PCOS symptoms worsened with weight loss?

[missy_girl23]

Hi all - I'm a 23 y/o female who recently lost 100lbs to sit at a current weight of 240lbs. I was diagnosed with PCOS in my late teens but the diagnosis was removed last year since I've never had elevated androgens or cysts in my ovaries. I am however insulin resistant. I also didn't respond to Metformin. At 23, I've only had 2 periods, 1 that was natural and 1 that was forced with progesterone because my endomentrium was 18mm thick. I have severe facial hair problems and have only developed acne in the last few years. Everything got worse with weight loss, not better - except still no period, aside from 2-3 days of super heavy intermittent spotting that stopped as quickly as it began. They decided last year it was just my obesity that was the cause...but I don't understand that answer, because shouldn't I be getting better with a 30% body fat loss? Also, the weight was incredibly difficult to lose and was done so through a medically supervised starvation diet where I only drank shakes totally 500-750 calories per day for several months. My body literally clings to fat! Any suggestions as to what it could be? Could it still be PCOS?

[missy_girl23]

Thank you for your answer, Dr Wanjari! I fully plan on continuing to lose weight, it's just immensely difficult. Slow progress is better then none, however! My ratios in 2010 were 1:1 and were 1.6:1 in 2012. Is that still indicative of PCOS? I also have minor elevation in my ACTH levels (16.1, normal is 0-10), low growth hormone (0.05, normal is <=8) with normal cortisol. This is from blood drawn in 2012 and I recently discovered the results sheet in my house. I have near constant dull pelvic pain as well. Is it still PCOS or should I be looking for something else?

[Sanjivani Wanjari, MD]

Hi,
It could still be PCOS. Excessive facial hair, acne, obesity, absent or irregular menses are all features of PCOS women. Insulin resistance and altered FSH/LH ratio can be the only indication of PCOS. Ovarian cysts may not always be present. Weight loss will be beneficial PCOS or no PCOS and hence you should not stop your dietary modification and regular exercise. Consult your Doctor for an evaluation. Hope this helps.
The answer is based on information provided. Exact advice is not possible without a proper examination and investigations. You are requested to consult your Doctor. Take care and keep us posted.