Interesting opinion on thin PCOSers and IR

pcc10012 · 11-14-2002, 02:03 PM

Last night I went to a chapter meeting of a PCOS group in NYC. There was an endocrinologist speaking there who specialized in PCOS and had participated in several pioneering studies. He has researched PCOS for the last twenty years, I believe.

He said that in his opinion, thin women with PCOS were very unlikely to be IR. He didn't think glucophage was necessarily a good option for them. He said (as many of us have noted before) that the testing typically done to evaluate IR (fasting glucose blood test and GTT) are very inaccurate. He conducted more accurate research on test subjects by injecting them with glucose through IV and monitoring them hourly, and he concludes that thin women have very little problem with IR.

He did say, however, that for thin women who are TTC, it does not hurt for an RE to prescribe glucophage. It's a relatively inexpensive, non-invasive first line of treatment that could help a little.

I found this very interesting, because I have been on glucophage for over 3 months now and have not gotten AF on my own and it did not help with my last clomid cycle. I have not lost weight on it (in fact gained a couple of pounds because it makes me hungrier). The only change I've noticed is a decline in excess hair growth.

About the hair--this doctor said that women with PCOS should avoid BCPs that contain androgens, like the Tri-Phasil ones, because they make it worse. Well, those were the pills I was on for a decade! I had no idea about PCOS at the time. Now that I have been off those pills for a year now, I wonder if that has as much to do with the decline in hair growth as the glucophage.

Anyway, I know there are lots of different opinions on the IR issue, but I just wanted to share this because I found it interesting.

pc

cliner71 · 11-14-2002, 03:36 PM

As a 5'4", 104 lb woman who is on metformin because she tested IR, I disagree with his conclusion that thin=not IR!

After being on glucophage for 6+ months, and eating a low-er carb diet, my cycles are now 30 days long. Before the IR dx and the glucophage, my cycles were 46 days on average. This has happened without any fertility meds at all. My conclusion is that glucophage was essential for me, therefore IR must be the problem!

JulieC · 11-15-2002, 03:19 PM

It is interesting. I still don't have a definiate diagnosis (*growl*), but I did talk the doctor into prescribing glucophage for me this morning despite the lab results coming back non-IR. Hmmm, I still want to try this glucophage thing, but it's good food for thought, thanks for sharing!

Chrissy · 11-15-2002, 05:02 PM

Thanks for sharing this informationl My doctor seems to have the same opinion as the speaker. I do take Alesse however and it hasn't seemed too androgenic for me yet even though it contains levenorgestrel. It does still keep my free testosterone low and makes me have AF. It seems my only option other than PRovera.
CHrissy

Oana · 11-19-2002, 12:27 PM

pc, while I agree with avoiding the tri-phase bcp, I don't believe the non-IR labeling of all thin cysters; it is true however that the IR in obese cysters can be compounded by the extra weight, and sometimes IR is the only cause of their PCOS. While, for thin cysters there may be other pituitary-hypothalamic genetic disfunction at work. But this doesn't mean that there is no IR component, at least for some of us.
Also testing for IR is just as accurate (or inaccurate) for thin cysters as it is for overweight ones.
I do believe however that, given what I said above about the PCOS causes, overweight cysters may have better response to insulin sensitizers than thin cysters may (or rather, more among the overweight cysters will have a good response to insulin sensitizers in terms of menstrual regulation, than anong the thin ones).

Thanks for sharing this,
Oana

Lublu · 12-06-2002, 10:11 PM

I'm 5'4", 126 lbs....and IR. My endo who specializes in pco said thin women with pco can still be IR, but the incidence can be lower. He said also some docs miss the pco diagnosis if a woman is thin because you can't be thin and have pco. I actually had a well known OB tell me this. he sadi I was too thin to have IR or pco. I just laughed.

packerfan · 12-09-2002, 12:45 AM

I too was almost a missed diagnosis. I had done an internet search about facial hair causes and PCOS came up. I read on and when I went in for my yearly exam asked if I could have this. My nurse practitioner thought no since I was not overweight. I had very irregular periods, mild acne and some facial hair. We did the test anyway and sure enough PCOS. I was never tested for IR but started on metformin and 6 weeks later----Pregnant!!

I believe in metformin needless to say and really believe it is the reason I am pregnant.

Kittycat · 12-19-2002, 07:01 PM

Im 5'2, 115 lbs and have been taking metformin 2000 mg a day for 6 months. So far I haven't had a voluntary visit from AF and the met didn't help me repond to clomid either. I guess that would conclude that I'm not IR but I don't think that and here's the reason. Last year I participated in a clinical trial for the then new drug for PCOS, INS1. INS1 was a substance that is naturally found in fruits and vegetables and the body makes it as well. This substance actually works at the cellular level to bring sugar into the cells via the insulin. (It is an insulin receptor in the body). Therefore, INS1 is an insulin sensitizer, but it works in a much more natural way than met and has no side effects or toxicity. It was a 9 month study and for the first 3 months I was sure I was either on placebo pills or the drug didn't work. Then, AF started coming. She showed up every 30 days for the next 6 months. As soon as the study was over and I stopped taking the INS1 my cycles abruptly stopped and I didn't have another one for another year. (I usually get one period per year, sometimes only one per every two years). SO this is my conclusion. I believe that we all have an insulin/blood sugar problem, probably at the cellular level, that hasn't yet been fully realized or understood. The makers of metformin are still unsure of how it works. They know it works in the liver and it's theorized to work in some way at the cellular level. It may be that metformin helps the mechanism by which we're having trouble, but it may not help enough for some of us. (I think there's another component.)

D Chiro Inositol (The ingredient in INS1) is found in every living thing. In people, it's absolutely vital for normal glucose uptake. Researchers have been doing studies and took blood levels of DCI in diabetics and normal people. It was found that diabetics and women with PCOS had very little DCI in their systems and normal people had plenty. They theorized that we either don't make enough DCI or excrete too much of it. Theyve found that supplementing with it can help. They're known about this for over 20 years and are just noiw getting to where it will hopefully be made available to us (See my post in Alternative Remedies). Anyway, I think that is a big part of the problem.

Even though the met hasn't brought on cycles for me, it has helped alot with the hair growth. I do feel better than I did without it, too. I used to be hypoglycemic and now I'm not.