SD Doctors and/or Pharmasists, why is this a bad idea?

In My Humble Opinion
1

First a little background.
Mrs. Cad has been battling weight for years and is at least 100 lbs overweight. However, the two times that she has been pregnant she’s lost weight - like being 50 pounds lighter at nine months than when she got pregnant. After the baby the weight got packed on despite diet and exercise. Shes done weight watchers and had a little success but even with exercise it got maybe 30 pounds off after a couple years but she did learn to food-jounal (important later on).

She has been with a couple doctors and please do not suggest we keep going until we find one that will listen to her. We say we think it is hormonal because of the emperical evidence but they ignore her. We can’t afford to keep shopping around and to be honest, I don’t think doctors that listen to patients actually exist. Basically her doctors tell her to take the fork out of her mouth and exercise. When she shows them her food journal, they ignore it and her current doctor wants her to try some heavy duty drugs for appitite suppression (not her issue on a 1500-2000 cal diet). The rare case she does get a endocrine test that she begs for (even from an endocrinologist) they basically test thyroid (slightly low, take levothyroid) and diabetes (not even pre-diabetic).

Now she at 46 is hitting menopause (not pleasant) and is breaking out with pimples. So now for the probably horrible idea - ortho cyclen. That’s right, birth control. She doesn’t smoke and doesn’t fit into any danger groups except 35+ (and she was pregnant at 35 with no complications) so my layman idea is

  1. Simulates pregnancy and we know that equals weight loss
  2. Hormone replacement therapy
  3. Ortho cyclen seems relatively safe . . . at least compared to other BC and OpalCat
  4. Helps reduce acne

I know the answer is to never take perscription meds without a prescription but ignore that for a second. Why given this specific situation would ortho cyclen be a bad choice. Assume this patient history, would you at least consider it as a possibility?

2

IANAD, but use of hormonal birth control by post-menopausal women creates a significant increase in breast cancer risk.

3

Birth control does not simulate a pregnancy, really - birth control prevents ovulation. It does this by mimicking the hormonal milieu that exists during early pregnancy. Progesterone and estrogen (the two hormones in birth control) exert negative feedback on the hypothalamus and pituitary gland, which subsequently don’t release the hormones necessary for follicular development and ovulation. Preventing ovulation is in the best interest of a developing proto-baby, as subsequent ovulation can lead to a subsequent proto-baby, and then you have two embryos with no recourse but to duke it out for ultimate uterine supremacy; they have to import weapons, and the other internal organs start choosing sides, and the whole thing is just a mess, which is why the first proto-baby gives off hormones to prevent the possibility of a second.

Birth control is like a fake, eternal proto-baby, and with it you achieve a steady-state level of exogenous hormones (save the week of placebos, if you are so inclined) to prevent ovulation, and thus prevent pregnancy. Pregnancy, on the other hand, is not a steady state. Pregnancy is a nine-month hormonal ballet, with multiple hormones (progesterone, estrogen, FSH, LH, GnRH, hCG, aFP, HPL, cortisol, that hormone that makes pickles with ice cream sound like a good idea) coming from mom, placenta, and baby, with everything affecting everything else over a prolonged period of time.

It seems to me, that if your wife lost a bunch of weight during her pregnancy, that would be due to the whole gestalt of pregnancy, hormonal and otherwise, and thus unlikely to be replicated by birth control, which replicates only a small part of the pregnant state. Unless she lost all the weight in the first half of the first trimester, it doesn’t seem, to me, like birth control would be an effective weight loss tool.

If your wife is going through menopause, hormone replacement therapy would be a legitimate prescription to help treat the symptoms of menopause, but I wouldn’t pursue this as a weight loss plan. (HRT is like a less-potent form of birth control. For information on the risks and benefits and studies of HRT, a good place to start is the
Women’s Health Initiative.

Weight loss is hard and frustrating enough without feeling like you are being ignored by your doctors. It is possible that your wife’s doctors have heard and considered your evidence, and discarded it because they did not find it compelling. They should still have explained to you why they disagree with your hypothesis, but it could very well be that your hypothesis is wrong, and is being rightfully ignored (as in, they are not acting on it). Is it possible to return to your wife’s doctor and ask for an explanation of why they seem to be ignoring your observational evidence?

But anyway. It’s late, and what do I know? Best of luck to your wife.
love
yams!!

4

Also: what kind of hormones do you think are in disarray? Given the pregnancy/weight loss/birth control idea, you are probably thinking of something involving the reproductive axis? Did you and your wife have any problems with infertility? Did your wife have irregular periods (prior to menopause)? Did she suffer from hirsutism and acne prior to menopause? Do you have any other evidence for a hormonal imbalance that has been ongoing through her battle with obesity? If the answer is no, that could be cheap evidence pointing away from hormonal imbalance.

love
yams!!

5

We prefer that personal medical questions be asked in IMHO rather than General Questions. Moved.

samclem, Moderator

6

  1. I don’t know. That’s why we try to talk to the doctors and occassional endocrinologist but their reply is always, “Yeah whatever. Stop fucking eating so much.”

  2. She never had problems with infertility. In fact she was quite fertile even on BCP and she has always had a problem with acne and it is getting worse with menopause.

  3. The evidence we have is empirical. Pregnancy = lost weight. Not pregnant = gained weight independent of eating & exercise. She was skinny growing up and only started having a problem with weight after her first pregnancy at age 25 - like immediately after.

7

1500 - 2000 calories a day is a lot for a woman who’s not breastfeeding or isn’t 6 feet tall. Has she tried the 1200 - 1500 range?

I wouldn’t take birth control anyway - too much monkeying around with my body. Honestly, I would ask the doctor directly for a specific response to your question. If they won’t, then find one who will. And then listen to his answer and subsequent advice.

8

I disagree. It’s especially not a lot for a woman who is 100 lbs overweight. Personally, I could not lose weight in a sustained fashion for years because everyone seemed to think a healthy diet was 1200-1500 calories, which left me so ravenous I couldn’t think straight. When I was 100+ lbs overweight I lost at a good clip on 2000-2200 calories without exercise.

Saint Cad, Are you sure your wife isn’t hungry? I didn’t recognize my hunger for what it was because women are pretty heavily socialized to believe that it’s uncouth to be too hungry: we are really encouraged to explain our eating as “emotional” because that’s more ladylike. I thought I had some horrible complex because when I dieted I would day dream about hotdogs and cake, but it turns out that once I was eating ENOUGH cottage cheese and chicken breast, the junk food cravings and the binging went away. It was physiological, not psychological.

Also, when she food journals, does she weigh her food? I think a lot of doctors don’t take food journals seriously if they don’t have precise numbers.

My advice would be to try one more time for a good endocrinologist. Where are you? Many endocrinologists are basically diabetes doctors these days and they are old and tired, made bitter by non-compliant patients killing themselves. I personally had much better luck with a younger doctor, both for my normal endocrinologist and my reproductive endocrinologist (fertility doctor). You might also try a reproductive endocrinologist: they mostly help people get pregnant, but they know a lot about female hormones.

[Soapbox]

Why the HELL isn’t there a board-certified medical specialty for weight management? We have an epidemic and no doctors that really understand much about weight management. I was over 100 pounds overweight and never had a doctor tell me anything useful. GPs don’t know anything, endocrinologists are just looking for problems in one area, surgeons only have the one tool, and none of them know anything about maintenance. “Nutritionists” are often utterly unqualified (in some states, anyone can be a nutritionist) and at best, rarely have more than a B.S. in the field. If you are looking for a doctor to help you manage your weight, you can’t tell the utter quacks from the serious professionals, and frankly the proliferation of utter quacks discourages anyone from becoming a serious professional in the field.

There needs to be a specialist one can go see who can make recommendations about various diets, set up exercise plans, discuss and perform surgeries, and monitor progress and maintenance.

Right now, being morbidly obese is like having cancer, but instead of going to an oncologist, you get sent to a chemotherapist, a radiation tech and a surgeon, none of whom ever talk to each other or know anything about each others fields.

[/soapbox]

9

I cannot respond directly to the OP, but I will make this one anecdotal statement.

My sister has spent the last three years losing 145 pounds. Her peak weight was 389. She started a food journal, and gradually changed everything about her eating habits. She joined a gym and now works out 5-6 days a week. Her doctors were making noises about PCOS (polycystic ovarian syndrome), which she may indeed have; however, despite that, she’s still managed to lose a whole person’s worth of body weight.

She has a blog which includes tips, her story, and healthy low-calorie recipes. It is a fundraiser website, so I won’t post the link here. (She’s trying to raise funds for excess skin removal surgery.) If anyone would like to know more about what she’s done and how, PM me and I will send you the link. My point was: there was no hormonal problem, there was no endocrine problem, there was no gastric surgery, and there were no appetite suppressing drugs. Just hard work exercising and being extremely conscious of what she ate… 24/7/365 for the rest of her life. It’s much easier to run to the docs looking for hormonal excuses, but I’m beginning to lean toward “95% of morbidly obese people are only being held back from losing weight by themselves.” Diets do not seem to work. Conscious, mindful, healthy eating habits plus disciplined, frequent cardio does seem to help.

ETA: Actually relevant to the OP-- My sister also lost weight throughout both of her pregancies, during which she was morbidly obese (for both). She weighed less at delivery than she had pre-pregnancy. This made her OB docs lose their minds, but both children were born healthy. My theory is she just happened to have enough fat/energy stores so that her body was able to provide what her babies needed without her having to ingest more calories.

10

Sounds about right. What do you want them to say? The number of obese people who have an treatable hormonal imbalance is very small.

Food journals are usually hilariously inaccurate. Like off by a factor of 2 or more isn’t unusual at all. It’s amazing what people think 4 ounces of meat looks like. They also seem to forget the oil they used to grease their pan contains a 100 calories or more. When people say stuff like:

Something isn’t adding up and it’s usually not hypothyroidism or an obscure endocrine disorder. (Not impossible, of course)

Because patients already have all the answers?

Basic weight management doesn’t really require an MD to supervise it. People who would benefit from surgery could be referred to a bariatric surgeon, just like oncologist refer patients to various surgeons as needed. That sounds like the worst specialty in the world by the way. I suppose if you pay enough someone would do it…

11

I was on the Pill, including a while on Ortho Tri-Cyclen, for 13 years before I got pregnant. Before I got pregnant, I was hoping that, because my side effects from birth control generally hadn’t been too bad, my pregnancy symptoms might not be, either. That’s not what happened. I didn’t find that early pregnancy symptoms and being on the Pill were all that similar. I got nausea in pregnancy that I didn’t get on any formulation of the birth control pill that I tried. I got food aversions during pregnancy, which I never got while on the Pill. If you’re nauseous and vomiting a lot of the time, it shouldn’t be too surprising if you’re losing weight. If her symptoms on Ortho-Cyclen aren’t the same as her pregnancy symptoms, there’s no guarantee that it would make her lose weight the way pregnancy did.

You do know that doctors are no longer recommending hormone replacement therapy for most menopausal women, right? They’ve found that it can not only increase the risk of breast cancer, but also the risk of heart disease and strokes. The risk of blood clots with the birth control pill also goes up with age, even in women who don’t smoke (though not as much as in women who smoke).

12

Actually, just this week, there have been news articles published criticizing the age group selected for that 10-year-old study as well as a coalition of multiple medical groups stating there are definitely groups of women out there who are good candidates for HRT.

13

It is? I’m 5’ 3.75" tall, 53 year old female, moderately active, 116 lbs, and according to the basal metabolic rate calculator my daily caloric needs are 1876. While I don’t obsessively track what I eat, that seems about consistent with what I consume, on average.

14

Small but it does exist, right?
What do I want the doctor to say? Maybe something like, “So you lost weight when pregnant and gained it when not pregnant? And your weight problems started after your first pregnancy? That’s unusual.” At least something that says they’re listening. I understand that the calorie intake vs. output is the problem in 99% of the cases but the doctors we’ve been to refuse to think outside the box - even when there is evidence that maybe, just maybe, this is one of those rare cases where it is not a calorie issue.

I know that hormones after 35 has some side-effects, but it is hard to take that into consideration when her doctor wants her to take appetite suppresant meds with far worse side effect AND having to take into account increased chance of breast cancer (no history of cancer in the family) and blood clots vs the side effects of being 100 lbs overweight. And if the doc want to experiment with meds, then why not try a hormone therapy for a couple months and see if there is any change? Yams pointed out that there are a lot more hormones that are around during pregnancy than just increased estrogen and progesterone and that BCP do not really simulate a full-term pregnancy. But why is it a person on SD explaining that and not the doctor when we talk about our concerns? And why doesn’t that ever translate into testing for all of those hormones even if the doc is 99.999999% sure that isn’t it? How does the doctor know she’s not low in hCG or cortisol or LH?

And Manda Jo is right on about endocrinologists. I would love for her to have a full panel (is that what it’s called?) done up even though hitting menopause it may not give any useful information. Instead it’s the in-the-box thinking of low thyroid and let’s see if she’s pre-diabetic.

Hunger is not an issue although the doctor insists it is. She eats a small lunch and most of the time doesn’t finish her dinner. In fact, I think her appitite had decreased while menopausing.

15

That article takes pains to state that this is for temporary relief of menopause symptoms, not for long term use. If the OP’s wife’s weight problems really do stem from hormones, then this would be a risky long term solution. It might be the right one, depending on the benefits vs risk, but it certainly isn’t the clear cut best answer (not that I think Ferret Herder is saying that, but just clarifying the article’s message).

16

You might need to be prepared to hear “That happens to a lot of women, and is not a factor in your wife’s weight gain.”

Because she would be having other symptoms.

*LH - problems with menstruation/fertility
*hCG - non-pregnant women are supposed to have really low levels; it is made by the placenta
*cortisol - excess cortisol causes Cushing’s syndrome, which is a rare cause of obesity; it also causes a bunch of other symptoms and does not disappear during pregnancy, so this seems, to me, unlikely. If your wife had insufficient levels of cortisol, she would be having other symptoms.

And on and on.

I think Manda JO raised a good point about weighing food. Does your wife weigh and measure? Food journals are an excellent weight loss tool, but people are not known for their supreme accuracy in keeping food journals and, 99 times out of a 100, when someone presents a food journal and claims it as proof that they are not losing weight in the face of eating right and exercising, the reason is not hormonal, but inaccurate recording of calories consumed.

I think your wife should return to her doctor for an information session, and maybe a referral to a nutritionist.

And - the name is yams**!!** : )

love
yams!!

17

Can you be completely sure that your wife is not lying to you about her food intake?

18

Could it have to do with giving up alcohol or any of the other stuff you’re supposed to give up or limit during pregnancy? Alcoholic beverages themselves, of course, have calories. So do coffee drinks other than black coffee. Could she be drinking a substantial number of calories?

ETA: Did pregnancy food restrictions or aversions keep her away from certain restaurants or types of restaurants while she was pregnant? If they did, she might want to try avoiding those restaurants now and see if that helps.

19

I’m reminded of that scene in “The Sopranos” when Johnny Sack finds Ginny’s snack drawer.

Something about this thread doesn’t sit right with me. It has the stink of “My wife is fat and pimply and why won’t the doctor’s just give her a pill to make her look better.”

Saint Cad, how does your wife feel about this thread? Does she know about it?

20

I don’t see that at all. I see “my wife is miserable and no one will listen and help her out”.