Also see Fact
Sheet - PCOS
& Weight
Issues
Running and irregular cycles
Conceiving naturally
PCOS & Weight
Hypothyroidism, weight gain, & infertility
Question: I am a 34 year old female with 9 year old fraternal
twins. We used Clomid and estrogen therapy for one month to
conceive the girls with continued progesterone support until
8 weeks gestation. My husband and I have now been on Clomid
50mg for three months with day 14-28 progesterone support.
Our concern is that with this attempt at pregnancy, I am doing
exercise in the excess of 25-35 miles of running per week.
What are your thoughts on estrogen replacement therapy in
addition to clomiphene/progesterone therapy? . My OB/Gyn doesn't
seem concerned with the exercise factor, but I am concerned
that it may be hampering our efforts.
Comment: It is highly speculative that additional estrogen
therapy is of any benefit in clomiphene therapy and there
is no scientific data to support its use. However, I am a
big believer in repeating what works and no harm is being
done with estrogen use. You should not start the progesterone
until after ovulation, maybe day 15-16. Its early use can
inhibit ovulation. While commonly used, even in my practice,
progesterone has not been conclusively shown to be effective.
Regarding the exercise, an interesting presentation at an
Endocrine Society meeting showed that exercise itself did
not alter menstrual function, but caloric intake did. Are
you eating enough to support normal ovarian function? It may
be prudent for infertility patients to reduce their running
to fewer than 20 miles a week and limit other aggressive exercise.
Your body is not smart enough to distinguish your good health,
from a situation that may have occurred a thousand years ago
as you were trying to cross the desert running from hunger
or attach, rather than for pleasure. There is a belief that
any body stress, whether from exams, work, or exercise can
lead to ovulatory dysfunction and infertility. A sound scientific
study has recently addressed running in pregnancy and found
that for the conditioned athlete that it did not increase
complication ratre although babies tended to be smaller. sst
Question: I was diagnosed with PCOS 6 years ago. My husband
and I have been trying to get pregnant for the last 2 years.
We are in our mid-twenties and would like to get pregnant
naturally if possible. My gynecologist doesn't seem to want
to help us. All she wants to do is load me up with hormones.
Could you give me any suggestions on things we could do to
get pregnant naturally?
Comment: There is excellent evidence that lifestyle changes
such as modest weight reduction, increased physical activity
and smoking cessation can have significant impact on fertility.
This said, you should avoid rapid weight loss or aggressive
physical activity that may put additional stress on the system
and worsen fertility. We aim for a 10% reduction in body weight
in our PCOS patients who are overweight and suggest a lower
carbohydrate diet. You also should be using 1 mg of folic
acid daily. Once you have done your best on lifestyle, the
next step would be to investigate the possibility of insulin
resistance using a glucose tolerance test and insulin level.
Metformin (Glucophage), while a potent drug for the treatment
of diabetes and certainly not effective in all cases of PCOS,
is not hormonal and does not increase the risk of multiple
births. Some women report that they feel better and weight
loss becomes easier while taking the drug. sst
Question: I have just been told that I have polycystic ovaries.
In the past 5 years I have gained an excess of 100 pounds,
my sugar is low and unstable, my feet swell, and I'm often
sick to my stomach. Can this all be related to these cysts?
I am especially concerned about my weight. I want to have
a baby, but not at 259 pounds and I have tried to lose weight,
without success. I saw a dietician and followed a diet plan,
but did not exercise, and I did not lose weight. Is there
anything that I can do to lose this weight?
Comment: Most everything you have said can be related to PCOS,
probably insulin resistance. It is great that you have recognized
that weight reduction is important before a pregnancy. It
will certainly improve your chances of conception and reduce
complications for both you and the baby. Hopefully, physicians
are beginning to recognize the PCOS spectrum and PCOS patients
will not be dismissed as "fat" women with no self-control.
Certainly, a comprehensive approach is needed to fully evaluate
your health status. There is no scientific breakthrough to
report. There is no quick fix. You can and should loose weight,
but to do it successfully, the loss must be slow. Go down
no more than 500 calories a day and modestly increase your
physical activity. This is the first line approach, but an
evaluation to include a glucose tolerance test with insulin
and lipid levels to better evaluate you metabolic status is
also in order, sst
Question: Do you recommend a low-carbohydrate diet for woman
with PCOS?
Comment: Carbohydrates form the largest part of our energy
intake, up to 80% in some. In effect, virtually all diets
involve carbohydrate restriction.. Many with PCOS have success
with low carbohydrate diets and favor “low carb”
diets over all others. Low carb dos not mean no carb. A balanced
diet of higher protein, lower saturated fat, higher bulk with
avoidance as much as possible of simple sugars is a good diet
for all regardless of age, but it is especially healthy for
those attempting pregnancy. The goal should be balanced nutrition
rather than restriction of one food type. A reduction of 250
to 500 calories a day in addition to a modest increase in
activity can have very positive benefits for most women with
PCOS. Fad "diets" are almost always doomed to fail
and "yo yo” dieting can have negative health benefits.
The key is lifestyle changes that can be maintained forever.
We usually aim at about a 10% weight loss as a realistic goal
for most. sst
Question: What can I do to stop gaining weight? My testosterone
is really high but I am on Clomid so can't take any medications that will harm
a possible pregnancy. I have tried low carbohydrate diet but
because I am a fussy eater I don't eat many items on that
list. I also have a treadmill and a few free weights that
I use regularly.
Comment: I know I will offend some with this comment, but
weight is gained when the calories consumed are greater than
the calories used. Weight is lost by either decreasing calorie
intake or increasing physical activity. I believe this is
an absolute truth. HOWEVER, I am convinced those with PCOS
utilize calories differently. Many with PCOS have high insulin
levels. With increased insulin the body is programmed to hold
on to every calorie and store them as fat. It is like the
body is attempting to enter hibernation and so it must store
all the fat possible and firmly resists fat loss. As weight
increases, insulin increases, and then weight increases more.
It can be a hopeless spiral down. The objective is to fool
the body into not realizing that calorie loss is grater than
calories. You must be clever, eat the foods you like, just
less. Exercise more and hopefully find a healthy lifestyle
you can use over the long run. Some may find help with metformin
and I believe an evaluation for insulin resistance can provide
an important insight into PCOS and its therapy. Metformin
can help reduce testosterone levels.
Question: I am 31 years old and have hypothyroidism. As a
result I have gained a lot of weight. I am obese. My husband
and I have been trying to conceive for almost a year. Despite
being hypothyroid, my periods were very regular -- every 28
days, prior to trying to conceive. However, over the past
year my cycle has changed from anywhere from 28 to 36 days.
I am concerned with the change as it only started changing
after we started trying to conceive. Is this normal? I know
I ovulate as I have a fertility monitor. My concern is this:
how does the change in my cycle, along with being obese/hypothyroid,
affect my chances of conceiving?
Comment: I know this will be an unpopular statement, but weight
gain due to an underactive thyroid has been shown in numerous
studies to be relatively small. Still, small changes in thyroid
function can markedly alter the way you feel as well as fertility.
Clearly, hypothyroidism can cause infertility and fertility
therapy can be as simple as thyroid hormone replacement. Replacement
therapy should not be used unless there is documented hypothyroidism.
In the past some have tried thyroid hormone to improve fertility
or to help with weight loss. It doesn't work. Individuals
taking replacement therapy should have periodic measurement
of thyroid stimulation hormone and the levels should be kept
in the mid-normal range (usually 1.5-3.0). Normalization of
TSH levels is a very important first step. I am concerned
that your cycles are as long as 36 days and would search for
a reason as to why this has occurred. Cycles over 32 days
are associated with significant decrease in fertility. A more
detailed endocrine evaluation, possibly including insulin
levels is in order, followed by a consideration of strategies
to promote timely ovulation. sst
Also see Fact Sheet -
PCOS &
Weight Issues
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