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Understanding PCOS

Many patients come into our office having heard of PCOS (Polycystic Ovary Syndrome). They have a sister or a friend with it, they’ve read about it online or a previous doctor mentioned they might have it. They wonder if PCOS is why they are having a hard time getting pregnant.

The truth is that PCOS is the MOST common cause of infertility in women; about 5-10% of the population is affected with PCOS (~5 million women in America), and up to 34% of female infertility cases are caused by PCOS. And for those women with PCOS who can get pregnant, up to 50% of them will experience multiple miscarriages.

The reality is that PCOS isn’t just about periods and fertility though, having PCOS means a lifelong impact on the entire hormone system of the body. Women with PCOS are at increased risk of metabolic syndrome, type 2 diabetes, and heart disease. With heart disease being the #1 killer of women in America, identifying and treating PCOS as soon as possible is key not only for fertility, but for lifelong health1.

For many women, the first sign of PCOS is having irregular periods. However, with so many teenagers being put on birth control for this exact problem, many women don’t get diagnosed with PCOS until they start trying to get pregnant. And that can be devastating news.

In our office, we sit down with our patient and explain all the details about what is happening inside her body. We explain how a combination of her genetics and her environment are triggering her symptoms.

We start at the top, explaining that the Luteinizing Hormone from her pituitary gland in her brain tells her ovaries to make lots of testosterone and sends mixed messages about which egg is going to be released.

We talk about how her irregular periods are due to her body not releasing an egg from the ovary (anovulation). We explain that heavy periods or severe cramping are due to the way her hormones affecting the lining of her uterus. We review the way the body is releasing high levels of insulin every time she eats and this is why the weight gain happens so easily and is so difficult to reverse. We tell her that she has high levels of testosterone causing facial hair growth and painful cystic acne.

If all this gets clearly and slowly explained, she can walk out of our visit feeling empowered, hopeful and ready to take charge of her hormonal health.

Since PCOS involves imbalances of so many different hormones, it can be a little tricky to diagnose. Before we tell a woman that PCOS is her issue, we want to know for sure so we always start with a baseline hormone panel2 that includes:

  • LH & FSH

  • Estrogen

  • Testosterone (free and total)

  • DHEA-S

  • SHBG

  • Fasting glucose

  • Fasting Insulin

Ideally, we also test for Progesterone but that test is a little bit tricky to order properly in women who are not ovulating reliably.

If any of these tests come back indicating PCOS, we will order an ultrasound to look for cysts on the ovaries.

Then what?

Can you cure PCOS? Technically, no. Since it is triggered by a combination of genetic and environmental factors, women with PCOS will always have a tendency to show symptoms.

But can we manage PCOS to the point of not having symptoms, being able to have babies and preventing the metabolic diseases that can occur later in life? Definitely.

The traditional medical approach involves birth control (not really helpful for those trying to conceive) and other drugs like Metformin or Clomid.

In our practice, we use a natural approach to managing both the symptoms and minimizing the long-term side effects of PCOS. We teach women about nutrition3, specific exercise plans4, ridding their homes of hormone disrupting chemicals, and a variety of personalized herbs or supplements. All of these tools help our patients address the main trigger of PCOS, that blood sugar issue, without having to suppress the normal functions of their hormones with birth control pills or Clomid.

PCOS is a big deal for the women who have it and also for us, as fertility doctors who treat it. We understand the impact of PCOS, the day-to-day struggles with weight and acne, the seasonal challenges with fertility and the lifelong increased risks of heart disease and death. We are committed to walking the path with our patients, helping them make the decisions that work for their way of life, their ideal family, and their long-term well-being.

Are you ready to kick off your fertility journey?

  1. Zhu S, Zhang B, Jiang X, et al. Metabolic disturbances in non-obese women with polycystic ovary syndrome: a systematic review and meta-analysis. Fertil Steril. 2019;111(1):168-177. doi:10.1016/j.fertnstert.2018.09.013

  2. Karakas SE. New biomarkers for diagnosis and management of polycystic ovary syndrome. Clin Chim Acta Int J Clin Chem. 2017;471:248-253. doi:10.1016/j.cca.2017.06.009

  3. Faghfoori Z, Fazelian S, Shadnoush M, Goodarzi R. Nutritional management in women with polycystic ovary syndrome: A review study. Diabetes Metab Syndr. 2017;11 Suppl 1:S429-S432. doi:10.1016/j.dsx.2017.03.030

  4. Kite C, Lahart IM, Afzal I, et al. Exercise, or exercise and diet for the management of polycystic ovary syndrome: a systematic review and meta-analysis. Syst Rev. 2019;8(1):51. doi:10.1186/s13643-019-0962-3

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