The Ultimate PCOS Handbook: Lose weight, boost fertility, clear skin and restore self-esteem. Theresa Cheung

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       CHAPTER 5 HOW CAN MY DOCTOR HELP?

      Your doctor is most likely to suggest a combination of medication and lifestyle modifications to help you control the signs and symptoms of PCOS. Medical and surgical treatment can also help you if you’re having trouble conceiving.

      Do bear in mind that your treatment will be unique to you and will depend upon your individual symptoms. If you do decide to take medication we would strongly urge you to take an active role in your medical care by learning as much as you can about the condition and by working with your doctor to develop the best treatment plan for you.

      TREATING IRREGULAR PERIODS

      If you have irregular periods, your doctor is most likely to prescribe you oral contraceptives. In addition to protecting the uterine lining by inducing a monthly bleed, some brands of contraceptive pill can control excess face and body hair. And, of course, you get the contraceptive benefit.

      Before prescribing oral contraceptives, your doctor will perform an examination or a blood test to be certain that you aren’t pregnant. If you haven’t had a period for six weeks or longer, your doctor may also first prescribe medroxyprogesterone acetate or a progestin (Provera) to induce a menstrual period. A progestin is a medication that mimics the action of progesterone. This will cause a period in almost all women with PCOS, but it doesn’t help with the cosmetic concerns (excess hair or acne) and doesn’t provide contraception.

      A modest amount of weight loss can also restore normal periods in some women. For example, many overweight women with PCOS who lose 5 to 10 per cent of their body weight notice that their periods become more regular.

      The final treatment for irregular menstrual periods is the use of insulin-lowering agents (see page 55).

      POSSIBLE SIDE-EFFECTS

      Some women who take oral contraceptives (not just those with PCOS) may notice amenorrhoea (lack of menstrual periods) or breakthrough bleeding (bleeding that occurs at the wrong time of the month). Often this breakthrough bleeding settles down after a few menstrual cycles, but if it happens your doctor may order an ultrasound scan of the uterus to check your endometrium (uterine lining).

      If ultrasound shows that the endometrium is very thin, and if you don’t mind having no periods, your doctor may simply recommend continuing with oral contraceptives. If you prefer having menstrual periods, the type and dosage of contraceptives can be changed.

      If the ultrasound shows that the endometrium is thick, your doctor will often prescribe a different type and dosage of oral contraceptives to trigger a period.

      Many women worry that they will gain weight on the Pill. In the early days of the Pill this was a real problem; however, with the low-oestrogen pills now used, weight gain is very unusual. Nausea and bloating are potential side-effects, but these symptoms almost always go away after two or three months of taking the Pill.

      Some women also say that the Pill increases their appetite. The British Medical Association’s Official Guide to Medicines and Drugs,¹ does list weight gain as a possible side-effect. It goes on to say that ‘Oestrogen may also trigger the onset of diabetes mellitus in susceptible people, or aggravate blood sugar control in diabetic women.‘This isn’t usually a concern, but if you have PCOS you are at an increased risk of obesity and insulin resistance already, so you need to discuss this carefully with your doctor.

      In addition, blood clots can occur, although this is a rare complication in healthy women. The risk of a healthy woman developing blood clots with the contraceptive pill is estimated at just 1 in 30,000.

      While the Pill is thought to be very safe and effective, it’s important that we point out that it might lower your libido and can occasionally raise blood pressure, as well as cholesterol, blood sugar, and insulin levels.² A preliminary study reported in the January 2006 Journal of Sexual Medicine claims that taking the contraceptive pill may lead to long-term loss of libido. A US–Canadian study³ has also found that even low-dose oral contraceptives appear to increase women’s risk of a heart attack or stroke. Dr John Nestler and Dr Paulina Essah of Virginia Commonwealth University, and Dr Jean-Patrice Baillargeon of the Université de Sherbrooke, analysed the results of several studies published between 1980 and 2002. They determined that women using low-dose contraceptives have approximately twice the risk of stroke or heart disease.

      Women with polycystic ovary syndrome already have an increased risk of cardiovascular disease, Dr Nestler said, and are at an even greater risk if they are treated with low-dose contraceptives. He suggested that doctors consider alternatives. Long-term use of oral contraceptives may also increase this risk, Nestler said. But he said that for most women the risk is still very low.

      This study reinforces why we emphasize the importance of natural approaches for treating PCOS, such as a healthy diet, regular exercise, stress management and selected nutritional supplements and herbs. Hormone contraception is effective in preventing pregnancy, but should be chosen with a full understanding of the health risks involved. Always consider alternatives including barrier methods (diaphragm, cervical cap, IUD, condoms), which have the added benefit of protecting you against sexually-transmitted diseases (STDs).

      There are also health risks associated with being on the Pill if you’re overweight. Synthetic oestrogens in the Pill can increase the body’s drive towards insulin resistance, a precursor to diabetes. There’s also the increased risk of high blood pressure. So, for women with PCOS who have weight problems being on the Pill isn’t a good idea unless you’re following a healthy eating, healthy living plan and having regular check-ups for blood pressure, blood sugar and blood cholesterol levels.