Managing PCOS Through The Reproductive Years and Beyond

March 7, 2007 - Wednesday
12:52 PM to (EST)
Guest Speakers: Jacqueline Guttman, MD
Women's Institute / Pennsylvania Reproductive Associates

Categories
Endometriosis • PCOS • Pregnancy • Pregnancy Loss

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Corey_Whelan	Welcome everyone to tonight's chat - I'm sorry that our screen reflects next week's chat. It's a computer gaff.
Corey_Whelan	I am Corey Whelan, your chat moderator. Tonight we are very very lucky to have Dr.Jackie Gutmann here to discuss pcos - when you're trying to conceive and your health issues after the reproductive years.
Corey_Whelan	Dr. Gutmann is nationally known as a leading expert in PCOS. She is the Associate Director of the Division of Reproductive Endocrinology and Infertility at Thomas Jefferson University Hospital and a physician at Pennsylvania Reproductive Associates. She will be here shortly and our chat will begin promptly at 8 p.m.
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Corey_Whelan	Hi Dr. Guttman, welcome! We will be starting in a few minutes. If anyone has a question that they would like to type on the screen, feel free!
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jackie_gutmann	Thank you. And welcome to all. Let me apologize in advance for my poor typing skills. I may answer some questions in electronic shorthand.
Dolores	Hi Dr. Guttman, thank you for being here. I have a question. I don't get regular periods and I think that I have pcos because of weight, hair, all the symptoms I have read about. I have been ttc using clomid for about a year and I don't think I ovulate. Is it time for me to see a specialist?
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jackie_gutmann	Delores, what does ttc mean? Have you used clomid already?
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beachgrrl2007	Hello Dr. Guttman. I really need to know what to do. About 2 years ago I weighed 118 and stopped getting my period. My PCP said lose weight. I could not and ballooned up to 138. SInce then I have seen 3 obgyn's, Dr Legro at Hershey Med (endocrinologist) and am working with my PCP to try and get my weight down by using Meridia. I have had recently an MRI and Cat scan and have worked with 2 nutriotionists. The endocrinologist did a lot of blood work b/c my obgyn suspected PCOS. All work came back normal (LSH, FSH, tetosterone, thyroid, glucose, fasting etc). so neither he or my pcp wanted to diagnose me with PCOS. They did a test and put me on the pill for 6 months (April - Oct 2006) and I got my period every month. However when I stopped taking the pill in Oct my period stopped. I eat 900-1000 calories a day and treadmill 18-21 miles a week. I just had a 2nd round of bloodwork done Monday but have not heard back. I am only 34. I have now not had my period in almost 2 years (besides the 6 months they put me on the pill). What do you suggest?
Corey_Whelan	ttc means trying to conceive
jackie_gutmann	Beachgrrl2007, have they given you progesterone or provera? If so, do you bleed when you take that?
beachgrrl2007	No they have not. They have only put me on the pill. The original bloodwork Dr Lego did in Feb 2006 all came back normal so they did not want to start me on anything.
jackie_gutmann	Corey, thanks. Dolores, I do think that it is time to see a specialist.
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Dolores	thank you Dr. Guttman. I know that the Atkins diet was in the news today. Is there any real connection to the low carb hight protein thing and pcos?
jackie_gutmann	Beachgrrl, It is possible that your periods have stopped because your brain (parts called the hypothalamus and pituitary gland) is not sending the correct messages to your ovaries. This is very different from PCOS. How tall are you.
jackie_gutmann	I do think that there is something to the low carb high protein thing.
beachgrrl2007	I am 4"11 and weigh now 128. The dr who took the bloodwork on Monday mentioned that. What is it and what is the solution? Wouldn't that show a high prolactin level if that was the issue?
beachgrrl2007	BMI is 27
jackie_gutmann	You could have "hypothal;amic amenorrhea.' Prolactin would be normal.
Corey_Whelan	There was for me. I have pco and started getting regular periods for the first time in my life when I went on a low carb lifestyle.
beachgrrl2007	Could that be why i cannot lose the weight as well? I researched it a little and it was very interesting to read about it. From what I understand it is located under your brain and controls appetite, weight gain/loss, hormones. What would be the treatment for this and is it dangerous left untreated? How do they test for this? Would I get my period on the pill if this is what I have?
jackie_gutmann	IBeachgrrl, I don't think that it all about your weight.
jackie_gutmann	The pill will regulate one's period regardless of the underlying problem
jackie_gutmann	Therec a few advantages of a low carb high protein diet. It is somewhat restrictive (most snack foods are carbs), it tends to keep you full, and it allows for mor efficient use of calories.
Suzi	Dr. Guttman, I was wondering about the low carb connection too. Why does it work?
Suzi	I am 32 and never get my periods. I am overweight - about 180 lbs.
jackie_gutmann	I think that a strict Atkins is not ideal (though it probably works soooo well because it is so strict). I prefer including some fruit and vegetables in the diet and watching fat intake.
jackie_gutmann	Suzi, did you ever have regular periods?
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Suzi	I never had regular periods, no. I would get no period for afive months and then a heavy one that lasted forever
Suzi	I would say I average 2, 3 per year
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jackie_gutmann	Insulin ( a hormone made by the pancreas) helps us use glucose (sugar) effectively. If one is overweight our cells becaome resistant to the action of insulin. So the body tries to make more. The ovaries are not resistant to the insulin and the extra insulin causes the ovaries to make more male hormone (increased hair, acne) and causes irregulkar cycles. This only makes it harder to lose weight (talk about a vicious cycle!)
Suzi	Welcome anitet. We are discussing pcos during the repro years and beyond with Dr. Jackie Gutmann. Please feel free to ask any question!
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anitet	Good evening
jackie_gutmann	Hi!!!
Debbied	good evening everyone
Corey_Whelan	Hi Debbied!
Debbied	has the session started?
Debbied	hi Corey
Corey_Whelan	yes, the session started at 8. Do you have any question for Dr. Guttman?
christalp	i have pcos and have been seeing a fertility specialist. we are getting ready to try ivf. what are the chances it will work? i have had 2 IUI without success.
Debbied	Yes...where do I post them?
Corey_Whelan	just do what you're doing. type em in!
Debbied	christal..have you been taking Metformin for the PCOS
Debbied	thanks Corey!!
christalp	yes, i have been on metformin for almost 18 months
Debbied	Dr. Guttman, what is the best diet to be on when dealing with PCOS?
jackie_gutmann	Christalp, the success of IVF (or any infertility treatment) is dependent on sooo many thing things. Age, sperm, and the IVRF program...
christalp	i am 30 and sperm is normal
jackie_gutmann	I favopr a low carb, high protein diet.
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Debbied	I've also been on Metformin..for almost 2 years..but I'm not that faithful in taking...I don't know why?
Debbied	Thanks Dr. Gutmann! Can PCOS be linked to endometriosis?
Corey_Whelan	Everyone is different, but for women with pcos, if you bring your carb count down to around 30, 35 carbs a day, including good veggies and fruits, you'll lose weight and start ovulating.
jackie_gutmann	It is good to be young!!!!! The likelihood of success in an IVF cycle should be quyite high (50%/cycle or so)
Debbied	Thanks Corey!
Corey_Whelan	Welcome tfolks!
jackie_gutmann	PCOS does not seem to be linked to endo, though sopme women are unlucky enough to have both!
jackie_gutmann	Metformin is hard to take. Are you on the XR preparartion.
Debbied	My dr. thinks that I've developed Endo now, I've been having really bad pains since my january period. I went for a pelvic CT scan on Monday and waiting for the dr. to see if I need to go for a laproscopy. What is the XR preparation?
jackie_gutmann	eXtended Releases so that you can take it once ady. Endo usually creeps up on you a little more slowly. Do you have pains everyday? Does anything make it better or worse?
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Debbied	yes...my dr. gave me the extended releases..I'm suppossed to take every night at 6pm...but for some reason I can't get that in my head. I've been at this a long time and i think on some levels I'm tired. I don't have pains everyday. The last day I had pain was last week...it's very, very strong pain in the bottom right of my pelvis. The only thing that makes it feel better is 4 advil.
jackie_gutmann	Debbied, Have you had an ultrasound?
Debbied	yes...two of them back at the end of January when I first got the pain..an internal and on top..I think these were sonograms
jackie_gutmann	It is hard to take medication regularly, pariculary when not at the beginning or end of day (next to toothbrush). Though I like metformin and use it alot. It is not a magic bullet. Don't be too hard on yourself!
viviane	hi doctor, I became pregnant in August with the help of clomid, I have pcos, unfortunately i gave birth to a stillborn at seven months being a month ago today, my question would I have to go through clomid teatment again or would it happen naturally, also, how long do I have to wait to try again.
jackie_gutmann	Were the ultrsounds normal?
Corey_Whelan	Sorry, Viviane.
viviane	k
Debbied	yes...they said there were some cysts there but nothing abnormal.
Debbied	I'm so sorry Viviane!
viviane	thkx
anitet	I'm sorry :(
Debbied	I've also become very emotional lately...could this be a sign of endo?
jackie_gutmann	Viviane, I am sorry!!! Do they have any idea what happened?? It is likely that you will need clomid again. You can probably gert started within about a month or so if everything else is ok.
viviane	by the way I did clomid with iui
jackie_gutmann	The cysts could be causing the pain (they dont have to be endometriomas or endometriosis cysts to cause pain.
viviane	I got the results today from my OB, they tested the placenta and she told me it was inflammed and it was caused my a virus but not thimbosis?
jackie_gutmann	I would recommend going back to what worked before.
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jackie_gutmann	They should do an evaluation to make sure that there is nothing that needs to be done to reduce the risk of it happening again. This is something that a high risk ob (perinatologist) can do.
Debbied	would a laproscopy help me at all? see what's going on?
anitet	I'm on metformin, spironolactone and clomid from October. First three cycles were regular ( 35 days). Last one I had on December 28th. I'm not pregnant. 10 days ago i get progesterone. But still didn't get my period. How long I supposed to wait ?
viviane	I am attending genetic and my next pregnancy will be considered high risk . my Endo doctor took blood to check for my levels and maybe start treatment next month
jackie_gutmann	I Debbied, I think that the increased "emotions" are not a sign of endo but perhaps frustration (and why not!!!) with pain and irregular cycles
jackie_gutmann	viviane, it sounds like they are on top of things...
Corey_Whelan	Andree, we haven't heard from you. Do you have any questions for Dr. Guttman? Please feel free to post or not.
jackie_gutmann	Debbied, a lap would help figure things out.
viviane	yeah, genetic did not find any abnormalities with my blood nor my husbands
Debbied	Thank you Dr. Gutmann!
jackie_gutmann	anitet, they gave you progesterone to take? When did you finish it?
jackie_gutmann	yyour welcome, good luck!
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anitet	No, I get a injecion.
anitet	Once
jackie_gutmann	anitet, it can take up to 2 weeks to bleed. You should call your doctor if you don't bleed in the next few days
Debbied	Dr. G, one last question....I've been pregnant three times, one was a miscarriage, one was ectopic and one was a chemical pregnancy....could the ectopic be a sign of endo?
jackie_gutmann	You are more likely to have an ectopic with tulbal scarring oradhesions which can be caused by endo (or other things), so sort of..
anitet	Thank you
Debbied	oh...okay...thank you!!
anitet	How long I can take clomid?
jackie_gutmann	your wecome
Corey_Whelan	Folks, we're at the 15 minute mark.
jackie_gutmann	Most women who are going to conceive with clomid do so in the first 3 or 4 good (ovulation, good timing-sperm-) cycles..You can take it longer but it is less likely to work
Lisa	Dr. G, I have PCOS and it took us a year and a half to conceive. I am now 6 weeks pregnant. My RE discharged me as soon as we got pregnant and I am now seeing an OB. Is there any reason that I should be monitored between now and our first OB appt at 9wks? I am on 1000mg of metformin daily to decrease the chance of miscarriage.
anitet	Is it safe to take (3x) clomid and Ovidrel in next cycle?
anitet	Congratulations
Debbied	Congrats Lisa!!
beachgrrl2007	Dr. Guttman do you have any last bits of advice for what my next step should be? Sometimes I feel like the dr. are in a rush to just diagnose me and it is a litle frustrating.
jackie_gutmann	Lisa, all is likely to be fine. We tend to monitor our patients until about 8 weeks gesttation (its not that we can prevent miscarriage with our ultrasounds but it is nice to see that all is Ok). The metformin should be fine. We are not so sure about preventing miscarriage or the dose to use but (depending on the situation)i will continuue the metformin in early preganancy
jackie_gutmann	anitet, yes!
anitet	Thank you
Lisa	Thanks all for your congrats. It will happen for you too! I never thought it would happen for us.
jackie_gutmann	I would really need more information (to be fair to you()
Lisa	Dr. G, when do you advise your patients to go off of metformin?
jackie_gutmann	I second lisas comments
Debbied	thanks ladies for the support!
jackie_gutmann	Usually at about 10 weeks depending on cirumstance (does someone have abnormal gluse levels etc). There is not much science that addresses this
Lisa	Thank you!
andree_e	is the risk of gestational diabetes higher in women with PCOS?
jackie_gutmann	andree_e: Yes!
andree_e	would that be a rationale for continuing with met past 10 wks gestation
jackie_gutmann	which is why i may continue the metformin for diffrent lenghts of time
jackie_gutmann	You read my mind. I type so poorly that I must look at keyboard and still make mistakes!!
andree_e
anitet	What is your next step if with clomid women still not getting pregnant ( sperm and time - good)?
andree_e	i am wondering, conception issues aside, what is the best way to know if one's PCOS is "under control"? What sort of things should be monitored? Is ovulation a proxy for control? I am really nervous about the long-term implications for my health
jackie_gutmann	Make sure tubes OK (HSG, if not done) and then injectible medications (gonal-F etc) with iui or IVF
Corey_Whelan	Guys, please let Dr. G answer the questions that are up on the board and then I'm sorry to say, our time is at an end
jackie_gutmann	Ovulation is one proxy. Cholesterol levels, glucose eval, blood pressure checks.
anitet	Good night, thank you again
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Debbied	yes...thank you and good night
jackie_gutmann	Thank you!!!! And good luck to alll!!!!!1
andree_e	don't seem to be ovulating - but all those things are fine so far. Thank you.
Corey_Whelan	I want to take a minute to thank you all for being here. When you ask questions, we all learn. And especially thank you Dr. Gutmann, for giving of your time and expertise this evening. I wish ALL of you the BEST OF LUCK!!!!!!
jackie_gutmann	Corey thanks to you and the AFA for making these sessions possible
Corey_Whelan	Please check out the AFA's InFocus magazine on PCOS, which appeared in the blast that this chat linked to, our check our our pco message board for more support and medical advice. Goog night all!!!!!!
Corey_Whelan	Thank you Dr. G!
jackie_gutmann	YW!
Corey_Whelan	Out chat is officially over. good night and best.
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Managing PCOS Through The Reproductive Years and Beyond

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