PCOS - where to go from here?

mockingjay1 · January 2014

You ladies are so knowledgable, I just wanted to get your advice and opinions on this. I posted some of this (before the PCOS diagnosis) in a W2O thread a couple days ago, but now that I have more information I wasn't sure if I should do something besides wait and see.

I was diagnosed with PCOS by my OBGYN (met enough criteria based on symptoms and polycystic ovaries, androgen lab work pending but has been elevated in the past). I went off progesterone only BC in early October, had a period 23 days later after an anovulatory cycle, and then have not had a period or ovulated since (85 days). I've been temping/using OPKs since I went off BC. I was given provera yesterday to induce a period.

My OB said since we know I have PCOS she would be ok if I waited it out to see what happens or I could try medications (clomid with monitoring). I don't really know what to do from here? Would you wait it out before doing the SA, HSG, and meds since it's only been 4 months off BC? I meant to ask about metformin yesterday, but I was a little overwhelmed and didn't think about it. Wouldn't that be the ideal thing to try first or would you just see how this next cycle goes? I don't want to rush anything if it's not needed, but knowing that I have PCOS makes me want to be proactive since I haven't ovulated for 4 months. If I do go the SA, HSG, med route, should I ask to be referred to a RE (even if I will be monitored by my OB)?

mockingjay1 · January 2014

MeatandBandP said:

Yes, since you have been off BC for only 4 months, I would try at least one more cycle personally. If that cycle is annovulatory I would ask to be referred to an RE and I would not take any meds before getting an SA, HSG etc. I would ask her about metformin also. That seems to have helped some ladies with PCOS regulate.

Thank you! Do you think I should see how this next cycle goes before I ask about metformin, or if you were me would you ask about it now?

mmb248 · January 2014

I have insulin resistant PCOS, so if you're diagnosed with non-IR PCOS my advice may not be helpful. Metformin and changing my diet helped me to ovulate with more regularity, and I waited until we had been TTC for 2 years before seeing a RE.

Because you've only been off BC for 4 months, I would give it a few more cycles and definitely ask your dr about metformin and other ways to regulate your cycle before going through the testing needed for clomid.

mockingjay1 · January 2014

CLECyclist said:

MeatandBandP said:

Yes, since you have been off BC for only 4 months, I would try at least one more cycle personally. If that cycle is annovulatory I would ask to be referred to an RE and I would not take any meds before getting an SA, HSG etc. I would ask her about metformin also. That seems to have helped some ladies with PCOS regulate.

I agree though I would not accept Metformin without having the doctor test to see if you're insulin resistant. It's a cheap prescription but it might not do anything for you but give you the thundershits.

Don't do Clomid without testing (SA, HSG beforehand) unless you enjoy potentially wasting money.

I wasn't 100% sure if I needed lab work done or not. I had read a study on pubmed that said, "Metformin improves parameters of IR, hyperandrogenemia, anovulation, and acne in PCOS irrespective of pre-treatment IR or obesity". I interpreted that to mean it helped with hyperandrogenemia, anovulation, and IR separately. Maybe I am interpreting it incorrectly.

If I've learned anything from this board (besides how important it is to temp), it's that you need to have the proper tests ran (SA, HSG) before ever starting fertility meds.

I will just wait and see how this cycle goes before doing anything else. As always, thank you ladies for the great advice!

renbee · January 2014

I'm in a very similar place as you right now - I'll tell you how I'm going about it and hopefully that will be helpful to you.

I was diagnosed earlier this month by my gynecologist after having a 70+ days cycle and now an 80+ day anovulatory cycle that I'm ending with provera. My blood work showed a 3:1 LH:FSH ratio and normal free testosterone but slightly high "bound" testosterone. My gynecologist doesn't think I have insulin resistance, but she prescribed me Metformin anyway and advised me to start a healthy diet and exercise since I am probably about 30-40 lbs overweight (25 of which I've gained since June...ugh). She offered me Clomid but I decided to wait it out and try to lose weight.

Ultimately, I've decided to make an appointment with an RE, who I am seeing next week. I just want to make sure that the PCOS diagnosis/treatment is correct. My gynecologist didn't seem all that confident (calling it "boderline"), and she never gave me an ultrasound to look at my ovaries, which I think is an important part of this diagnosis. Plus I want to make sure the metformin is the way to go if I'm not insulin resistant.

TL;DR version - Do you feel comfortable with the ability of your OBGYN to diagnose you? Or was she like mine, who looked at me like "I'm not sure what to do with you!". If so, it might be best to go to an RE, who is usually more knowledgeable about PCOS, hormones, and what it means for your fertility. This is just the approach that I am taking, but in the end you should do what you feel most comfortable with. Good luck!

mockingjay1 · January 2014

Aaren91011 said:

I'm in a very similar place as you right now - I'll tell you how I'm going about it and hopefully that will be helpful to you.

I was diagnosed earlier this month by my gynecologist after having a 70+ days cycle and now an 80+ day anovulatory cycle that I'm ending with provera. My blood work showed a 3:1 LH:FSH ratio and normal free testosterone but slightly high "bound" testosterone. My gynecologist doesn't think I have insulin resistance, but she prescribed me Metformin anyway and advised me to start a healthy diet and exercise since I am probably about 30-40 lbs overweight (25 of which I've gained since June...ugh). She offered me Clomid but I decided to wait it out and try to lose weight.

Ultimately, I've decided to make an appointment with an RE, who I am seeing next week. I just want to make sure that the PCOS diagnosis/treatment is correct. My gynecologist didn't seem all that confident (calling it "boderline"), and she never gave me an ultrasound to look at my ovaries, which I think is an important part of this diagnosis. Plus I want to make sure the metformin is the way to go if I'm not insulin resistant.

TL;DR version - Do you feel comfortable with the ability of your OBGYN to diagnose you? Or was she like mine, who looked at me like "I'm not sure what to do with you!". If so, it might be best to go to an RE, who is usually more knowledgeable about PCOS, hormones, and what it means for your fertility. This is just the approach that I am taking, but in the end you should do what you feel most comfortable with. Good luck!

Thanks for the advice/sharing your experience. I think I'll see what happens after taking provera (which will hopefully induce a period) and go from there. If I have another long anovulatory cycle that needs provera again, I will probably go to a RE. I have done lots of checking with my insurance and as long as they are in network (which they are) I don't need a referral. I think I'd just be more comfortable working with a RE, and I've heard wonderful things at work and from friends about the ones I would go to.

renbee · January 2014

No problem! And feel free to PM me anytime - sounds like we are going through very similar stuff and it's always nice to have a buddy who understands

Want a personalized experience?

PCOS - where to go from here?

Re: PCOS - where to go from here?

Choose Another Board

Search Boards