Just FYI, PCOS doesn’t always mean anovulatory.
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Yes, I don’t think I have ever missed ovulation (I have never missed a period)…but I also have never gotten pregnant despite 17 years of sexual activity without any contraception. PCOS is like diabetes, a bit different for everyone. My symptoms were always mild enough to keep me and my doctors from suspecting it. I was only tested for PCOS when I asked my endo about it because of my troubles with weight gain and other symptoms that pointed to it (hairiness, acne, infertility, changes with menstruation, etc.). I also do not know if I have cysts on my ovaries (not everyone with PCOS has cysts) or not since the PCOS was confirmed via hormone tests and we never did a physical exam for cysts. I can confirm that the Metformin and birth control pill have definitely helped with my hairiness, acne, and menstruation issues. I’m told this is because my levels of male hormones are lowered by both medications. But I am still having weight gain and insulin resistance.
You may still be ovulating but not as regularly as without the PCOS. Essentially what happens with this condition is that the developing follicles that are normally ovulated each cycle remain trapped inside the ovary, from time to time or more frequently. After some time, they can swell with fluid and turn into cysts but like you said not everyone gets them. If you occasionaly ovulate you may actually be shedding some of these trapped follicles which would be a good thing. An epidose of bleeding, even in a cyclical pattern, is not proof that you are ovulating. You can have anovulatory cycles that end in estrogen breakthrough bleeding but this is not a true period. The only way to confirm ovulation is by ultrasound or basal temperature charting. What I was trying to say is that ovulations are what you want because they trigger a surge in progesterone. Without it, your hypothalamus continues to try to stimulate the ovary by increasing gonadotropin-releasing hormone. This in turn ups your pituatary production of follicle-stimulating and luteinizing hormone. This is what causes your ovary then to make more estrogen and androgens to again stimulate follicles to be ovuated. But if these follicles fail as is common in PCOS, your cycle becomes dominated by increased estrogen and androgen production without progesterone to oppose. This is where the acne and hairiness can come from. The pill will overrride this but without actually restoring your natural menstrual cycle, and thus your natural progesterone production. I teach sympto-thermal charting and some of my clients with mild PCOS were able to restore their cycles by applying natural progesterone for the two weeks of the latter part of their mostly anovulatory cycles. I just thought you might want to look into it because you are on a lot of meds and this natural progesterone is applied on the skin where it is better absorbed. It would not be a burden on your liver.
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Thank you for the information. I’ve often been a bit concerned that I apparently have had PCOS since puberty but have never really had the major period problems I hear about being so common with PCOS. For me I had always been very regular (always starting on the 27th day) but my periods were always on the lighter side and 3-4 days long. Once in a great while I would have a very heavy period, but not often at all. I never had cramps. But then the past three years my periods got heavier and heavier ( I would be overflowing a heavy pad every hour) and lasted 5-6 days and my cycle shrunk to 25 days. When I started birth control and Metformin my cycle went back up to 27 days and my periods have all but disappeared (barely spotting for 2 days).
I will look into the natural progesterone. I do prefer to treat naturally rather than with pills, etc. when possible.
@Tamra11 given your complex health issues, I would encourage you to see a reproductive endo, if you haven’t already. Hormone imbalances are not something that should be self-treated.
I’m certainly not self-treating or plan on self-treating or ever have self-treated. Everything I am doing is under my endo’s care. I keep in very close contact with her and let her know everything that is going on with me and she keeps tabs on my lab work, symptoms, medications, etc. We discuss everything and make decisions together. She is very aware of all my issues and treatments and does an excellent job at covering all the bases. The only issue at the moment is that there is so much going on that we are having trouble figuring out what’s causing and contributing to my weight problem and insulin resistance. It’s more than likely multiple things. We’re just trying to untangle it all and get to the root and fix it.
However, I have only been treated by my primary, and two endocrinologists (diabetes specialty) regarding my PCOS. I really should ask about seeing a specialist about it. I hadn’t been concerned before because I really thought my PCOS was mild. But now that these two symptoms I thought would be alleviated by treatment for PCOS are not being affected by the treatments, I’m just confused and frustrated.
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You’re caught in a loop of sorts. The more resistant you are to insulin, the more you’ll need to inject. Higher levels of circulating insulin lead to higher levels of androgens, which leads to more resistance. Metformin is anti-androgenic, but it can only do so much. A visit with a good reproductive endo & a referral to a dietician with experience in PCOS might help you find a workable solution. PCOS is a lot like diabetes…there is no one size fits all treatment. I wish you the best of luck on your journey. I know how difficult & frustrating it can be.
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You’ve got so much is going on and you’re working so hard to figure it all out - it sounds really frustrating! Since you have a doctor you trust, and you’re on so many medications, I’d consider consulting with a practitioner with a different perspective, like a Chinese medicine doctor/acupuncturist or naturopathic doctor. They can work to complement what you’re already doing, and may be able to help your body use the medications more effectively as well, with supplements, diet, etc.
I’m not suggesting you stop anything you’re doing now - though I do agree that changing to Novolog or Apridra is worth trying. Sometimes I’ve responded better to one or the other. I wish you best of luck!