I'm finishing my second month on Accutane this week. So far, I've seen about a 60 to 70% improvement in my acne. Unfortunately, my doctor says it's still not where he wants it to be (and I completely agree). He's increased my dose to the maximum and plans to keep it there for the next three months (the rest of my course) unless the side effects become too much to handle.

Another reason for the increase is to avoid a relapse after I go off of it. He's mentioned this to me several times...that he isn't quite sure Accutane will be a permanent fix for me. The reason being that if I truly do have PCOS (which multiple doctors have agreed with now) then my hormones will just go back to where they were and it won't matter.

So I'm taking some time today to look into my different options with PCOS treatment. Unfortunately, I've done or am doing quite a few of the suggestions. And I'm just not sure where else to turn.

I tried Spiro (or aldactone) back in August. I was on it for three weeks, but finally stopped because the side effects were driving me crazy. I'd seen minor improvement in my acne, even over those brief three weeks. But I couldn't imagine spending the rest of my life on that drug. My hair was falling out in clumps, my motivation level was next to none, basically it was taking my testosterone levels to the bottom floor. And once I stopped, everything returned to normal.

I've also been on the pill twice now. Once back in 2007, where I saw no improvement in my PCOS symptoms. And now, which is the same. Although I've only been on this new pill (Ortho Tri Cyclen Lo) for roughly two weeks, if you don't count all that confusion back with the switch from Seasonique. I'm hopeful that once I get clear from Accutane, the OTCL will just maintain the PCOS symptoms.

The other option for PCOS patients is to use Metformin. A good friend of mine is actually on this treatment and saw improvement in her mild acne, weight gain, and irregular periods. I've been reading today that it can greatly reduce the irregular periods and hirsutism from PCOS, which are two things that I'd really like to see. But I'm not sure if this option is an available one for me. Or if it is a good option.

For one, my blood levels of insulin are always within a normal range. I do experience insulin resistance on occasion, but it's not a common enough thing to call for drug help. However, maybe it's greater than I know. Or maybe it might help with my testosterone levels and not severely affect my insulin levels (because honestly, the risk of lows is pretty scary between insulin and Metformin).

Although I have every symptom of PCOS, I'm still not opposed to looking at different options at what might be causing my issues. Vitamin deficiencies have long been on my list of "maybes." In 2006, my vitamin B12 levels were low, although not deficient. And my vitamin D levels were terribly deficient in 2008 and I've been on intensive supplements ever since. So perhaps there is another vitamin that we haven't looked at that might cause some of these problems.

I'm not due for another endo appointment until mid Februrary, but I think I might head in a month early. I'd really like to talk to my doctor about some different options that I might be able to start within the next few months and offset any regression after the Accutane. She'll be able to give me a clearer picture about the Metformin as well as run the vitamin level tests (I hope).