9 of the Most Embarrassing PCOS Questions Answered

If you have polycystic ovary syndrome (PCOS), there may be a lot of things that don’t make sense to you or questions that you may be too embarrassed to ask about. Here medical experts answer nine of some of the most embarrassing PCOS questions.

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Why Does Metformin Cause Diarrhea?

You may be aware that a big side effect of metformin is diarrhea. But why does it do that, and especially after a meal? According to Dr. Mark Perloe, a reproductive endocrinologist with Georgia Reproductive Specialists in Atlanta, Georgia, it’s related to serotonin.

“Serotonin is an important neurotransmitter produced in the small intestine that affects bowel motility. During the first few weeks of metformin therapy, excessive release of serotonin can cause diarrhea and nausea,” says Perloe.

So what can be done to help with the unwanted side effects of metformin? Perloe offers “if you are just beginning with metformin, start with small doses, gradually increasing over time, and taking metformin at mealtime with a full glass of water.”

Avoiding high carbohydrate meals or meals that include processed or refined foods can also help to minimize the side effects of metformin.

Also, the Sustained Release form, which is prescribed once a day as opposed to the immediate release which is prescribed twice a day, is less likely to cause GI side effects.

Are Large Menstrual Clots Serious?

If you get heavy periods, you may sometimes come across large and somewhat terrifying blood clots. While many people suffer from heavy bleeding during their periods and pass blood clots, it doesn’t necessarily mean that something bad is going on.

“During menses, the body releases anticoagulants to keep the blood from clotting as the lining sheds from the uterus. When bleeding is heavy (released at a quicker pace), there is not enough time for the anticoagulants to do their job and therefore clots form,” explains Dr. Heidi Strieb, an OBGYN in West Reading, Pennsylvania.

Should you be worried? “If you continue to pass clots larger than a quarter or are saturating a tampon or a pad in an hour,” says Strieb, “you need to be evaluated by a doctor to determine the cause.”

Why Do You Worry All the Time?

Do you feel like your mind is constantly racing at 100 plus miles per hour and you can’t slow down your worried thoughts? It may be related to anxiety.

According to Dr. Stephanie Mattei, author of "The PCOS Workbook: Your Guide to Complete Physical and Emotional Health" and co-founder of the Center For Acceptance and Change, “if you notice yourself worrying more often than those around you, and you find it difficult to control your worry, you might have an anxiety disorder.”

How do you know if it’s serious? “If you feel nervous most of the day, every day, or have difficulty concentrating, or are irritable, or if it interferes with your ability to socialize, sleep or eat, you might want to seek help from a professional who specializes in anxiety disorders.”

Why Take Metformin If Glucose Is Normal?

While metformin is the most common medication prescribed for individuals with type II diabetes, it has been shown beneficial in women with pre-diabetes or PCOS. It is not approved for use in people without diabetes and its use in those without diabetes is considered off-label.

“Metformin works in the liver and primarily allows for better sugar control with less insulin. As a result, when combined with a low glycemic diet and exercise, metformin will often reduce post-meal insulin response,” explains Perloe.

“This drop in insulin leads to a reduction in androgen [testosterone] production in the ovary and restoration of ovulation.” Perloe adds “Metformin is associated with weight loss which can further improve menstrual irregularity and the odds of conceiving.“

Why Can’t You Just Stop Eating?

If you find yourself battling constant carb cravings and can’t stop eating, you’re not alone. People with PCOS tend to have high insulin levels, which stimulate the appetite.

“High circulating insulin levels make every cell in a woman's body scream ‘eat those brownies NOW!’ as if life depends on it,” says Julie Duffy Dillon, a registered dietitian and food behavior expert in Greensboro, North Carolina.

“It's not a lack of willpower or a personality flaw. Managing insulin levels with nutrition, supplements, and/or medication can help lower insulin levels. Once insulin levels are lower, the craving to binge eat is significantly lower as well.”

What to do about it? Dillon recommends people with PCOS focus on healthy food choices, activity, and self-care and offers these helpful tips: “be sure to eat consistently throughout the day, include all the food groups, and stop thinking about food as good or bad. Being more flexible with food choices will help cravings lose their intensity.”

Why Do You Have Excess Hair, Skin Boils, and Lumps?

You might notice excess hair on your body or face. This is called hirsutism, and it is caused by the hormone imbalances of PCOS. There are many ways to manage it, including cosmetics, skin treatments, and medication.

If you have pea-sized or larger lumps above and beneath the skin in places where the skin rubs together such as under the arms, thighs, groin, under breasts, and between buttocks, you may have hidradenitis suppurativa (HS).

This chronic inflammatory skin condition is believed to be both autoimmune and hormone-related. Those who have HS can experience physical pain and emotional pain from this chronic condition. Research is showing the impact of an anti-inflammatory diet in managing this condition.

What’s in Those Ovarian Follicles?

A follicle is a fluid-filled sac that contains one egg and the cells that prepare the egg for early embryo development. People with PCOS typically have an endocrine disorder that results in many small antral follicles at the start of every period.

Due to an imbalance of sex hormones, the eggs inside those follicles do not grow, and as a result, the follicles remain small for the entire cycle.

According to Dr. Isaac Sasson, a reproductive endocrinologist with Shady Grove Fertility in Chesterbrook, Pennsylvania, “without follicular growth, ovulation does not occur and typically women will have an irregular cycle.”

Sasson doesn’t think you should be worried about the number of follicles. “From a fertility perspective, having too many follicles is a fantastic problem to have,” says Sasson. “It means that there will be many more eggs to work with. The challenge is getting them to grow.”

Medications can be used in most instances to help one or two follicles grow in size and induce ovulation.

Why Is Your Liver Fatty?

Having a fatty liver is pretty much what it sounds like—you have a lot of fat in your liver. Non-alcoholic fatty liver disease (NAFLD), commonly referred to as fatty liver, is highly prevalent in people with PCOS.

NAFLD occurs as a result of excess triglycerides (fat) stored in the liver, which causes damage and inflammation. The liver isn’t meant to store fat; its role is to serve as the detox organ for the body, filtering out harmful substances and regulating blood glucose levels with the pancreas. While there are many causes of NAFLD, it can be reversed with a healthy diet and lifestyle.

Will PCOS Ever Go Away?

PCOS won’t ever go away for good. The good news is that with a healthy diet, regular physical activity, medications, supplements, and other lifestyle changes, PCOS and its symptoms can become manageable.

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