PCOS treatment

[Anonymous]

Anonymous wrote:Thanks. Thyroid and prolactin normal - in fact everything normal except free testosterone is high and LHR/fsh is 2.2

If you have reasons to not do BC, ask the OB-GYN if spironalactone is an option. That worked for DD who did not want BC.

Same DD as above who had no cysts on ultrasound but scores of them on MRI.

[Anonymous]

Is your dd expected to be on spiro indefinitely? Thanks

[Anonymous]

Anonymous wrote:Is your dd expected to be on spiro indefinitely? Thanks

She has sporadically gone off, but the acne returned. She's late twenties now and I haven't asked her recently.

[Anonymous]

the most common reason for irregular periods is anovulation. anovulation can be caused by stress, being underweight or overweight, excessive exercise, inadequate caloric intake, thyroid dysfunction, pituitary dysfunction, and PCOS. PCOS is the most common cause. PCOS is a diagnosis of exclusion meaning that you need to rule out all of the above. If you can do so, PCOS is the likely diagnosis. Assuming that has been done, she would meet 2/3 Rotterdam criteria for a PCOS diagnosis (menstrual irregularities + symptoms of androgen excess [acne]). this is a chronic condition with no one size fits all treatment. treatment largely depends on if the person is or isn't trying to get pregnant. if not trying to get pregnant, treatment is focused on symptom control and health optimization (PCOS is associated with increased risk of metabolic dysfunction, heart disease, anxiety, depression etc). If primary concerns are irregular cycles and acne, a combined birth control pill is a good option as it will allow for more predictable bleeding pattern (no teen likes a surprise period!) as well as lower androgens to treat and prevent acne. Hormonal birth control gets a bad wrap these days but for those with hormonally driven issues (like PCOS), it can a real game changer. I typically prefer to use a pill that contains drosperinone. Assuming all other labs were fine and no concern for other possible etiology, endocrinology is unlikely to offer much more or different than gynecology. also assuming her estrogen levels were fine and she's not underweight, bone health (while important) wouldn't be my primary concern in someone with PCOS having infrequent periods. my concern would be that with chronic anovulation over many years, this can cause abnormal thickening of the uterine lining and increase the risk of precancerous and cancerous cell changes. a hormonal agent (like a pill) will help to keep the lining thin.

[Anonymous]

This is super helpful, thank you!

[Anonymous]

Anonymous wrote:

Anonymous wrote:Op - Ratio is 2.2

That is typical of Pcos. I have had “lean Pcos” since 15, diagnosed at 25 and have been on metformin ever since (except during pregnancies, for which I did need to so iui and ivf.)

at the time I was diagnosed the rec was for metformin even with no indicators of insulin resistance because the rate of diabetes is very high even in lean Pcos.

Definitely wish I didn’t have it but it hasn’t been a huge deal. Good luck to you daughter!

Reviving this thread in case this poster is reading… For lean PCOS, did metformin actually help? Just wondering because my 15-year-old daughter is about to be diagnosed with lean PCOS (not OP). She has high testosterone, high Lh/FSA ratio, high prolactin, etc. But normal glucose and has always been skinny. She is a stress case so I can totally see her adrenals being the cause. Wondering if metformin still helps in this case.

[Anonymous]

I’m op here and doctor just recommended pill (generic yaz). Fwiw she said metformin wreaks havoc on digestive system and she wouldn’t recommend for young women with no weight issue.