Ask the GP: When hormones can be to blame for weight gain
Q: My 40-year-old daughter has polycystic ovary syndrome and I'm worried about her weight gain. Her GP has said they can't do more, and she's now taking tablets and electrolytes for her metabolism. I'd like her to be seen privately, but would a gynaecologist or an endocrinologist be better?
A: Polycystic ovary syndrome (PCOS), often referred to as polycystic ovarian disease (PCOD), is a common hormone-related condition that affects between 5 per cent and 10 per cent of women.
Although it's not completely reversible, with the right treatments most women can minimise their symptoms and lead a normal life. The condition often causes irregular or infrequent periods, as well as acne, thicker, darker body hair, and hair loss or thinning head hair (which, as you mention in your longer letter, your daughter has experienced).
We don't know exactly what causes it, but it leads to abnormal levels of female hormones, including luteinising hormone (LH) and follicle stimulating hormone (FSH), and higher levels of male hormones such as testosterone.
The increased production of testosterone is caused by the insulin resistance triggered by PCOD (insulin resistance is when the cells don't respond to insulin, so blood sugar levels rise).
The main clue to the condition is the presence of tiny cysts, measuring between 4mm and 9mm, in the ovaries. These can be seen on an ultrasound scan (recommended for any patients with irregular periods).
The diagnosis is then confirmed with blood tests to check hormone and insulin levels.
Between 40 per cent and 50 per cent of women with PCOD are overweight, meaning they are at increased risk of heart disease as well as type 2 diabetes.
Research shows that women with PCOD who are obese are at three times the risk of prediabetes, and more than 10 per cent of those do ultimately develop type 2.
So you are not wrong to be concerned about your daughter's risk of long-term diseases. However, you do not need to be overly worried at this stage as her risk will almost certainly be lowered by her efforts in diet and exercise.
I applaud her determination to stick to a low-carbohydrate diet, now a recognised part of treatment. This diet will help her lose weight, which, in turn, can improve insulin resistance and help regulate the menstrual cycle.
Her exercising (running and cycling) will also be key to weight loss.
In some patients, medication can also help, so you are right to ask about your daughter seeing a specialist who can prescribe this.
Both a gynaecologist (who specialises in women's reproductive health) and an endocrinologist (who focuses on conditions related to hormone disorders) would be able to help.
But my suggestion is that she sees a gynaecological endocrinologist. This is a gynaecologist with a specialism in hormone-related conditions - combining the two areas of expertise most relevant.
Depending on whether your daughter plans to have more children (you say she has one child), the specialist may suggest one of a number of treatments.
These will likely prioritise her weight loss, along with a drug such as metformin (a medication for diabetes which improves effectiveness of insulin). Pioglitazone, which reduces insulin levels, may also be considered.
Q: I am 88 and was born with an irregular heartbeat. I have trouble getting to sleep and I hear my heart beating very loudly when lying down. Is this unusual?
A: The good news is that, as you were born with an irregular heartbeat, it is unlikely that your sleep disruption reflects any further heart deterioration, but rather confirms what you already knew.
You have what are known as extrasystoles (also called ectopic beats or PVCs - premature ventricular contractions). These occur in all of us at times and are more common when we are under stress or drink excess caffeine, for example.
My guess is that your palpitations have always been occasional, rather than constant, but that they feel persistent when you lie down, possibly because the change in posture makes you more aware of it.
Despite my reassurance, it may be worth asking your GP or practice nurse to carry out an electrocardiogram (ECG, an electrical recording of the heartbeat). This simple test involves attaching sensors to the chest to check the electrical signals each time your heart beats.
The most common heart rhythm problem that occurs later in life is atrial fibrillation, which can feel the same as frequent extrasystoles but, if not identified and treated, may have significant complications, such as a raised risk of stroke.
For this reason, it is worth discussing the test with your doctor.
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