Today’s topic is polycystic ovary syndrome, PCOS. Do you know what I think of PCOS? I think the name should really be “please confirm this ovary syndrome.” I find that there is no condition that is more misdiagnosed than PCOS.
This is the thing. P stands for “poly,” C stands for “cysts,” and then ovary syndrome. As soon as you tell someone that you have polycystic ovary syndrome, the first thing they think is, “That’s what I have; I get this pain once a month; I’ve been to the ER for ovarian cysts, so that must be me, that must be what I have.” But the thing is that you need to confirm the syndrome through blood work.
You can have four people, and they can all have completely different symptoms. One of the things people think of when they think of PCOS, if you just go to Google and click on Images, is they think of someone who is, let’s say, a little bit curvier. We’ll go through all of the symptoms from head to toe in a moment, but just because your friend has PCOS and has her set of symptoms doesn’t necessarily mean that you do or don’t have it. The only way you know if you have this or notis to confirm it. It’s not a diagnosis that is made just by looking in the mirror. You don’t just look in the mirror and say, “I’m a little curvy and I have irregular periods, so I must have PCOS.”
I find that as human beings we tend to be a little bit prejudicial and we just look at people and label people with things. I have seen so often young women who have actually run out of eggs and they saw that pattern and it changed over time, and they were labeled with something that they really didn’t have. I don’t want that to happen to any of my patients. I don’t want that to happen to anyone watching this show. So, please confirm this ovary syndrome.
I just told you that the image of PCOS tends to be women who are on the curvier side. There are actually celebrities with PCOS who are far from curvy. How can this be?
Number one, Jillian Michaels. She is famous for being one of the fittest women in the world and being one of the fitness coaches of the show America’s Biggest Loser. That’s where we know her from. Now she promotes health and wellbeing, and she talks often about PCOS and she coaches people on diet and exercise. She has PCOS? Yes. Just because you have PCOS doesn’t necessarily mean that you have to accept being the body size of someone who is larger if you don’t want to be that size.
Another celebrity reality TV star is Kate Gosselin. I use her as an example because I think a lot of people know who she is, especially women in their 30s and older because of the time that her reality show was on TV. She’s famous for having six babies all at once. How did that happen? The way that happens is she has lots of eggs.
If you’ve heard the term PCOS, and maybe you’ve read a little bit about it, maybe you’ve been told that you can never have kids. I hear this all the time, “I was diagnosed with PCOS when I was 14 years old, and my doctor told me that I would never have children.” That’s not what PCOS is. I’ll talk to you a little bit more about that in a second.
Here we go, another celebrity with PCOS, Posh Spice from The Spice Girls. Four kids, and she has PCOS. This just shows you that PCOS does not mean infertility.
The reason why women with PCOS might have a harder time getting pregnant is they’re just not ovulating all the time, or consistently, or regularly. We all know how hard it is to temp and check your mucus and check your OPKs, especially when you have irregular cycles. That’s why women with this condition have a harder time getting pregnant, because you’re not ovulating consistently and it’s hard to predict, it’s hard to time intercourse or insemination when that’s happening, and that makes it more difficult.
This is what I tell my patients with PCOS… I know this sounds a little out there. I tell them that you are dangerously fertile. They’re like, “What? No one ever told me that before. I’ve always been taught that PCOS means almost no chance of pregnancy.” I say absolutely not, it’s actually quite the opposite. You have so many eggs, you have a hormonal imbalance such that your brain is not sending the right levels of hormones to your ovaries so that you consistently ovulate one egg a month, but you have a ton of eggs.
Now let’s say you already know you have PCOS. There’s something else I should tell you about you and this condition. You actually have an evolutionary advantage over all of your friends. Yes. Just Google it, PCOS evolutionary advantage, and you’ll see what I’m talking about.
This is the thing. Women with PCOS have a harder time burning calories. When would that actually be a benefit? That would be a benefit back in the hunter-gatherer days. If you have a harder time burning energy and you’re in a situation where there is a scarcity of food, then you’re going to be the survivor. If you’re also pregnant and there isn’t food around, you’re also going to be a survivor. So, women with PCOS, that show Naked and Afraid, my favorite show – seriously, one day I will be on that show. Paula?
Paula: I’d go on that show.
Dr. Aimee: It’s a good show.
Paula: It’s a very good show.
Dr. Aimee: Women with PCOS would be great candidates for that show just because of this aspect of their ability to survive. But we’re not hunter-gatherers anymore.
Everywhere you look, there’s a grocery store. So, how can this help us now? That’s the challenge of having PCOS in current times.
Back to the ovary, just a little bit. This is a picture of an ovary. This is what I look at every day. I love looking at ovaries. Those eggs are really cute. This is a follicle. This follicle is about two centimeters, and we call that a cyst. Every time we ovulate, we make a cyst of ovulation. They come, they go, sometimes they take a little bit longer to go. This is normal. It’s normal to have cysts.
These tiny little things over here are follicles. They each have a little tiny egg inside them. This is what I would call a normal appearing ovary on ultrasound. And when I look at PCOS ovaries, I say, “Wow, you have so many eggs. They’re so pretty, they look like a pearl necklace or a string of pearls. If you look here, all of these little follicles that are surrounding the ovary are what we call a PCO-appearing ovary.
You can actually have a PCO-appearing ovary and not have this condition called PCOS. Please confirm this ovary syndrome. Studies show that maybe around 15% of women can have ovaries that look like this and not have PCOS.
This is what I see come through my office. Women come in and they have an ultrasound report, they say, “My doctor did an ultrasound, and I’ve been diagnosed with PCOS.” I say, “But your lab levels don’t show that. You ovulate regularly. Guess what? You’re just a young woman with lots of eggs, you don’t have PCOS.”
I want to go through from head to toe as to how PCOS can affect you if you have this condition.
Let’s start with the head. Number one, you can have some hair loss in the scalp. We call that male pattern balding. The other thing you can have is acne. Perhaps what we call hirsutism, which means hair growth on the chin and other areas, upper abdomen, lower abdomen, back, inner thigh. There are different grades, there’s a score that we use to score the degree to which you have hair in these areas, and this is associated with high testosterone levels. But not all women with PCOS have this. It’s really important to know what you have.
Going down, we then have the heart. In the heart, women with PCOS may have a higher risk of having heart disease, high cholesterol, hardening of the arteries. My point is this is why it’s really important if you have PCOS, it is not a condition that you wait to treat when you’re trying to get pregnant. I feel like I should have a shirt, “PCOS: Not about the cysts.” Be sure to get treatment even before trying to conceive and after you’re done having a baby.
If you wait until you’re trying to conceive, let’s say you don’t want to try until you’re 32, now it has been years of untreated PCOS, high testosterone, high insulin levels, all these things. But if you had treated it at a younger age, if you need to see me, then we’ll have a much easier time of helping you reduce your testosterone, increase your Vitamin D, drop your prolactin levels, make sure your thyroid is normal. This is something that definitely needs the care and guidance of someone who understands the condition, so make sure that you get that care and guidance that you need.
Moving down the body, let’s go to the breast area. Women with PCOS may have an increased risk of breast cancer. That’s associated with having higher estrogen levels. Again, that’s not the case for everybody. It really depends on how much estrogen you have around, and that can also be related to your body size. We know that women who are a little bit on the heavier side with a BMI over 30 may have a higher risk of breast cancer in and of itself.
Moving down the body, now we’re going to go to the uterus. Same idea. Women with PCOS who, let’s say, have months and months of no periods might have a higher risk of what we call endometrial hyperplasia, which can be a risk factor for uterine cancer. We don’t like the C word, bad word. We don’t like the M word, menopause. Both of them are bad words.
Now what do you do? I’m all about imagery, using easy images to describe to people what they need to know in as short a time as possible. That’s why I’m here. If you think about the images of Jillian Michaels and women like that, they are literally extremely active. If you have a slow metabolism, I tell my patients with PCOS that you need to change your lifestyle and be as active as you can every single day. Literally like a hamster on a hamster wheel. But I don’t think of you as a hamster. I think of you as awesome with evolutionary advantage and dangerously fertile.
Aside from activity, it’s also diet. Studies show that eating an anti-inflammatory diet, because PCOS could also be considered somewhat of an autoimmune condition, and we’re learning more and more as researchers are studying PCOS, a Paleo-type diet, kind of like the hunter-gatherer days, may actually improve metabolic parameters and the symptoms of PCOS. That can’t hurt anybody.
The other thing that can help with PCOS are drugs. I’m not just talking about drugs like birth control pills, which are commonly used, and I’ll talk about that. I’m talking about nutraceuticals, natural ways of improving the symptoms of PCOS.
One of the most common ways or easier ways of reducing testosterone is birth control pills. But if you’re a patient of mine, you don’t want birth control pills. That’s extremely confusing. It’s like, hey, don’t you know I’m in your office to get pregnant and now you want to put me on birth control pills. Birth control pills can reduce testosterone levels, but we’ll talk about other things if you’re trying to get pregnant.
Spironolactone is another steroid that can also reduce testosterone. Metformin. Those three together can help reduce testosterone. Sometimes if you’re not responsive to fertility pills, you can add a steroid like Dexamethasone.
How do you know how much medication you should take? Remember the acronym, please check this ovary syndrome. That’s how. You check levels. You check your testosterone level. You check your glucose and insulin levels. You check your hemoglobin A1C. You don’t have to start with all of the medications at once, you can start slowly. Once a month, check your levels and see how you’re doing. Then decide if you need to titrate up, titrate down, or add something else. I don’t want you to be a human pharmacy. I want you to feel like a normal person living the healthiest life ever with your team surrounding you.
There are supplements that can also improve the symptoms of PCOS. Those things are CoQ10. Ovasitol – Ovasitol has D-chiro-inositol and myo-inositol. There’s also another supplement called NAC, or N-Acetyl-Cysteine. These are things that can also naturally reduce the fasting insulin glucose levels and testosterone levels of patients without running to the pharmacy per se, so it’s another thing to consider doing. Resveratrol is another vitamin that can also help with heart health for women with PCOS; it’s also a very potent antioxidant.
If you’re a patient of mine with PCOS, I’m looking at the full picture. It’s not just about getting pregnant, it’s about what I can do to make sure you have the healthiest pregnancy possible. Make sure your Vitamin D levels are normal. Make sure your prolactin is normal. Make sure your thyroid is normal. Make sure your testosterone is normal. We know that women with high testosterone may have a higher risk of having a baby with autism. I’m not making this up, this is what the studies show. Before you even get pregnant, get your levels checked to see what’s going on. Then do everything possible to make sure that you have everything you need to have the healthiest pregnancy.
This is the other thing; you need a team. It isn’t just about having me. You may need a nutritionist. You might need a psychologist. You might need a personal trainer. You might need a naturopath doctor. Even an acupuncturist. Believe it or not, acupuncturists can help women ovulate without drugs like Clomid, which is evil by the way, I’ll dedicate a whole show to that, or Femara, also known as Letrozole, which is a medication that I prefer to help women with PCOS.
So, get your levels checked, make sure you have a team around you, and don’t think that PCOS is something that you only address when you’re trying to conceive. It’s a lifelong condition that takes careful management and the guidance of someone like me, a medical endocrinologist, an OBGYN that really understands the condition. Get that team now, and don’t wait too long because the symptoms of PCOS just get worse over time. Think of yourself as awesome, dangerously fertile, with an evolutionary advantage, and please get your levels checked.
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