PCOS & Weight Gain

Just what is it about PCOS that makes weight loss seem virtually impossible? If you’re a woman suffering with Polycystic Ovarian Syndrome you’ll know just how infuriating weight control is (or perhaps the lack of it). It is frustratingly easy to gain weight and equally frustrating to lose it. Such weight issues unfortunately come hand in hand with PCOS, along with skin and hair troubles, which are inevitably all factors that can make us feel ugly and insecure.

So what’s different in our bodies that makes ‘losing weight’ such an illusion …and, more importantly, how can we make it a reality?

#1. The Role of Insulin in PCOS

The most influential factor that makes this whole losing weight malarkey so impossible for women with PCOS is the defective role of Insulin.

Insulin is the all important hormone in our bodies that’s responsible for metabolizing glucose or dealing with sugar in our blood stream. It transports sugar to the muscles and if the body has more glucose than is needed then it is stored as fat should we need it later (1). Women with PCOS are proven to have some kind of dysfunction in the cells responsible for secreting insulin (our Beta cells). These cells are responsible for detecting sugar in the blood stream and seemingly overreact, producing more insulin than what’s needed. This means that more glucose is stored as -you guessed it- fat. Women with PCOS are also known to have insulin resistance, meaning that your body needs more insulin than normal to deal with sugar in your blood stream. High levels of insulin cause your body to store more fat and also causes your ovaries to make more testosterone, making the symptoms of PCOS worse.

#2. Appetite Control

Women with PCOS do not feel as full after meals as women who don’t have PCOS, research has proven. There are a number of hormones involved with hunger and appetite control including cholecystokinin, ghrelin, and leptin. (7). When such hormones are impaired it can lead to cravings of sugar, binge eating and ultimately obesity. This means that women with PCOS will continue to feel hungry, even if they have eaten all of the nutrients and calories they require.

#3. Sluggish Metabolism

Basal metabolic rate is the number of calories you need, daily, to function including keeping your organs working, digesting food, staying alive etc. Women without PCOS needed roughly 1800 calories per day whilst women with PCOS only needed around 1400 calories per day, and those with insulin resistance needed even less. What does this mean? That women with PCOS, women dealing with all these other issues and feeling constantly hungry, don’t need as many calories per day as the average women? Doesn’t seem very fair, does it?

So what can be done to help us control our weight better? Here’s how I do it:

  1. Eat smaller meals but more often. This helps in two ways; it encourages our metabolism to get a move on by eating more frequently, and it also helps us psychologically as we will subconsciously feel fuller as we have eaten more meals, albeit they will be smaller in size. This reduces the chances of snacking.
  2. Eat a low glycemic index diet. Some foods are converted to glucose at a slow and steady rate that encourages healthy insulin and blood sugar levels. These are called low glycemic index, or low GI, foods. Diets made up of low GI foods has been proven to improve weight loss in women with PCOS, probably because it improves insulin levels while lowering blood glucose. Such foods would be whole grains, vegetables, and fruits, all low GI, rather than processed foods and simple sugars.
  3. Choose resistant starches for carbs. Not all carbs, or even all starches, are created equal. The starch present in many plant foods such as beans, potatoes, and bananas is a type called resistant starch.Resistant starch has been found to lower insulin levels by up to 50% in overweight people, making it a valuable tool in the battle to lose weight while living with PCOS. Choose these foods over more processed starches when you are having carb cravings, as they will give you the energy boost of a starch while helping to fight insulin resistance.
  4. Give up soft drinks and other liquid calories. Soft drinks and other sweet drinks are cram packed with sugar, which can worsen insulin resistance. This makes it harder to lose weight over the long-term, so swap it for water instead. Yes this can get boring but there are lots of ways to make your water more enjoyable. Scroll to the bottom of  this blog post to find out how: Drink More Water
  5. Excercise. Seems fairly obvious but it’s imperative.
    And I don’t mean go for a run or go to the gym, I mean be active as much as you can. Low to moderate impact exercise is actually best for people who are just beginning a weight loss journey. Walking, taking the stairs, swimming, all help you get fit without over-exerting yourself. Mild exercise will lower insulin resistance if you participate in it everyday, even when it does not lead to weight loss. As you get in better shape, you can slowly add more time or switch to more strenuous activity.

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Losing weight is important in managing our symptoms but boy it isn’t an easy road. It’s not through lack of trying and it’s not all in your head. I know personally that the struggle is real. But, it’s a struggle shared by thousands of women who also have PCOS. As long as you try your best to manage your symptoms the best you can, make some simple lifestyle changes as explained above (and there’s plenty more tips if you read more about it) then believe me, you will take control.

 

 


PCOS & Fertility

Women with polycystic ovaries and fertility problems:

  1. Do not release an egg (ovulate) regularly
  2. Have ovaries that contain many small cystic structures, about 2-9 mm in diameter

How does normal ovulation work?

In a normal menstrual cycle with ovulation, a mature follicle – which is also a cystic structure – develops. The size of a mature follicle that is ready to ovulate is about 18 to 28mm in diameter. About 14 days after ovulation the woman would be expected to get a period if she is not pregnant. The key difference between polycystic and normal ovaries is that although the polycystic ovaries contain many small antral follicles (also referred to as resting follicles) with eggs in them, the follicles do not develop and mature properly – so there is no ovulation. This is why women with polycystic ovaries don’t ovulate regularly, hence one of the syptoms of PCOS is irregular periods.

Can women with PCOS conceive?

The good news is that the chance of getting pregnant with polycystic ovarian syndrome using fertility treatment is increasing by the year due to new treatments and drugs being discovered which can aid ovulation. The real question for women under the age of 35 with PCOS, is not so much ‘will treatment help me?’ but rather ‘which treatment will work best for me?’

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Treatment options:

  • Clomid (clomiphene citrate or Serophene) is an oral medication that is commonly used for the treatment of infertility.
  • Femara (generic name is letrozole) is also an oral drug which can be an effective fertility treatment for women with ovulation problems, or for those with unexplained infertility. This medication is in a class of drug called aromatase inhibitors. Femara has also been used to treat certain cases of breast cancer.
  • Injectable Gonadotropins: these are the next option when oral medications, such as clomid and femara fail to result in pregnancy. However, because there’s a substantial risk for multiple births (of triplets and higher) injectables for PCOS are being used less often.
  • Metaformin is a relatively new method of treating women with PCOS. Like Clomid and Femara it’s an oral medication which has, until now, been traditionally used to help control diabetes. Then, it was figured out that metformin could be very effective way of treating polycystic ovarian syndrome. If it does not work alone, it’s commonly combined with Clomid to induce ovulation.
  • Lastly there’s In Vitro Fertilization (IVF) which many of us have heard of. The large majority of women with PCOS that didn’t get pregnant with other treatments will be able to get pregnant and have a baby with IVF.

PCOS & Acne

This time last year I’d be waking up every morning to a reflection in the mirror that I hated. All I could see were deep, painful, fiery breakouts all over my face. At the time I blamed it on the stress of the final months of Uni but unbeknown to me it was much more serious than that. I now know that this ugliness that I would look at in the mirror, that I would try to cover up, that I would cry about, that would prevent me from attending lectures …was not a just a breakout.

After missing an entire week of Uni, two shifts in work and having not left the house in eight days, my mum was, understandably, becoming more and more worried. “I’ve made you a Dr’s appointment Ann, we’ve got to get to the bottom of this” she told me one morning from the other side of my bedroom door. As mothers often are-she was right. Whatever this was, this red mass of painfulness on my face, had changed my whole appearance, was affecting my social life, getting in the way of my education and stopping me from going to work.”It’s in half an hour so hurry up and make our way down there” she tells me as I hunt for my foundation that I haven’t used in what feels like forever. As I found my tube of false hope I caught a glimpse of myself in my dressing table mirror. I realised then how bad it was. I realised then that my Dr needed to see how bad it was.

I couldn’t bear the thought of leaving the house with my red inflamed skin exposed for the world to see… but I had to. I got my shoes on, wrapped my scarf around my neck and up over my chin, pulled my hood up and left. Walking five minutes around the corner to the Doctors surgery, bare-faced, was the most agonising thing. Well, the second most agonising thing. The first would be having to talk to the receptionist and then having to sit in the waiting area with dozens of unfamiliar eyes staring my way. But boy was it worth it. In just thirty minutes I was speedily walking home, prescription bag in hand, within which contained some actual hope to get this thing under control.

Cystic Acne. That’s what it was. Unlike normal acne, which occurs due to the hormonal change in puberty, Cystic acne is caused by hormonal imbalances which are a result of having  Polycystic Ovarian Syndrome. It can be painful, it can occur well after puberty and it can be seriously emotionally distressing due to its severity in the way in which it basically takes over your face .

After my appointment with my Dr I started my course of antibiotics. I was prescribed a drug called Tetracyline (Tetralysal) an oral medication to help fight my cystic acne. It’s a fairly common first step to prescribe a type of antibiotics, then it can be monitored by ‘less of this’ and ‘more of that’ which I’ll talk about in a bit.

These photos were taken four days after I made that terrifying trip to the doctors. I couldn’t believe it- my face was getting better.

Low and behold, in one week my skin transformed. It went from the first two pictures, to the ones above, to, well, this….

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It’s been a rollercoaster. I have had a few breakouts since, three maybe, in fact my first one after these photos were taken was about a month after. I called my Doctor and I was given a repeat prescription of the same antibiotics as before and, as expected, they worked. Then, a few months after that I had another breakout. This time, I was told to try a topical antibiotic called Duac. My Doctor informed me that like with any antibiotic, the more I use Tetralysal, the less effective it will be as my body will eventually become immune to the drug. With Duac, a cream, I can use a tiny bit every now and then on the affected area and let it do its work over-night.

Now that I very rarely get bad skin (and when I do I use my Duac cream) I make sure I look after it as best as I can to ensure it stays acne free.

Here’s some simple tips to remember how to prolong your clear clear:

  • No scrubbing your face with exfoliators containing microbeads and harsh chemicals.
  • Drink lots of water! Check out my blog post about the benefits of staying hydrated: FIVE REASONS TO DRINK MORE WATER
  • Use alcohol free face wipes or micellar water and a soft flannel to remove makeup.
  • Use a fragrance-free calming moisturiser before bed and before applying makeup.

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Disclaimer: This blog is based on my own personal experience with Hormonal/Cystic Acne. This is to act as a reflection, not a means of expert opinion or advice, If you have acne of any kind and want to get to the bottom of it, like I did, it’s best to just make an appointment with your local GP as they’ll be the one’s who’ll know exactly how to deal with it 🙂

 

 


Myths about PCOS

As you might imagine, it’s very frustrating for anyone who is affected by PCOS. As prevalent as it may be, it’s also quite misunderstood. I’m the one sat here with a sticky note on my forehead saying “I have PCOS” and I’m reading things online about it that are downright myths. I’ve read so much over the years, trying to find out a little bit more about my condition, and I’m always left feeling confused or frustrated. There’s statements and uneducated assumptions on these forums and websites that don’t quite add up or make sense to me personally when I think about myself and what I have to deal with.  There’s a lot out there to do with PCOS and a lot is far from the truth.

Let’s start with myth number one being that polycystic ovarian syndrome is a sorrowful, awful, life changing condition affecting women in their 30’s or older. No. It’s not all that life changing. It’s not fun but it’s not dreadful. It actually affects between 5-10% of all women aged between ages 18-44. That makes it an unfortunately fairly common condition.

Myth number two is that surgery is the only option to treat PCOS. While for some women this may be the case, it isn’t always the best way to treat PCOS and there’s actually loads of diet and lifestyle changes that can help grab your PCOS by the horns. (Read my blog ‘Controlling PCOS’)

Myth number three is that ‘Women with PCOS can’t have children’ – a misconception I cannot stand. Undeniably, fertility problems may be present such as irregular and/or painful periods and it may take longer to conceive but, here’s a thought:  if PCOS is hereditary then women with PCOS evidently can have children…. or it couldn’t be passed on? Right? Right.

You might also be surprised to learn that cysts don’t always have to be present for a diagnosis of PCOS. Myth number four, in my case, doesn’t apply as having cysts were the main feature of my diagnosis. However, women can often be diagnosed after seeing the doctor about period pain, excessive hair growth, irregular mentruation, or having detected that the ovaries are different sizes or enlarged using an ultra sound.

Myth number five is that women with PCOS are obese.Well, I’m a size 8 and my Nan, who also had the condition (who also had five children), was only ever chubby when she became a Nan and needed to be for cuddle purposes. Win.

Lastly, while the belief that there is no cure for PCOS isn’t really a myth, the fact is, there are many treatments and changes that you can make that will make a difference when it comes to this frustrating, supressing condition.


What is PCOS?

I was about 15 when the nurses told me what was wrong. I’d had some scans done at the hospital after a Dr’s appointment left me with some unanswered questions regarding why my periods were so irregular. After seeing some abnormalities (cysts) on my ovaries combined with the other symtoms such as a low mood and painful periods when, once in a blue moon, I’d have one, the nurses concluded what it was. Polycystic Ovarian Syndrome, or PCOS for short.

In a nutshell:

  • PCOS affects 5-10% of women worldwide.
  • The syndrome is present throughout a woman’s life.
  • Women with PCOS have to tackle an array of health issues such as irregular menstruation, infertility, depression, acne and anxiety.
  • Two out of the three features must be detected in order to be diagnosed with PCOS: Oligo (anovulation) Hyperandrogenism (clinical or biochemical) and Polycystic Ovaries visible on an ultra sound.
  • PCOS has three well-known traits; obesity, fertility issues, and hair/skin problems. Most women with PCOS have a combination of symptoms. For example, you may have irregular menstruation and bad skin but be slim, or you could have cysts on the ovaries, weight problems but not hirsutism (unusual hair growth).

Understanding PCOS :

PCOS causes a disruption in a woman’s normal hormone cycles. Hormone production by the ovaries becomes out of balance, producing higher than normal amounts of androgens (the male sex hormone). This can cause acne, weight gain, and excess body and facial hair but thinning of hair on the head. That said, physical changes are not the only concern with PCOS. Unbalanced hormones can make it more difficult to have children because ovulation may stop. Underdeveloped eggs in the ovaries lead to the formation of cysts. Women who do get pregnant may have in increased risk of miscarriage. In most cases, the first symptoms of PCOS are the physical ones – and I truly empathise because affected women can feel less beautiful due to the shifts in her weight and overall appearance. Other unpleasant symptoms can include heavy periods or no periods at all, pelvic pain, and a decrease in breast size. Depression is also a common problem in women with PCOS.

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So ok, I’ll have this condition for the rest of my life and yes, certain elements of it really suck, but it isn’t all as bad as it seems. There are ways to take control of the symtoms, loads of information online and the fertility treatments out there that are constantly being researched and made even better. If you have PCOS or are just interested in learning more about it then check out some of my other posts in this category.