So here it goes...
What are the symptoms of PCOS and how do they relate to IR (Insulin Resistance).
The symptoms vary from woman to woman, a few of the most common are,
- weight gain
- facial hair
- cysts
- enlarged ovaries
- raised/lowered hormone levels
- skin tags
- absent/irregular periods
- male pattern balding
- infertility
IR is basicly pre diabetes, so in theory its better to treat yourself as a diabetic, healthy diet and light exercise willmore or less help with IR.
What tests can i have to see if i have PCOS?
Theres 2 ways, 1 is a blood test testing LH FSH and other things such as blood sugar levels, the 2nd is a pelvic ultrasound to see if there is any visible cysts.
What is the medication?
Theres only a handful of things medicly cleared for us cysters, Metformin, Birth controll pill, Clomid plus a few others, not all doctors believe all the cleared medications work as well as herbal suppliments and vitamins (please see previous post on supplements)
How many women suffer with PCOS?
It is now estimated that 25% of women of childbearing age suffer with PCOS to put that in context out of 100,000 women 25,000 have PCOS!
Will i ever be a mum?
the good news is 96.7% of cysters go on to be mums and have healthy pregnacies! albeit with some medical help or naturally, but it can happen!
What is Amenorrhea?
its means absent periods, a cycle of more than 6 weeks with no cycle.
Is PCOS a Syndrome or a Disease?
PCOS is generally considered a syndrome rather than a disease (though it is sometimes called Polycystic Ovary Disease) because it manifests itself through a group of signs and symptoms that can occur in any combination, rather than having one known cause or presentation.
Are there are other names for PCOS?
Other names for Polycystic Ovary Syndrome are Stein-Leventhal Syndrome, hyperandrogenic chronic anovulation, functional ovarian hyperandrogenism, and Polycystic Ovary Disease.
Is there a cure for PCOS?
No, it is a condition that is managed, rather than cured. Treatment of the symptoms of PCOS can help reduce risks of future health problems.
How should i prepare for a medical appointment to discuss PCOS?
- Write down any questions before the appointment. It is usually faster and more orderly to have a list, no matter how long it may get. Many questions will be answered in the of conversation.
- Be ready to supply family history, especially about insulin resistance, diabetes, lipid abnormalities such as high cholesterol, obesity, high blood pressure, heart disease, and infertility. Include information from both parents and their families. PCOS characteristics may be passed down from either side of the family.
- Familiarize yourself with the symptoms of PCOS and discuss any concerns with the doctor.
- If looking for help in getting pregnant, consider bringing in basal body temperature (BBT) charts to initial evaluation.
- See if it would be helpful to arrive for the doctor's appointment in a fasting state, and clarify any other requirements.
What are some questions to ask the doctor?
- What tests are used to confirm PCOS?
- What tests are done to confirm insulin resistance and/or diabetes?
- Are insulin-sensitizing medications prescribed for insulin resistance, or only for diabetes?
- What recommendations or medications, if any, are typically given for the symptoms of PCOS, such as weight gain/obesity, acne, hirsutism, balding, lack of periods, high cholesterol, high blood pressure, and insulin resistance?
- After initial diagnosis of PCOS, what kind of future monitoring is recommended?
- Will diet and exercise information and support be provided?
- What kind of birth control is recommended for women with PCOS?
- What kind of treatment is offered to women with PCOS who are trying to conceive?
- Is weight loss in obese patients a requirement before any stage of fertility treatment? For example, would i be allowed to try Clomid, but not allowed to pursue IVF?
- Can insulin-sensitizing medications be used while trying to conceive?
- Can insulin-sensitizing medications be continued in pregnancy?
- Which medications used to reduce PCOS symptoms, such as those for acne and hirsutism, can be continued while trying to conceive or when pregnant?
Is it possible to have polycystic ovaries without having the syndrome?
A large percentage of women with polycystic ovaries have at least some subtle hormone alterations, even if they do not clearly exhibit other signs of the syndrome.
Is it possible to have PCOS without having cysts?
It is difficult to make a firm diagnosis of PCOS without the presence of either an increased number of small cysts or ovarian enlargement. Polycystic ovaries may not have been recorded as an official finding on an ultrasound even though they were seen. Often ultrasounds have been performed to exclude pathology and may not have diagnosed minor increases in cystic structures or ovarian enlargement. Some ultrasonographers may consider the milder forms of PCOS as variations of normal. Ovarian enlargement is not always associated with ovarian cyst development, but still can be a variant PCOS. In other words, if one has the signs and symptoms of PCOS it is likely that there is some alteration in the appearance of the ovary, even if it has not been recognized.
What are normal values for the blood tests?
this is for general guidance only!
| Hormone Levels | |||
| Hormone to test | Time to Test | Normal Values | What value means |
| Follicle Stimulating Hormone (FSH) | Day 3 | 3-20 mIU/ml | FSH is often used as a gauge of ovarian reserve. In general, under 6 is excellent, 6-9 is good, 9-10 fair, 10-13 diminished reserve, 13+ very hard to stimulate. In PCOS testing, the LH:FSH ratio may be used in the diagnosis. The ratio is usually close to 1:1, but if the LH is higher, it is one possible indication of PCOS. |
| Estradiol (E2) | Day 3 | 25-75 pg/ml | Levels on the lower end tend to be better for stimulating. Abnormally high levels on day 3 may indicate existence of a functional cyst or diminished ovarian reserve. |
| Estradiol (E2) | Surge/hCG day | 200 + pg/ml | The levels should be 200-600 per mature (18 mm) follicle. These levels are sometimes lower in overweight women. |
| Luteinizing Hormone (LH) | Day 3 | < 7 mIU/ml | A normal LH level is similar to FSH. An LH that is higher than FSH is one indication of PCOS. |
| Luteinizing Hormone (LH) | Surge Day | > 20 mIU/ml | . |
| Prolactin | Day 3 | < 24 ng/ml | Increased prolactin levels can interfere with ovulation. They may also indicate further testing (MRI) should be done to check for a pituitary tumor. Some women with PCOS also have hyper-prolactinemia. |
| Progesterone (P4) | Day 3 | < 1.5 ng/ml | . |
| Progesterone (P4) | 7 dpo | > 15 ng/ml | A progesterone test is done to confirm ovulation. When a follicle releases its egg, it becomes what is called a corpus luteum and produces progesterone. A level over 5 probably indicates some form of ovulation, but most doctors want to see a level over 10 on a natural cycle, and a level over 15 on a medicated cycle. Some say the test may be more accurate if done first thing in the morning after fasting. |
| Thyroid Stimulating Hormone (TSH) | Day 3 | .4-4 uIU/ml | Mid-range normal in most labs is about 1.7. A high level of TSH combined with a low or normal T4 level generally indicates hypo-thyroidism, which can have an effect on fertility. |
| Free Triiodothyronine (T3) | Day 3 | 1.4-4.4 pg/ml | Sometimes the diseased thyroid gland will start producing very high levels of T3 but still produce normal levels of T4. Therefore measurement of both hormones provides an even more accurate evaluation of thyroid function. |
| Free Thyroxine (T4) | Day 3 | .8-2 ng/dl | A low level may indicate a diseased thyroid gland or may indicate a non-functioning pituitary gland which is not stimulating the thyroid to produce T4. If the T4 is low and the TSH is normal, that is more likely to indicate a problem with the pituitary. |
| Total Testosterone | Day 3 | 6-86 ng/dl | Testosterone is secreted from the adrenal gland and the ovaries. Most would consider a level above 50 to be somewhat elevated. |
| Free Testosterone | Day 3 | .7-3.6 pg/ml | |
| Dehydroepi-androsterone Sulfate (DHEAS) | Day 3 | 35-430 ug/dl | |
| Androstenedione | Day 3 | .7-3.1 ng/ml | |
| Sex Hormone Binding Globulin (SHBG) | Day 3 | 18 — 114 nmol/l | Increased androgen production often leads to lower SHBG |
| Fasting Insulin | 8-16 hours fasting | < 30 mIU/ml | The normal range here doesn't give all the information. A fasting insulin of 10-13 generally indicates some insulin resistance, and levels above 13 indicate greater insulin resistance. |
| Blood Glucose Levels | |||
| Type of test | Time to Test | Normal Values | What value means |
| Fasting Glucose | 8-16 hours fasting | 70-110 mg/dl | A healthy fasting glucose level is between 70-90, but up to 110 is within normal limits. A level of 111-125 indicates impaired glucose tolerance/insulin resistance. A fasting level of 126+ indicates type II diabetes. |
| Glycohemoglobin / Glycosylated Hemoglobin (HbA1c) | anytime | < 6 % | An HbA1c measures glucose levels over the past 3 months. It should be under 6% to show good diabetic control (postprandial glucose levels rarely going above 120). Good control reduces the risk of miscarriage and birth defects. |
| Cholesterol, Triglycerides and C-Peptide | |||
| What to test | Time to Test | Normal Values | What value means |
| Triglycerides (TG) | 8-16 hours fasting | < 200 mg/dl | Borderline high is 200-400, high is 400-1000, and very high is >1000. Elevated levels are a risk factor for coronary artery disease. |
| Cholesterol Total | 8-16 hours fasting | < 200 mg/dl | A level of 200-239 is borderline high, and a level 240+ is high. Increased levels are associated with increased risk of heart disease. |
| low-density lipoprotein cholesterol (LDL) | 8-16 hours fasting | < 160 mg/dl | This is the "bad" cholesterol. In someone with one risk factor for heart disease, <160 is recommended, with 2 risk factors <130, and those with documented coronary heart disease the target is <100 |
| high-density lipoprotein cholesterol (HDL) | 8-16 hours fasting | > 34 mg/dl | This is the "good" cholesterol which may be increased through a healthy diet and exercise. The HDL level is usually estimated by taking total cholesterol and subtracting LDL, rather than by direct measure. |
| C-peptide | 8-16 hours fasting | 0.5 to 4.0 ng/ml | Levels increase with insulin production. |
| Creatinine | <1.4 mg/dl | Levels 1.4 mg/dl and higher may indicate renal (kidney) disease or renal dysfunction. | |
Some doctors will suggest an oral glucose tolerance test in addition to the tests above for insulin resistance.
How often should tests be repeated?
Most of the blood work, unless monitoring a fertility treatment cycle, does not have to be repeated unless there is abnormal result. Most infertility clinics will repeat basic labs annually.
How important is the LH:FSH ratio?
The emphasis doctors place on the ratio of luteinizing hormone (LH) to follicle stimulating hormone (FSH) varies. Most pre-menopausal women have a ratio close to1:1. In PCOS, the LH level may rise above the FSH, sometimes significantly. Any case where the LH is higher may be suggestive of PCOS and further investigation may be warranted. Some doctors say that an LH:FSH greater than 2:1 or 3:1 indicates PCOS.
Are PCOS and hypothyroid related?
What are the long-term health risks associated with PCOS?
PCOS is associated with increased risk for endometrial hyperplasia, endometrial cancer, insulin resistance, type II diabetes, high blood pressure, high cholesterol, and heart disease.
Nadine xx
