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  1. #1
    Registered User BookAddict's Avatar
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    Default Lean Pcos theories?

    I have been researching the cause of lean pcos, because it seems like more often then not in overweight pcos they say it is insulin related. But in lean pcos I find things like "somewhat insulin related" "possibly insulin related" "mildly insulin related" "insulin related in 30% of lean patients".Many studies show that after metformin pcos is greatly improved, but it has also been shown that this is most likely due to the fact that metformin increases aromatase activity.

    So is it an insulin problem we have? or an aromatase problem? or does one fuel the other? or maybe a bit of both?

    aromatase is what helps convert androgens into estrogens. It is said even if our testosterone is in the normal range, because we are thin our androgen : estrogen ratio is off because aromatase is found in adipose tissue , and us being thin means less aromatase. Which means less androgens are being converted into estrogens. Which means our ratios are altered.

    But if this were true then could we not increase aromatase activity and become more "normal"?

    I know some herbal things increase aromatase activity. Green tea is one of them and I know green tea has been found to help decrease testosterone in pcos. I guess I am just thinking out loud. I do not like metformin just because it can be hard on our liver/kidneys, and it doesnt seem great long term (for people who might not need it I mean). Not only that but I feel like something is missing for us. I mean, many of us arent IR at all. Many of us take met and find it doesnt help much. Many of us have normal insulin results, normal blood glucose, normal testosterone levels.

    Any thoughts ?

    I think its a pretty valid theory.
    Me (26) DH(31) DS(4) 123 lbs 5'6 Oily Skin, Acne, Irregular periods, Thinning hair
    MTHFR, PCOS (although I think AAE is more fitting)
    Currently taking
    100 mg Aldactone, Diane -35, Retin-A
    Tests before pregnancy and breastfeeding revealed:
    DHEAS (335) Testosterone (85) LH:FSH 1:1 (it has been higher previously) Fasting insulin 7.5
    Tests done 06/23/2010-LH 11.2 FSH 4.7
    Tests done Sept 2010-All normal!
    Tests April 2013-Low everything? Not normal. I

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  3. #2
    Registered User krissy12's Avatar
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    I completely agree with you BookAddict!!!!!

    It isn't adding up & there does seem to be a missing link. It seems that aromatase expression may player a bigger role than what is currently believed. Hopefully at some point it will be researched further in the medical community.

    I'm glad to hear that green tea increases activity. I had done a search on that awhile back and the only thing that I could find that directly increases aromatase is alcohol and metformin. Most information on the internet focuses on estrogen dominance and aromatase inhibitors.

    It's no wonder my symptoms didn't surface in my 20's......I was either on the pill or hitting up happy hours!!

    Anyway, I'll keep an eye out for any additional information I come across re: aromatase. In the meantime, ground flaxseed is here to stay!

    Krissy

  4. #3
    Registered User naygirl's Avatar
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    BookAddict...that makes so much sense! All the reasearch i've read has all the info scattered all over the place, that it is so hard to make any connections between the different theories. And especially for us thin cysters because there is so little research out there on how our bodies are working in comaprison to the typical pcos woman.

    In my personal experience, my symptoms seem to worsen when I loose weight, so I have to be very careful when I diet, not to lower my fat intake. Never understod that before, but now it makes total sense. Thanks for making some of those connections. I'll have to focus my research on increasing aromatase activity.

    Btw, bookaddict, I noticed from your sig, that you use spearmint tea? Can I ask you how you take it, which days of your cycle, and also, has it affected the length of your cycles? It seems to be helping some of my symptoms but it has lengthened my cycles , and if I don't take it my symptoms are amplified.
    Last edited by naygirl; 04-30-2011 at 04:32 PM.

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    Registered User BookAddict's Avatar
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    I only take the spearmint tea for 5 days in the follicular phase, once a day. Maybe CD2-7 or something. My cycle seems of normal length so I dont think it affected it much, although I think that if you take it throughout your whole cycle it can be a problem
    Me (26) DH(31) DS(4) 123 lbs 5'6 Oily Skin, Acne, Irregular periods, Thinning hair
    MTHFR, PCOS (although I think AAE is more fitting)
    Currently taking
    100 mg Aldactone, Diane -35, Retin-A
    Tests before pregnancy and breastfeeding revealed:
    DHEAS (335) Testosterone (85) LH:FSH 1:1 (it has been higher previously) Fasting insulin 7.5
    Tests done 06/23/2010-LH 11.2 FSH 4.7
    Tests done Sept 2010-All normal!
    Tests April 2013-Low everything? Not normal. I

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    Super Moderator Pnksunflrws4ever's Avatar
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    Hey ladies... I'm so lost in this conversation. Is there any good website you can give me to start understanding what you're talking about. I'd love to learn more and comprehend.

  7. #6
    Registered User naygirl's Avatar
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    Quote Originally Posted by Pnksunflrws4ever View Post
    Hey ladies... I'm so lost in this conversation. Is there any good website you can give me to start understanding what you're talking about. I'd love to learn more and comprehend.

    Hi pnksunflrws4ever, I have found that jarret fertility group presents this topic and a very thorough, yet somewhat comprehendable way. Below is a link you can check out. There is a section specifically devoted to lean pcos. It is a good place to start, and then you can then search for articles or studies in relation to lean pcos. Hope this helps.

    http://www.jarretfertility.com/PCOS%...%20handout.pdf

  8. #7
    Registered User naygirl's Avatar
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    sorry, for some reason the link didnt work, but if you go to jarretfertility.com and click pcos on the left, you will see a long article on it. Then find the pdf file they have a link to on this page.

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    Registered User linds2729's Avatar
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    I am interested in knowing more about lean pcos also. I've wondered if metformin would help, but I am hesitant to try it. I already have IBS so the stomach issues don't sound fun to me at all. My doctors seem to submit that if your cycle is longer than 40 or so days, you are probably not ovulating. I've never been able to tell if/when I am. However, I've conceived twice around cycle day 35 (one time one Femara, and one time not) which would make my cycle about 50 days or so. Before this, I was assuming I wasn't ovulating if I didn't get a period by then...so I wonder if that is the case with any other thin cysters as well? Although, BookAddict said yours is normal length.
    Age: Me (29), DH (32)
    Height/Weight: 5'8"/126 lbs
    Meds: Proverra and Clomid for 3 cycles, then Prometrium and Femara for 2 cycles
    TTC'd #1 since 10/07 , BFP in 04/09 after Femara, but way late in cycle.
    DS born on 12/12/09
    TTC #2 now
    BFP on 1/17/10 w/out meds ended in M/C on 3/9/11

  10. #9
    Registered User anoushka's Avatar
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    Hi book addict thats a very nice summary. I think the part of the puzzle thats missing is what exactly is what causes the androgen excess in the first place. This could happen with any of the hormones in the hypothalamic -pituitary-ovarian axis as well as their receptors. From what I'm reading it seems to be that the specific type of PCOS one has is more important than simply lean or obese PCOS. Thus a thin woman with classic PCOS is likley to have more in common with an obese woman with classic pcos than a thin woman who has pcos that involves regular cycles and excess androgens. Of course this still doesnt tell us what exactly causes PCOS.

    Look up Rotterdam/ESHRE criteria and Androgen Excess society....
    113lbs, 5' 2"
    Mildly elevated testosterone and not IR
    Started Metformin in July, 2011.

  11. #10
    Registered User BookAddict's Avatar
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    Mines about 30 days and I know I O so I consider mine normal length. But mine was not always that way. For a long time I would have cycles that were 45ish days.

    I dont remember which specific sits I looked at tofind this info. Like the previous posters have said, the jerrett fertility one in the lean pcos section states that lean pcos is probably not due to IR, but that metformin still helps because it increases the aromatase activity. If you wikipedia aromatase it will say that aromatase converts androgens to estrogens and that it is located in adipose tissue. If you google aromatase green tea you may find links showing the green tea lowers the aromatase. I dont have time right now, but later on tonight I will try to find some of these links and add them to the thread and maybe to the first post too (:
    Me (26) DH(31) DS(4) 123 lbs 5'6 Oily Skin, Acne, Irregular periods, Thinning hair
    MTHFR, PCOS (although I think AAE is more fitting)
    Currently taking
    100 mg Aldactone, Diane -35, Retin-A
    Tests before pregnancy and breastfeeding revealed:
    DHEAS (335) Testosterone (85) LH:FSH 1:1 (it has been higher previously) Fasting insulin 7.5
    Tests done 06/23/2010-LH 11.2 FSH 4.7
    Tests done Sept 2010-All normal!
    Tests April 2013-Low everything? Not normal. I

  12. #11
    Registered User BookAddict's Avatar
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    I found a couple intersting links, I copied and pasted some of the relevant text from each site. I know one of the sites is more catered to overweight pcos, so I just copied and pasted the relevant quote because it ends up talking about how we have excess estrogens because of all of our adipose tissue (And that part is referring to overweight pcos). I was looking up the green tea increasing aromatase activity and it seems like there are conflicting thoughts, the main chemical in green tea seems to be good for us but the rest of the green tea actually does the opposite, I will have to research that more later or just buy a supplement for it.


    http://www.jarrettfertility.com/PCOS...%20handout.pdf
    Dr. Baillargeon was the first to demonstrate that glucophage was of value in treating thin women with PCOS. 90% of her
    patients ovulated after treatment with glucophage. Thin women must be cautioned about weight loss with glucophage, as this is not the goal in this group. As noted earlier, we know that glucophage works in this group because of the increase in the activity of aromatase, with the resulting increase in estrogens and decrease in androgens in other words, correction of the androgen/estrogen ratio.


    http://toxsci.oxfordjournals.org/content/82/1/70.full
    The natural flavone quercetin and isoflavone genistein induced aromatase activity 4- and 2.5-fold induction, respectively, at 10 μM.
    In the present study, quercetin was found to be a relatively potent and efficacious inducer of aromatase activity in H295R cells, followed by genistein, as also shown previously (Sanderson et al., 2002), and flavone.
    ****I have found that some studies say the opposite?****

    http://www.eje-online.org/cgi/content/full/158/6/861
    women with congenital aromatase deficiency, caused by loss-of-function mutations of CYP19 gene, develop the features of PCOS phenotype
    The follicular cysts in the ovaries of PCOS women do not mature fully. Granulosa cells in these arrested follicles are few in number and are virtually devoid of aromatase activity

    http://herkules.oulu.fi/isbn9514264266/html/x482.html
    However, aromatase activity in granulosa cells in the PCOS follicle is very low which results in a higher androgen to estrogen ratio and follicular arrest. These findings have led to the hypothesis that locally active inhibitors of IGFs or FSH, most likely insulin-like growth factor binding proteins (IGFBPs), in small antral PCOS follicles block stimulation of aromatase

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198730/
    Immature follicles are deficient in aromatase, the enzyme that produces estrogen in the ovary by converting it from its precursor, testosterone
    Me (26) DH(31) DS(4) 123 lbs 5'6 Oily Skin, Acne, Irregular periods, Thinning hair
    MTHFR, PCOS (although I think AAE is more fitting)
    Currently taking
    100 mg Aldactone, Diane -35, Retin-A
    Tests before pregnancy and breastfeeding revealed:
    DHEAS (335) Testosterone (85) LH:FSH 1:1 (it has been higher previously) Fasting insulin 7.5
    Tests done 06/23/2010-LH 11.2 FSH 4.7
    Tests done Sept 2010-All normal!
    Tests April 2013-Low everything? Not normal. I

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  14. #12
    Registered User anoushka's Avatar
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    Oohh thanks Boodaddict... The CYP19 gene and the local aromatase difciency studies sound very interesting. I am going to look them up. Have you come across anything that looks at the role of exercise on aromatase activity?

    I've been having the Tazo Zen tea - green tea+ spearmint and I dont think its really doing anything. It cleared up my skin a bit though.
    113lbs, 5' 2"
    Mildly elevated testosterone and not IR
    Started Metformin in July, 2011.

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    Registered User anoushka's Avatar
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    Hi this maybe of interest to you ladies. I found other studies that suggest that AMH correlates with ovarian volume and follicle number on the ultrasound and may be predicitive of who is clomid resistant and more likely to respond to metformin.


    Am J Physiol Endocrinol Metab. 2009 Feb;296(2):E238-43. Epub 2008 Oct 28.
    Anti-Mullerian hormone levels reflect severity of PCOS but are negatively influenced by obesity: relationship with increased luteinizing hormone levels.

    Piouka A, Farmakiotis D, Katsikis I, Macut D, Gerou S, Panidis D.
    Source

    Division of Endocrinology and Human Reproduction, 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54622 Thessaloniki, Greece.
    113lbs, 5' 2"
    Mildly elevated testosterone and not IR
    Started Metformin in July, 2011.

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  17. #14
    Registered User pcos.rm's Avatar
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    wow!! great info all you ladies.. at my first appt with my RE, he did an u/s and a couple of blood work tests that also included AMH test. he said it might take 2-3 weeks for the result to be back coz they don't do that one locally. But he was trying to explain me how it was related to me being thin and still have classic PCO symptoms. I'll look into more when I get some time tonight.. nice place to start with..
    and yes, my testosterone levels were nearing border line and my LH levels are always elevated. So he put me on metformin for this first month and monitor to see if/how I respond to it...
    Thanks gals!

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    Registered User BookAddict's Avatar
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    What I read about green tea seems to say its bad for us (which sucks because I drink it everyday). Apparently it increases testosterone?
    Me (26) DH(31) DS(4) 123 lbs 5'6 Oily Skin, Acne, Irregular periods, Thinning hair
    MTHFR, PCOS (although I think AAE is more fitting)
    Currently taking
    100 mg Aldactone, Diane -35, Retin-A
    Tests before pregnancy and breastfeeding revealed:
    DHEAS (335) Testosterone (85) LH:FSH 1:1 (it has been higher previously) Fasting insulin 7.5
    Tests done 06/23/2010-LH 11.2 FSH 4.7
    Tests done Sept 2010-All normal!
    Tests April 2013-Low everything? Not normal. I

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