Debating Going Back on Metformin

London · 09-09-2006, 11:13 PM

I have been told by two doctors that I am "borderline" PCOS -- all of my numbers look great, never had cysts, etc. I have been hypoT for a while but wasn't dx until early August 2006. I have been on Synthroid (75 mcg) for about 6 weeks and on Day 20 of my cycle with no signs of ovulation...fertility monitor reads low, have had some EWCM but temps are still low.

Would Metformin help, even if the PCOS is borderline? I've tried looking up some stuff on hypoT, Metformin but am coming up with very little. Would love to hear your thoughts!

shenacat · 09-10-2006, 04:23 AM

What do you mean by "borderline"? What labwork was this that showed it?

London · 09-10-2006, 03:45 PM

I am posting what I took to my general practitioner the day I was dx with hypoT - the physician's assistant of course wasn't overly knowledgeable about GYN issues and told me to follow up with my GYN. Well, he's told me he's at the end of his infertility expertise so once I am able I will go to a GYN who specializes in PCOS and fertility issues (waiting on DH new job to start). Our insurance has a high deductible to meet so basically we pay out of pocket (my PCOS dx made it a nightmare to get coverage).

Lab Work
(first is from August 2005, the other from February 2006 - both sets done later in
my cycle, around Day 21)

TSH 3.86 ... 3.12
FT4 .57 ... 1.8
FSH "normal" per doctor ... 3.1
LH n/a ... 17.7
Prolactin 16.7 ... 24
Progesterone ... always low unless I've been on a fertility drug (acupuncture, Chinese
herbs and other natural herbal type things have not touched it)

My FT3 was 319 (normal range on lab report is 230-420 pg/dl). My FT4 was 1 (report range is 0.7-1.9 ng/dl).

Symptoms of PCOS vs. my symptoms:

·Multiple ovarian cysts – No (which I understand are not required for diagnosis)

·Irregular menses – For 3 years since going off the Pill; can be caused by hypoT

·Infertility – Yes, but also can be caused by hypoT

·Acne – Yes, but also can be caused by hypoT

·Obesity/inability to lose weight – I have lost 12-15 lbs. since 2003 and could lose another 10 lbs.; also can be caused by hypoT

·Excessive body or facial hair (hirsutism) – Not present

·Insulin resistance and possibly diabetes – No

·Thinning of scalp hair – No

·Velvety, hyperpigmented skin folds (acanthosis nigricans) – No

·High blood pressure – No

·Polycystic ovaries that are 2-5 times larger than healthy ovaries – No

·Multiple hormone imbalances, commonly including:

oAndrogens (testosterone) – Levels appear to be normal
oCortisol – Never checked per labs that have been run since 2003
oEstrogens – Never checked per labs that have been run since 2003
oFSH (follicle stimulating hormone) – Levels appear to be normal
oInsulin – Does not appear to be an issue; have read that between 10-13 indicates some resistance; my level is a 5.7. Glucose levels great.
oLH (luteinizing hormone) – Levels appear to be normal
oProgesterone – Levels appear to be normal; also can be caused by hypothyroidism since it disrupts ovulation
oProlactin – hard to say, never taken on Day 3 which is the standard
oDHEA – Elevated? Range is 35 - 430 mg/dL. Mine was last checked in August 2005 and was 260 mg/dL
oThyroid hormones – Normal since starting Synthroid

I appreciate any help in decifering all of this. On a good note, I did get a HIGH on my fertility monitor this morning!!! FINALLY

Allison. · 09-10-2006, 05:17 PM

I am not insulin resistant, but Metformin has helped most of my PCOS symptoms. I am having regular menstrual cycles for the first time ever on this medication. Here is a link to help you understand your results:

http://www.inciid.org/faq.php?cat=infertility101&id=2

I hope that it helps you.

London · 09-10-2006, 05:30 PM

Thanks, Allison!

I think I am going to at least call my OBGYN and try to get his thoughts - hopefully he won't make me come in...if that's the case, I'd rather just shell out the money to see the specialist-OBGYN. When I did take Met, though, I never really saw a difference...expcept I felt WORSE due to the s/e (and my stomach has never been the same since taking it).

I was hopeful with the HIGH reading though today so, who knows!?!?!? My gut, I guess, is still saying it's not PCOS but I'm not 100% convinced it isn't.

Sonya

shenacat · 09-10-2006, 06:31 PM

WTH is up with your LH! Normal LH:FSH ratio is 1:1. PCOS has a ratio more like 3:1 or more. Your ratio is like 4.5:1 or something. :o I wouldn't say that's borderline.

Why is the doctor saying you don't have insulin resistance? Did you do a glucose tolerance test and get your insulin levels measured?

London · 09-10-2006, 06:45 PM

Pretty sad when I get MORE help and knowledge from women I've never even met before compared to my own doctorS (note the plural!!).

GLUCOSE
12/03 ~ 69 (fasting)
2/04 ~ 108 (non-fasting)
7/04 ~ 99 (fasting)
8/05 ~ 75 (fasting)
2/06 ~ 74 (fasting)
8/06 ~ 88 (non-fasting)

INSULIN
8/05 ~ 7.6

I read that the PCOS ratio is 2:1 to 3:1 (pre-menopausal women is 1:1). I'm not trying to be dense, but, I based this on my last labs in February 2006 -- LH ~ 17.7 and FSH ~ 3.1 I took 3.1 divided by 17.7 which equaled 5.7 ... meaning, my LH:FSH ratio is 5.7:1? Is this right?

I am Googling up a storm right now, trying to find out some stuff. I have refills left on the Met, guess I should call in a refill?

I really appreciate your help -- you have been amazingly helpful!!!

If so, I do have this damn thing!!!!

London · 09-10-2006, 06:52 PM

I looked back and the only other time my LH & FSH were checked was in 12/03, when I was dx. The ratio then was 3.81:1 It jumped up, wonder why? At that point when it was checked in February, I had not taken Met in over a year.

shenacat · 09-11-2006, 08:09 AM

It no doubt jumped up because you were off the metformin.

A high ratio indicates PCOS, and I would suspect that a HIGHER ratio would mean it was worse. I could be wrong but that's what I've read.

Are those glucose numbers from a Glucose Tolerance Test (where you drink that awful sugary stuff) or just regular finger pokes?

London · 09-11-2006, 03:24 PM

Thanks so much for keeping in touch

My blood levels are from "vein pokes"...I wish just a finger (I have horrible veins so drawing blood is pure hell for me). As soon as I can, I will go see this doctor who is a OBGYN specializing in infertility (esp. PCOS) who will do a full round of bloodwork, I'm sure. I would go today but money is an issue

I did, however, get my Metformin rx refilled so I'm back on that. Hopefully it will help! It's just crazy how I have no other symptoms except for my lab levels...which is how my doctor dx me in the first place (no u/s was done until over a year later after I demanded one).

Did you get pregnant taking thyroid medicine and Metformin? How long did it take? Just trying to gauge what to expect. Again, you've been awesome, thank you so much

shenacat · 09-11-2006, 04:07 PM

Well you need to get a GTT done. Frankly without drinking the sugar crap and THEN getting your blood drawn an hour later, your glucose monitoring is useless. I don't know where your doctor is coming from saying you're borderline without doing the proper testing. Also, while on the metformin, a GTT will tell you nothing except that the drug is working for you.

I started thyroid meds in April 2002 and Metformin in June 2002. I had my first pregnancy in Feb 2003 and miscarried. When I got pregnant again in July 2003 I insisted on a progesterone test and my levels came back dangerously low, so I went on supplementation for the first 12 weeks of pregnancy. That resulted in my son who is now 2.5. This pregnancy my progesterone was also low so I supplemented again.

CRISTINACEC · 09-11-2006, 05:35 PM

Quote:

Originally Posted by London

I am posting what I took to my general practitioner the day I was dx with hypoT - the physician's assistant of course wasn't overly knowledgeable about GYN issues and told me to follow up with my GYN. Well, he's told me he's at the end of his infertility expertise so once I am able I will go to a GYN who specializes in PCOS and fertility issues (waiting on DH new job to start). Our insurance has a high deductible to meet so basically we pay out of pocket (my PCOS dx made it a nightmare to get coverage).

Lab Work
(first is from August 2005, the other from February 2006 - both sets done later in
my cycle, around Day 21)

TSH 3.86 ... 3.12
FT4 .57 ... 1.8
FSH "normal" per doctor ... 3.1
LH n/a ... 17.7
Prolactin 16.7 ... 24
Progesterone ... always low unless I've been on a fertility drug (acupuncture, Chinese
herbs and other natural herbal type things have not touched it)

My FT3 was 319 (normal range on lab report is 230-420 pg/dl). My FT4 was 1 (report range is 0.7-1.9 ng/dl).

Symptoms of PCOS vs. my symptoms:

·Multiple ovarian cysts – No (which I understand are not required for diagnosis)

·Irregular menses – For 3 years since going off the Pill; can be caused by hypoT

·Infertility – Yes, but also can be caused by hypoT

·Acne – Yes, but also can be caused by hypoT

·Obesity/inability to lose weight – I have lost 12-15 lbs. since 2003 and could lose another 10 lbs.; also can be caused by hypoT

·Excessive body or facial hair (hirsutism) – Not present

·Insulin resistance and possibly diabetes – No

·Thinning of scalp hair – No

·Velvety, hyperpigmented skin folds (acanthosis nigricans) – No

·High blood pressure – No

·Polycystic ovaries that are 2-5 times larger than healthy ovaries – No

·Multiple hormone imbalances, commonly including:

oAndrogens (testosterone) – Levels appear to be normal
oCortisol – Never checked per labs that have been run since 2003
oEstrogens – Never checked per labs that have been run since 2003
oFSH (follicle stimulating hormone) – Levels appear to be normal
oInsulin – Does not appear to be an issue; have read that between 10-13 indicates some resistance; my level is a 5.7. Glucose levels great.
oLH (luteinizing hormone) – Levels appear to be normal
oProgesterone – Levels appear to be normal; also can be caused by hypothyroidism since it disrupts ovulation
oProlactin – hard to say, never taken on Day 3 which is the standard
oDHEA – Elevated? Range is 35 - 430 mg/dL. Mine was last checked in August 2005 and was 260 mg/dL
oThyroid hormones – Normal since starting Synthroid

I appreciate any help in decifering all of this. On a good note, I did get a HIGH on my fertility monitor this morning!!! FINALLY

Is your current TSH 3.12 ? your on 75mg of synthroid? I would talk to your doc about putting you on 88mg to bring your tsh down to 1.00. I saw on your charts your temps seemeed a little low. I would try that and see if it makes a difference. I went from 75 to 88 and there is such a difference in how I feel, my temps,my skin is clearing up, my periods went normal and I even o on cd 14 compared to 19 or later, my lh phase of my cycle went from 9-10days to 14days. Its a small amount but can make a big difference.

London · 09-11-2006, 05:39 PM

No, the first number is from August 2005, the other from February 2006. My TSH of 3.12 was earlier this year. After a month on 75mcg of Synthroid, my TSH is at 0.459 The doctor's office told me to stay on 75mcg and to return in 3 months for another blood check. I will go in ONE month; I'm afriad of going hyperT.

CRISTINACEC · 09-11-2006, 06:12 PM

Ok so you only have been on synthriod for a month? I'm shocked they did not start you at 50mg then retest. When I first got put on syntroid back in 04 each month my cycles got better. It took almost 6months till they were normal.