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Q&A Topics

Polycystic Ovarian Syndrome


Yesheen (dr.) Singh Medical Doctor View profile

Dear A



Thank you for your concise statement. I an assuming you would like to know why you have not had a period for five years? If so you will need to provide more information, preferably in a personal consultation because the many possible causes of secondary amenorrhoea (which is the technical term for what I assume your condition to be). Please contact me through www.healthnation.co.za if you would like help on this matter.



Many thanks and warm regards

Yesheen Singh

Yesheen (dr.) Singh Medical Doctor View profile

Dear C



Thank you for your question. Danazol is an androgen-derivative, i.e. a brother of testosterone, and it's use has been discouraged because of the powerful side-effects it can have in the femal body. I would not advise beginning this medication.



Polycystic ovarian syndrome is quite a complex disease to manage because of the many different pathways that contribute to the underlying imbalance that results in disruption of the balance between oestrogen and testosterone in the female body. I usually take a detailed history before making recommendations on how one can begin to heal and correct the imbalance without relying on synthetic contraceptive or other pharmaceuticals. I would recomend making an appointment directly at www.healthnation.co.za



For now I would suggest asking her to begin by beginning a Saw Palmetto supplement (Solgar make a good one) and introducing some Psyllium Husk (1 teaspoon before bed in a glass of water every night). These two will begin to rebalance the oestrogen:testosterone ratios and streamline the excretion of oestrogen metabolites out of the body. Additionally I would recommend cutting out all sugar and gluten-containing foods and limiting carbohydrate intake to 2-3 servings of low GI carbohydrates per day (e.g. brown rice, buckwheat or quinoa).



If managed correctly there is no reason why PCOS should preclude you from beginning a family.



Many thanks and warm regards

Yesheen Singh

HealthNation

Angela Lombard Nursing Practitioner View profile

Dear S

Thank you for your question, and I apologise for the delay.

Microval is the minipill, and is recommended for mothers who are breastfeeding their babies. It is not usually recommended for any other reason. It would be better for you to be assessed in person so as to determine which contraceptive would suit you, once diagnosed with polycystic ovarian syndrome.

Kind regards

Angela

Yesheen (dr.) Singh Medical Doctor View profile

Dear S

Thank you for your question. PCOS is a conglomeration of symptoms and you do not need all of them to be diagnosed with the disease. From the couple that you describe in your question I would be highly suspicious of it as well. One of the main symptoms of PCOS is an irregular period so it is not surprising that you have begun to experience them. Another one is infertility - without a healthy balance of sex hormones your body cannot create the appropriate environment within which to grow a baby. Conventional medicine uses drugs such as Metformin to "manage" PCOS but these simply sweep the disease under the covers where it continues to churn away. This is a disease that is ideally suited to lifestyle modification as it forms part of the cardiometabolic umbrella of diseases that relate to imbalances in hormones and subsequent inflammation and abnormal metabolism.

Lifestyle modification involves loosing the weight, increasing your activity levels, cutting your calories in a healthy manner, managing stress in a beneficial way and the use of tailored supplements to help in the interim to balance the sex hormone imbalance. Supplements such as Saw Palmetto have been shown to help, BUT only in conjunction with proper lifestyle modification.

If you would like advice on a tailored plan for yourself please don't hesitate to contact us at 076-229-4662 for an appointment.

Many thanks and warm regards

Yesheen

Yesheen (dr.) Singh Medical Doctor View profile

Dear M

Thank you for your question. Has anyone mentioned a diagnosis of Polycystic Ovarian Syndrome to you? Ovarian cysts from a young age, obesity, increased hair growth (hirsuitism), male-pattern balding, acne, irregular periods and infertility are but a few of the more common symptoms of this syndrome. It is basically an imbalance in the regulation of oestrogen and progesterone resulting in malfunction of several of the organs reliant on healthy sex hormone balance.

Traditional western medicine isn't very successful at managing this condition, resorting to cycles of oral contraceptives to regulate menstruation and swopping to metformin when one wants to try to fall pregnant. The use of steroids isn't helping either, only causing further imbalance of your hormonal axis.

From a functional medicine perspective I firstly try to create an internal environment that encourages the body to return to a more balanced state of being, using nutrition, appropriate supplementation and lifestyle modification. There is a knock-on effect with appropriate supplementation, weight-loss and increased activity resulting in better regulation of the oestrogen-progesterone balance, which results in improvement of skin, hair and other bodily functions. With this approach there is a very high success rate with many clients attaining their goals, be it better regulation of menstruation or falling pregnant or resolution of hirsuitism. All this without the need to resort to pharmaceuticals that invariable cause more dysfunction than the original condition.

Please contact me at www.healthnation.co.za if you would like to discuss such a program in more detail.

Many thanks and warm regards

Yesheen

Sameera (dr.) Abbas Naturopath View profile

Dear N

Thank you for your question. The use of Metformin for the management of ovarian cysts is usually indicated when those cysts form part of a diagnosis of Polycystic Ovarian Syndrome. There are several diagnostic characteristics of this syndrome and some of them include obesity, type 2 diabetes mellitus, cardiometabolic syndrome, hirsuitism, irregular menstruation (or no menstruation), adult acne and infertility. Doctors often prescribe Metformin as a life-long drug to try and stabilise your menstruation into a regular cycle but this doesn't affect fertility. Mainstream medicine would advise the swopping of the Metformin for a secondary drug if the patient decides to try and fall pregnant.

I would recommend going through a lifestyle modification program if you have been diagnosed with PCOS. Fertility has been shown to improve as the obesity and insulin resistance drops without the need for further medication. But this would require a commitment from you to truly change your lifestyle. Managing the PCOS also creates a healthier body for mom, within which a new baby can grow and obtain the best chance of a healthy beginning. Discuss this type of program with your gynaecologist or feel free to contact us at healthnation.co.za for further information.

Maca root powder has indeed been used successfully in anecdotal evidence to manage a variety of hormonal problems, such as ovarian cysts and PCOS. I would recommend beginning with around a teaspoon every morning and working your way up to a dessert spoon a day. Saw palmetto is another useful supplement to help stabilise hormonal imbalances. But both of these need to be appropriately prescribed, and used within the context of a proper lifestyle modification program that also includes appropriate activity and stress reduction.

Many thanks and warm regards

Yesheen

Gabriell (dr.) Prinsloo Medical Doctor View profile

Hi

PCOS can result in periods that are irregular in timing as well as strength of flow. As the symptoms that you experienced were similar to the symptoms that you usually have before a period it is most likely that you had spotting associated with normal hormonal changes (a very small period). This isn’t anything to be concerned about.

Breast tenderness such as that experienced before menstruation, generally occurs as a result of hormonal fluctuations. Breast tenderness also occurs with pregnancy (again as a result of hormonal changes) and a small implantation bleed can occur about a week after conception. If you have had unprotected intercourse I would suggest that you do a pregnancy test.

However the most likely cause for your symptoms is just an irregular small period with spotting rather than full flow.

Warm regards

Gabriell

Gabriell (dr.) Prinsloo Medical Doctor View profile

Hi

I assume that your question is regarding whether you are pregnant or not.

Given that all 3 pregnancy tests have been negative it is unlikely that you are pregnant. It sounds more likely that your cycle has been irregular (which commonly happens in PCOS) resulting in the spotting, the missed period and the nausea. Often pregnancy tests can be falsely negative when done too early, however from about 2 weeks after conception (so generally around the first missed period) the levels of human chorionic gonadotropin (the hormone made by the placenta after implantation) will be high enough to yield an accurate test.

If you are still experiencing nausea or breast tenderness, then it would be a good idea to visit your GP or Gynae to confirm the diagnosis.

Warms regards

Gabriell

Sean (dr.) Gomes Medical Doctor View profile

The nature of PCOS means that you will ovulate irregularly and hence will find it more difficult to fall pregnant. There have been links to insulin resistance and diabetes and hence you have been started on Metformin. I would recommend that you take the dose that was originally prescribed by your doctor or visit your doctor again to see whether he needs to adjust it according to your blood sugar levels. It is difficult to say whether this is in deed your period due to the erratic nature of your bleeding. Please see one of my previous answers here on PCOS for further information and an outline of medications that can be prescribed by a health professional to assist with fertility. Hope this helps and you fall pregnant again soon. Regards Dr Sean Gomes

Angela Lombard Nursing Practitioner View profile

I suggest that you first be assessed at our WellClinics for your suitability of the Yasmine contraceptive pill before considering Diane 35. Yasmine is schedule 3 and is a lower dose contraceptive pill - the formulation of this particular pill is androgen based and has been processed to deal with acne problems successfully. Diane 35 is schedule 4 and is a much higher dose contraceptive pill - with your recent diagnosis of polycystic ovarian syndrome I would prefer you to be assessed for Yasmine first. Congratulations on completing your family - this is such an accomplishment! Should you require help and advice for your PCOS we can assist you further. Please also view the previous question answered on PCOS for more information and treatment options. Kind regards, Angela, Nursing Practitioner.

Sean (dr.) Gomes Medical Doctor View profile

I am sorry to hear about your recent diagnosis. Their are varying degrees of this condition and dependant on teh severity needs different degrees of treatment. PCOS needs medical management by your gynaecologist and I would recommend you visit him or her agin to discuss your condition in more detail with you.

The following will provide you a brief outline and some suggested treatements. Please discuss this further with your regular health professional.

Polycystic Ovarian Syndrome is characterised by the formation of many small immature follicles on the ovaries. PCOS is a result of the body producing irregular amounts of certian hormones which are involved with the ovarian cycle. These iregular amounts result in excessive androgen and insulin production. There is no specific treatment unfortunately that can make the condition go away. Treatment focusses on treating the symptoms and effects of PCOS. The four main treatment goals are the following:

  • Restoration of normal menstrual cycles
  • Increasing fertility (by restoring ovulation)
  • Treatment of symptoms associated with increased androgens
  • Lowering insulin levels.
Treatment options include the following:
  • Medications
  • Weight loss
  • Ovarian stimulation with special fertility medicines
  • Laser hair removal or electrolysis
  • Surgery as a last resort

Lifestyle changes such as regular exercise can aid weight loss and help
reduce blood sugar levels and regulate insulin levels more effectively.
Weight loss can help lessen many of the health conditions associated
with PCOS. Many women with PCOS will start to have regular periods and
will start to ovulate again if they are able to get closer to their
ideal body weight. Even modest decreases in weight can help.

PCOS symptoms can be controlled by medication.

  • Menstrual cycle regulation:
    • Birth control pills can regulate menstruation, reduce androgen levels and clear acne.
    • Progesterone pills can also regulate the menstrual cycle
    • PCOS patients who are insulin resistant may ovulate when treated with metformin (Glucophage).
  • Hirsuitism and acne treatments:
    • Birth control pills can also decrease acne.
    • Spirinolactone may be used to decrease hair growth in combination with birth control pills.
  • Infertility caused by anovulation (lack of ovulation):
    • Clomid is an anti-estrogen that tricks the brain into increasing FSH levels. The FSH stimulates follicle growth and therefore leads to ovulation.
    • Injectible Gonadotropin medicines (fertility injections) such as Gonal-F, Pergonal, etc which contain high doses of FSH can be used to cause ovulation. However, these medicines can stimulate many follicles and eggs and therefore they have an increased risk of causing twins and triplets.
  • Other medications are used to control blood pressure and cholesterol levels.
I hope the above gives you some more background to the condition. Best of luck.

Kind regards

Dr Sean Gomes


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