MORE
than CHOLESTEROL PROBLEM
a
U
rsula had made an
42” BP: 140/90. Moderate
appointment be-
acne on her face and chest.
cause her muscles
Increased facial hair. Dark-
began to ache after she
ened skin around her neck
started a statin drug pre-
and over the anterior aspect
scribed by her primary care
of her elbows.
doctor for her elevated cho-
"How long have you had
lesterol levels. Also, she had
trouble with acne and facial
gained a signifi cant amount
hair?" I asked.
of weight in the past 2 years.
"I’ve had it since I started
She was only 32 years old.
having periods," responded
She had always been on the
Ursula. "I went on birth con-
heavy side. She explained,
trol pills and that cleared it up.
"My weight is out of control.
But I gained a lot of weight.
I have been trying to exercise
When I stopped the pill in my
and eat a healthy diet and I
20’s, everything came back:
am still putting on weight.
the acne, the beard, the ir-
On top of this, I started tak-
regular periods. And I stayed
ing this drug for my high cho-
fat. I tried to get pregnant and
lesterol because my doctor
it didn’t work. Then I got di-
told me I was going to have
vorced and it didn’t make
a heart attack if I did not take
any difference for a while,
it, and now I can’t exercise
but now I’ve remarried and
because I hurt so much."
I stopped the pills again to
"Are you still taking the
try to get in shape, lose the
statin?" I asked.
weight and hopefully have a
"No, I stopped it 2 weeks
child. Can you help me?"
ago, but I am still hurting
"I think your problem is
and it gets worse when I ex-
more complicated than just
ercise," she complained.
your cholesterol. Have you
She brought in her lipid report, stopping the drug because 10%-15%
heard of polycystic ovary syndrome,
which showed that her total cholesterol, of people will get signifi cant symptoms
PCOS?" I asked.
TC, was 290, LDL 175, HDL 38, and from being on a statin because statins
"Yes, but my doctor did an ultra-
triglycerides, TG, 430. I understood why can lower your Coenzyme Q10 level
sound to check to see if I had any cysts
her doctor had put her on a statin. These and induce hypothyroidism causing
on my ovaries and I didn’t, so he said
were not trivial elevations of her lipids. pain and fatigue. Lab work can still be
that I didn't have PCOS," she explained.
"Did your doctor do a muscle enzyme normal, sometimes. We need to work on
"Well, this is going to sound odd to
blood test to see if there was any muscle your lipids, but right now I want to get
you, but women who do not have PCOS
damage from the statin?" I asked. you in shape so that you can go ahead
can have ovarian cysts and women who
"Yes, he did and it was normal, so and exercise again," I suggested.
are diagnosed with PCOS may not nec-
he suggested that I stay on the drug," re- Physical exam showed that Ursula
essarily have ovarian cysts. The diagnos-
plied Ursula. was overweight with signifi cant trun-
tic criteria for PCOS is irregular periods
"Well, I think you did the right thing cal obesity. Wt: 222 lbs Ht: 5’5” Waist:
and hyper-androgenism. That is having
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