PCOS Questions

Hello all! I am looking for a little information and advice.
My sister-in-law has been suffering from irregular periods, bad PMS and cramps, some excess hair growth, and quite bad acne since she was a teen. She is not overweight. She is 23. I am wondering if she might have PCOS (she has never been tested). She is desperate to find some way to manage the acne, and has tried a few different prescription medications, as well as mail-order cleansers, etc. These things seem to work for a couple of months, but then she's back to square one. Currently her doctor thinks that the acne is because of a hormonal problem, and put her on the pill. This is her third cycle on the pill, and she is finding that the acne is TERRIBLE during the week off. After doing a little reading on PCOS and insulin resistance and elevated testosterone levels, I am wondering if the low-GI diet that has been recommended would help her. Is there anyone who has tried that diet? What exactly is permitted, and what should be avoided?
Also, what would be involved in testing her for PCOS? Is it difficult to diagnose? I suggested that once she is off the pill again, she should learn to temp and chart to find out if she is ovulating, but is there some simpler, quicker way?
Do her symptoms sound like PCOS to you? Or is this probably something else, IYO? Can PCOS be hereditary, or "run" in families? Her mother had it.
Of course, I know that in order to get some real answers, she has to go to her doctor, but I think it might be helpful if she can go to him with some research, and some questions about the cause of her acne problems, rather than having him just try to patch them up!
Thanks so much for your help!

Hi Cricket,

I was diagnosed with PCOS in August last year. I was on the pill for 6ish years. When i decided to stop taking it i still hadn't see AF for 8-9months so thought i should see a doctor. Luckily for me the GP sent me for blood tests and an Ultrasound as she suspected PCOS straight away without even asking about any other possible symptoms. The Ultrasounds showed over 14 cysts on each ovary. I was then sent to a specialist who confirmed it. He suggested i loose weight - not that he thought i was 'fat' (weighed about 65kg) but he said my body was telling me i needed to loose some. I went on the CSIRO diet and with in loosing only 1-2kg i saw AF again. DR said that was a good sign. I did the 12weeks and lost almost 10kgs. I didn't really find loosing the weight cleared up many of the other symptoms except acne. He also said i was unlikely to fall pregnant without help. The day i was due to go in and start the medication i was able to tell him i was pregnant! So i think a low GI diet helps in some cases.

Hope this rambling was of some help.

Hi Cricket,

The irregular periods, acne and hirsuitism are all symptoms of PCOS. I was diagnosed with PCOS 13 years ago and have all of these but I am not a particularly bad case of it. So I would say, there is a chance that she may have PCOS.

I am not overweight but I find that my periods are most regular when I my BMI is 21, which I am finding impossible to get down to post-baby!!

Testing for PCOS involves blood tests for hormone levels and ultrasound to check the appearance of the ovaries. Your SIL should ask for a referral to an endocrinologist who specialises in the condition, generally I find that the Drs who specialise in reproductive endocrinology and gynaecology to be more knowledgable about PCOS, than a general endocrinologist.

Not all women diagnosed with PCOS have insulin resistance, I am one of them. The last time I checked about 75% do (I am in the minority). This has lead some drs to believe that insulin resistance is the main factor involved (but it does not explain all of us!!!!!). Therefore your SIL may not necessarily have the insulin resistance. She may not necessarily have elevated testosterone either (I don't!!), she just be more sensitive to it leading to the hirsuitism and acne. So, it can be confusing to get an accurate diagnosis!! Some women have PCO as shown on ultrasound but do not have PCOS due to the absence of other symptoms.

I still find that the low GI diet is beneficial to maintaining weight even though I am NOT insulin resistant. For me, just being at the upper end of normal weight range causes my symptoms to be worse than if I am leaner.

It does run in families, but the familial connection has not been proven in my case. My mother DOES NOT have it and there is no evidence of it on her side. Could be on my father's side but no strong evidence there except for male premature boldness. So yes, given that her mother has it there is a good chance that she may have it.

With PCOS, the right kind of pill is important as the pill prescribed for "normal" women without PCOS can actually make things worse. The pills prescribed for PCOS women have different hormones in it to counteract the androgens. In Aus, we have Diane-35ED and Brenda - there may be others. My acne and hirsuitism were helped by the pill.

I don't think PCOS is particulary difficult to diagnose from the blood tests and ultrasound, it is just there is such a wide degree of symptoms and the degree to which each person is affected varies enormously and so does the emphasis that drs place on the importance of the results v. the symptoms. Your SIL would need to come off the pill for a while in order to be tested.

Temp charting can be a useful guide, but may not be all that accurate in determining ovulation. It doesn't really work for me. I find the CM a much more useful guide, especially when TTC, but your SIL is probably not at that stage yet. A better guide may simply be how often she is getting periods. Generally, if you are within the normal range of about 28 - 36 days, give or take a few days, there is a good chance that she is having ovulatory periods. Anovulatory tend to be outside this normal range, but even this is not always the case. (My DS was concieved naturally in a 60 day cycle, and a cycle this length would usually be considered by some drs to be anovulatory!!). Ovulation can also be tested via blood and ultrasound but in my experience Drs don't worry about this until your are TTC. Before then it is about managing the symptoms.

There are some books written by Colette Harris, an english woman with PCOS about the lifestyle issues involved with PCOS and they give some ideas on how to manage the condition. Basically, I find too that it is a lifestyle thing. I have to maintain a healthy diet and lifestyle, reduce stress otherwise my body just rebels.

There is also a good Australian book about the low GI diet for PCOS - "The New Glucose Revolution - Managing PCOS, The Glycemic Index solution for Optimum Health" by Prof Brand-Miller, Prof Farid and Kate Marsh. Basically a healthy diet focusing on the right type of carbohydrates and fats.

I think that the irregular periods, acne and hirsuitism should be enough for your SIL to be referred for blood tests and ultrasound. She should question her DR about coming off the pill for a while in order to do the tests and ask why the acne gets worse in the week off.

Good luck and I hope she finds the answers she is looking for. I would just keep in mind, that even if she does have PCOS, it affects all of us very differently.

If she has any more questions, there are more of us here who have the condition and may be able to help.

TICKLISH.

I have PCOS, am on the pill (Brenda aka Diane) and experience terrible acne when I come off the active tablets. However my dr said this is normal. There are other medications she can use inaddtion to the pill (my dr has suggesed some if I want to go onto them) if the acne really bothers her in that week off.

Before was diagosed (diagnosed April 07), I had severe acne and painful cramping around the time of my period. But no excess hair growth, and not overweight. I had watched my ovulation signs (I just followed my cervical mucous, it can be very accurate and extremely easy to do once you know how), and I realised I wasnt ovulating. I had regular 5 day periods and consistent 34 day cycles, which never varied at all. But I wasn't ovulating during most cycles. I told my dr all these things.

It wasnt hard to be diagnosed - blood test and internal scan. I was diagnosed after I had a blood test that showed that my hormones were way off, and an internal scan that showed cysts on my left ovary.

I don't have diabetes/insulin resistence, so the low-GI diet wouldn't really help the symptoms. But if your SIL does have these issues, and a low-GI diet was recommended for her by her dr, then I would suggest she try it and see how it goes.

Thanks ladies - I will be passing this information on to her, and hopefully she can get some answers!
One thing that I find interesting - I myself am somewhat overweight, have some mild acne, and irregular periods. But I ovulate (by checking CM and temp) with every cycle. And ultrasound has never shown cysts on my ovaries. I've always wondered though, what causes my cycles to be so weird. I vary from 28 days to 50+ days, with an average of about 37ish day cycles. The luteal phase is always the same - 12 days. It seems funny then to me that a doctor would assume that a long cycle, or irregular cycles are anovulatory.
Anyways, I will do a little more reading on the low-GI diet for SIL, and see what I can come up with, and hopefully things will improve for her! :)

Hi Cricket,

I find that doctors have some GENERAL rules and that GENERALLY, they do not apply!!!

My FS told me that I was very unlikely to concieve, I had all sorts of tests at regular intervals which all showed that I was not ovulating and then I rang the FS only a week later to say I was pregnant - well, the FS was a bit surprised!!! The reaction "Oh, well you must have ovulated!!" Oh well, yes indeed!!!!

I have read that there are women who have symptoms of PCOS, but don't have the appearance of cysts on their ovaries - so you might be one of these women. I have also read some alternative therapy books which say that the anovulatory rule is nonsense and it is perfectly normal to have ovulatory periods which are 40 plus days - some women are just like this. Whereas, other alternative therapy books claim that cycles longer than 29 days lead to reduced egg quality and a higher risk of miscarriage - probably another nonsense!!

I had one endo who told me never to read any sources about PCOS on the internet because most were rubbish and generally only applied to women at the more severe end of the scale. My first OB also told me that he thought that PCOS was over diagnosed and was unnecessarily atrributed to far too many fertility problems!!!! For those of us at the milder end of scale, perhaps he is right, but for those at the other end of the scale, he is probably very wrong!!!!

Hormone levels are related to weight. I am just trying to shift the post-baby butt with a hope that my cycles will shorten and become more "normal" - whatever that is??????

Hope things improve for your SIL.
TICKLISH.

Hi Ticklish, your doctor said the same thing mine did. She said 'stay off the internet'. But this is because I had already told her that I had a history of dperession, stress, and generally just worrying too much. She said I had mild PCOS, mild symptoms, and the fact I get a period is a good sign; she said the best treatment was to relax, eat well, and exercise to maintain my weight (I'm thin). She prescribed me the pill (Brenda) for the chin hair- but I only have one, and it would come back every 3 weeks after i'd plucked it. But since I started eating better and exercising it hasn't come back at all. So I figure I'm doing something right.

Hi Scarlett,
Yes, I think your dr has given you some good advice. If you get a period that certainly is a very good sign. Lifestyle changes certainly helped me too, weight is important too - although the hirsuitism thing for me is more than one hair unfortunately. Sounds like you are doing everything right :)

I must be doing something right too - am now UTD for the 3rd time - all concieved naturally despite the PCOS.

All the best.
TICKLISH.