PCOS help pls :(

[some_stars]

So I've been seeing an OB-GYN over the summer for various issues, and at one point got a pelvic ultrasound, and the doctor told me, basically, that I probably have PCOS and that there's nothing medical to be done about it.

I didn't ask about drugs at the time, because 1.) she's always been really great in the past so I didn't have an immediate "bullshit" reaction, and 2.) I am one of the Bad Fatties who don't eat right and don't exercise, so I felt really defensive and guilty because, of course, I had obviously brought this on myself, and it was MY RESPONSIBILITY to lose weight no matter how hard it is and asking for drugs would just make her think I was lazy and shiftless and looking to blame someone for my fat or take an easy way out. (These are obviously not rational thoughts, and I wouldn't think them about anyone else.)

However, as soon as I left I started thinking about something that hadn't really registered at the time--when they weighed me, I found that I had gained five pounds in a month despite not having any changes in my diet/lifestyle except that I've been getting significantly more exercise--not enough, but a LOT more than I was getting over the summer. And then I started thinking, what if I never stop gaining? What if I just get bigger and bigger? And totally freaked out. Because I have been steadily gaining pretty much since age 10 and obviously a lot of that is, you know, growing, but it never stopped. I was 200 lbs when I left middle school, and I'm now 275, eleven years later. Some of those years I was eating very healthy, some of those years I was getting a lot of exercise, and I still kept gaining weight, albeit more slowly. The majority of it goes to my belly--I'm a size 26 in the middle, size 18/20 at the shoulders and thighs.

This Wednesday, I'm going to see a primary care doctor about thyroid issues, and I'm hoping I will be able to bring up the PCOS with her(without having to explain why I didn't ask the OBGYN about it, since that would be pathetic). The main treatment protocol I've heard about is Metformin and possibly birth control pills. The symptoms I have are ovarian cysts, obesity, and extremely irregular(both in occurence and length) periods. I don't have facial hair/excessive hairiness, and my periods are never painful at all; they run towards overly light/never-ending spotting rather than being excessively heavy. My blood sugar has always been much too high. Obviously I'm worrying that I don't really have PCOS, I just want something external to blame for being so fat instead of ~taking responsibility~.

So, what should I say to the PCP that, 1.) will likely end with me being prescribed medication, and 2.) will not make me implode into a ball of anxiety and self-loathing?

Comments

[minim_calibre]

All you really need to tell her is that your gyn said you have PCOS, but didn't give you medical options on it, and in researching your diagnosis, you have realized that your cluster of other symptoms (probably anovulatory from your bleeding pattern, gaining midsection weight, high blood sugar) are related, and you have seen the medical protocols, you are concerned about your health, and would like to explore treatment options.

[minim_calibre]

(Seriously. You are not to blame for your hormones being off. You aren't.)

[jonquil]

This is awesome. And also what she said in the later comment : you are not responsible for your hormones. You are not responsible for the shit your body gets up to when you're not looking.

[laurajv]

this. like. print this out and memorize it.

oh, or! rewrite it in your own voice, print it out, take it with you, and if you start to lose it, hand it to your doctor.

[aris_tgd]

Yeah, what minim said. And when I asked the RN who I was seeing about a pap smear about PCOS last time I was in, she told me that it's diagnosed basically via external symptoms (if they don't do an ultrasound and find cysts) and the treatment is usually birth control pills. *HUGS* It will be all right! And you did not bring this on yourself. It'll be OK.

[violetisblue]

I have "borderline" PCOS (their words) and was never prescribed Metformin because I don't have the insulin-resistance issues, but otherwise was on Yasmin for a while. She's correct that there isn't much medically to be done about it per se besides attempt to induce ovulation chemically and treat some of the symptoms, since PCOS is one of those umbrella terms encompassing a host of badly understood, related endocrinological conditions--however you absolutely need to discuss it with the PCP, since it impacts the risk for hypertension (which I developed in my late thirties), heart disease, diabetes and a host of other lovely things. I think thyroid problems as well. If the PCP doesn't take it seriously, be stubborn and look for one who does.

Re the weight thing, BTW (and your weight gain pattern is absolutely a classic PCOS marker), I went undiagnosed for a good fifteen years because despite a host of other symptoms doctors kept looking at me and going, "You can't possibly have PCOS, you're thin!" So, you can't win.

[rydra_wong]

I have nothing useful to offer, but wanted to point you at pcos_support -- it's only existed for two days but there are a bunch of people in there who I know from elsewhere as really cool folk.

[sohotrightnow]

I can't tell you from PCOS in particular, and as you point out you're probably going to face some of the size issues that I don't deal with. But I know doctors can be very skeptical of people who show up saying "I have ADHD, give me Adderall", so I did have to figure out how I was going to present my case to my doctor without just coming off as some punk kid trying to get drugs. With all of those caveats in mind, I'd recommend you basically enumerate all the symptoms you've outlined, and stress that your OB-GYN, with whom you have a good relationship, has given you a diagnosis of PCOS. If it won't upset you too much to do so, I'd recommend being particularly specific on the weight issues: "when I was doing exercise X at a rate of B hours a week, and eating a lot of D, E, and F, I still gained, just at a slower rate -- J over the course of a few months rather than over the course of a month."

If the question of why you didn't bring it up with the OB-GYN is raised, you don't have to go into detail; just say you were still processing the diagnosis and you didn't really have the wherewithal to discuss the matter more fully at the time, but you'd like to find out more about your options now, when you've had time to process and look up medications. Hell, that might be a good way to open, just to get the question out of the way, if you think you're up to it.

Finally, ♥ I'm crossing my fingers that it works out for you, bb.

[skipthedemon]

I second what <lj user="sohotrightnow" said. I would tell him pretty much exactly what you typed out here about your history of weight gain. You are doing the responsible thing. What you've tried hasn't worked, so you're asking for help with trying something else.

[pearwaldorf]

This. The biggest ping for me was the still exercising but gaining weight thing. I think if you present it as somebody who has done all the non-medical suggestions and still hasn't been able to treat it effectively and also knows what she wants to get out of the visit you'll be successful.

Good luck. As a fellow PCOSer I sympathize with how bullshit this is.

[ladysorka]

When I was actually on meds, they had me on metformin, birth control, and spironolactone. I'm not actually entirely sure what the last one is for. But I do know that while I was actually on the correct meds, I dropped about 30 pounds, without changing my diet or exercise at all. And since having to go off the meds for monetary reasons, I've gained those 30 pounds back, again, without changing my diet or exercise patterns at all.

[lilacsigil]

That doctor is full of shit - there are lots of things that can be done, depending on which group of symptoms you have. At the very least, they should have you on the pill and be testing your thyroid, blood sugar and giving you an ultrasound. Tell your GP that the gynaecologist didn't tell you what to do next - specialists are notoriously close-mouthed about treatment, so the GP won't think that strange. PCOS is always treated symptomatically, so they should be addressing the symptoms you have, not being judgemental about whether you may or may not have PCOS in the same way as someone else. I've heard of women who have every symptom except a certain (and variable) number of ovarian cysts and therefore their doctor claims they don't have PCOS; other women who only have the cysts and yet were put on Metformin, with predictable and dangerous results. You need to talk about your specific symptoms and treat those.

I have PCOS and major thyroid problems (not PCOS related but they do intersect), weigh more than you, and the pill controls my PCOS beautifully. Without the pill, I have heavy, long, random periods with intermittent spotting; occasional boils and skin tags; obesity; and the occasional burst cyst (ow ow ow). I don't have excess body hair, balding, acne or blood sugar issues. PCOS is always like that - some people get the whole lot, others get bits and pieces. And even if you were fat and didn't have PCOS, that still doesn't make you an evil bad person - it means that your body responds to circumstances by gaining weight where another person doing exactly the same might get acne, or lose weight, or do nothing at all.

[vass]

Have you seen an endocrinologist? PCOS isn't really the ob/gyn's specialty, so she didn't know what she was talking about.

And btw, they didn't even do an ultrasound for me. Well, they tried. Years ago my GP sent me to get the thing with the wand done, and the technician refused to do the test because I was a virgin who couldn't drive. And everyone since has said "Well, you don't actually need the cysts to have the syndrome, so we're just not going to test you."