Correct Weight Loss Blog

This is the second part of the PCOS story. In the first article Polycystic Ovarian Syndrome – The Battle With Weight Loss, I explained what PCOS was, the symptoms of PCOS and risks of PCOS.  In this article, I want to elaborate further on the diagnosis and management of this syndrome.

Diagnosis of PCOS

Diagnosis of PCOS is largely based on the symptoms, eg menstrual irregularities, acne, excessive facial/unwanted hair, weight gain, difficulty to lose weight or even frequent 1st trimester abortions. However, I also mentioned in my earlier article that many women have varying degrees of the symptoms. In these cases, other tests can be done to establish a proper diagnosis. These include having hormone tests done, glucose tolerance tests, fasting insulin tests and pelvic ultrasounds.

• A ratio greater than 3:1 for LH: FSH
• Pelvic ultrasounds may show multiple cysts in the ovaries ( smaller than 10mm in size)
• An abnormal fasting insulin and/or glucose tolerance tests
• Thyroid tests, Serum Prolactin levels, testosterone levels to rule out other disorders
• Cholesterol levels as some people with PCOS may have elevated total, LDL and triglyceride levels.

Management of PCOS

Management of PCOS is usually tailored to the particular individual who is suffering from PCOS. This is because different women may be bothered by different symptoms of the disease, and indeed may display the symptoms with varying degrees.

There are many options of drugs available nowadays for the treatment of PCOS. Most commonly used is Metformin, which was traditionally a diabetic medication but has been shown to improve insulin resistance as well. It also helps with menstrual regularity, and therefore fertility. Besides that, it has also shown some benefit in weight loss. There are some risks of gastrointestinal upsets, mostly diarrhea with this medication and that is usually countered by increasing the dose slowly. Another risk associated with Metformin is lactic acidosis, which is lactic acid build up in the blood and can be fatal. People with kidney or liver problems are at high risk of this problem.

Other medication frequently used are Oral Contraceptive pills (OCP). The newer OCP’s regulate menstrual cycles and reduce unwanted body hair. These medications however cannot be used in women who are planning to get pregnant. It is also not recommended in women above 35 who smoke and women with a history of blood clots in the veins (thrombosis).

For women who want to conceive, ovulation drugs have been used. These medications provide menstrual regularity and increased the number of eggs released. It is sometimes used in combination with Metformin. There is some suggestion that prolonged exposure to this medication may increase the risk of ovarian cancer (more than 12 months). It also increases the risk of multiple pregnancy.

By far the most successful therapy is weight loss via proper nutrition and exercise. This includes low glycemic index food, 5- 6 small meals a day and an exercise program with weight resistance and cardio. Missing meals is not allowed as this will lead to a heightened hunger response and consequently poor food choices, eg high in simple sugars and fats.

The benefits of weight loss are multiple. The weight loss helps to regulate menstrual patterns as it bring the  insulin levels down. Weight resistance training helps to make the body more sensitive to insulin. The regularity of menstrual patterns and reduction in insulin resistance in turn helps with fertility. A study published in The journal of Clinical Endocrinology and Metabolism showed that by using a lifestyle program that sets realistic weight loss and exercise goals, subjects were able to sustain an improvement in carbohydrate metabolism over a 6-month period and hence improve their likelihood of pregnancy. Although weight loss as a percentage of body weight was small, a 70% improvement in insulin sensitivity index was obtained, and this was associated with the return of reproductive function. Other  benefits of weight  loss are also seen in the form of reduction in heart disease, diabetes and improvements in cholesterol profiles. It also reduces depression and gives the women a sense of confidence that comes with the improvement in body shape.

As PCOS can be a lifelong disease and have major influence in a woman’s life, it is important to be able to overcome this problem. By far, in my opinion, effective and correct weight loss is the way to go. Though medications do have their place in treatment, nothing is able to adequately replace the tangible and intangible benefits of weight loss and exercise.

Tags: insulin resistance, lactic acidosis, medications for PCOS, metmorfin, multiple pregnancy, OCP, PCOS, Oral Contraceptive Pills, Polycystic Ovarian Syndrome, Thyroid tests