fertility and weight!

[deblah]

hi i was diagnosed with pcos 5 years ago and so far have changed doctors twice as the only thing being suggested was to lose weight, i have lost two stone since i was diagnosed and while i know i am overweight the doctor i am currently seeing put me on the pill which has caused me to gain weight again, i went to speak with him and he said i should stay on pill eat more salad and walk more, he would not even offer any other suggestions or willingness to change from contaceptive pill (which is also doin nothing to help with my pcos), after being on it for six months he said that should of been enough to start my periods again which have been absent for 4 years! this did not happen so again i saw him and was given another 3 months of the pill which again makes me gain weight, he has said after this course of them is up i should do nothing for 3-6 month because that should be enough but if not after 6 month he will do blood test to check levels!! i am just so fed up and depressed all the time i am doin all i can to lose weight but being on the pill is not helping and the lack of help from my doctor is making me feel like nothing is ever going to happen and after nearly 6 years of trying to get pregnant, being told it is all down to bein chubby and not helping, i neeed some proper advice, i have lost two stone but he says i need to lose another 3 before willing to help!

[Denise Kennedy]

Well done on losing 2 stone already - this is a significant achievement and you should be positive about the changes you have already made.

PCOS is a complex disorder and the causes are not really known. However, what we do know is that losing excess weight will significantly improve the symptoms and health problems that is causes, so it is really important. However, it is also more difficult to lose weight because in PCOS the body usually has a resistance to insulin, and so produces higher levels of this hormone in response to refined carbohydrate and sugary foods. Too much insulin affects other hormones, notably testosterone, which can interfere with ovaries producing eggs normally.

Key elements of a diet for PCOS are as follows:-
1. A low Glycaemic Index diet is important to try to keep your blood sugar levels stable and prevent spikes of insulin being produced. Glycaemic Index means how quickly a carbohydrate food is absorbed into the blood stream - look up more details on line. Essentially it means eating wholegrain, high fibre foods and avoiding foods made from refined, white flour or very sugary foods.
2. Eat plenty of fibre - this helps to slow down absorption of sugar and prevents spikes in insulin. For example an apple will give a much lower insulin spike than a glass of apple juice.
3. Eat these foods as part of your meals, if possible mixed with protein foods (such as meat, fish, beans and lentils, nuts, eggs). Aim for 3 healthy meals per day. Healthy proteins slow down the absorption of carbohydrates in your diet and help to keep your insulin levels low.
4. Include soya regularly in your diet as there is some thought that phytoestrogens found in soya are helpful in balancing hormones in the body.

The Food Hospital programme (that ran recently on Channle 4) also suggested other things to try including avoiding caffeine (in coffee, tea and chocolate), avoiding alcohol and high fat diets. They suggested eating more oily fish and flaxseeds (for omega 3 oils), spearmint and green tea, and foods high in chromium (lean meat, sweetcorn, apples, eggs, broccoli, sweet potato).

I think you might also benefit from a weekly slimming group (although bear in mind the diet rules above) to help keep you on track. Is there a friend or family member you could go with? Can you plan a regular exercise session - what about going for a walk every evening with a mate? Plan a route and see if you can gradually do it more quickly. Being active not only improves your state of mind but it also gets you out of the house so you can't snack!

YOU CAN DO THIS. Make it your number one priority. Get some help and support and start today!! GOOD LUCK

[deblah]

Thanks I just don't understand my doctors not being willing to try something other than contraceptive pill which has made me gain weight again, I tried to discuss metaformin or other options with him n was just offered a blood test in 6 months time, I don't drink alcohol and have started eating a healthier diet I also go to a gym and have fitness equipment at home which I use, I was a member of slimming group but found it hard to attend with my shift patterns. I was told I should be Round 11 stone mark to receive help, but my weight has stuck around what I am for a fair while now should my hormones of not adapted to this size?

[Denise Kennedy]

Hi - I am not an expert on the medical treatment of PCOS and cannot really comment on the treatment you are being offered by your doctor. But you could ask for a second opinion if you are really unhappy about the options you are being offered. Besides the treatment though other doctors will suggest you try to lose weight as this is known to be the most important thing.

I know it can be hard to shift excess weight, especially if medical treatment and shift work etc. does not help. As we have suggested to a few other questions here try keeping a food and activity diary to help you identify areas where you can make changes. Try keeping the diary for a week or two and then review. Be honest as you fill it in. Are there snacks creeping in? Are portions getting bigger? Are you as active as you could be?

Wendy has suggested aiming for 5 @ 60minutes of activity a week - hard enough to make you hot and a bit sweaty and breathless. Are you managing this level of activity?

Whenever you eat ask yourself "How hungry am I?" on a scale of 1 to 5. If I am really hungry then have a healthy meal. If not, am I eating for other reasons such as stress, bordeom, habit? If it is these other reasons try not to eat and do something else.

And keep the diary going - evidence suggests those people who keep a food diary and are very "mindful" about what they eat are the most succesful.

[deblah]

Thank you for replies I am starting a food diary and will up exercise

[Dr Masud Haq]

Hi

I've just been added to the expert panel so my photo and profile aren't up as yet but I'm a Consultant Endocrinologist so look after many PCOS patients.

Most Physicians would base the diagnosis of PCOS on blood tests and an ultrasound of your ovaries. I presume this has been done in the past? If you were on the pill at the time of the ultrasound the scan findings can often be negative but this doesn't necessarily exclude PCOS. I think you should have been thoroughly investigated for other conditions normally associated with weight gain - specifically hypothyroidism, diabetes, raised cholesterol, hypertension and excess endogenous production of steroid hormone (also known as Cushing's syndrome). There are also many conditions also associated with a lack of periods - raised prolactin, raised testosterone, following prolonged treatment with the pill, and weight gain.

If your previous tests were indeed consistent with PCOS and your are having problems with a lack of periods off the pill together with weight gain, I'm not convinced going back on the pill is going to help. As you've stated most patients put on further weight on the pill and this leads to further insulin resistance which needs to be corrected. Metformin can be very effective at improving insulin resistance and many patients notice their periods return to normal. Weight loss is of proven benefit so dietary support in conjunction with an exercise program can be effective. Unfortunately, there is only one licensed medication available to assist with weight loss which can now be bought from most good chemists or can be prescribed by your GP.

If you continue to have problems I would recommend you be referred to your local specialist.
Best wishes
Dr M Haq

[deblah]

Hi I did have an ultrasound nearly 4 and half years ago and that is when I was told that I had pcos, I had a couple of blood test but was just told that same of my levels were high. I had gone four years without a single period and have now been on the pill for six months, then I have been told to not return to my doctors for between 3-6 months as he said the pill should of been enough despite my not being happy with this as an answer it was most would say, he said if still nothing by then he would do a test to see if I was ovulating. While I do understand that losing more weight will be of benefit and that I should be doing it I seem to just be stuck at my current weight, do you think I should ask for tablets to help me lose weight? I have a friend with pcos and her doctor gave her metaformin within few weeks of her going and she is over 20st and has regular periods still, I just finding it all very confusing and depressing.