by Dr. Henry Bohler
Although obesity (BMI > 30) is often present in patients with PCOS it is not required to make the diagnosis. An increase in weight may be the tipping point for those not previously experiencing irregular cycles. Weight gain after a pregnancy or an increase because we’re happy or sad. Whatever the reason an increase in weight (usually adipose tissue or fat) unmasks the condition or makes it worse.
It is now very clear that PCOS is not just a problem of abnormal bleeding, infertility and hirsutism. Insulin resistance is found in more than half the patients. Insulin, secreted by the pancreas, finds it difficult drive sugar or glucose into cells-our muscle and fat, so the pancreas releases more to make up for this inefficiency. When insulin can’t do its job, glucose remains in the blood and rises, so PCOS patients are often pre-diabetic or even diabetic! This is why the doctor orders a 2-hour glucose tolerance test or a fasting glucose level. You should never become pregnant in the presence of high blood sugar levels.
Increases in insulin throw off your lipids so a lipid panel may be ordered (it should be done every 5 years anyway!). Diet and exercise may improve your cholesterol, triglycerides and high-density lipoprotein (‘HDL’), or it may not be adequate. It is worth a good try before committing to more medicine.
Metformin is now commonly prescribed to PCOS patients because it lowers insulin levels and may assist in ovulation and it may even promote weight loss! The ‘but’ is that in may have gastro-intestinal side effects, and for now, let’s leave it at that. For those not wishing to become pregnant, oral contraceptives and other meds to block the testosterone effect (hair growth and acne) are usually ordered.
Henry Bohler, Jr., M.D. received his medical school training from Columbia University College of Physicians and Surgeons, one of the perennially top-ranked medical schools in the country located in New York City. His obstetrics and gynecology training was done at one of its affiliated hospitals, St. Luke’s-Roosevelt. He became ‘Major’ Bohler while serving as chief of OB/GYN in the United States Air Force, Whiteman AFB, MO, and then he was honored with a National Research Scholarship enabling him to do his subspecialty training in Reproductive Endocrinology and Infertility at Walter Reed Army Medical Center and the National Institutes of Health in the Washington, D.C.-Maryland area. Afterward he continued his research experience at Yale University after receiving the prestigious Mellon Fellowship.
Dr. Bohler is Board Certified in Obstetrics and Gynecology and Reproductive Endocrinology and Infertility and a Fellow of the American College of College of Obstetrics and Gynecology. He is also a member of the American Society of Reproductive Medicine and the Society of Reproductive Endocrinology and Infertility.
As Medical Director, Dr. Bohler has helped maintain very high standards and pregnancy rates at the University of Louisville’s infertility practice. Their pregnancy rates for patients in the Attain IVF program are among the highest in the national Attain-Network. Besides having a keen interest in IVF, Dr. Bohler other interests include polycystic ovary syndrome, recurrent pregnancy loss, obesity-related infertility problems and endometriosis.
2 Comments
I appreciate reading these articles because its educational
to me n others whom and not have PCOS>
But I am stupped because I dont know what to do reagarding
the common treatments i’ve tried (metformin,Pregestrone an birthcontrol)
I am exercising and strving to eat better, but its like
how can I win? Or what else to do?
this is fustrating and I am sadden to feel I may never
be a parent someday.
Dear Chell,
I guess it is more than obvious that losing weight is difficult, which is why I suggest that you seek out a weight-loss program or company to assist you, if possible. This is assuming that weight is an issue although that was not really said. Never skip meals. ‘Graze’ all day (eat healthy snacks between your modestly portioned meals). Watch what you drink. Sodas, juices are out. Do not eat late in the evening. Do the free stretch workout on the public education channel: “Classical Stretch”. It works. I did it to become more flexible and lost a pant size, unintentionally.