Not long ago, Renata Mangrum (who you'll soon see more of on our blog, she's studying to be an inCYST provider) forwarded me a note from a discussion list for lactation consultants. Someone on that list wanted to know if excessive vomiting during pregnancy (hyperemesis) was common with PCOS. The person asking the question had a patient who was experiencing that problem. There didn't seem to be much information about it in the scientific literature, but when this person lurked on a few PCOS listserves, it seemed to be commonly accepted as an issue.
LESSON ONE: Be sure to report all your unusual symptoms to your physician. When they start to see trends, that is when they can research the problem…the first step toward finding a solution.
I wrote Renata back and told her I'd never heard about it, but I did know that there was a very strong correlation between PCOS and bulimia, another medical diagnosis including vomiting. I did post about two weeks ago to see if any of inCYST's readers had experiences to share with their own pregnancy. One reader did write back to say that yes, she did experience vomiting, and was told it was due to having a low progesterone problem.
LESSON TWO: inCYST is as much about our readers sharing their experiences for us to learn from as it is about our giving advice. It's important that this be an interactive forum with communication moving in both directions.
Curious, I went into the National Library of Medicine database and used the keywords"bulimia" and"progesterone". It turns out, there were several articles reporting progesterone imbalances in bulimia. And, a correlation between imbalanced progesterone and binge eating. (References below.)
Hmmmmm…
What I know from my eating disorders work is that bulimia has many different colors. Sometimes it's induced. Sometimes it just happens. Sometimes women binge specifically so they can induce vomiting. Sometimes they overeat, and induce vomiting to relieve the discomfort that overeating produced. I learned that it is very important to get as much detail about how, why, and when the vomiting occurs, and not just lump all of it into one symptom with one cause and one motivation.
What I know from my PCOS work is that cysters have a low stress threshold. Meaning it takes less stress to activate the stress response. If you are prone to vomiting, that means you might be prone to feeling more nauseous with less stress than the average person. You may have learned over time that throwing up is a quick way to relieve discomfort other people quite simply never feel.
Here are some new insights I'd like to share and propose that all of you consider.
1. If you have bulimia, whether or not you have been diagnosed, and you honestly believe you are doing everything you possibly can to not vomit, and it's still coming, ask your physician if s/he might be amenable to checking your progesterone level. Correcting that (and natural ways to do so are written about elsewhere in this blog), may make it easier to stop vomiting.
When I worked in an eating disorder treatment center, I always felt for women I knew were doing their best to stay in recovery, who couldn't, who were considered by treatment teams as somehow being noncompliant or rebellious. I'm not saying you don't have a responsibility to work on challenging behaviors to the best of your ability, but I do think there may be an important physiological factor being overlooked that may be undermining the very best efforts of some of you.
2. The very first thing I thought of when I envisioned how these pieces fit together, was the poor woman who'd worked her tail off to get out of an eating disorder, finally became pregnant, and despite everything going seemingly well, having vomiting come back, with a vengeance. It might cross your mind to just silently live with it, thinking the first thing your treatment team is going to think is that you've relapsed. Which is why physicians may not be hearing about this.
Don't freak out…be proactive! Tell your physician, tell them your fears, and ask for help. Your problem may be low progesterone, and hyperemesis. And a susceptibility to low progesterone may actually have been the loaded gun that set you up as a candidate to get into bulimia in the first place.
If you have PCOS, with a history of an eating disorder, have become pregnant, and have found yourself all of a sudden vomiting or wanting to vomit again…we're here to help you find solutions. And we very much look forward to that.
LESSON THREE: inCYST needs to continue to challenge itself to think in a hugely interdisciplinary fashion. We are best at that when our readers are comfortable sharing their PCOS stories with us, trusting that we aspire to be inquisitive and scientific, not judgmental and shaming.
Pirke KM, Fichter MM, Chlond C, Schweiger U, Laessle RG, Schwingenschloegel M, Hoehl C. Disturbances of the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1987 Aug;27(2):245-51.
Pirke KM, Dogs M, Fichter MM, Tuschl RJ.Gonadotrophins, oestradiol and progesterone during the menstrual cycle in bulimia nervosa. Clin Endocrinol (Oxf). 1988 Sep;29(3):265-70.
Schweiger U, Pirke KM, Laessle RG, Fichter MM. Gonadotropin secretion in bulimia nervosa. J Clin Endocrinol Metab. 1992 May;74(5):1122-7.
Edler C, Lipson SF, Keel PK. Ovarian hormones and binge eating in bulimia nervosa. Psychol Med. 2007 Jan;37(1):131-41. Epub 2006 Oct 12.
Klump KL, Keel PK, Culbert KM, Edler C. Ovarian hormones and binge eating: exploring associations in community samples. Psychol Med. 2008 Dec;38(12):1749-57. Epub 2008 Feb 29.