Be careful with progesterone. I've had bad experiences on even a small dose and so have a lot of other people

Whoa, I love dealing with PCOS! I see a lot of pts with it. First of all.... consider your goals. If your goal is menstrual control, and the Diane-35 is working well for this, do NOT change it. However, if you feel unwell on it, then you should consider something different.

Re: Yaz. The progestin (synthetic progesterone) component is called drosperinone. It is an analog of spironolactone, one of your body's own mineralocorticoids. It is HIGHLY anti-androgenic, which means it is wickedly good at suppressing androgen effects. It can be very good at stopping issues like acne and male-pattern hair growth, both by direct androgen receptor blocking, as well as the usual method common to all other combined oral contraceptives, which is increasing the liver's production of Sex Hormone Binding Globulin (SHBG). This latter method basically 'imprisons' androgens bound to a protein in the circulation, preventing them from activating cell receptors. However, one down side is very low libido for some women.

If your goal is ovulation because you are pursuing FERTILITY - then Metformin is an excellent choice. But going on Metformin in the hopes that you will just spontaneously ovulate and thus have regular menstrual cycles, I don't think this is something too reliable for most women with fairly severe PCOS. One upside, however, is it increases insulin sensitivity, and often leads to a moderate weight loss.

Re: Biotidentical hormones - there is minimal evidence to support their use. They do not 'promote ovulation' as you mentioned. The degree to which they absorb and stabilize the uterine lining (endometrium) is variable and unreliable. Not recommended.

One other option which you haven't mentioned is the progesterone-releasing IUD. This has minimal systemic absorbtion, so therefore minimal systemic side effects (a bonus over oral contraceptives and cyclical progestins). It provides highly effective endometrial protection, and will thin down the endometrium significantly by counteracting estrogen in the uterine lining. Menses become very light with this, and may even stop. But there is an adjustment period of 3-6 months with irregular spotting and bleeding at the beginning of use.

Congrats on your committment to Paleo, too. The lower carb you go, the better response you will have in improving your insulin sensitivity (one of the underlying problems in PCOS is insulin resistance).

I don't know if I should even comment from now on since my herbal experience changed the way I view sickness and disease. I highly recommend seeing a good Chinese herbal doctor. That's the only thing that worked for me. And I can only recommend what I believe in.

hey paleo4ever! i don't have much advice, but i can't think that what you are taking now could even be helping. 12-17 days of the month a write-off? i say be bold and make a change. how could it be worse? praying for you!

I would suggest that u move onto Yasmin. I have been on both and it is much better. It definately screwed me up less. When u are moving off the pill I would recommend Dim and Agnus Castus to help balance your hormones. I have too much testonerone and estrogen.