Nina Berry posts some interesting info re PCOS, low supply and the
concomitant insulin resistance. Lisa Marasco has been instrumental in getting the PCOS
information out and was really groundbreaking in her observations of this
phenomenon. I have seen a tremendous and predominant amount of insulin
resistance in women who never get in a full supply; I'm glad to hear that there is a
paper in the works about this. Dr. Mona Gabbay also wrote an abstract which
was presented at the ABM conference a few years ago re insulin resistance and
pathological low supply. I think we need to change the lenses through which
we are seeing these women. I feel that ever since the PCOS piece has been
introduced, that the term has become the tail that is wagging the dog. I can't
tell you how many times I have read on this board and heard in conferences,
"She never got a full supply but she doesn't have PCOS, so it isn't that." I
think the idea here is that maybe low supply can be one of the criteria through
which we (eventually) can identify PCOS (or marginal PCOS). Remember, if a
woman has never been diagnosed as PCOS, that doesn't mean that she doesn't
have it. I had a client a few years ago who 1) was hirsute, 2) was overweight,
3) got her period three times a year, 4) had tremendous skin-tag growth during
pregnancy, 4) had gestational diabetes--I could go on and on. She was the
poster child for PCOS. She had a great supply, got pregnant "by accident"
(and therefore said "no," when I asked if she had any problems getting pregnant).
She was a great woman and we had a great rapport, and I said to her, "I'm
not an MD, but you seem to have many of the clinical signs of Polycystic
Ovarian Syndrome. You should mention it to your OB/GYN." It turns out that she
did mention it at her post-partum visit, and her doctor, without hesitation,
said, "Yes, I do think you have PCOS. But you never had any fertility
problems, so there was never really any reason to mention it (!)." Bad medicine
aside, this woman wouldn't have "had" PCOS, either, if I had just asked her and
not looked carefully. That was an extreme, obvious case. But there are
subtle, subtle cases, where OUR expertise has to play a role. An example: Let's
say you have a client who had tons of skin-tag growth during pregnancy,
failed her first gestational diabetes test, but passed the longer one. On asking,
she has no history of menstrual irregularities, but has been on the pill for
10 years. She got pregnant as soon as she came off the pill (which often
happens with PCOS women, as the pill regulates hormonal deficits). **And also
skipped her period for a year in high school because she was "a runner" and her
coach had told her that sometimes that happens.** After that year, that's
when she was put on the pill. And she has hypoplasia or insufficient milk.
Is this woman PCOS? If you ask her or her doc, probably not. But is she?
Maybe. I think the idea here is that the milk or breast tissue is going to
(theoretically) help us determine what is, by nature, a very subtle,
multi-faceted dx. As I said before, I think that the hard-and-fast PCOS *diagnosis*
(and hence, the terminology) has become a dangerous tail that wags the dog, and
often keeps us from even really looking at the dog. We need to continue to
look, investigate, educate ourselves about this, and not be afraid to have our
own opinions and think outside the box. We are, after all, in the trenches.
It shouldn't surprise us that a woman may not be officially diagnosed with
something that can be somewhat of a spectrum disorder in the first place.
Heather Kelly, MA, IBCLC
NY, NY
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