Polycystic Ovary Syndrome (PCOS)

Question about diagnosing PCOS

Question:

I have had irregular periods for most of my life.  Within the last 5 years, I have also gained about 125 pounds.  Based on these two facts alone, my new OB/GYN has decided that I have PCOS.  I have *none* of the other symptoms and the little bit of blood work that my GP did showed that my estrogen is extremely low…not elevated. Am I wrong to think I should seek another opinion?  Or is the anovulation and weight gain enough in and of itself to make this diagnosis?  My Gynecologist doesn’t see any reason to do "thousands of dollars worth of hormone tests" to prove what she "already knows." Thanks for any help you can give me. Beverly

Response:

HI there, As far as I knew, its the testosterone that is high, and the cysts on the overies etc, and you need a vaginal ultrasound for that….it never hurts to get another opinion. Hope all goes well Fiona – Hide quoted text — Show quoted text -beve…@neHtusa1.net wrote in message <372264CF.5F173…@netusa1.net>… >I have had irregular periods for most of my life.  Within the last 5 >years, I have also gained about 125 pounds.  Based on these two facts >alone, my new OB/GYN has decided that I have PCOS.  I have *none* of the >other symptoms and the little bit of blood work that my GP did showed >that my estrogen is extremely low…not elevated. >Am I wrong to think I should seek another opinion?  Or is the >anovulation and weight gain enough in and of itself to make this >diagnosis?  My Gynecologist doesn’t see any reason to do "thousands of >dollars worth of hormone tests" to prove what she "already knows." >Thanks for any help you can give me. >Beverly

Response:

In article <7ftp0c$29…@the-fly.zip.com.au>,   "fiona" <f…@zip.com.au> wrote: > HI there, > As far as I knew, its the testosterone that is high, and the cysts on the > overies etc, and you need a vaginal ultrasound for that….

I have read and been told by doctors that they no longer consider PCOS and ovarian cysts to be directly linked.  You can have PCOS and not have cysts, and you can have ovarian cysts and not have PCOS.  They’re probably going to start using a new name, although I’m sure the old one will be sticking around for quite a while. It seems to be a toss-up right now, between docs who look at the overall set of symptoms and say "this fits the profile for PCOS more than it fits anything else," and docs who believe that the link to insulin resistance is cut-and-dried *the* definition of PCOS now, and confirm a diagnosis based on blood testing for that. When I had the ultrasound, they said that my ovaries *weren’t* cystic, but that even with PCOS with cysts, they come and go, so my not having them then doesn’t mean I don’t ever have them.  They also never did the fasting insulin-to-glucose ratio that’s supposed to indicate insulin resistance.  My hormone levels, weight, etc. convinced them enough to try Glucophage, which seems to be working, at least as far as the weight goes. Response to treatment *is* a legitimate way to test for a given disease or condition.  You give the drug a try, and if it works, that was what you had; if it doesn’t, then you have something else.  In retrospect, I probably would have asked for the ratio to be measured, but I had already started Glucophage when I heard of that, and it probably wouldn’t be an accurate reflection of my pre-drug state now. > it never hurts to > get another opinion.

Absolutely.  If you have any question, then either tell your doctor you’d like to confirm the diagnosis before you start on drug treatments, or ask for a second opinion (and call around for someone who *will* ask for the tests). You’re talking about drugs with potentially dangerous and/or uncomfortable side effects, which you will be taking long-term, if not for life, so you have every right to make certain that you *should* be taking them before you do. -Janet   253/235/168 (Haven’t had a scale handy lately, middle # may be off…) ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/       Search, Read, Discuss, or Start Your Own    

Response:

>Am I wrong to think I should seek another opinion?  Or is the >anovulation and weight gain enough in and of itself to make this >diagnosis?  My Gynecologist doesn’t see any reason to do "thousands of >dollars worth of hormone tests" to prove what she "already knows." >Thanks for any help you can give me. >Beverly

The thing is perhaps you should see a reproductive endocrinologist.  Other disorders can cause symptoms similar to PCOS  such as hypothyroidism, Cushing’s Syndrome, tumors of the adrenal glands or the pituitary glands.  You should be thoroughly tested just for your own peace of mind.  Please see an RE, who will probably give you an exam as well as a battery of blood tests, some do ultrasounds to see if they actually see any cysts, but since cysts is only one of the possible symptoms, the absense of cysts doesn’t mean you are PCO free. In particular, you should be tested for insulin resistance. <html><P ALIGN=CENTER>Cathy (to email, delete spamslam) <A HREF="http://www.geocities.com/Heartland/Cottage/8060/index.html">My Web </A> <A HREF="http://www.geocities.com/Heartland/Cottage/8060/PCOS.html">PCO page </a></P></html>

Response:

>The thing is perhaps you should see a reproductive endocrinologist.  Other >disorders can cause symptoms similar to PCOS  such as hypothyroidism, >Cushing’s >Syndrome, tumors of the adrenal glands or the pituitary glands.

Absolutely – PCOS is diagnosed by excluding other rare but serious conditions as well as looking for the obvious symptoms (if they are any). The tests are not that costly and are done in most but the most obvious cases. Al am…@medscape.com

Response:

In article <372264CF.5F173…@netusa1.net>,   beve…@netusa1.net wrote:

<snip> > Am I wrong to think I should seek another opinion?  Or is the > anovulation and weight gain enough in and of itself to make this > diagnosis?  My Gynecologist doesn’t see any reason to do "thousands of > dollars worth of hormone tests" to prove what she "already knows."

Run, don’t walk to another OB/Gyn or RE who does not have her head up her rectum.  You could have any number of problems, such as Cushing’s Disease or pituitary tumors. Sorry to speak so plainly, but you know, your doctor is *negligent.* Good luck to you. Beth ———–== Posted via Deja News, The Discussion Network ==———- http://www.dejanews.com/       Search, Read, Discuss, or Start Your Own    

Response:

While this is true, insulin resistance seems to correlate best with transvaginal US appearance and when you are treated with gonadotropins for ovulation induction, you behave like PCOS regardless of other stigmata. In UK, they believe TVUS is an important criteria. In the US, menses and androgen abnormalities (ie, chronic anovulation hyperandrogenism) are considered most important. Shutting your eyes to either diagnostic criteria means you will miss out on some of the benefit from the newer therapeutic options. – Hide quoted text — Show quoted text ->I have read and been told by doctors that they no longer consider PCOS and >ovarian cysts to be directly linked.  You can have PCOS and not have cysts, >and you can have ovarian cysts and not have PCOS.

Response:

So, in your professional opinion, to confirm a diagnosis of PCOS before starting a patient on Metformin, what tests would need to be done? Is a gtt necessary? What about TVUS? I went to a Mayo Clinic RE (you might have read some of his articles) to see about getting on Met. He said that if I didn’t want to be treated via traditional treatments (BCPs–which I will never take again) then he would Rx Met after confirming the diagnosis of PCOS and insuring that I am, indeed, IR. Is it really possible to have the one problem without the other? He set up a TVUS (though mainly because I asked if he was going to do one), two days of gtt (one lasting 3hrs, one 5hrs), and had a list of labs ordered (insulin, FSH, LH, progesterone, prolactin, free testosterone, thyroid cascade, DHEA-S, and 17-hydroxyprogesterone). There was no C-Peptide, no blood glucose, no PAI-1, no estrogen. While I was very interested to see the results of the gtt’s and tvus, I chose to cancel all of the above appts. because he was very arrogant and not someone I would like to discuss such personal issues with. I asked him every question that came to mind and, at the end of the appt., he said that he would give me some articles to read over so that I could ask better questions next time (one of a few crappy comments made). He gave me three articles to read; guess who wrote them all. He did, of course. Amazing, huh? I decided that I am willing to travel out of state and spend the extra time and money to see a doc that is great. I think he viewed my goal of feeling better, losing weight and getting healthy as pretty trivial (as opposed to wanting to get pregnant, I guess). I think he doesn’t view treating PCOS as necessary in single women not trying to conceive. There are still the health risks, however, along with self- esteem issues of being overweight. Mayo Clinic, despite their reputation, is a terrible place to be treated. You only get listened to if you have a lot of money and/or are famous. Otherwise, the docs (mostly specialists) treat you like you are an annoyance in their day and talk to you like you are five years old and wouldn’t have a clue about anything medical. I’d take a private practice doc anyday over a large clinic or hospital. They tend to be much nicer and more receptive to their patients. Sorry to get off on a tangent. It just makes me so angry how I’ve been treated there (have also seen 2 reg docs and an endo who were also terrible). I drive or fly to Michigan (live in Minnesota) to see a wonderful family doctor out there. Sad, really, that I have to do that. By the way, are you/your clinic accepting new patients? Thanks! Darlene – Hide quoted text — Show quoted text -Mark Perloe wrote: > While this is true, insulin resistance seems to correlate best with > transvaginal US appearance and when you are treated with gonadotropins > for ovulation induction, you behave like PCOS regardless of other > stigmata. > In UK, they believe TVUS is an important criteria. In the US, menses > and androgen abnormalities (ie, chronic anovulation hyperandrogenism) > are considered most important. Shutting your eyes to either diagnostic > criteria means you will miss out on some of the benefit from the newer > therapeutic options. > >I have read and been told by doctors that they no longer consider PCOS and > >ovarian cysts to be directly linked.  You can have PCOS and not have cysts, > >and you can have ovarian cysts and not have PCOS.

Response:

Darlene: You might want to see just a plain endocrinologist.  The goal of an RE is to get you pregnant.  PCOS is an endocrine disorder.  I see just a regular endocrinologist and he is wonderful.  Should I ever desire to try and have children (which isn’t likely since my chances are so very poor from this and other health concerns), he would work in partnership with any doctor I choose. So, if you aren’t trying to get pregnant, go to just a plain endo. Louise

Response:

Filed under: Endocrine disorder

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