This will be cross posted to the PCOS forum and general discussion.

I am writing with a heavy heart today because the PCOS I struggle with is fighting back and now my hormonal battle just got more complex.

Prior to surgery, I took Metformin and hormones to help with PCOS. I got WLS because beyond the ~20 lb loss from the metformin, I was unable to lose weight despite a low carb diet and exercising hard at the gym. 

I went off the meds and hormones for over 1 year 7 months.  Around March 2015, my endocrinologist declared my labs were normal and congratulated me for beating PCOS. I was happy but kind of had to wonder as I was still having acne, darkened skin, and hair issues..but maybe it really was something in my heritage/family tree (i.e. just being a hairy woman).

Unfortunately, despite eating low carb and a low GI diet, my Hb A1C is 5.5 (it is in the upper limit of normal; the upper threshold is 5.6). Thank god for the vets that tell people to eat protein forward/ low carb. Had I NOT been eating this way, I would certainly have been in the pre-diabetic range or at least in the "monitor closely stage".

My free and bound testerone is also high.

So now I am back on metformin.  Interestingly, Metformin seems to absorb better and have a better bioavailablity AFTER RNY as compared to non-RNY patients. So this may be the ONE drug on the planet that does better after WLS.

 

http://www.diabetes.org/research-and-practice/patient-access-to-research/gastric-bypass-surgery-can.html?referrer=https://www.google.com/

 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3114332/

Effect of Gastric Bypass Surgery on the Absorption and Bioavailability of Metformin

Raj S. Padwal, MD, MSC,1 Raniah Q. Gabr, MSC,2 Arya M. Sharma, MD, PHD,1 Lee-Ann Langkaas, LPN,3 Dan W. Birch, MD,4 Shahzeer Karmali, MD,4 and Dion R. Brocks, PHD2     What I am most worried about is the progesterone and other hormones I am going to have to take. Prior to surgery, an oral birth control would have handled it. NOw, my endo is referring me to a gynocologist to get it all figured out (along with preventing pregnancy ).   It would have been easier to have a "remedy" (there is no remedy for this) to combat these symptoms had I had the slee***** WLS. To be clear, I do not regret RNY. I Love my surgery. But alternatively, it makes the treatment "landscape" so much more complicated and limiting.   While resolution of PCOS MAY occur, I knew going in it wasn't 100% thing.  I was really pleased to be PCOS free for a few months.   But I am scared and disappointed too.  I WI**** could have gone away forever, hence the disappointment.  I am scared because the last time I had a flare up, I could gain 7 lbs a week WHILE on a diet. I am afraid that I will regain my weight and have no mechanism to get it off. LIke I used my one nuke (WLS), I dont have anymore weapons in my arsenal beyond anorexia, but anorexia isn't a sane, normal option is it.   Sometimes, I really really hate my body and how it turns against me.   That is it. -SS

Your words are painful to read.  I am sorry.  Maybe HOPE can be considered an arsenal for miracles to come your way, okay?

Thank you. I am trying to see the blessing in this (i.e. WLS causes me to visit ALL my docs quarterly and this was caught "early"). Right now things are in the upper threshold of normal (i.e. they havent become abnormal yet) and I am being treated early.

I wrote the NUT at the surgeons office, and the surgeons PA, to let them know what is going on and requested a meeting wiht the NUT. If it takes going back to 1/2 cup or a 3/4 cup of food (total per meal) rather than my normal cup...I will do it.  

I am recruiting my healthcare team as quickly as I possibly can.  Hopefully, they will know what the right answers are. I KNOW that I can do whatever it is they deem appropriate. I WILL NOT be the weakest link in this effort.

I'm so sorry.  No words.  You are so strong.  If anyone can figure out an approach that works, it will be you.  Hugs!

Thank you for your kind words. I am recruiting my WLS surgeons staff (particularly his NUT) as fast as possible.

I'm so sorry to hear about the return of PCOS.  I am hoping that your new style of eating will limit your flare ups.  We are all here to support you while you deal with this! 

I hope so too. I havent gained any weight beyond normal/usual 3 lb variation (i.e. today I am 142...tomorrow if I use the bathroom I will 139..You get it. I just vary between 139-142 on any given day).

Thank god for eating protein forward.  Seriously, if I were twirling pasta, rather than zoodles, I KNOW exactly were I would be because I have been there before. Packing on the pounds!

I am just scared that it is going to happen anyway (i.e. gaining the weight back) just a slower rate. So it will be a long slow drawn out horror movie rather than a fast horrific horror movie.

:(

 

There is something about torture.  I would prefer that it happen fast and just be over, ya know?

I hate hearing this. I'm hoping this is not a long term issue for you.  I also have PCOS and I understand the helplessness you can feel about weight gain and this was one (of the many) of the reasons I was considering RNY. 

Is there any evidence that it will eventually go away (like with menopause)?

 

I dont know. It is a chronic condition.

I wonder, if I didnt have ovaries, for the excess insulin to sit on, would I still get fat? 

I will also have to see where the majority of aromatase is (it makes the testerone which vitilizes the body hair which makes us hairy).

Considering moving to East Germany (ok. that was a bad joke)

O dear, SS, this is not at all what I would've hoped for. You have worked so hard and been through a lot. Since this is your first flare up post WLS, let's hope that it's different than before and maybe easier to manage. We can't know until we're there. Fact is, you haven't yet gained any weight, right? So maybe you won't. I'm certainly hoping with all I have that this is the case and your levels return to a better range quickly.