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www.drdunckley.com Check out this Psychiatrist's website for more info. She continues to work with women dealing with PCOS. She incorporates vitamins and medication therapy to help with this syndrome.
By Jannet Huang, MD, FRCPC, FACE.
Description
Polycystic ovarian syndrome (PCOS) is the most common hormonal problem in women of childbearing age, with an estimated prevalence of 5% to 10%. It accounts for 90% of women with infrequent periods, 30% of women with absent periods, and over 70% of women who are not ovulating. It tends to run more commonly in families, and the core problem in PCOS has been identified to be insulin resistance.
There is overproduction of insulin by the pancreas in women with PCOS in attempt to compensate for their insulin resistance to maintain glucose homeostasis. Ovaries react to this by making excess androgens (male hormones) which interferes with the pituitary-ovarian axis. The symptoms and severity of the syndrome vary greatly among affected women. Some patients are found on pelvic ultrasound to have ovarian cysts (fluid filled sacs), characterized as looking like a “strand of pearls” at the periphery of the ovaries. Others can have irregular or absent menstrual periods. PCOS patients may not be ovulating even if they are having menstrual periods. This can lead to fertility problems, increased risk of miscarriages, pelvic pain, acne, excessive hair growth, and weight gain – particularly around the midsection. Overweight women have an even more exaggerated degree of insulin resistance which further increases the risk for diabetes and sleep apnea.
Evaluation
As part of your evaluation here at The Center, we will carefully listen to your history, and look for any physical manifestations of PCOS, including acne, increased facial hair or body hair, and signs of insulin resistance, such as darkening of the skin folds and skin tags. We will be checking your male and female hormones, thyroid function, pituitary function, and metabolic parameters such as cholesterol and glucose metabolism. Ten percent of women with PCOS have diabetes and 30-40% have abnormal glucose tolerance by age 40. Our goal is to bring you whole body and mind wellness, and therefore, we will look at other stressors, such as sleep and lifestyle in determining your risk profile.
Management
First line management may include diet modification, weight loss, and stress reduction, which can all help to alleviate the androgen excess. Maintaining a healthy weight will help the body use insulin more efficiently, thereby lowering the demand on the pancreas, and can help restore a normal period. Your plan may include seeing our dietitian and physical therapist to help you attain or maintain a healthy diet and physical activity regimen. Our behavioral health team have also been very effective in aiding patients deal with stressors and transform knowledge into action by behavioral modification techniques.
Treatment of PCOS often involves medication therapy, as well as lifestyle modification. Metformin, a medication often used in the treatment of diabetes, affects the way insulin regulates glucose and decreases testosterone production. When the male hormone levels go down, the androgenic consequences, such as acne, weight gain, and abnormal hair growth will slow down. Ovulation may return after a few months of use and patients will notice that their periods become more regulated. In addition to enhancing ovulation, there are also studies which showed metformin to reduce risk of miscarriages.
Other treatments for PCOS include birth control pill, spironolactone, and PPAR gamma agonists. Birth control pills can help regulate periods and reduce male hormones, but does nothing in the way of treating the metabolic risk factors and insulin resistance causing the PCOS. Spironolactone is a blood pressure medicine that has been shown to decrease the effect of male hormone, but it can adversely affect the development of a male fetus and should only be taken while practicing adequate contraception. PPAR gamma agonists can help our tissues use insulin more efficiently, thereby improving both the metabolic and hormonal aspects of PCOS. It is sometimes used in combination with metformin.
Jannet Huang, MD, FRCPC, FACE, ABHM.
Endocrinology & Metabolism and Holistic Medicine
Medical Director, The Center for Optimal Health
6825 Quail Hill Parkway, Irvine, CA 92603
Ph: 949.872.2850
Fax: 949.872.2855
www.thecenterforoptimalhealth.org
Here is an article from Courtney Harkins on the emotional effects of PCOS
The emotional effects of PCOS
You have been told that you have a diagnosis of PCOS. This often means a wide range of emotions will be experienced. These may include shock, uncertainty, loneliness, isolation, anger, depression and low self-esteem. This article will give information on some of the emotions you may have or will experience in the future along with ideas on how to you manage them. It includes suggestions of how you can help yourself as well as other sources of help and support.
Each person has their own experience of PCOS and how it impacts their lives. The diagnosis and treatment may bring out a range of strong emotions, such as uncertainty, depression, fear, and sadness. These emotions can be overwhelming, hard, and scary to deal with. Over time they usually get easier to handle and deal with however you often need time to be sad and to think about everything you have been through and told so you can adjust and begin to manage.
Uncertainty
PCOS can bring out uncertainty in many areas of your life, and this may be a cause of some of the emotions that you have. Feeling that we have some control over our lives gives us a sense of security and allows us to enjoy things that we do. Since PCOS now questions how life will unfold in the future security might feel as though it is being threatened. It is natural to want to know what is likely to happen to us, so that we can plan for our future. Many people find uncertainty is a hard feeling to cope with. Finding out as much information about treatment options will assist in decreasing the feeling of uncertainty.
Loneliness and isolation
Loneliness and isolation are two very common feelings people have and experience. Loneliness usually stems from not feeling understood. A common belief is that no one really understands what you are going though. Also body image may change and as a result being ashamed of your body and other changes that are common with PCOS such as excess hair and acne will lead a person to isolate. Coping with the feelings and changes PCOS brings out are important in overcoming loneliness and isolation because the lonelier a person feels it makes everything else harder to handle.
Anger and resentment
Anger is a very understandable feeling to have especially because of the many aspects PCOS impacts. This distress may lead you to feeling angry and irritable. You may feel resentful that others do not have to go through what you are going through. You also may have had dreams and desires about how your life was supposed to be and PCOS is getting in the way of how you imagined your life would be. These feelings are common reactions to what you are going through. It is very important that the family and friends in your life understand that your anger is aimed at PCOS and not them.
Depression
It is not unusual to have times when you feel very low after a diagnosis of PCOS. Many people feel sad when some symptoms of PCOS do not go away as quickly as they had hoped even after being on medication. Some people feel physically and emotionally exhausted from the doctor visits, medications and side effects. However, for some people affected by PCOS their low mood may continue or get worse and they may need specialized help or treatment. Some people find that their sadness gives way to a situation where their mood is low most of the time for several weeks or more, and they are depressed.
The relationship between PCOS and depression is complex. Depression may be triggered by the diagnosis of PCOS or the hormonal imbalances that are a part of PCOS. However, depression may occur by chance or be related to other difficult events, either in the past or in the present, which are nothing to do with PCOS.
This section outlines the common symptoms of depression, which may help you to decide if you are depressed. It also gives information to help you understand more about depression when it occurs alongside PCOS.
Depression can develop slowly, making it very difficult for either you or your family to recognize when it started. In other cases it can seem to hit you suddenly – one day you wake up and realize that you feel hopeless and helpless and are engulfed in a 'black cloud' of depression.
Depression can affect anyone at any age. It is extremely common – one in five (20%) people are affected by depression at some time in their lives. Depression is not a sign of personal failure or inability to cope. You can’t 'pull yourself together' or 'snap out of it'. There are things, however, that you can do to help yourself.
Depression can usually be successfully treated. The first step to feeling better is getting appropriate help.
Symptoms of Depression
Most people are familiar with some of the symptoms of depression; we all have days when our mood is low. Usually people or events can cheer us up, or after a few days we feel our usual selves again.
Symptoms of depression can include:
--having a very low mood for most of the time
--not being able to be lifted out of your low mood
--not feeling your usual self
--not being able to enjoy anything
--loss of interest in favorite activities
--problems getting off to sleep or waking early
--poor sleeping patterns or sleeplessness
--poor concentration and forgetfulness
--feelings of guilt/burden/blame
--feeling helpless or hopeless
--feeling vulnerable or oversensitive
--feeling close to tears
--irritability
--loss of motivation, unable to start or complete jobs.
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When men become depressed they are more likely to be aware of the physical symptoms rather than the emotional or psychological ones. Women tend to be more aware of the emotional symptoms.
Loss of self-esteem
A PCOS diagnosis can make you feel very vulnerable. You may feel as though you no longer have control over your life. You can feel tired and stressed. Also the physical changes that accompany PCOS often greatly impact they way in which a female sees herself and feels about herself. This can be very difficult to cope with and may cause you to lose some confidence in yourself. This can be hard to cope with, but you may find that your own ways of adapting to your diagnosis of PCOS will give you a new focus and sense of control. However, this can take some time and your confidence and self-esteem will need to be built up again gradually.