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Polycystic ovarian syndrome is a treatable condition

Date published: 2/20/2005

DO YOU sometimes go months at a time without having a period only to fear that you're bleeding to death once it finally starts? Are you doing all the right things to lose weight, but the weight just won't come off--in fact, you're gaining weight?

Have you noticed hair growth in places where women just aren't supposed to have hair? Have you had trouble getting pregnant?

If you answered yes to any of these questions, you may have polycystic ovarian syndrome.

PCOS is a common condition affecting approximately 5 percent of all pre-menopausal women. Although the exact cause of PCOS is not fully understood, insulin resistance and over-secretion of androgens (male hormones) are important factors.

When we eat carbohydrates, our pancreas secretes a substance called insulin, which allows our cells to use the glucose in our food. Some people's cells are resistant to insulin, so the glucose isn't absorbed as well. The pancreas responds by secreting more insulin, and blood levels of this important hormone rise.

Among other things, this overabundance of insulin affects the ovaries, causing them to secrete excessive amounts of androgens--which leads to abnormal hair growth and anovulation (the failure of the ovaries to release an egg on a regular schedule). That then leads to irregular periods and infertility.

PCOS can be diagnosed by symptoms alone, but sometimes laboratory studies are necessary to make or confirm the diagnosis, and to rule out conditions that can have similar symptoms.

For an overweight woman with infrequent periods and hair on her chest, there's a good chance that PCOS is the problem. However, the diagnosis is a bit trickier in a woman of normal weight with no abnormal hair growth.

The work-up of women with suspected PCOS includes lab tests to rule out tumors, adrenal gland and pituitary problems. It's also important to commence routine screening for associated conditions such as high blood pressure, diabetes and elevated cholesterol. A pelvic ultrasound also may be helpful.

Once the diagnosis is made, one of the best and longest-lasting treatments in those who are overweight is weight loss. This can be difficult because insulin promotes weight gain, but it's not impossible.

Lower-carbohydrate diets are often more effective than lower-fat diets. Also, simple sugars should be avoided; instead, opt for complex carbohydrates such as whole grains.

Among the medications that are helpful in alleviating the symptoms and physical signs of PCOS are: the birth control pill/patch/ring; drugs commonly used for diabetes such as metformin; and a host of medications aimed at reducing abnormal hair growth.

For those women trying to get pregnant, medications to induce ovulation are available.

Women with PCOS are at higher risk for endometrial cancer (cancer of the lining of the uterus) so it's important for them to have periods, which can be induced using birth control.

The higher cancer risk stems from anovulation, which leads to a secretion of estrogen without a counteracting secretion of progesterone. This is called unopposed estrogen.

It stimulates the endometrium, which is the lining of the uterus, and the part that partially sloughs off during a period. If there is no progesterone around to counteract the estrogen, then the endometrium is under continual stimulation, and this can lead to endometrial cancer.

The missed periods, infertility, hair growth and weight gain of PCOS can be very unnerving. If you happen to recognize yourself in this description, don't fret--you're not turning into a hairy, overweight man. It's infinitely more likely that you have PCOS, and effective treatments are available.

DR. ARLENE LEWIS welcomes reader comments and questions. She can be reached by writing at Free Lance-Star, 616 Amelia St., Fredericksburg, Va., 22401 or by e-mail at newsroom@freelancestar.com.

Date published: 2/20/2005

Despite teen’s surgery ‘She still is our Zannah’
By SHERRI CONER
Daily Journal staff writer
sconer@thejournalnet.com

Feb. 16, 2005

Health problems prevent Zannah Harbert, 18, from sprinting along the fast track like most high school seniors.

But Harbert’s ability to jog along at her own pace, despite the setbacks, keeps her goals intact and her attitude positive.

When she was a youngster, Harbert’s parents, Ed and Nancy Harbert of White River Township, noticed their second child did not appear to be growing normally.

At age 4, Harbert weighed only 29 pounds. By the time she was 9, she was experiencing headaches and peripheral blindness. And she was still much shorter than other children.

Hospital tests discovered a non-cancerous tumor wedged near Harbert’s optic nerve and pituitary gland. Doctors at Riley Hospital for Children monitored the growth of the tumor, hoping to delay brain surgery as long as possible.

But when Harbert was in eighth grade, surgery loomed in her future.

"That year, for unknown reasons, the tumor doubled in size and was causing significant blindness," her father, Ed Harbert, says. "There had to be relief. And Zannah adamantly wanted it out."

In March 2001, Zannah Harbert was wheeled into surgery.

Knowing that brain surgery might affect their daughter’s personality, the family prayed for a specific result, Nancy Harbert says. "We prayed so hard that she would just be our Zannah," her mother says. "That she would still be who she is: kind, sweet and loving."

As she looks across the living room at her second daughter, Nancy Harbert smiles and says, "And she still is our Zannah."

Not long after Zannah Harbert was discharged from the hospital, she was readmitted with complications. Though her pituitary gland was left intact after the surgery, it was no longer functioning.

While other kids her age made summer plans and shopped for a high school wardrobe, Harbert’s life now included a pediatric neurosurgeon, an endocrinologist, a neuro-ophthalmologist and a health issue she would likely struggle with for the rest of her life.

When the pituitary gland no longer functions correctly, various other bodily functions are affected. So Harbert is dependent on daily medications. She also has very low resistance to bacterial infections. She developed diabetes and battles chronic fatigue.

Frequent absences kept their daughter from enjoying her freshman year of high school, Nancy Harbert says. Instead of attending classes, Zannah Harbert received tutoring at home.

Her high school experience, overall, has been riddled with frequent illnesses. Her free time is limited. She requires a lot of extra time to muster the energy to complete homework assignments.

But her parents are more worried about that lost time than she is, Harbert says.

"Even though I am home a lot, I still have friends who come by and see me," Harbert says with a smile. "I still have to work pretty hard to get the good grades. I still struggle with being tired. And I’m absent more than other kids."

Medications to offset the lack of a pituitary gland caused Harbert to gain weight. And she takes that side effect in stride. She prefers to focus on the success of ingesting an oral growth hormone, which added nine inches to her height.

"I’m 4 foot, 11 inches and a hair," Harbert says with a laugh.

Faith helps her deal with day-to-day challenges, Harbert says.

"And I have a lot of people praying for me," she adds.

Right now, Harbert is not sure where she would like to attend college next fall. But she says she does feel ready to move away from home. And she is fairly certain that nursing will be her field of study.

"I think I would be able to connect with my patients quite well," she says.

Hypothyroid condition requires medication

Q. Please address weight and women with hypothyroid condition. Twice I've gone on hypothyroid medicine and then gained weight. I'm 60, eat less than ever (both types and portions of food), work out with weights two to three times per week, walk on a treadmill and take vitamins. The weight just creeps upward. Others must have the same frustrations.

A: Satirist Ambrose Bierce defined "patience" as "A minor form of despair, disguised as a virtue." Dealing with thyroid problems requires patience in spades.

The thyroid gland looks like a butterfly sitting on the front of the windpipe. It pumps out the hormones, which affect cell growth, development and metabolism. This means that virtually every organ in the body can be affected if it is malfunctioning. "The thyroid is like a battery. It charges up all the other organs," says Barbara Glass, executive director of the Thyroid Society for Education and Research. "If it runs too low or too high, it throws off the entire body." Left untreated, a wonky thyroid can cause high cholesterol, heart disease, osteoporosis and infertility.

One in 10 women over 40 have undiagnosed thyroid disorder and are five to eight times more likely than men to have a thyroid problem. If you start feeling unusually exhausted, suddenly start gaining or losing weight, feel depressed, become mentally foggy, start losing hair, begin having vision problems, have chronically cold hands and feet, an irregular heartbeat or changes in your menstrual cycle, do not assume it is menopause. Instead, go to your physician and request two simple blood tests: thyroid-stimulating hormone (TSH) and free-T4 to see if your thyroid is on the fritz.

The caveat with the TSH test is that "normal" range is anywhere from 0.4 to 4.4 milliunits per liter. It is recommended, therefore, that young women in their 20s and 30s get a baseline thyroid test to determine their normal range. Even slight changes from what is normal for you can cause problems.

If the TSH levels are too high, the pituitary gland is working overtime to normalize the thyroid, causing hypothyroidism, which is characterized by weight-gain, mental fogginess and sluggishness. Eighty percent of the thyroid cases fall into this category. The opposite condition is hyperthyroidism, characterized by bulging eyes, rapid heart rate, nervousness and sudden weight loss. This is because hormones are overproduced, which makes the thyroid operate on full throttle.

The solution is two-fold. First, work with your doctor to find a thyroid medication that works for you, and then stay on it until your thyroid becomes balanced. This may require blood work every four to six weeks; and, it may take as long as six to eight months for your thyroid to achieve balance. Second, exercise is very important, but only once you are balanced. Pushing yourself too hard before you are balanced could cause harm, so stick with light activity, no more than 40 minutes, three times a week, starting at an easy pace.

Contrary to popular assumptions, hypothyroidism does not make anyone fat. The fatigue and deep weariness that characterize this condition have much more to do with weight gain than the malfunctioning thyroid.


Linda Buch is a certified personal trainer and co-author of "The Commercial Break Workout." She will answer fitness questions in her column but not individually. Send questions to Body Language, Bay Area Living, 4770 Willow Road, Pleasanton, CA 94588 or e-mail her at linda@ljbalance.com.