 article “Insulin Sensitivity in Women with Polycystic Ovary Syndrome” published in The Journal of Clinical Endocrinology and Metabolism.
Moreover, even if the serum insulin levels are normal, the ovaries of women with PCOS tend to be over-sensitive to the effects of insulin, thereby leading to increased ovarian androgen output.
Oral contraceptives are commonly prescribed to women with PCOS, regardless of whether they are overweight or of normal weight. However, using oral contraceptives in women with “lean PCOS,” as it is termed, may increase the risk of weight gain in this population and put them more at risk for insulin resistance or other negative effects on insulin and glucose metabolism.
Women with lean PCOS have much in common with their heavier counterparts. For example, lean women with PCOS may still have the same risk factors for cardiovascular disease as overweight women, according to a study conducted by Kravariti and colleagues and reported in the September 2005 issue of The Journal of Clinical Endocrinology and Metabolism. They conclude that all women with PCOS, regardless of weight or BMI, should work to prevent cardiovascular complications.
Another article by Tarkun et al published in The Endocrinology Journal in October 2004 suggests that lean women with PCOS were at higher risk of cardiovascular disease and anovulatory infertility compared to age-and weight-matched healthy women without PCOS. Therefore all women with PCOS should work to prevent complications like hypertension and diabetes mellitus. This can be accomplished through a whole foods, low carbohydrate diet, an exercise plan tailored to you, and certain nutritional and herbal supplements.
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About the author
Dr. Sari Cohen received her doctorate in naturopathic medicine with High Honors from the Southwest College of Naturopathic Medicine, and graduated cum laude from Dartmouth College. A clinical practitioner in New Hampshire, where she sponsors a PCOS support group, Dr. Cohen is the author of the prize-winning article “Melatonin, Menstruation and the Moon” published in The Townsend Letter for Doctors and Patients. A contributing author of the Board Review Study Materials for the Naturopathic Physicians Licensing Examination, she is also a member of Insulite Laboratories’ Medical & Advisory team where she undertakes research and provides professional guidance to individuals with insulin-related disorders. Dr. Cohen has developed the company’s 52-week Customer Protocol and has co-authored The Insulite Guide to Reversing Insulin Resistance and its Related Conditions.
I’m a little confused about the whole PCOS thing. Still struggling with how I got it. I exercise regularly, eat right, and I’m not overweight. I have stopped all alcohol, processed foods, starchy foods, etc.
Obviously, my ovaries are still producing too many male harmones,because I continue to have facial hair and scalp hair loss.
Dear Kimberly,
Thank you for contacting the PCOS Support Blog.
I understand your confusion. You are not alone. The topics of lean women with PCOS, and PCOS without insulin resistance are still not entirely understood in the medical community. Many thin women with PCOS do have insulin resistance, but some do not. It is not a clear-cut distinction that thin women are not Insulin resistant. Some lean women with PCOS hyper-secrete insulin but do not yet manifest insulin resistance. And in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
Here is a link to study that was done with lean women who have a history of PCOS:
http://www.insidepcos.com:80/articles/612/1/Lean-Women-with-Polycystic-Ovary-Syndrome-Respond-to-Insulin-Reduction.html.
If you have a family history of obesity, diabetes, and heart disease, if you have cravings for carbohydrates or sweets, if you have skin tags or acanthosis nigricans (dark patches on the skin, especially in the armpits) I would be more inclined to think there is a component of insulin resistance in your case.
It’s great that you have worked so hard to eat a healthy diet and to exercise. It’s possible that with the Insulite PCOS System you would see improvements in the excess facial hair and scalp hair loss. We have seen many women with lean PCOS improve using the system. These particular symptoms can take longer to see improvements than others. The excess/unwanted hair that currently exists may have to be removed via laser, electrolysis, etc. However, as your insulin resistance reverses and your hormones balance, the new hair growth should become finer, less visible. Honestly, we are all different and your body may respond more quickly but this can often be one of the last symptoms to resolve.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
I was just diagnosed with PCOS. I am 5″7, 120 lbs. I eat pretty healthy and exercise vigorously 5-6 times a week. I have always suffered from depression/mood swings, but do not have any of the other symptoms of PCOS. My husband and I have been unable to conceive, which is why PCOS was even discovered. I am so confused by this syndrome. Will I gain weight from this over time? Can the other symptoms show up at some point? Also, how did I get this? There is no history of it in my amily.
Thanks for your input!
Cammie
Dear Cammie,
Thank you for contacting the Insulite PCOS Support Blog. I am so glad you found our website.
It sounds like you may have lean PCOS. The topics of lean women with PCOS, and PCOS without insulin resistance are still not entirely understood in the medical community.
Many thin women with PCOS do have insulin resistance, but some do not. It is not a clear-cut distinction that thin women are not insulin resistant. Some lean women with PCOS hyper-secrete insulin but do not yet manifest insulin resistance. And in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
Here is a link to study that was done with lean women who have a history of PCOS:
http://www.insidepcos.com:80/articles/612/1/Lean-Women-with-Polycystic-Ovary-Syndrome-Respond-to-Insulin-Reduction.html.
If you have a family history of obesity, diabetes, and heart disease, if you have cravings for carbohydrates or sweets, if you have skin tags or acanthosis nigricans (dark patches on the skin, especially in the armpits) I would be more inclined to think there is a component of insulin resistance in your case.
Women with PCOS may be able to improve their fertility by improving the insulin resistance that underlies PCOS.
The Insulite PCOS System, which you may have read about on our website, http://www.pcos.insulitelabs.com, is designed to help heal PCOS by addressing its underlying cause, which in most cases is insulin resistance.
With insulin resistance, the body becomes insensitive to the insulin it produces, which leads to elevated circulating levels of insulin. This in turn leads to hormonal imbalances such as increased testosterone and other androgens (masculinizing hormones).
Elevated insulin also contributes to the formation of cysts in the ovaries in part due to the hormonal imbalances and also because the ovaries are highly sensitive to the influence of insulin.
All of these factors combine to complicate a woman’s chances of conceiving if she has PCOS.
The Insulite PCOS System helps to improve insulin sensitivity with its combination of nutrients and herbs as well as diet and exercise guidelines. The supplements are also designed to correct the hormone imbalance of PCOS.
Our system is designed to balance the testosterone, insulin and other reproductive hormones that impact ovulation.
While we cannot promise that you will conceive on our program, we know that theoretically reducing insulin and testosterone will increase your chances of conceiving. Your mood swings may improve, as many women with PCOS suffer from anxiety and depression due to the hormonal imbalances, and they noticed improved outlooks and increased energy while on the system.
It is safe to continue trying to get pregnant while you are using the System. We do recommend, however, that, if you become pregnant while using the PCOS System, you discontinue using the supplements during your pregnancy and then resume them after you finish breastfeeding. The reason is that while we know that the Insulite PCOS System is safe and non-toxic in general, these supplements have not been tested in any clinical trials specifically on pregnant women or infants.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
I have not been diagnosed with PCOS, but I have thought I have it for about 6 months. I talked to my doctor about it and she said that even with the symptoms that I do have (hair growing in darker and in more random places, ovarian cysts, terrible acne), that I’m still not a “picture candidate” for it because I’m not overweight…so she doesn’t think I have it. My symptoms are staying the same, and the hair growth is only getting worse. Should I get a second opinion, or have her run the tests just in case? Is it possible that I could have it with just those symptoms? (I have an IUD, so I don’t have any periods to know if they’re irregular)
—————
Dear Danielle,
Thank you for writing into the PCOS Support Blog. This is a great inquiry as I think there are a lot of doctors that are not aware at how many different ways PCOS can present in women.
I have to say in my experience with PCOS, I know what the “picture” is supposed to look like but every women with PCOS can present very differently.
The fact that you are not overweight does not rule out PCOS. There is a group of women with PCOS who are lean and this can be as much as 50% of the PCOS population according to some resources.
The symptoms that you do have are important and the reason should be further investigated. Acne, increase in body hair and darkening of hair and ovarian cysts are all symptoms of PCOS. I would recommend getting further testing.
Here is a link that discusses this topic:
http://pcos.insulitelabs.com/PCOS-and-Lean-Women.php
Here are some of the tests that we recommend:
- free testosterone- elevated in PCOS
- DHEA-S- often elevated in PCOS
- Sex Hormone Binding Globulin (SHBG)- usually low in PCOS
- Fasting insulin- elevated in PCOS. Some doctors may hesitate to order this test because the normal range (0-20) is so wide. However, we find that results greater than 9 indicate insulin resistance. Insulin resistance is usually the underlying cause of PCOS, as you may have read about on our site. Some doctors may also order a 2-hour post-prandial insulin test, along with a 2-hour post-prandial glucose test. For the post-prandial insulin, results over 25 or 30 may indicate insulin resistance.
- Fasting glucose or 2-hour post-prandial glucose test- elevated in PCOS. Using this information in combination with the insulin levels helps to diagnose insulin resistance. Also, women with PCOS have a higher risk of diabetes so it is important to screen for this early and often.
- LH: FSH- Some doctors may also look at the ratio between these two hormones. In PCOS, we would expect LH to be elevated in comparison to FSH.
- You could get an ultrasound to check for the presence of ovarian cysts. Even if the ovaries do appear normal, the absence of ovarian cysts does not mean that you don’t have PCOS. Not everyone with PCOS has ovarian cysts.
- I would also check your cholesterol levels and liver function tests, as these can also be abnormal in PCOS (as well as in many other conditions).
I do want to let you know that there is another condition called Cushing’s disease that has many symptoms of PCOS and is sometimes mistaken for PCOS. Cushing’s is not very common, but I still wanted to mention it to you. This would be something to discuss with your doctor to ensure it has been ruled out. In addition, I would recommend that a thyroid panel also be done for further evaluation.
Symptoms that are also associated with PCOS include the following. Some women may have 2 or 3 of these traits while others struggle with all of them. Most experts consider that a woman must have evidence of both lack of ovulation manifested by irregular periods AND signs of excess male hormones to be diagnosed with PCOS. Some experts also require the presence of polycystic ovaries to diagnose PCOS.
1. Weight Gain or Inability to Lose Weight. Other people may not necessarily gain weight but find that no matter how hard they try, they cannot lose any weight. Not every woman with PCOS will have problems with excess weight. In fact, up to half of women with PCOS are lean. Even lean women with PCOS may struggle with high insulin levels or insulin resistance, however.
2. Absent or Irregular Periods (Amenorrhea or Oligomenorrhea). Irregular or absent menses indicate that a woman is probably not ovulating.
3. Infertility. The high levels of excess insulin seen with PCOS can stimulate the ovaries to produce large amounts of the male hormone testosterone, which can possibly prevent the ovaries from releasing an egg each month, thus causing infertility. Because women with PCOS don’t have regular menstrual cycles, many are unable to become pregnant. With help,
however, many PCOS sufferers conceive.
4. Excess Hair Growth (Hirsutism). This symptom causes excess hair, which can be difficult for many women. For most PCOS sufferers, hair in the mustache and beard areas becomes heavier and darker. Masculine hair on the arms and leg is also possible, as well as hair on abdomen, chest or back, together with more growing in the pubic area. High levels of male hormones (androgens) cause this condition.
5. Thinning Hair. Just as heavier hair growth is possible, so is the type of hair thinning that many men experience.
6. Acne and oily skin
7.Ovarian Cysts. The elevation in insulin levels also contributes to the formation of cysts in the ovaries in part due to the hormonal imbalances and also because the ovaries are highly sensitive to the influence of insulin. These multiple, immature ovarian cysts that are the hallmark of PCOS are associated with irregular menstruation and trouble conceiving. Polycystic
ovaries are defined as 12 or more follicles in at least 1 ovary as seen by ultrasound. Note that not every woman with PCOS has polycystic ovaries.
8. Fatigue. Fatigue is a common symptom that may be related to PCOS in that insulin resistance can be one cause of reduced energy levels. Furthermore, many women with PCOS also have low thyroid function (hypothyroidism) which
itself causes fatigue.
9. Other Skin Problems. Skin tags: thick lumps of skin sometimes as large as raisins can form as a result of PCOS. They are usually found in the armpits, at the bra line or neck and can easily be removed by a dermatologist. Darkening and thickening of the skin can also occur around the neck, groin, underarms or skin folds. This condition, called Acanthosis Nigricans, is a
sign of Insulin Resistance, the underlying cause of PCOS. Other women with PCOS note an increase in dandruff.
10. Mood Swings.
11. High cholesterol (Hyperlipidemia) and High Blood Pressure (Hypertension).
12. Sleep Apnea. Women with PCOS have a high risk for sleep apnea. This may be due to the increased BMI (Body Mass Index) in about half of women with PCOS. Another possible reason for the increased prevalence of sleep apnea in people with PCOS is the effects of testosterone on blood vessels.
Again, just because you don’t fit what some think is typical, does not mean that you are not affected by PCOS. I would ask for further testing and if your doctor does not want to do that, then getting a second opinion with evaluation should be sought. Ruling out other reasons will also be helpful. I have seen some women be evaluated to only have the tests all come back normal and without any other medical reason for their symptoms and in those, I have seen quite a few respond well to treatment as if it was PCOS and their doctors would often treat as if this is what they had since nothing else fit.
I do hope that this helps you and that it turns out that this is not what is causing your symptoms but something that can be easily managed. If we can help further, please let us know.
–
Best Wishes,
Dr. Heather DeLuca, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email and the Insulite Labs website is for the sole purpose of being informative. This information is not and should not be used or relied upon as medical advice. Always seek the advice of your physician, nurse or other qualified health care provider before you undergo any treatment, take any medication, supplements or other nutritional support, or for answers to any questions you may have regarding a medical condition.
i am 19 years old and my weight is 46 kgs and i have pcos with an insulin level of 135 which is very high. i have been having diane 35 ( oral contraceptive) and gluconorm (for preventing high insluin) but my family doctor adviced me to stop all medecines since their long term consequences are very serious and that i should just work out and not put on weight. he says since i am not overweight and i am very thin my pcos will be okay with time without any medecine. i am confused.even my parents are satisfied because i feel very weak because of these medecines. please help if i should stop the medecines and just work on my weight and proper diet.
Dear A Arushi,
Thank you for contacting the Insulite PCOS support blog.
We do not recommend oral contraceptives as a treatment for PCOS because they are synthetic hormones that mask some of the symptoms of PCOS rather than fixing the problems. Treating absent menses or other symptoms with oral contraceptives does not treat the underlying disorder of PCOS and when the contraceptives are discontinued, the PCOS symptoms will persist.
Our philosophy is to treat the cause of the disorder so that there is no longer a need for using contraceptives. Of course if you are using birth control to prevent pregnancy, you will need to find an alternate form of contraception (condoms, diaphragm, etc.) if you decide to discontinue the birth control pill.
The supplements of the PCOS System do not do the same thing as the birth control pills, they do something even better! They work to correct the underlying cause of PCOS.
Diet and exercise are also crucial in the treatment of PCOS. I think your doctor has a good point: you’re young, not overweight and these medications do have side effects that could be avoided by first trying to treat the PCOS with diet and exercise. Re-test your insulin levels after trying his diet and exercise plan. If you don’t see improvements consider using the Insulite PCOS System which contains supplements that have been shown to lower insulin and blood sugar levels and reverse insulin resistance. You can read much more about the Insulite PCOS System by visiting the following link and browsing around: http://www.pcos.insulitelabs.com/.
I hope this information answers your questions.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
I’m 5′2 and I weight 105lbs. I was recently diagnosed with pcos. I’m so so confused I don’t have facial hair, I’m not overweight I have regular periods I have had a period EVERY single month since I got them at age 11 (now 21)
The only reason it was discovered is because I have terrible period pains every month often causing me to vomit and nearly pass out.
My GP hasn’t even been helpful, she’s trying to get me to take the contraceptive pill but hasn’t explained to me the ins and outs of it.
All she said was that is would help my acne go away, but I went to see a dermatologist who said that thank God my acne is only on the upper layer of my skin so it won’t scar.
I don’t want to take it just for acne. What are the benefits of taking the pill? And what are the cons?
I get a period every month so I’m so confused, can women with PCOS who get periods every month get pregnant? I want to have children more than anything in this world. Will the pill stop cysts from forming? And do the cysts lessen my chances for cobcieveing? i.e. will not taking the pill lessen my chances of concieving?
What are the other medictions for PCOS? I don’t have any of the main symptoms so what do I do?
I have acne (but it was got a lot better in the last few months ever since I cut out dairy a lot beter) and I have bad period pains.
Please help I’m sos so confused.
Dear Nad
Thanks so much for contacting the PCOS Support Blog. I’m so sorry to hear about your debilitating periods. Having monthly periods and maintaining a healthy weight is a good sign that you will be able to get pregnant. Do you know if you are ovulating or not? Also, have you had a pelvic ultrasound?
The benefits of taking the birth control pill include: regulating the menstrual cycle and decreasing painful periods (especially for women with endometriosis). However, the pill shuts down our bodies’ own natural production of hormones. Also, there is evidence that the birth control pill can possibly increase the risk of heart disease later in life.
Overall, I think it’s best if you could avoid taking the pill long term. I recommend trying acupuncture and herbal medicine prescribed by a licensed Naturopathic Doctor or a licensed acupuncturist.
We do not recommend oral contraceptives as a treatment for PCOS because they are synthetic hormones that mask some of the symptoms of PCOS rather than fixing the problems. Treating absent menses or other symptoms with oral contraceptives does not treat the underlying disorder of PCOS and when the contraceptives are discontinued, the PCOS symptoms will persist.
Our philosophy is to treat the cause of the disorder so that there is no longer a need for using contraceptives. Of course if you are using birth control to prevent pregnancy, you will need to find an alternate form of contraception (condoms, diaphragm, etc.) if you decide to discontinue the birth control pill! The supplements of the Insulite PCOS System do not do the same thing as the birth control pills, they do something even better! They work to correct the underlying cause of PCOS.
If you do indeed have PCOS, it is definitely still possible to get pregnant. I hope to hear back from you again soon.
Best wishes,
Dr. Shana Spector Deneen, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email and the Insulite Labs website is for the sole purpose of being informative. This information is not and should not be used or relied upon as medical advice. Always seek the advice of your physician, nurse or other qualified health care provider before you undergo any treatment, take any medication, supplements or other nutritional support, or for answers to any questions you may have regarding a medical condition
I have been diagnosed with lean PCOS. I am a little confused by the diagnosis. My body has always been normal…my periods did come about every 6 weeks, but they were regular. Never painful or anything weird. I stopped birth control after 5 years last January. I got my period that month, February, and March. Then nothing until they induced it with Provera in September. All of my lab values are normal, except my LH/FSH ratio was more than 2 to 1. They did the pelvic ultrasound and I had 6 follicles (guessing 1 for every month of no period?). I’m not insulin resistant. I did gain weight for TTC and now my doc wants me to gain more. I am 5′10″ and 147 lbs. My doc wants me over 150 (I have never been that heavy in my life) and my body worked when I was around 130 so I question the weight gain. My testosterone was normal, cholesterol normal, thyroid normal. Everything was normal but the LH/FSH ratio. My infertility NP still has me taking Metformin 500 mg daily and advised me to begin exercising 30 minutes daily adn then wait and see. Are there better treatments out there?
Dear Cate,
Thank you for contacting the Insulite PCOS Support Blog.
The topics of lean women with PCOS, and PCOS without insulin resistance are still not entirely understood in the medical community. Many thin women with PCOS do have insulin resistance, but some do not. It is not a clear-cut distinction that thin women are not insulin resistant. Some lean women with PCOS hyper-secrete insulin but do not yet manifest insulin resistance. And in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
Here is a link to study that was done with lean women who have a history of PCOS:
(check this link first as it may not be available) http://www.insidepcos.com:80/articles/612/1/Lean-Women-with-Polycystic-Ovary-Syndrome-Respond-to-Insulin-Reduction.html.
You can use this one instead on lean/ overweight http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2265.1993.tb02144.x
If you have a family history of obesity, diabetes, and heart disease, if you have cravings for carbohydrates or sweets, if you have skin tags or acanthosis nigricans (dark patches on the skin, especially in the armpits) I would be more inclined to think there is a component of insulin resistance in your case.
We have had customers with lean PCOS on the Insulite PCOS System with success. You could certainly try the System. I do want to let you know we offer a 100% satisfaction guarantee. If for some reason, the system does not work for you, Insulite Laboratories offers a 90 day money back guarantee. If you are not completely satisfied with the Insulite System, we will refund your original purchase price for up to 90 days. (Excluding shipping and handling)
You just might want to pay close attention to your blood sugar in the first few weeks on the System, to make sure it does not drop too low. You can monitor blood sugar with a home glucometer (blood glucose meter) and by watching for symptoms of low blood sugar such as: headaches, feeling faint or dizzy, feeling clammy or sweaty, trembling and hunger. These symptoms relieved by eating.
The dietary guidelines on the Insulite PCOS System are flexible enough that you can adjust the caloric intake to meet your needs to sustain your weight. If you would like guidance to help you gain weight, we might be able to help with that too.
The nutrients themselves will not make you lose weight. If you find that you are having difficulty maintaining your weight while using the Insulite PCOS System, please contact us right away so that we can help you with that.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
Hi
I’m 28yrs old (5ft, 90 pounds) who was diagnosed with PCOS 7 yrs back through an ultrasound. I have regular menstrual cycles of 33 days. After some treatment, for 6 months, my next ultrasound revealed no cysts whatsoever. I stopped takin the medication. its 7 yrs now and i’m now 5 weeks pregnant and we had no problem in conception. we tried for jus 2 months. I want to know now if i still have PCOS and what precautions i should take during pregnancy.
Thanks
Dear Naveena,
Thank you for writing in to the PCOS Support blog. Congratulations on your pregnancy! This is great news.
The birth control you used did help with the cysts. The hormones helped establish a more normal period and also helped you ovulate. Controlling the hormone levels can prevent cysts from forming.
But onto your question… I would assume that your Ob is aware of your history of PCOS. This is important since women with PCOS are at a higher risk for miscarriage. Has your doctor measured progesterone levels? This is something that we would recommend and especially if in the past the level was lower.
Progesterone is produced in the second half of the cycle after ovulation. During pregnancy, the placenta produces progesterone and is not functioning in the beginning and only fully functions at week 10 or so. At 3 months some people are on progesterone to compensate for lack of placental progesterone but then can be weaned off safely.
Progesterone supplementation would depend on your levels of progesterone and should only be used and recommended by your doctor after testing determines that this is needed. If you use it, I would recommend making sure it is a natural, bio-identical form of progesterone. Women respond much better to this than the synthetic forms of progesterone.
Also, other hormones can be implicated and again testing can help (testosterone, DHEA-s) to determine this. Women with PCOS are also at higher risk for having gestational diabetes. Eating low glycemic foods that support a healthy glucose level is important to reduce this risk. Make sure that you are eating a healthy diet and not eating too many processed or refined foods. Lots of vegetables, lean protein, healthy fat and be sure that you are taking a high quality prenatal vitamin.
Your doctor will be doing some tests at each visit that will include fasting glucose and blood pressure that will screen for some complications. Also, if anything changes or you are not feeling “right” contact your doctor.
Also, be sure that you are discussing these concerns as well as any other, with your doctor. I hope that this helps. Please keep us posted on how you are doing.
–
Best Wishes,
Dr. Heather DeLuca, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
Hi, I m 16 years old and i was diagnosed with PCOS 4 months back. And the doctor prescribed me 6 months contraceptive pills. Right now 4 months have passed, and I m halfway through the 5th. I recently inquired from her what should be done after this medication is over. She says i should have a good diet and do yoga. As far as i know, this doesn’t seem to be a proper treatment for PCOS. My symptoms are acne and loss of hair only. I m not over weight. I m too young to decide what should be done, yet i m concerned. My mom says she would take me for a check up again. I hear about various things such as insulin problems,infertility,etc which really scares me. And i also found that PCOS don’t really have a cure. I need advice on what should be done.
Dear Rebecca,
Thank you for writing into the PCOS Support blog. I am sorry to hear about your recent diagnosis.
I know it can be very scary to get this diagnosis and even more when you start learning more about the condition and the possible complications. It is true that there are risks that increase with PCOS. Infertility is higher in this population but that does not mean that it will be your experience. There are many women with PCOS who have had successful pregnancies and lead very healthy lives.
We cannot say for sure that PCOS is a curable disease. Conventional medicine asserts that PCOS is incurable. However, we can say that insulin resistance is a reversible condition, and insulin resistance is one of the underlying causes of PCOS. Therefore, by removing this underlying cause of PCOS we would expect your experience of the PCOS to greatly improve.
Birth control pills are commonly used to help restore a normal menstrual cycle and may help with some of the symptoms such as acne and hair loss because some birth control pills can lower testosterone levels. It is often the increase in testosterone that can lead to symptoms such as acne, hair loss. It can also be responsible for irregular periods and excess facial and body hair. But birth control pills do not address the underlying cause, which is often insulin resistance. With a population that is not overweight, it is not as clear cut, regarding the cause.
Many thin women with PCOS do have insulin resistance, but some do not. It is not a clear-cut distinction that thin women are not insulin resistant. Some lean women with PCOS hyper-secrete insulin but do not yet manifest insulin resistance. And in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
Research does support that there is some dysregulation still with insulin and glucose even in thin/normal weight women. However, this population still benefits from controlling insulin levels.
A healthy diet and exercise is going to be very important. But there are many different ideas about what is a healthy diet and what is appropriate for someone with PCOS. Most women benefit from a lower carbohydrate diet with focus on vegetables, lean protein, healthy fats (nuts, seeds, avocadoes, olive oil, etc.) and some whole grains and fruit.
Your doctor seems to want to limit the amount of medications that she uses. This is not a bad thing. But you do want to address the problem. You may find that you are fine with regard to your symptoms once you are done with the birth control. However, you may see them reappear if you are not addressing the problem.
I assume other tests have been done with regard to the diagnosis (fasting insulin, fasting glucose, testosterone levels, FSH and LH, etc.). And that other reasons for your symptoms have been ruled out.
I would recommend that you sit down with your mom and consider the Insulite PCOS System. This is a non-pharmaceutical approach to addressing PCOS. It includes supplements and a lifestyle plan and support: http://pcos.insulitelabs.com/.
I also wanted to pass along this link of different sites that you can use to further educate yourself about PCOS and support (such as this blog). http://pcos.insulitelabs.com/Insulite-PCOS-System-Support-Links.php
I hope that this answers your questions, Rebecca. The good thing is that you are being proactive in your health and taking the information and using it can help you optimize your health and how you are affected by PCOS.
Please feel free to ask any questions and let us know how we can help.
–
Best Wishes,
Dr. Heather DeLuca, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
Hello. I was diagnosed with PCOS after having a high LH/FSH ratio about a year ago. I was on and off the pill – so I’m wondering if there can ever be a false diagnosis? Or if sometimes you can have a high LH/FSH ratio and not PCOS? I was tested (and found not to be) insulin resistant. I also have had an internal ultrasound that did not reveal irregularity. I guess the question is whether the LH/FSH test is 100% as far as PCOS diagnosis? My husband and I want to try to conceive within the next year or so – and I want to make sure I’m doing what I can. If I do have PCOS, is it harmful to not be on birth control?
Dear Rachel,
Thank you for writing into the PCOS Support blog.
This is a great question and I hope that I can answer it appropriately for you.
First, I assume that you also had some other symptoms that led to the testing of these hormones. Is that correct?
Not all women have all the symptoms, which range from irregular or completely absent periods to hirsuitism (excessive facial or body hair), ovarian cysts and Alopecia (male pattern hair loss). Other symptoms can include obesity, acne and skin tags, Acanthosis Nigricans (brown skin patches), high cholesterol levels, exhaustion or lack of mental alertness and decreased sex drive.
An increase in LH can be associated with some other conditions and stages of life. Menopause is one of these where LH can be elevated. But we would also expect FSH to increase as well and to be higher than LH. We would also see LH increased in some genetic disorders. But these are most likely to be found early on in life.
What is important is to rule out other conditions that are similar to PCOS and to look at not one test level but the whole picture and person.
PCOS is notoriously difficult to diagnose. It is a diagnosis of exclusion. In other words, it is important to rule out other diseases that can cause symptoms similar to PCOS (such as Congenital Adrenal Hyperplasia). To diagnose PCOS, we use a combination of clinical symptoms (what you experience as the patient, such as excess hair growth, irregular menses, acne, skin tags, weight gain, infertility, etc.) and lab tests.
The blood tests to consider are:
- free testosterone- elevated in PCOS
- DHEA-S- often elevated in PCOS
- Sex Hormone Binding Globulin (SHBG)- usually low in PCOS
- Fasting insulin- elevated in PCOS. Some doctors may hesitate to order this test because the normal range (0-20) is so wide. However, we find that results greater than 9 indicate insulin resistance. Insulin resistance is usually the underlying cause of PCOS, as you may have read about on our site. Some doctors may also order a 2-hour post-prandial insulin test, along with a 2-hour post-prandial glucose test. For the post-prandial insulin, results over 25 or 30 may indicate insulin resistance.
- Fasting glucose or 2-hour post-prandial glucose test- elevated in PCOS. Using this information in combination with the insulin levels helps to diagnose insulin resistance. Also, women with PCOS have a higher risk of diabetes so it is important to screen for this early and often.
- LH: FSH- Some doctors may also look at the ratio between these two hormones. In PCOS, we would expect LH to be elevated in comparison to FSH.
-You could get an ultrasound to check for the presence of ovarian cysts. Even if the ovaries do appear normal, the absence of ovarian cysts does not mean that you don’t have PCOS. Not everyone with PCOS has ovarian cysts.
The mechanism of PCOS without insulin resistance is still not entirely understood in the medical community. As you may know, many women with PCOS do have insulin resistance, but some do not. Some women with PCOS hyper secrete insulin but do not yet manifest insulin resistance. Furthermore, in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
How did your doctor determine that you are not insulin resistant? I am wondering if you have ever had your serum insulin checked.
As mentioned above, insulin resistance can be verified by looking at the insulin levels (fasting and random) and the insulin: glucose ratio. Some doctors hesitate to perform a fasting insulin test on their patients because the normal range (0-20) is so wide. Other factors that would make me suspicious of insulin resistance include high blood pressure, difficulty losing weight, skin tags, acanthosis nigricans (dark brown patches on the skin), and a family history of diabetes or metabolic syndrome.
In general, we do not recommend oral contraceptives as a treatment for PCOS because they are synthetic hormones that mask some of the symptoms of PCOS rather than fixing the problems. Treating absent menses or other symptoms with oral contraceptives does not treat the underlying disorder of PCOS and when the contraceptives are discontinued, the PCOS symptoms will persist.
Our philosophy is to treat the cause of the disorder so that there is no longer a need for using contraceptives. If you are interested in this comprehensive approach to PCOS, please visit: http://pcos.insulitelabs.com/
The Insulite PCOS System consists of several elements, all designed to work together to address PCOS. It includes supplements, diet and exercise guidelines, and customer support. We provide ample customer support because we advocate lifestyle changes, and we know that these types of changes can be difficult to make without some help!
Rachel, I hope that this helps. Please let us know if we can help further.
–
Best Wishes,
Dr. Heather DeLuca, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
Hi, I am 23 and I was diagnosed with PCOS 6 months back, but I believe I had it for a while, because I have most of the symptoms, like irregular periods, facial hair, darkening of the skin, tiredness, and the list goes on. Well, I was prescribed BCP, but I could not tolerate them. As a result of that, my gyno prescribed Metformin, and now my period is becoming more regular and less heavy.
Now, I am more conscious on the food intake, I excerise 3 times at least for 40 mins, and I lost more than 20lbs.
My question is, how do I know, that my PCOS is under control. I cannot seem to get rid off the excessive facial hair and darkening of the skin. For darkening of the skin, I use differin gel…but it is not fading away.
I have not gotten to check insulin resistance test, but my Prolactin level is few points higher than normal. My gyno wants me to see an endocrinologist.
I feel like I am going back and forth, coming back to square one.
I would love to get pregnant sometime, but is it possible if I continue to have PCOS?
I am quite depressed.
Hi
I am 19 years old and was diagnosed with PCOS when I was 16. I have never had regular periods and had a feeling that there was something wrong with my body since I didn’t start my period til I was 14 or 15. I’ve done everything imaginable to try and control it/ get rid of it but nothing seems to work. I have dropped 28 lbs over the last 3 yrs, I am now 5′4 and 121-124 lbs. I feel like I should lose more weight becasue my acne and mood swings, and cravins have spiraled out of control. I was wondering about what else I can do?
Hello, I am 18 years old and I was just recently diagnosed with PCOS. I have always had trouble with my weight and I barely get my period. I was recently pregnant…. but had a miscarriage within a few weeks due to my pcos. I want to have three children in the future I hope my dream will come true! I need to loose weight asap because I’m in sports and I’m trying to get back in shape. What is the fastest way to loose weight if you havd pcos?
Dear Tracy,
Thank you for contacting the Insulite PCOS Support Blog.
I am sorry to hear about your miscarriage. I hope we can help your dream of having a family one day come true. Women with PCOS may be able to improve their fertility by losing weight and improving the insulin resistance that underlies PCOS.
The Insulite PCOS System, which you may have read about on our website, http://www.pcos.insulitelabs.com, is designed to help heal PCOS by addressing its underlying cause, which in most cases is insulin resistance.
With insulin resistance, the body becomes insensitive to the insulin it produces, which leads to elevated circulating levels of insulin. This in turn leads to hormonal imbalances such as increased testosterone and other androgens (masculinizing hormones).
Elevated insulin also contributes to the formation of cysts in the ovaries in part due to the hormonal imbalances and also because the ovaries are highly sensitive to the influence of insulin.
All of these factors combine to complicate a woman’s chances of conceiving if she has PCOS.
The Insulite PCOS System helps to improve insulin sensitivity with its combination of nutrients and herbs as well as diet and exercise guidelines. The supplements are also designed to correct the hormone imbalance of PCOS.
Our system is designed to balance the testosterone, insulin and other reproductive hormones that impact ovulation. We advocate a slow weight loss which is healthier and more permanent. This is not a quick fix or fad diet. We want you to be healthy for the rest of your life by applying sensible lifestyle changes to your diet and exercise routine.
While we cannot promise that you will conceive on our program, we know that theoretically reducing insulin and testosterone will increase your chances of conceiving.
It is safe to continue trying to get pregnant while you are using the System. We do recommend, however, that, if you become pregnant while using the PCOS System, you discontinue using the supplements during your pregnancy and then resume them after you finish breastfeeding. The reason is that while we know that the Insulite PCOS System is safe and non-toxic in general, these supplements have not been tested in any clinical trials specifically on pregnant women or infants.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email
and the Insulite Labs website is for the sole purpose
of being informative. This information is not and
should not be used or relied upon as medical advice.
Always seek the advice of your physician, nurse or
other qualified health care provider before you
undergo any treatment, take any medication,
supplements or other nutritional support, or for
answers to any questions you may have regarding a
medical condition.
Hi. I was diagnosed last year at the age of 18. Symptoms include acne, excess hair growth everywhere on my body and periods that are slightly irregular. I am underweight by most standards though I eat healthily and eat whatever I want (though luckily this tends to not be large amounts of food). I have a high muscle mass and low fat percentage despite the fact that I rarely exercise.
I am concerned about insulin resistance being the underlying cause but my doctor is appeared not to be concerned about PCOS at all and hasn’t advised me to seek any course of action whatsoever.
I read that you mentioned the following ‘a family history of obesity, diabetes, and heart disease, cravings for carbohydrates or sweets, skin tags or acanthosis nigricans (dark patches on the skin, especially in the armpits)’ which would cause you to believe that insulin resistance played a key factor.
I do not have any of these. I realise I’m hopeful in asking whether that rules out the possibility entirely? Will I start putting on weight dramatically one day? What foods should I be eating to attempt to prevent problems such as heart disease and diabetes?
I’m quite worried about the future in general in regards to this and would greatly appreciate your response.
——————–
Dear Maz,
Thank you for contacting Insulite’s PCOS Support blog.
It sounds like you have lean PCOS. The topics of lean women with PCOS, and PCOS without insulin resistance are still not entirely understood in the medical community. Many thin women with PCOS do have insulin resistance, but some do not. It is not a clear-cut distinction that thin women are not Insulin resistant. Some lean women with PCOS hyper-secrete insulin but do not yet manifest insulin resistance. And in many women with PCOS, their ovaries are highly sensitive to insulin, so that even if their serum insulin levels are normal, the ovaries are highly reactive to that insulin.
Here is a link to study that was done with lean/obese women who have a history of PCOS: http://www.blackwell-synergy.com/doi/abs/10.1111/j.1365-2265.1993.tb02144.x
Since you don’t have any of the signs of insulin resistance you may not be insulin resistant. Consider testing your fasting insulin and glucose. Fasting insulin is elevated in PCOS. Some doctors may hesitate to order this test because the normal range (0-20) is so wide. However, we find that results greater than 9 indicate insulin resistance. Insulin resistance is usually the underlying cause of PCOS, as you may have read about on our site. Some doctors may also order a 2-hour post-prandial insulin test, along with a 2-hour post-prandial glucose test. For the post-prandial insulin, results over 25 or 30 may indicate insulin resistance. Fasting glucose or 2-hour post-prandial glucose test are elevated in PCOS. Using this information in combination with the insulin levels helps to diagnose insulin resistance.
We have had customers with Lean PCOS on the Insulite PCOS System with success. You could certainly try the System. I do want to let you know we offer a 100% satisfaction guarantee. If for some reason, the system does not work for you, Insulite Laboratories offers a 90 day money back guarantee. If you are not completely satisfied with the Insulite System, we will refund your original purchase price for up to 90 days. (Excluding shipping and handling)
You just might want to pay close attention to your blood sugar in the first few weeks on the System, to make sure it does not drop too low. You can monitor blood sugar with a home glucometer (blood glucose meter) and by watching for symptoms of low blood sugar such as: headaches, feeling faint or dizzy, feeling clammy or sweaty, trembling and hunger. These symptoms relieved by eating.
The dietary guidelines are flexible enough that you can adjust the caloric intake to meet your needs to sustain your weight. If you would like guidance to help you gain weight, we might be able to help with that too. We recommend a whole foods low carb diet plan in which you would avoid refined grains and sugars.
The nutrients themselves will not make you lose weight. If you find that you are having difficulty maintaining your weight while using the Insulite PCOS System, please contact us right away so that we can help you with that.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email and the Insulite Labs website is for the sole purpose of being informative. This information is not and should not be used or relied upon as medical advice. Always seek the advice of your physician, nurse or other qualified health care provider before you undergo any treatment, take any medication, supplements or other nutritional support, or for answers to any questions you may have regarding a medical condition.
Hi, I’m 35 years old, 5′7″, 120lbs. I recently had a miscarriage at 8 weeks. I have always had regular periods, every 29 or 30 days. I chart/temp so I also know that I ovulate every month. This month is the first time there was a cyst leftover at my baseline ultrasound. (I do typically have many small follicles each month until the dominant one is “chosen” but I thought this was normal). I have been TTC for 4 months, with no medication. I have a bit of light facial hair but attributed that to just getting older. My blood sugar is fine, not overweight, no acne, no hair thinning, etc. One thing though is my LH/FSH ratio this month is 1.7:1. With this and having a cyst I am now wondering if I have PCOS? Is it possible to have while ovulating every month?
Thanks,
Nicole
——————
Dear Nicole,
Thank you for contacting Insulite’s PCOS Support blog. Your ratio is not very elevated. Often with PCOS there is a ratio of 3.0 or greater. The cysts on the ovaries seen with PCOS are often what is referred to as a string of pearls because there are many small follicular cysts.
PCOS is notoriously difficult to diagnose. It is a diagnosis of exclusion. In other words, it is important to rule out other diseases that can cause symptoms similar to PCOS (such as Congenital Adrenal Hyperplasia). To diagnose PCOS, we use a combination of clinical symptoms (what you experience as the patient, such as excess hair growth, irregular menses, acne, skin tags, weight gain, infertility, etc.) and lab tests. You may have already had these lab tests done, but the other blood tests to consider are:
- free testosterone- elevated in PCOS
- DHEA-S- often elevated in PCOS
- Sex Hormone Binding Globulin (SHBG)- usually low in PCOS
- Fasting insulin- elevated in PCOS. Some doctors may hesitate to order this test because the normal range (0-20) is so wide. However, we find that results greater than 9 indicate insulin resistance. Insulin resistance is usually the underlying cause of PCOS, as you may have read about on our site. Some doctors may also order a 2-hour post-prandial insulin test, along with a 2-hour post-prandial glucose test. For the post-prandial insulin, results over 25 or 30 may indicate insulin resistance.
- Fasting glucose or 2-hour post-prandial glucose test- elevated in PCOS. Using this information in combination with the insulin levels helps to diagnose insulin resistance. Also, women with PCOS have a higher risk of diabetes so it is important to screen for this early and often.
- LH: FSH- Some doctors may also look at the ratio between these two hormones. In PCOS, we would expect LH to be elevated in comparison to FSH.
- An ultrasound to check for the presence of ovarian cysts. Even if the ovaries do appear normal, the absence of ovarian cysts does not mean that you don’t have PCOS. Not everyone with PCOS has ovarian cysts.
- I would also check your cholesterol levels and liver function tests, as these can also be abnormal in PCOS (as well as in many other conditions).
Also consider testing prolactin, thyroid panel, progesterone and estrogen to rule out other hormonal imbalances that could affect fertility.
I hope this information answers your questions. Please don’t hesitate to contact us again with any further questions or concerns.
Best wishes,
Dr. Nicole Kellum, ND
Insulite Laboratories Consulting & Advisory teams
DISCLAIMER: The information contained in this email and the Insulite Labs website is for the sole purpose of being informative. This information is not and should not be used or relied upon as medical advice. Always seek the advice of your physician, nurse or other qualified health care provider before you undergo any treatment, take any medication, supplements or other nutritional support, or for answers to any questions you may have regarding a medical condition.