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Polycystic ovary syndrome
[00:00:00] It's Friday. Good morning. So we're gonna talk about polycystic ovary syndrome, A K A P C O S. Some of you use the vernacular picos. I don't. I don't know why. Let's first start with polycystic ovary syndrome is not a disease. It is an entity I like to say that just shows us that your hormones are behaving a little irregularly, a little out of balance.
A couple of very important nuggets before we talk about what the syndrome ick actually is. One, it's hard to say what causes it. , we know that risk factors are if you have a family member with type two diabetes, and we know that sometimes the P C O S seems to show up at times of either stress or weight gain, for example.
But the underlying condition was always there. Much like you have been born with a predisposition to type two diabetes, if it was in your family, but circumstances unmasked it. Unfortunately gaining weight, for example, [00:01:00] that can be the same thing with P C O S, meaning it didn't just show up. You were born with this predisposition.
They don't know exactly. There's not one single gene, but we know that we're born with a predisposition and then something unmasks it. Some of the time it is a story like. God. I went abroad and I gained 15 pounds, and all of a sudden my period went away. Sometimes it's a woman in her forties, she's already had her children, and she says to me, my period is like all of a sudden 35 days apart.
So there are a lot of different circumstances where we suddenly discover it. So one of my other nuggets is that I deeply believe that P C O S is underdiagnosed, meaning many women have it and we don't know about it there. That's a two-pronged conundrum On one hand. We need to find out for other women who should know because it is, um, edifying for certain women to have the knowledge of what's going on in their body.
So when they're having certain symptoms or features, it's nice for them to have a label, even though we don't like labels in general, but some women really need that. Oh, this is what it is. On the other hand, I'm [00:02:00] actually glad, in a way, it's underdiagnosed because I like to be able to use that to calm my patients down in saying, millions of women are walking around with P C O S who never knew it, and they've had their babies and they're perfectly fine.
The reason I say that is because the pervasive feeling when someone finds out about P C O S and they Google it is, oh my God, I'm never gonna get. It causes infertility, and my take on it is it does not cause infertility. It makes it harder to get pregnant if you are not ovulating. If you are ovulating with P C O S, you will get pregnant.
Just like millions of women who, again, in their forties report certain symptoms. That make me think, huh, I wonder if you have P C O S. We do some blood work, we do some ultrasounds and we discover that they've had it. Some of these women have had like four. So other nugget, polycystic ovary syndrome implies to you guys that you got big cyst on your ov.
Yet you do not. Your ovaries will look like an ovary, maybe slightly larger than a typical [00:03:00] ovary with multiple little fluid-filled pockets. Some people will call it a string of pearls the way it looks on an ultrasound or a chocolate chip cookie, meaning if you picture chocolate chip cookie with all those little black dots, which are the chocolate chips, those represent the follicles.
A follicle, which is where the egg is housed and then pops out when one ovulates. A follicle is a small, fluid-filled pocket, couple of millimeters. A cyst is a fluid-filled pocket, so by definition, a follicle is a cyst, so polycystic ovary syndrome. Very much confuses people. They do not necessarily have cyst.
In fact, if they do have cyst, it has nothing to do with polycystic ovary syndrome. It is just that they have multiple little fluid-filled pockets. . Okay, so what happens? Your hormones, because they are out of balance, will essentially create a situation where you still have your estrogen and to review your cycle, your estrogen thickens your lining, and then when your [00:04:00] progesterone kicks in with ovulation, your lining then gets shed out In P C O S, because the hormones are out of balance, patients will continue to secrete their estrogen, so that will thicken their lining because they don't ovulate, the progesterone does not come a.
To withdraw the lining. So they may go 1, 2, 3, 4 months without a period. They may just have a story of like, huh, I have like 35 day cycles. Isn't that interesting? And again, that means that their estrogen is working, but their progesterone is not allowing everything to get shed out, which means their lining can become very thick, and then when they do bleed, they bleed heavily.
What also comes along with it, for many women, about probably 80 ish percent of women, Challenging weight issues, so it's difficult to lose weight, and then the excess weight causes the hormone imbalance, and then the hormone imbalance makes it harder to lose weight, so it becomes a bit of a vicious cycle and other signs of what we call androgen excess.
The simplistic way I like to look at it for patients so I [00:05:00] can describe it to them is, your estrogen keeps working. It's not necessarily balanced in the way it should. . Therefore, it almost shunts itself into more of the male hormones, the testosterone hormone, which we all have. Women and men have estrogen and testosterone, but in a different ratio.
So women with P C O S might have higher testosterone levels. They do not always. Sometimes they will have other signs of. androgen, excess androgen is the term we kind of use loosely for the male hormones, right? So they will have sometimes acne, they will have hair. So if I ask a patient, do you ever get a hair on your chin?
And they say, oh yeah, I get a couple. Doesn't everyone, the answer is actually no. I am a actually hairy person because I am Persian. I'm from Iran, but I tend to not get hair on my chin. I get the fuzzy hair, bikini line legs. That's all very typical for different ethnicities, but the hormonal hair patterns where.
Darker, coarse hair on your chin, sometimes on your neck, sometimes essentially on your chest. Those are the hormone patterns that can go along with P [00:06:00] C O S. So acne, hair, irregular periods. These tend to be hallmarks of patients with P C O S and challenging weight issues. There is a subset. About 20 percent-ish.
We consider lean P C O S patients, meaning they are thin. They would not kind of look like a typical patient. If you Google a typical patient, they will always show someone who's like heavy and hairy and acne, and that's not always how it is. And even women who have those things can actually help reverse the signs and symptoms of their P C O S by losing weight.
I don't say by simply losing weight, because losing weight, as you know, if you know me, I think is. the most challenging thing in my entire life, so, More estrogen, not enough ovulation. So because you don't ovulate, your lining does not shed, and you can have these other signs and symptoms. Some people will believe that just nutrition alone will reverse this.
And I actually think that there are many times they are right, but just nutrition is such a conundrum and [00:07:00] very hard. So many women end up going on the birth control pill, and I wanna be clear about why you should go on the birth control pill if you have P C O S, meaning, I don't think you should go on it, but one would go.
If they say, I never get my period, or I don't know what's going on with my cycle, it's so irregular that I would like it to be more even. The misconception is that we are actually regulating your hormones. We're not regulating your hormones. The underlying hormonal imbalance is still there, but we are evening out your hormones when you're on the pill so that you have steady hormones, suppression of that estrogen so that the lining doesn't thicken up and doesn't have to shed itself out to the same.
Okay. So again, it's a misconception to say, oh, now my hormones are regulated because I'm getting a regular P regular period on the pill. You're getting a regular period on the pill because the pill is evening out your hormones and then giving you estrogen and progesterone together, and then a drop during your placebo week that withdraws your lining.
So it is not evening out your hormones. And that's important to know because when you go off the pill, the [00:08:00] underlying entity is still going to be there. You certainly can try to help your hormones regulate themselves by different. Weight loss. . Sometimes taking metformin, which is the type two diabetes medication, can actually help regulate your insulin and your sugar because those can be dysregulated when you have P C O S and that can actually help even out your hormones and get you to ovulate again.
Um, certainly in the more. Eastern realm, PA doctors who are either acupuncturist, traditional Chinese medicine doctors, functional medicine doctors have a lot of different tools that they can do to help you with it. Though I would steer clear of those practitioners who are maligning the pill and making it seem evil, I don't think the pill is perfect.
The pill has side effects that can be difficult and frustrating for patients and borderline dangers for rare patients, but it also has a very good place in our world. So like anything, , we should draw from both. The other issue that happens with P C O S patients, I find, or the most important issue in a way, I find, is that they tend to be wrecked with [00:09:00] anxiety even when they're 16, 17, 18, thinking that they're never gonna get pregnant because Dr.
Google said infertility, infertility, infertility. and like I touched upon before, it's not necessarily infertility, and I say that I know it's vernacular, but that just sounds so much more onerous. It is this, if you do not ovulate regularly, you might have a harder time getting pregnant, but when it comes to P C O S, we can get you to ovulate either indirectly by changing your nutrition or indirectly by putting you on metformin or indirectly through Eastern techniques like.
um, acupuncture and things that functional medicine doctors can do to balance your hormones. So indirectly, getting your body to get back into balance, which gets more to the root cause and then can cause ovulation or directly in a very western medical way. We send you to the re e i, the reproductive endocrinology infertility specialist.
They give you medication, you get pregnant. So I don't wanna make it sound silly and simplistic, like, don't worry about it, but I do wanna make it sound. [00:10:00] Anything else in our world, here's an entity, here's what we can do about it. Here's why I'm not worried about your fertility, because I know that we can help you.
If you come in saying to me, only wanna get pregnant, if it's spontaneous and on my own, well then, sister, I'm sorry. You are shit outta luck in my world because I don't know what's gonna happen to any of us as women. Women with P C O S, women without P C O S, young women, old women, I can never predict if someone's gonna get pregnant.
Own. But I can say that with the techniques we have in the modern world, regardless of having P C O, You will get pregnant. It might take being pregnant on your own. It might take medication by your regular ob gyn. It might take medication by a fertility specialist. It might take ivf. I don't know what it's gonna take, but I know you're probably gonna get pregnant.
The likelihood of being unable to get pregnant at all is very small. Hence the reason I don't like when patients Google it and see infertility, infertility. Yes, there are fertility issues. That to me is a very different spirit than infertility, which [00:11:00] implies complete lack of being able to ever carry a human in your body.
Okay, so what are the other concerns with P C O S? I think that it causes a lot of anxiety because when people Google it, , they see pictures again of women who have a lot of weight issues, a lot of hair, a lot of acne certainly, which happens for many of our patients. I have patients who unfortunately have those categories of issues, and it's really challenging because again, weight tends to be the underlying cause, but their metabolism is disordered in a way that doesn't necessarily allow them to use the same techniques that someone else who only needs to lose five or 10 pounds can use.
So it becomes a challenge. It becomes a little bit of a social issue because. As women, we feel very judged about our weight. Right. We judge ourselves. We probably judge each other. Um, and then the acne in the hair becomes a challenge as well. People can also use a medication called sperm lactone, which is a hormone that actually works for blood pressure, but indirectly can help with acne and with hair, and it's actually a derivative of one of the components, or I should say one of the c.
[00:12:00] Of Speral Lactone, its derivative is in the birth control called Yaz or Yazmin. So that is the pill that many people come to us saying. That's the one I've heard for P C O S, and the answer is it might work for you for P C O S. On the other hand, there are other pills that might work as well. So the bottom line is hormones being imbalanced.
It is something that you inherit the predisposition from. And typically, if you have a history of someone in your family with type two diabetes, that's where you probably inherited it from the way to diagnose it. By the way, often patients tell me their story, and in my mind I'm already thinking, okay, I know what's going on and I can tell what's happening.
And then there's different methods. There are different techniques, but essentially you'll most likely have a panel of blood work. Maybe an ultrasound that will kind of put the story together where your doctor will look at different ratios of your hormones and your ovaries and your story and your symptoms to help tell you.
Sometimes it's a definitive, there are absolute lab abnormalities that show it. Other times it's subtle. When you look at the lab [00:13:00] slip, everything will be in the normal range, but your doctor can help decide with certain ratios of hormones and other features, whether or not she thinks you. What I call, again, a predisposition towards it.
And that can be helpful because then you sometimes know why it's happening. A frustrating side effect that can happen for many women is hair loss. So while they get hair on their chin, they can sometimes lose hair on their scalp. Again, more of that male pattern type of hair loss, right? Where they get hair here but they lose it.
And I've seen that in women just with P C O S. I've seen that in. When they go on the pill initially to control their symptoms, but then, then they go off of it. They lose some hair. I don't have a great explanation for it. Any of you out there watching, please tell me. But it seems that a lot of it is when we even out those androgens and then we withdraw the pill, there somehow seems to be a change in the hormones because that seems to be the most common time where women report it on the pill.
Then when they stop it, that can happen. It does not happen for everybody. So I don't want [00:14:00] everyone to distress if they choose to go on the. It's still actually something that can really help you as far as evening out your hormones again, not evening out the underlying cause, but making it easier for you to not have to keep track because your choices are either put in an i u D with hormone to even out the lining of the uterus so that the lining doesn't get too thick.
Or taking the birth control pill to make the thin, the lining stay thin or every three months if you haven't gotten a. Your doctor will give you progesterone by mouth for a week to help withdraw your lining because you don't want the lining to get too thick over time. Okay? P C O S misconception, not cys in your ovaries.
That's what I wanna say about that. You guys have a good day. I'm gonna go to the office.