Acne

Thankfully acne treatments have moved forward a lot in the past years and very few doctors nowadays will simply tell you to ignore your condition or just wash your face. Treatments offered can be topical or oral and prescription or non-prescription. The main treatments are:

1) Antibiotics such as tetracycline and  minocycline - These are usually prescribed for a period of 4-6 months. Side effects are nausea, vomiting and vaginal thrush.

2) Roaccutane - The active ingredient of Roaccutane is isotretinoin which is a natural by-product of vitamin A. This clears acne by decreasing the size and activity of sebaceous glands. It is usually prescribed for a period of up to six months and is generally used only for  those with severe acne as it is very drying on the skin. It has also been linked to depression. These reports are not necessarily well substantiated. However because of this alleged link most dermatologists/doctors will only prescribe it if acne is severe and unresponsive to other treatments.

3) Topical agents - Tretinoin (prescription only) and creams, gels and lotions containing benzyl peroxide and salicylic acid.

4) Cypreterone acetate - I refer to this drug here only because it will most likely be the first medicine offered to you if you are suffering with PCOS related acne. However, as I have mentioned before it can cause serious weight gain, worsen or cause insulin resistance or increase appetite. It is contained within a pill known as Dianette and I would urge extreme caution to all women using it.

According to the distinguished award winning investigative journalist Sue Ellen Browder, this drug is wholly inappropriate for women suffering from PCOS. She asserts that "[a] PCOS treatment [women] will want to avoid is cyproterone acetate, the drug most frequently prescribed in Europe to get rid of excess hair...... this medication has been likened to a "superstrong birth-control pill". It's most common side effects are fatigue, loss of libido and....... weight gain" (2001, The Power, p166).

5) A Low Carbohydrate Diet can often result in improved skin condition.

Amenorrhea

Amenorrhea is the medical term for lack of periods and is one of the most common symptoms of PCOS* with 28% of sufferers presenting with it, while a further 52% suffer from oligomenorrhea (irregular periods). It is vital that all women have a period at least once every 3 months as lack of periods is a significant risk factor for endometrial cancer. Current treatments offered are: 

1) The Pill -various brands can be tried until one that suits can be found. However, the PCOS afflicted women does better with monophasic pills which deliver the same dose of hormone throughout the month than with the modern triphasic pills which vary the hormonal dosage throughout the month to more closely mimic the natural cycle. This is because the varying hormone levels may allow cysts to grow in the ovary which is not desirable. In general pills which have tri in their name are triphasic and are not suitable for women with PCOS.

There has recently been much talk about the pill Yasmin which contains spironolactone (see the hirsutism section). This seems to suit many women and seems less likely than other pills to lead to weight gain. However, it is worth noting that the pill is not the only option that can be used to bring on periods, and if it does not suit  you then there are other options. 

There is much debate as to whether the pill is good for those suffering from PCOS.  This debate will rage on for some time I am sure. The references here (1, 2, 3 , 4, 5) link to articles describing the arguments against using the pill as a treatment for PCOS. However, some studies assert that it is beneficial for cysters. Visit this site to read the latest on the pros of using the pill to treat PCOS. I am against the use of the pill for cysters, but feel deciding whether or not to take it is a very personal decision.

2) Provera -  This is a progestin that matures the lining of the womb so that when it is withdrawn there is a menstrual bleed. The advantage of it over the pill is it does not have to be taken daily; in fact it is generally only administered for 10 to 14 days, after which a period will occur. It is also much more flexible than the pill as it can be taken whenever it is needed (e.g. if a women has not had a period for 3 months). The disadvantage of it is that it can cause severe PMS like symptoms such as depression.

3) Natural Progesterone - This can be prescribed by a doctor ( brand name Prometrium**) or can be ordered online from http://www.progesterone.co.uk/  or  http://www.life-flo.com/ .It is important not to confuse natural progesterone cream with wild yam cream. The manufacturers of this cream state that wild yam contains diosgenin (which the body converts to progesterone), however no scientific study has proven this claim. The body does not appear to covert diosgenin to progesterone. Wild yam creams are available in healthfood shops in Ireland, however progesterone cream is only available on prescription or online. 

Many women with PCOS are low in progesterone and supplementing this hormone by use of the cream has been known  to induce menstruation, even in women who have not menstruated for years. According to Dr. John Lee, low progesterone levels are responsible for a host of female problems such as PMS, infertility, PCOS  and menopausal difficulties. There is indeed clinical evidence that low progesterone levels are implicated in miscarriages and also, that women with PCOS (who incidentally are more prone to miscarriage than other women) tend to have low levels of this hormone. I am aware of many women who have successfully used progesterone cream to induce regular menstruation. The only problem with the cream is that it tends to be quite expensive if not bought on prescription. The renowned Dr. Mercola also feels the use of this cream tends to be beneficial .           

4) Evening Primrose Oil - This herb is more useful in restoring regularity rather than treating amenorrhea. However, it can be very effective in treating oligomenorrhea, acne and PMS. 

5) Vitex - This herb is also known as Agnus Castus and Chasteberry. It works by balancing  LH:FSH levels, and may also increase progesterone levels. It is most effective if taken in the morning in tincture form.  It is recommended that one see a qualified herbalist or alternative medicine specialist when using herbs as herbs can be just as potent as traditional medicines. In fact in Germany this herb is only available on prescription, so be warned: it is a very powerful herb. I was amenorrheic for 9 months until I started taking this herb. It has worked for me, and I know of other cysters whom it has also helped. If you have never had periods or never ovulate though, the progesterone cream may be much more helpful to you.

6) Glucophage (Metformin) -  Use of this insulin sensitiser sometimes results in spontaneous ovulation along with a regular menstrual cycle.

Hirsutism

This is one of the most distressing symptoms facing afflicted women because it makes many women feel unfeminine. Thankfully, there are treatments available.

1) Low-dose dexamethasone

2) Aldactone (act ingredient Spironolactone) - This is a diuretic, however it also acts as an anti-androgen thus reducing hair  growth. About 70% of patients will improve when this drug is used.

3) Eulexin (act ingredient Flutamide) - This is also an anti- androgen. However, it may be difficult to obtain as it can cause serious liver toxicity. Therefore, if you wish to obtain it a comprehensive liver enzyme examination is required. Because of this it is much more rarely prescribed than Aldactone.

4) There are also mechanical methods of hair removal such as hair removing creams, shaving, waxing, bleaching, electrolysis and laser

Insulin Resistance

Many doctors here still do not believe that insulin resistance exists and, if it does, that it is associated with PCOS. Therefore, you may have to go through various doctors until you get the necessary medication for this dehabilitating condition. Unfortunately, along with suffering the symptoms of the illness, it seems one must also suffer from ill treatment by doctors. In my experience the only way to get an insulin sensitiser prescribed to you is to be incredibly persistent and keep trying new doctors until you find one that will prescribe it. Treatments here are:

1) Glucophage (active ingredient metformin) -  This medication has been the savior of many women afflicted with PCOS. It corrects not only insulin resistance but has a knock-on effect on other hormones in the body so that skin improves, weight loss occurs and the menstrual cycle either appears or becomes regulated. Incidentally, it has helped cysters who don’t test as insulin resistant lose weight, ovulate etc. I am of the opinion that EVERY women facing PCOS should be offered the drug. It has some nasty gastrointestinal side effects such as diarrhea, nausea, and vomiting, however these tend to occur  mainly when the drug is first administered and when the dose is increased. 

2) There are other insulin sensitisers such as Avandia and Actos, and to the best of my knowledge these are available in Ireland . Ask your doctor if you wish to try these. These two medicines are not as linked with weight loss as metformin is.

Infertility

This is a vast topic which covers a huge amount of information so I shall just give a basic overview of current treatments here:

1) Clomid (act ingredient clomiphene citrate)- This induces ovulation in women but can only be used for 6 cycles and, although it causes women to release eggs they don’t necessarily become pregnant with this drug because many PCOS women have poor quality eggs. It can cause PMS- like side effects and intense anger in certain women.

2) Gonadotropin injections - These work by stimulating the eggs therefore improving quality. However, they tend to be very expensive and may result in hyperstimulation so that a woman may become pregnant with twins, triplets,  etc.

3) Intrauterine Insemination - This is where sperm is directly implanted into the uterus so that chances of conception increase because the "middle man" is cut out.

4) IVF - This procedure involves placing sperm and egg together in a test tube and then inserting the fertilised egg into the mother. The disadvantages of this method are that it only has a 20% success rate and it is wildly expensive.

Detailed information regarding infertility treatment treatment can be found at: 

 http://www.vhi.ie/topic/infertility 

*Gilling-Smith, C. and Franks, S. "Polycystic ovary syndrome", Report Med Rev 2 (1993): 15-32 (back)

** I was unable to obtain information as to whether this medication is currently available in Ireland. All other medications mentioned here are, although it may prove difficult to get many doctors here to prescribe some of the above medications such as Glucophage. (back)