[Rana]

I need advice.

I know that I'm new here and not a lot of people know me, but this is only the place I think I can have this conversation. The people in my life are very conflicted about this whole PCOS thing, including the whole concept of medication and thus, why I'm personally conflicted.

I guess I need advice to figure out what to do.

Situation: Doctor's appointment this morning was about prescribing Metformin for me. I have a prescription for 500 mg, Extended Release, with the directions to start with one pill a day, if it works, try 2 pills a day, if that's fine, then 3 pills a day. For the rest of my life.

Questions/Advice:

1) Right now, if I were to go to a doctor and ask him to diagnose me, I'm not sure he would be able to diagnose me with PCOS. My insulin resistance is under control. My GTT came back normal (93 right after drinking, 90 after 2 hours). My cholesterol, including triglycerides, are normal (116 total cholesterol). I'm getting my period 9 out of 12 months. My testosterone and DSHEA levels are normal (although in the high range of normal). But, I'm still overweight and I have the AN, which is a sign that I was/am IR.

So, does it make sense to take Met when I've managed to make these changes with food and exercise?

2) Should I wait to see if I can lose more weight and then use Met if I reach a point where I can't?

3) Should I just chuck the prescription and not consider medication at all?

My family is generally against medication because in situations like these, they really do believe in diet and exercise and they apply that to themselves. My father, who is diabetic, has maintained his diabetes under control with diet and exercise, not with medication. His doctors are perfectly fine with that. Even my mother who has RA has chosen to manage it through diet/exercise, rather than medication. My sister who also has PCOS/IR, has been able to get pregnant through diet/exercise regimen (mostly diet, because she hates exercise) and hasn't had fertility problems.

On the other hand, my boyfriend really loves science and believes in medication, and my doctor (of course) is in this camp.

My fear (and why I haven't been able to make a decision yet) is that I understand both positions. Medication can have awful side-effects. Metformin can have awful side effects. I know about those. I fear those actually, because I spent many years on BCP that gave me GI problems.

But if Metformin can help me manage my IR, isn't that better health-wise over the long-term?

I'm afraid of trying Metformin and then finding out a few years later that it's ruining my liver or my kidneys or my ________ like I did with the BCP (gallbladder/overweight).

Help? Anyone around to talk this out?

[mmel3283]

I wish I had some advice for you...have you brought this up to your doctor?

[astrophe]

I don't know about "rest of your life." I guess that is up to you and if you are making the accopanying changes or not.

I only took it for a short while, learned to cope with exercise and diet, and my IR went dormant. My SIL who had full blown type II and had to do insulin shots has come off hers as well after she committed to the fitness/diet thing.

Met never helped me lose weight. It helped me stop GAINING, but I never lost with Met. Now I'm working on exercising more so that there's ALSO weight loss.

So even if you take it, I don't think you are doomed to it forever.

My AN has not cleared up yet. I asked my endoc about it since I'm supposedly IR free and she says she doesn't know how long that takes to fade away.

Any chance at a second opinion doc?

A.

[Rana]

mmel3283 -- I tried to talk to my doctor about it, but the sense that I get (now, after three appointments with him) is that he's really defensive about people questioning medicine. Not him. MEDICINE. So, I started to ask if this was for the rest of my life and he starts on his soapbox about how Met has been around for 50 or 60 years and it's the best medication out there for diabetes and that all diseases are "managed" never cured.

That was after he told me that my cholesterol levels were really low and that was because of my genetics and I started to ask him couldn't the reason be because I'm on a strict diet and exercise program? He said no, it's genetics because there are other people who have really high cholesterol out there who can't lower it because of genetics. I sighed because in his hands, he had my file which showed that my cholesterol levels were really high in the past and the last 12-13 months of diet/exercise have lowered from 200 down to 116. I almost rolled my eyes at him.

I don't know why he's defensive, but the conclusion I came to is that he IS NOT the person to have this conversation with.

astrophe -- your story is actually what stuck in my mind when I was asking him about whether this was for life or just for a little while. He told me that not everyone can stomach Met well and if I got sick on it, I didn't have to take it. He's having me take 500 mg first, then increase it.

I've heard that Met doesn't automatically make you lose weight either, some people stay the same, some keep gaining, for me, it would be just to increase my insulin sensitivity.

I'm doing the whole diet/exercise thing and I genuinely think if someone who didn't know my past tried to diagnose me now, they couldn't. My numbers are really good.

My boyfriend wants me to try it just to see if it works on me. Because I'm taking the chromium, I kind of don't want to mix the two.

And if diet and exercise are really going to be the final trick (since my father and you and your family are proving it), then why get on it now, right? I've lose 6 lbs in the last 4 weeks... if I can keep up that weight loss... then...

I'm thinking I won't take it unless I stall?

[astrophe]

Boy, he sounds weirdly defensive.

I felt it was worth trying because at the time I was struggling. It was like I could eat and eat but not feel full. Hello, IR! It's also a 5 star on Mary's PCOS Faq -- http://pcosfaq.com/ like diet and exercise are.

It's your call... but I'd spend more time finding new doc than fretting over the Met. Whether you decide to take it or not, I think successful "management" is going to have to include a doc you can talk to who isn't going to write off your comments or questions.

A.

[Jennifer 3FC]

Wow, tough spot between all those rocks!

You seem to be well educated on all of the reasons pro and con. My best advice to you is quit listening to us, your boyfriend, dad and doctor, and go with what you feel comfortable with. It's your long term health on the table.

But here's my 'if it were me' advice anyway. You don't sound like you are comfortable with the Met, but you are trying natural therapies. That's still science, so you can entertain your boyfriend with a scientific method that doesn't give you diarrhea that clears out the restroom at Target (ask me how I know), a lesser quality of life, or fear of kidney disease down the road. Say it with a confident smile and move the conversation on to something else, because this is a long term decision that is up to you. I'd also kick my doctor to the curb because it takes genetics and personal responsibility to keep cholesterol in check. I know a very fit individual who's cholesterol is always over 300. She takes meds like crazy trying to get it down, but genetically she has issues. But, if she took that as a ticket to eat whatever she wants, she'd have even worse problems! Your cholesterol may be good partly because of genetics, but PCOS says that could change at any time.

I would also ask my new doctor to run a fasting insulin. You want to see how much is running around in your system. The excess insulin can cause long term effects, so you want to make sure that your sensitivity is up. If it is, then you have nothing to gain from met. Those patches may be slow to fade, or could just linger because of the PCOS in general. Mayo Clinic also says it can be caused genetically, or from being being overweight, or as a result of birth control pills, among other things.

Maybe you can find a nutritionist to work with you, or a DO, or an integrative medicine specialist that will help you with the right mix of medication and supplements. (Mine also told me not to mix chromium with Met so you may want to look in to that - I can't remember if it was a suggestion or an order!)

You're doing a great job with exercise, eating right, actively pursuing weight loss, and trying to be a responsible patient. You deserve to have it all work out for you, and I hope it does!

[Rana]

Thanks for the advice.

This is actually one of the best doctors for PCOS in my county. I've been searching for that elusive doctor for years now and believe it or not, he's great in comparison to the other ones that I've had in the past.

Except for that weird defensive posture.

I've read Mary's PCOS FAQ, great information.

Jennifer, you're right about me not being comfortable with Metformin.

Is the glucose tolerance test the same thing as a fasting insulin? I've had the GTT and the A1C and the pinprick on my finger, all of which have come back in the normal ranges.

I think I need to do this on my own terms. Metformin isn't the right thing for me right now, it's diet and exercise and my natural supplements.

I'll try to find a DO or a nutritionist to work with closer. I've just had bad experiences with nutritionists in the past.

[tblassingame]

I was on Metformin for 4 months and it was horrible for me. I think the only reason I lost weight is because I was sick for the entire 4 months. I requested the slow release pills and didn't get sick anymore but my doctor when I was pregnant with my 2nd child had me stop taking them and now they don't want me to start back up. Now they want me to take a Birth Control Pill to regulate my symptoms since I am not IR. I think if I was you I would keep trying exercise and diet and if it doesn't help to consider Metformin. Good luck with your PCOS