PCOS is a chronic illness
And don’t you let anyone tell you it isn’t! This insidious illness affects us in so many different ways and it permeates every level of our lives, from our appearance, to our fertility cycles, to our relationships and to our jobs. It makes us depressed, feel worthless, it gives us terrible physical pain and makes us a bit gun shy (thanks Mum for the resurgence of the expression). So yeah, I think I’m more than right and justified for calling PCOS a chronic illness. Sorry … I’m phasing through some interesting emotions at the moment … right now, I’m a little bit pissed off with all of this. But that passes …
I’m considering making this into its own blog, to better sort through the topics and issues, but for now, this page will do.
The Technicalities of PCOS
PCOS, or Polycystic Ovarian Syndrome, is an illness that directly affects a woman’s fertility system. Simply, it is an over production of androgens, recognisably testosterone, which in turn lessens the production of progesterones. PCOS affects women of all reproductive ages, the average ages being 12 to 45, but I will better categorise it as from menarche to menopause. How this affects women is varied. Symptoms are:
- Few or no periods and when you do menstruate, they are long and heavy, and most often very painful
- Acute abdominal pain
- Embarrassing hair growth (medically known as hirsuitism)
- Hair loss
- Infertility – this ranges from non-release of eggs during ovulation to not producing eggs at all
- Weight gain
- Depression and anxiety (I include these here because of hormonal irregularity)
- Pain during penetrative sex (omg! Did I actually put that in here??? Yes I did, because as much as it’s not listed as a symptom, it is a common thing that all PCOS affected women deal with in the dark and it absolutely MUST be acknowledged and talked about)
- Development of the linea nigra, the dark line most commonly associated with pregnancy
- Illusion of being pregnant (that is, presenting all of the “symptoms” of pregnancy most annoyingly without actually being pregnant)
- Insulin resistance (mostly related to obesity)
As individual as we all are, we all present with different symptoms, some of us have a couple of symptoms, some a few, and some of us have many, if not all of them. Depressingly, I have all of the above and PCOS has affected my life on all levels.
Treating the enemy
Yes, PCOS is a woman’s enemy, because it does so many insidiously tortuous things to us. There are three ways to treat, or manage, PCOS: through diet, chemically, naturally and surgery (drastic!).
Reading through some of my research, it occurs to me that really, what chemicals are used depend on what end result a woman wants. Are we talking about menstrual regularity? Having a baby? Weight loss? Getting rid of that embarrassing hair and those horrible zits? What about insulin resistance? Personally, I am not a fan of chemicals. Truly, I am not. But, for some women, that’s the way it works for them.
So how do I tackle this subject? What to talk about first? I think first steps first; let’s talk about what chemicals are used in all fertility issues.
Hormones, fertility and those annoying periods
When we begin menarche, we are taught that it’s a natural part of life. For many women, we’re thrown a pack of pads and told to sort it out ourselves; the blood, the pain, the PMT, the embarrassment, the shame. For women with PCOS, it doesn’t get easier, it gets worse. All downhill from that first bloody encounter with our menstrual cycle. I remember being in agony when my period came. Trips to lie down in the school nurse’s office because I was in so much pain, I’d be bent double around my stomach being sympathetically told by the school nurse to “toughen up”. I thought it was normal … well, normal for me anyway; the other girls didn’t seem to have the same problems I did, but then, being a “nerd” I was outcast and didn’t speak to other girls much anyway.
This continued, all the way through my first struggles with menarche through to the very present day. Well, actually, not at the moment because I haven’t had a period in 5 months (yay me right?). If I had known then, what I know now, I would have talked to my mum about it and hopefully have gone on the pill right then and there. As it was, later on, when I became sexually active, I went on the pill and seemed not to have as many problems. Needless to say, I didn’t know that what the pill was doing at the time was regulating my hormones. As time went on, the types of contraceptive that I was taking got higher and higher in hormone doses to combat my heavy and painful periods. They still didn’t control my mood swings, but at least I was having regular periods and the pain wasn’t as intense. So, in my most humble opinion, if you have PCOS and a daughter, get her tested as soon as she has her first period and get her straight on the pill. If I had a daughter, that’s what I would do.
Continuing on the subject, depending on what results you wish to achieve, whether it is the quarterly menstruation cycles or the regular once a month deal, will depend on the type of contraception you wish to take. Many women opt for progesterone replacement contraceptives to make sure they “shed the lining” regularly if their periods are going past 3 months. Personally, I’m loving the fact that I haven’t had a period for so long, but this increases my chance of uterine cancer and endometrial abnormalities, so I really should get myself off to a doctor soon and get some sort of prescription *sigh*. Anyway, what contraceptive you decide upon should be made with proper consultation with your doctor, making sure they know you have PCOS and what results you desire.
So … fertility … a very very painful subject for a lot of PCOS sufferers. I know that it’s one of the most painful topics for me to deal with. To let you know, I’ve wanted children since I was 16, preferably four, names all picked out already. Young I know, but I heard that biological clock ticking loud and clear. Up until that point, I wanted a total hysterectomy and to never have kids at all. Then I turned 16 and I was in trouble. Little did I know at that age that my struggle to have children would be heartbreaking, disappointing and … well … simply heartbreaking. So yes, I know. As much as I wish any woman who has PCOS and have been able to have children one way or another, it is still so hard for me to deal with. Early on in our relationship and talking about having children, my current partner told me about his “super sperm” and how he got a girl pregnant when they were 17, even with her on the pill, and as much as I laughed and sympathised with him (the girl had an abortion because 17 is just too young), in the back of my mind I was screaming “I wish!”. Yes, I wish most fervently that his super sperm would work its magic on me, but, with a lack of ovulation, it’s just not going to work. Not to mention he doesn’t want children; his daughter is enough. So I am left with the option of “if it happens, great, if it doesn’t, awesome” and every regret for not having children at all. Sorry – had to take a breather there and get myself back under control.
What to do about fertility? First, if you’re on the pill or any type of contraceptive – stop taking it, lose some weight if you need to, change your diet (yes, I will handle this further on), start an exercise regimen including yoga, start taking pregnancy supplements, and have lots and lots and lots of sex. If after a year nothing happens, go to your doctor and demand help. Do not ever take “you’re healthy” from your doctor because with PCOS, you just never know what is going on. You should be diagnosed with PCOS by this point, so your doctor should know already, but I know from experience that some doctors just don’t get it. Make them get it.
There are a few options, the first being chemical. This is where they put you on a drug known as clomiphene citrate (brand name Clomid) to stimulate ovulation and FSH (or Follicle Stimulating Hormone), some doctors will put you on the anti-diabetes medication metformin, but this has been less effective than clomid. If that doesn’t work in conjunction with dietary and lifestyle changes, then FSH is used during IVF. And finally … although this isn’t chemically driven, if all of that doesn’t work, then there is a procedure called “ovary drilling”. This is a surgical procedure, so we’ll talk about that later.
To be honest, there is nothing wrong with old fashioned dieting and exercise. Changing your lifestyle in order to combat PCOS is the better alternative, rather than trying to rely on chemicals to help you out. There are many “diet” drinks out there that can help, but you always have to remember to add exercise and proper dietary requirements to that.
The annoyingly embarrassing hair problem or “I hate looking like a hairy gorilla … I’m supposed to be feminine and dainty!”
If you’re like me, and undoubtedly you are, you have a two-fold embarrassing hair problem. The good thing with me though, my hair is so fine and blonde (strange for a brunette, but there you go), it doesn’t really look any different on me – but it’s still there and putting on foundation is a nightmare as it shows up that awful moustache!
- Hair where you don’t want it: on your face and chest, over hairiness of the arms and legs that cost you a fortune in beauty treatments and hair descending from where it shouldn’t -_- ; and
- The loss of hair from your head … that glorious mop of hair that isn’t so thick any more because of those stupid fucking androgens tipping over the scales (testosterone is directly linked to hair loss in both men and women).
According to some sources, the chemical way of combating hirsuitism is to go on the pill. In this case, from what I read, cyproterone acetate is used as a way to reduce excess hair. It works by reducing the amount of androgens you produce … yes, those pesky testosterones. This also helps to reduce acne. Handy isn’t it? There are a few other drugs used such as flutamide, spironolactone and metformin. Metformin is a good one to help with insulin resistance too. So, essentially, any form of contraceptive which is specifically designed to block the production of androgens will help immensely with hirsuitism and I’m assuming, to some degree, androgen-based hair loss as well. Wow – I am so itching to write about one of my favourite topics – fashion and beauty! I’m gonna have to wait though.
Insulin resistance or “Wait! But I really love sugar and bread and … and … *pouts*”
Well, some of the above topics have covered chemicals that assist in the reduction of insulin resistance, but for all of those sugar loving readers out there, sorry, but the best way of reducing your risk of PCOS induced diabetes (type 2 by the way), your best bet is to reduce the amount of sugars or sugar producing foods in your diet. But that said, the drug metformin is commonly used although not clinically proven, so is thiazolidinedione. I’m not too sure on the whole insulin resistance issue at this point. I can only direct you to various research and studies that have been done on it as I can’t speak from my own experience, although, given my climbing weight, I should have a chat to the doctor about it.
Natural responses to PCOS
I figured I would handle some of the ways to combat PCOS in a two-fold manner; chemically and naturally since chemicals should always be used in conjunction with diet and exercise anyway. I’ll also throw in a bit about natural therapies in here too since it is a topic near and dear to my heart. To deal with PCOS in a natural manner, you have to treat it holistically, that is, all symptoms at once, rather than individually. To do this, you need to institute both a diet and exercise plan and stick to it. Yes, I know, famous words coming from me; her, the big eater of carbs and no exercise, but that will change very shortly. I’m already starting to integrate better foods and food changes into my life. Now, I’m not a sugar person, I don’t eat a lot of sugary things (I personally love salty stuffs), but what I don’t eat in sugar, I make up in carbs such as potatoes and bread. Recently, I discovered (like only just yesterday) that nibbling on bread really drives the energy out of me … and I got so tired and depressed it wasn’t funny. I’m experimenting right now and eating a bag of crisps to see what effects that will make in me, apart from filling me up.
Diet or “omfg do I really have to not eat all of my favourite things?!”
Yes, yes you do … I hate to say it … breads, sugar, carbohydrates … anything that boosts sugar production is pretty much off the list. Currently, I am putting together a nice recipe list of all the foods that we can eat because I just can’t stand the thought of having bland meals. Mmmm … food … *insert Homer Simpson drool here*
OK – I’m going to stop writing in here and write in Word so I don’t annoy too many people with constant updates (although I’m not sure if you get an email about page updates – correct me if I’m wrong).