Victoria Beckham is pregnant with her fourth child. The former Spice Girl and fashion designer already has three sons with soccer legend David Beckham. Getting pregnant has not been easy for Posh Spice, as she suffers from a disease called Polycystic Ovarian Syndrome, an endocrine disorder which can affect fertility.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is a reproductive metabolic disorder in young women that is often missed in a primary care office. A common complaint by a young woman is “I can’t lose weight” or “my weight keeps going up and I barely eat anything”. Other signs/symptoms such as irregular periods, inability to conceive, facial hair, persistent skin rash, acne, oily skin, and a darkened neck ring is specific and common to this disorder. About fifty percent of women are obese with insulin resistance and fifty percent are thin without insulin resistance. In PCOS affected women phenotype variability exists with a caveat of the above symptoms
Researchers are still uncertain to the exact cause of PCOS but believe environmental and genetic influences play a role in it. Another contributing factor that could be related is chronic body inflammation from the environment and fetal exposure to male hormones. It is believed hormonal imbalances are triggered by excess secretion of insulin from the pancreas. This leads to the ovaries to secreting more estrogen and testosterone and less progesterone which causes abnormal menstrual cycles, often skipping months at a time.
Laboratory markers correlating with this syndrome include the LH/FSH ratio 1:1 along with high values for free testosterone, estradiol, and a low value for progesterone. PCOS that is more advanced have LH/FSH ratios up to 4: 1 and sometimes much higher. Insulin levels are usually greater than or equal to 15 depending how advanced the syndrome is which also affects both metabolism and weight gain. Other metabolic findings include hypothyroidism, abnormal glucose metabolism, and elevated cholesterol triglycerides. The fasting sugars may be elevated indicative of impaired fasting glucose or the two hour postprandial blood sugar is elevated indicative of impaired glucose tolerance. Slowly, the hemoglobin A1C elevates along with FBS till diabetes is diagnosed.
Treatment must start early because complications of infertility, male balding pattern, diabetes, unopposed estrogen, and miscarriage are higher in PCOS women. The unopposed estrogen can lead to endometrial thickening and complications with numerous ovarian cysts; which are pearl-like strings laced through the ovaries. Obesity can lead to metabolic syndrome with dylipidemia, diabetes and hypertension.
The first goal in treatment is lifestyle change to a structured regimen of calculated macronutrients, and exercise involving both cardiovascular and strength training. The weight must be lost to help reverse this syndrome and restore normal ovulatory menstrual cycles. Patients who become partners in their management have the best success in weight loss and reversing their syndrome to normal cycles of menses. Pharmacological treatment consists of metformin, spirolactone, natural progesterone, and armour thyroid if T3 is low. These medications help with unwanted hair growth, energy, and metabolism, insulin lowering, and balancing estrogen. Once, approximately 10% of the weight is lost and progesterone is consistently taken the menstrual cycles resume and insulin levels start to lower. In thin patients without insulin resistance treatment is symptomatic with spirolactone, progesterone and T3 if needed. Some providers do use the birth control pill but I find it more of a problem with weight gain with this population.
Patients with this syndrome are seen biweekly for weigh in and to adjust exercise and dietary regimens. Successful weight loss patients lose up to 2 pounds per week which is a good range to prevent regaining the weight. The challenge in weight loss is exercise when lethargy is present. Vita Cell B injections two to three times a week and a daily supplement of B50 is suggested to counteract fatigue. I suggest Lap Band in a Bottle for hunger; which, can be taken three times a day with a full glass of water. The Vita Cell B injection is a compounded blend of B vitamins with lipotrophics, and Lap Band in a Bottle is a natural supplement that suppresses appetite. None of the supplements for weight loss contain any stimulants. Successful weight loss may take up to one year depending on amount of weight that needs to be lost.
Once weight loss is achieved and normal menstrual cycles resume, patients are monitored every three months, six months, and yearly for their weight, symptoms, and blood work.
Nancy Onyett, FNP-C
Pyramid Preventative Medicine
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