Masks and Illusions
Ask Dr. Quinn…
Dear Dr. Quinn,
I am a 35 year old woman with three children. I have recently been diagnosed with poly-cystic ovarian syndrome (PCOS). I am taking Lupron prescribed by my physician, and my menstrual cycle is regulating. But I feel tired and depressed all the time. I quit my job three months ago because I just did not think I could go to work every day, and my husband has just changed jobs. All of this has affected our relationship as well. Do you have any suggestions?
Nichole
Dear Nichole,
What you are describing is somewhat unusual. The great majority of women who have polycystic ovarian syndrome (or disease) are usually diagnosed in their teens or twenties. There are a complex of symptoms that are part of this diagnosis that are common for most women and the treatment follows one of several courses depending on the desired outcome.
In general, the woman with PCOS has irregular periods from adolesence, if she has them at all. As one of the most common causes of female infertility, this patient often has difficulty achieving a pregnancy. She will have difficulty with weight gain, (although some women are very thin) and will have trouble controlling her weight. This patient also has hirsutism which means that she will have growth in body hair that is like males: around the aureola of the nipples, moustache and facial hair, and increased midline forearm hair. She may also have outbreaks of acne that are a direct response to the increased levels of testosterone in her body. While her blood sugar levels may fall within normal range, one of the most currently determined factors of PCOS is that the body does not utilize the insulin produced in the pancreas at the cellular level. At this stage of research, what is not known is whether this is an effect or a cause of the lack of ovulation. On ultrasound the patient’s ovaries will appear in the classic somewhat flattened shape with a “necklace” of clear fluid cysts.
In your case, because of your age and the previous pregnancies I would strongly suggest that you get a second opinion regarding your diagnosis. Without having more specific information it is difficult to draw further conclusions.
There are some interesting questions that you should ask your physician as well as the healthcaring provider from whom you seek a second opinion.
One, why are you taking Lupron? That is NOT the treatment of choice with PCOS; it is more commonly used as a treatment for endometriosis. The action of Lupron is as a growth hormone agonist and it inhibits the production of estrogen which inhibits the proliferation of endometriosis and helps manage the associated pain. (It is also useful and is used for men with prostatic dysfunctions for the same reasons.)
Two, Polycystic Ovarian Syndrome is commonly a dysfuction of adequate progesterone production to support the development of the ova and the corpus luteum which assists in the rupture of the follicle allowing the release of the ova during ovulation. Commonly, treatment will include a progesterone challenge test to induce ovulation and determine if there is enough estrogen present to cause the uterus to thicken as preparation for a pregnancy and menstruation. When the appropriate dosage of progesterone is given the woman will usually begin a period within 7-14 days.
Three, normal treatment is then to begin tricyclic birth control pills to control ovulation and support the body in hormone balancing. This is normally what women do when they are not desirous of pregnancy.
Four, at your age (medically advanced maternal age) one of the questions that should be asked is whether you are desirous of more pregnancies. If not, then birth control pills are the treatment of choice!
Five, if you do want another pregnancy then the treatment protocol is different. After a series of insulin level tests….or confirmation by ultrasound and visualization of the cysts, the common treatment is to give glucophage and then a fertility drug if warranted. Usually the glucophage is sufficient to help precipitate normal ovulation.
Because there is a question of the safety of Lupron for usages other than which it was developed you should read as much as you can regarding this and PCOS.
Having said all this, the difficulty that you are having with your relationship with your partner may be worsened by your hormonal functioning but that is NEVER all there is to it.
When there are a series of changes within the family structure such as the ones you described, one of the consequences is for the partners to become depressed…together!!!! Remember that my working definition of depression is rage or anger that you cannot place where it needs to be placed so you have turned it on yourself. This problem that you are describing is one of those “chicken and egg” problems. It is difficult to know if what is happening with your hormones and your periods is based on your emotional mindset and the shifts within the family structure or the other way around. It is entirely possible that what you are experiencing emotionally has its origin in something that has gone before (remember that midlife issues for women begin arising around age 35!) and that has impacted your hormones which has impacted your emotional state and now your relationships.
It is for this reason that I always recommend that women see therapists who are well grounded in women’s health as well as psychotherapy. In any case, you are in a cycle that requires “appropriate” intervention with medication for hormones and appropriate psychotherapy (without medication!) and couples therapy to strengthen the marriage.
Other Stories
Collaboration for Holistic Care
written by Dr. Kathleen C. Quinn_Discovery CEO
Sometimes finding a colleague with whom to collaborate on a project is more difficult than finding a good healthcare provider!!!! Okay, maybe not; but it’s a toss up.
I have spent the last several months interviewing people…in fact, I cannot tell you how many providers I have spoken with since I moved to San Antonio just over a year ago. I have spoken with physicians, other nurse practitioners, chiropractors, homeopaths, massage therapists, etc. The list is endless. I actually had a twofold idea in mind: I needed to know who was doing what so that I could refer, and I needed to know with whom I could collaborate. There is a reason for this need. No healthcare provider can provide total care. It isn’t possible. At best I think we can coordinate care. This has deep significance when we consider women’s health.
Let’s consider the concept of health in terms of sexual, hormonal change as part of a developmental process that spans a woman’s (or a man’s) life. Care and treatment across that spanse of time requires understanding of wellness, illness and the process of prevention of illness. There are interventions which MUST be accomplished at appropriate developmental stages in order to ensure the health and wellbeing of the person. Couple this with a multiplicity of lifestyle options, orientations, and the subsequent consequences of those choices, and one is faced with educating the patient to make the best possible choices for his/her lifestyle, then coordinating that care when possible.
Now…find healthcare providers whose care is sufficiently broad to encompass all that!!!!
Since I have begun my television show, I cannot tell you how many providers have asked to appear to “inform the public” about their approaches to care. Much of what I have heard could well be detrimental in the long term to women’s health. I also must take great care NOT to have the appearance of endorsing products and treatments I think are not beneficial. So, as I have personally grappled with healthcare options for myself at midlife, and used those choices and the information gleaned from my experience and private practice, I have reached the fortunate position of assembling some wonderful thoughtful practitioners in my circle of colleagues. I am able in my treatment of women to offer an array of treatment options, including colleagues who do acupuncture, treat herbally, and provide chiropractic work.
There is in midlife women the need to evaluate their options to utilize hormone replacement; to use herbs and other acceptable alternatives; to be provided with exercise and diet options. Many practitioners will give combination herbs without consideration that there may be reactions to one of the combinants…the safest approach is to provide a single herbal treatment and add to those as toleration is demonstrated. It is also a good bet that most prescribers do not have working understanding of the underlying physiology of the hypothalamic-pituitary-ovarian axis and the adrenal implications at midlife. Nor have I found many who understand the concept of stress reduction versus hyperstimulation of the adrenals and the implications for weight gain (in response to increased blood sugar levels and diminished utilization of those sugars, combined with decreaased insulin functioning at the cellular level). Parallel this with hormonal shifts and changes in libido, and we find that patients will experience depression and/or food cravings (like chocolate, salt, sweets and carbohydrates). Often patients experience these symptoms along with unresolved emotional stress such as fear, anxiety, worry, guilt, anger, and chronic conditions such as chronic fatigue, fibromyalgia, allergies.
This is an area of serious long term consideration for women’s health because over time hyperstimulation of the adrenals leads to cardiovascular disease, some forms of cancer, Type 2 diabetes, and immune suppression; therefore, there is susceptibility to infection and undoubtedly the negative impact on sexuality, reproductive capability and ultimately the very fiber of relationships with others.
It is for this reason that I have collaborated with a chiropractor, Dr. Tina Grau, who will be doing noninvasive interventions for adrenal work, while I provide the pap smears, herbals, exercise (qigong) and psychosocial women’s health counseling, as well as traditional allopathic treatment. After the first of July, I will be opening additional office space in the Stone Oak Chiropractic Center (this, in addition to our offices at 7300 Blanco Road) and offering full care in women’s health with particular attention to Midlife Care and Menopause Management. Dr. Grau will be providing coordinated chiropractic care on the same day for the convenience of our patients. Our intent on these days is to provide comprehensive care surrounding potential adrenal deficits.
I would also like to invite women (and interested men) to consider appearing on my television show if you are in the San Antonio area to discuss the healthcare needs you have experienced, as well as the treatment options that have worked for you. I think it is important to hear from those we serve and share how our changing bodies affect our relationships and changing lives.
Homework from Broken Wings…
–Look at yourself in the mirror. Really look. What is my body’s truth? What do I say about it? What do others say? How is this different from what’s inside me?
–This week, everywhere you go, make a point of saying to everyone who helps you, waits on you, assists you: “I want to thank you for your kindness and graciousness to me.” What happens to them in the process? What happens to you?
“Masks and Illusions”
written by Dr. Kathleen C. Quinn_Discovery CEO
We spend a great deal of time creating faces–masks that we have been taught from childhood to create. Many are based on the image of what a woman is supposed to be and not on the possibility that “this being” might be able to create self…and self-expression. The inability to release or remove self from stress imposed from the outside leaves us growing into womanhood in a state of “hyperstimulation.” The consequences for this are vast.
For example, many of us lived in families where there was trauma to us that can be attributed to intentional abuse or ignorance. Either way, we carry within us the patterns and consequences of our childhoods. These patterns affect our minds/bodies in such a way that, by adolescence, when we begin to become women in physical reality, our bodies are already so stressed that it impacts our hormonal functioning and the women we become as adults and ultimately at menopause.
Stress is a very subtle force…some is externally generated and some is internal. But the one thing both have in common is the pathway created as the body’s response to accommodate to and manage the stress. We seldom think about the consequence of having a repeated pathway through the body but that is what we are looking at when we examine the consequence of bi-directional pathways. The external or internal stressors impact the body, and stimulation of the flight or fight mechanism happens here as means of self-protection. How we learn to manage stressors (physical, mental and emotional) is part of the internal process. And the way in which we do this becomes obvious over a period of time.
Men and women seem not to understand that when they look in a mirror they can actually see the shifts of stress across their bodies; but, what they are really seeing is the body’s hormonal response to stress. You may see fluctuations of weight, lines marking the face, a hump beginning at the base of your neck (often times at menopause!). These things indicate to you that your body is changing, and it may well be in response to stress. However, to those of us trained to see, there is a clear expression of fluidity. When I look at a woman’s body, what I see is like looking into a river. I see the liquid movement of her body’s response to stress in her life. I look for those changes, and it tells me what I need to heal her body and her life. Often times my patients get to me at midlife, with menopausal issues, and I wonder: Did they not see this happening to them in their 20’s and 30’s?
Last night I sat in a production of the play “Illusion,” and I considered the illusions that we create all the time.
“I’m fine,” “got this under control,” “put on a happy face,” “just forget this and go on”….what’s your favorite?! The difficulty is that over time in living with internal stressors as well as the myriad social/cultural ones and the personal/interpersonal stressors that we have leaves us in a state of “hyperstimulation,” a state of hypervigilance of which we are less and less aware. Until we look in the mirror….and there, just around the frayed edges of the mask…we glimpse a bit of our own face and begin to wonder how we got here…and “who?” is the person in the glass.
