DrLisaFish: Okay, thank you for having me. I am going to pass this over to Dr. Jaffe.
womenshealthADM: Thank you Dr. Fish
DrLisaFish left...
DrRobertJaffe joined...
womenshealthADM: Good evening Dr. Jaffe. Thank you for coming.
DrRobertJaffe: Hello! I'm the president of the Hormone Foundation which is the public education and outreach arm of the Endocrine Society. We're putting on a public forum here in Toronto for the women of the Greater Toronto area dealing with PCOS and insulin resistance.
That's Saturday (June 24, 2000) morning at 9:00 at the Royal York Hotel and admission is free.
I'm ready for your questions.
womenshealthADM: Mathilda your question
Mathilda: Is there data to support the use of MET in PCOS patients w/normal insulin tests?
DrRobertJaffe: No. Metformin is used only if you can demonstrate that there is increased insulin resistance. The way we currently do that is to measure fasting insulin and at the same time measure fasting glucose. If the ratio of insulin to glucose is excessively high, we take that as an indication that they have increased insulin resistance. Those are the patients with whom we would treat using metformin.
DrRobertJaffe: next?
womenshealthADM: Dmerck your question
Dmerck: What does insulin have to do with PCOS?
DrRobertJaffe: Well, that's a very active area of investigation. There is information suggesting that insulin acts on the ovary to cause increased production of androgens, which are male type hormones and which give rise to the excess skin oiliness, acne, and extra hair growth.
There also is evidence that insulin may act on the gland which regulates the ovary which is called the pituitary gland; and that gland in turn would stimulate the ovary to produce more androgens. The excess androgens also may have a negative effect on normal ovarian function.
Dmerck: I have PCOS and my insulin is normal.
DrRobertJaffe: I would not treat you with metformin if you have no sign of increased insulin resistance. Not all women with PCOS have increased insulin resistance, although a large number do particularly if they tend to be overweight.
DrRobertJaffe: next?
womenshealthADM: mish your question
mish: Last year I was diagnosed with Graves Disease by one doctor, does this have any relation to PCOS?
DrRobertJaffe: No, Graves Disease is a disease of the thyroid gland which doesn't put you at particularly increased risk for PCOS. But thyroid abnormalities can also interfere with normal menstrual function and frequently, when you correct the thyroid disorder, you restore normal menstrual function.
DrRobertJaffe: next?
womenshealthADM: PaulaPCOSA you're next
PaulaPCOSA: What kinds of resources should we present to our doctors if they don't know much about PCOS? My doctors are all very knowledgeable, but there are a lot of women who ask about how to educate their health practitioners.
DrRobertJaffe
- Well, the Hormone Foundation will be producing
information on PCOS and insulin resistance which we will put on
our website.
DrRobertJaffe: next?
womenshealthADM: who has a question?
tc: The doctor has not diagnosed me with PCOS so why the glucophage? He has checked my sugar/glucose level and it was fine. I have endo and only one ovary; tried clomid with no luck. He wants to try this before follistim.
DrRobertJaffe: I wanted to add that there are many sources of information for the physician at the present meeting of the endocrine society here. There are many talks related to these topics so the endocrinologists who attend these meetings get the latest information about how to make this diagnosis, what the underlying problems are, and how to treat the disorder. It's the job of the Endocrine Society to educate the physician and the job of the Hormone Foundation to educate the public about hormone related disorders.
DrRobertJaffe: Follistim is a hormone that is a synthetic form of the hormone that stimulates the ovaries to cause ovulation. If the patient isn't ovulating and the reproductive endocrinologist determines that her chances of ovulating would be better if the ovaries were stimulated, then she might choose that as a treatment. But if there is no sign of increased insulin resistance when the woman is not taking metformin then it is likely that she would not benefit from taking it.
DrRobertJaffe: next?
womenshealthADM: Heather your question...
