PCOS Review Newsletter #6


TABLE OF CONTENTS

1) Lab Tip: Afternoon Glucose Test Misses Blood Sugar Problems

3) "The Thief of Womanhood": Women's Experience of Polycystic Ovarian Syndrome


1) LAB TIP: AFTERNOON GLUCOSE TEST MISSES BLOOD SUGAR PROBLEMS

Your doctor probably ordered a blood chemistry as part of your PCOS diagnosis. (By the way, if your doctor did NOT order a blood chemistry before prescribing the usual birth control pills and/or metformin, we suggest you find a better doctor.)

Part of the blood chemistry test is your fasting glucose (blood sugar) level. "Fasting glucose" is your blood sugar level after avoiding food or beverages for at least 10 hours. Either a low or a high fasting glucose suggests you have an impaired ability to control your blood sugar. A high fasting glucose would make your doctor suspicious that you are diabetic or pre-diabetic. As you may know, women with PCOS have a much higher risk of developing diabetes than non-PCOS women.

A couple of things can go wrong when testing your fasting blood glucose levels.

First, it's possible you had your blood drawn too soon after eating a meal or consuming a beverage, which has the effect of raising your blood glucose level. Thus, you would have an elevation because you recently ate something, not because you may have a diabetic problem. Hopefully, if your fasting glucose was high, your doctor asked you if you had anything to eat or drink prior to the blood draw.

Second, and more important, is a fact that your doctor may not know about. According to a study in the Journal of the American Medical Association,(1) as many as 50% of people with undiagnosed diabetes may show "normal" results on an afternoon fasting glucose test. In other words, your fasting glucose level in the afternoon is naturally lower than in the morning. So if you had your blood drawn in the afternoon, your blood glucose level might be "normal" whereas a morning test would show your glucose level to be "high".

Researchers discovered that the afternoon test missed twice as many people with diabetes and nearly three times as many people with impaired fasting glucose compared to the morning test. Even a 2-hour shift in testing time may cause an inaccurate "normal" result in a person with blood sugar problems. The implication is this: If you had your blood drawn in the afternoon, and your fasting glucose was "normal" or at the high end of "normal", your blood sugar may actually be higher than you or your doctor think.

OUR RECOMMENDATIONS: We think it's a good idea to get more than one fasting glucose test before making major treatment decisions. And if you can, get your blood drawn in the morning.

Because many women with PCOS have blood sugar abnormalities, you should also get a glycosylated hemoglobin test (HbA1C), which measures the sugar level in your red blood cells. Because red blood cells live about 90 days, the HbA1C test gives you an average for your glucose levels over the past 90 days. If your HbA1C level is high or at the high end of normal, then it's clear you have a problem with chronically elevated blood sugar. We'll talk about other lab tests in future newsletters.


3) "THE THIEF OF WOMANHOOD": WOMEN'S EXPERIENCE OF POLYCYSTIC OVARIAN SYNDROME, Kitzinger C, et al, Soc Sci Med, 2002, 54(3):349-61

ARTICLE SUMMARY: "Previous research on polycystic ovarian syndrome (PCOS) has overwhelmingly been conducted within a medical or psychiatric framework, and has failed to explore women's own experience of the syndrome. Interviews were conducted with 30 women with PCOS recruited through a national self-help organization."

"Thematic analysis of the interviews revealed pervasive reports of feeling 'freakish', 'abnormal', and not 'proper' women. These feelings were related to three symptoms commonly experienced by women with PCOS: 'excess' hair growth; irregular, absent or disrupted periods; and infertility. Smooth hairless bodies and faces, regular menstruation and the capacity to bear children were associated with femininity, and as a result of their symptoms women expressed feeling 'different' from other women and less 'feminine'. The results are discussed within a feminist framework and suggest that polycystic ovarian syndrome is a deeply stigmatizing condition, 'a theft of womanhood', with far reaching implications for all women, whether or not they conform to 'feminine' norms."

OUR COMMENTS: It's no secret to you how emotionally painful PCOS is. It's time for this aspect of PCOS to be recognized in the medical literature for the serious problem it really is.

There's a physical component to your emotional pain. A feeling of being out of control, or carrying negative emotions such as repressed anger leads to a prolonged physiological stress reaction. This reaction creates stress hormones, including cortisol.

Under chronic stress, cortisol levels in your body may remain high for long periods of time. Excessive cortisol interferes with insulin's ability to store blood sugar into tissues. The result is insulin resistance and hyperinsulinism, which many researchers think is the primary driving force behind PCOS. Insulin resistance also contributes to other disorders such as diabetes and heart disease.

How you process your feelings about your body and the reactions of people around you has a lot to do with your eventual outcome with PCOS. Look into various stress management techniques and start using them. They will help you to keep your cortisol hormone under control, and you will have a more optimistic outlook. A few common stress management methods are exercise, meditation, reading poetry, taking a walk, deep yogic breathing, deep relaxation, getting a good night's sleep, resolving emotional issues with others, and sharing your feelings with a good listener or psychotherapist. Stress management is a necessary part of your PCOS healing program.


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