After proper diagnosis, woman finds strategy to win weight battle
Right doctor, testing and new approach to food help control hormonal imbalance
To Deborah Savage, a trip to the doctor was frequently an exercise in humiliation.
For more than 15 years, Savage’s doctors doled out the same advice: You need to stop gaining weight. When Savage replied that she had tried watching her diet and exercising, only to pack on more pounds, it was clear they simply didn’t believe her. Her family was equally skeptical.
“I would eat like my sister, and I would gain weight but she wouldn’t,” recalled Savage, a civil engineer who lives in Montgomery County, Md., and and turns 31 next month.
Savage’s inexorable weight gain, which began in middle school and resulted in obesity, was not her only problem: For years, she also struggled with eruptions of painful acne and facial hair. “These things made me feel ugly,” she said.
Last year, after Savage had trouble getting pregnant, an inability she suspected was linked to her irregular periods, she consulted a new obstetrician/gynecologist. The doctor suggested that Savage’s constellation of problems might have a single cause. But it took a second OB/GYN to conduct the proper tests, which led to a definitive diagnosis of a common — and consequential — disorder.
“It’s frustrating to me that so many doctors” didn’t think of this, she said. “If I’d known, I would have made changes years ago.”
From the time she was 12, Savage recalled, her inability to lose weight became one of the defining elements of her life. And because she is short — 5-foot-3 — extra pounds were particularly noticeable.
At her mother’s suggestion, Savage joined a gym, but that didn’t help her lose more than a few pounds.
In her early 20s, Savage said, her gynecologist chided her about how heavy she was; every year, she seemed to gain 10 pounds. “I explained that I had tried diet and exercise, but he said I was not trying hard enough,” Savage recalled.
To regulate her menstrual cycle and tame her acne, the doctor prescribed oral contraceptives, which helped clear her skin and made her periods somewhat less irregular.
When she got married in 2010, Savage and her husband joined a popular weight-loss program to see whether they could motivate each other.
Savage said she lost only about 8 pounds after several months, while her husband, who followed the same diet, had shed much more weight.
“It was very frustrating,” she recalled. “I was serious about following the rules, but it didn’t pay off. I kind of gave up.”
By early 2015, she was desperate. She had stopped taking the pill nearly a year earlier, in hopes of getting pregnant; without it, her acne had roared back and her facial-hair problem had worsened. Savage was at her heaviest weight — about 240 pounds — and her family doctor warned that her cholesterol was too high.
In March, she switched gynecologists. Her new doctor zeroed in on her irregular periods and her weight and asked Savage whether she had heard of a metabolic disorder called polycystic ovarian (or ovary) syndrome.
Savage replied that a friend in college had been diagnosed with PCOS. She was surprised when the doctor responded that she suspected Savage might have it, too.
PCOS is a common hormonal imbalance that often begins in puberty and affects as many as 10 percent of women. Its cause is unknown, but heredity appears to play a role: Women whose mothers or sisters have the disorder are at higher risk. Many women with PCOS have enlarged ovaries containing fluid-filled cysts that produce excess androgens — male sex hormones, which interfere with ovulation. Other signs of PCOS include irregular, absent or prolonged periods, acne and excess facial and body hair, a condition known as hirsutism.
Because it also disrupts the regulation of insulin, many women with PCOS are overweight or obese. The disorder, which can be controlled but not cured, also increases the risk of Type 2 diabetes, high blood pressure and heart attack.
When Savage asked whether it was possible to test for the disorder, she said that the gynecologist told her, erroneously, that there were no tests. The best way to treat the problem was to lose weight, the doctor advised.
She consulted a third OB/ GYN, Neil Horlick, who practices in Montgomery and Frederick counties. When Savage told him she had been told there was no test for it, he assured her that testing was available.
Because abnormalities of the thyroid or adrenal glands can cause similar symptoms, those must be ruled out first. PCOS is essentially a diagnosis of exclusion, made on the basis of blood tests, a patient’s symptoms and an ultrasound of the ovaries.
Horlick said he was surprised that Savage’s condition went undiagnosed for so long. “PCOS is always on our radar” when a patient with irregular periods complains of weight gain and hirsutism, Horlick said.
He told Savage that her best chance of getting pregnant involved losing weight. Horlick prescribed metformin, a diabetes drug that can promote weight loss.
Savage decided to take a new approach to food. She began following a paleo diet, which emphasizes meat, vegetables, nuts and fruit, and reduces the intake of carbohydrates, sugar and processed foods.
The first month, she said, she had lost 15 pounds; between April and September, she shed 50 pounds and her cholesterol dropped 20 points. Her acne also improved, her level of testosterone dropped, and her menstrual cycle became more regular.
In October, she was pregnant with identical twin boys. The babies were born April 22.
Savage said she hopes that her experience will spare other women from “struggling for years the way I did.”
“This isn’t a bizarre disorder,” she said. “It shouldn’t take [this many] doctors to find out, when I have a textbook case.”