Four Things You Should Know About Starting a PCOS Revolution (HOPE Syndrome)

Hi, everyone. Welcome to The Egg Whisperer Show. I’m Dr. Aimee, your host. We’re going to talk about the four things I want you to know about PCOS.

And I’ve renamed it HOPE syndrome. Why? Because if you have PCOS, it doesn’t mean you lose hope, it doesn’t mean that you can’t get pregnant. It simply means that you inherited something, probably from your mom and your dad, that caused you to have high androgens, lots of eggs on your ovaries, periods that are irregular, and paying attention to what you eat and how much you move your body is important.

Guess what? There’s a solution for all of that. That’s why I’ve come up with this. Think of it as a PCOS revolution to help you guys know what to ask your doctors so that you can get the help you need. I don’t want you to get the help you need just when you’re trying to get pregnant. That’s what gets me all fired up about doing these kinds of shows, because so often are told who have PCOS, “Oh honey, you don’t need to worry about it until you’re ready to have a baby.” I’m here to tell you, honey, I want you to deal with it and control it, so that when you’re ready to have a baby, you might not need to see someone like me, or if you do, you just need a whiff of fertility pills and you’ll be on your way and then have another pregnancy without my help.

There are also implications for women who have PCOS, not just during their fertile life, but also at the time of menopause. There are cardiovascular issues that can develop, higher risk of things like, for example, uterine cancer. That’s why I want you to understand this stuff. This information isn’t fear-based. It’s love-based. That’s why you can tell by the name HOPE syndrome that I’m trying to give you the hope that you need, so that if you have PCOS you don’t get depressed by some of the messaging you might be seeing online or maybe from really well intentioned doctors.

Let’s break it down…

The H, high testosterone or high androgens. Women with PCOS often have high androgens. Not everybody. If you are one of those people, be sure to get your levels checked. Levels; testosterone, dihydrotestosterone, androstenedione, DHEA, DHES. Talk to your doctor and see what levels they want to have checked for you. Get that as a baseline and then treat the levels.

I’m going to break down how to fix the high testosterone. Neutraceuticals, for example, like Ovasitol, Alpha Lipoic Acid, and N-Acetylcysteine. I even ask my PCOS patients to take CoQ10. The pharmaceutical drugs that you can take include Metformin, Spironolactone, birth control pills. These can also help in lowering your testosterone levels.

Then if you lower your testosterone, when you’re ready to get pregnant, potentially you’ll have normal and healthy ovulations and a healthy pregnancy. A high testosterone level is something that I think can impact the health of a pregnancy, so that’s why it’s super important for me to make sure that my patients who have HOPE syndrome go into a pregnancy with normal testosterone levels.

Now the O of HOPE is ovaries with lots of eggs. That’s just how they appear. You can see this beautiful, some people call it the string of pearls. Not everyone has it, but it’s just basically having over 10 follicles. Some people say it’s 10, 12, 15, 20, but basically there’s an appearance that the ovaries have. And an AMH level of over 3.0 can also be a key to the possibility that you might have PCOS.

The other thing is how they look when you’re actually looking at an ovary. You can see, during a laparoscopy surgery, for example, if someone has PCOS, they have a little bit more volume to their ovary. I’m just showing you a picture here of what an ovary looks like that doesn’t have PCOS and what an ovary looks like that does have PCOS. But just looking at an ovary does not mean that you have PCOS.

Something like 15% of women can have an ovary that looks like it has PCOS when it really just is an ovary that has lots of eggs. That’s why it’s super important to me that you confirm this ovary syndrome — get it, please confirm this ovary syndrome — before you start thinking you might have HOPE syndrome when you might not.

Now let’s break it down for the P, periods that are irregular. Periods that are irregular can cause issues like endometrial hyperplasia or uterine cancer. That’s why we care. For my patients, I suggest that they have a healthy period every three months or so to prevent these conditions from developing.

If you’re trying to get pregnant, periods that are irregular also mean ovulation that is not occurring. That’s super frustrating when it’s time to get pregnant, so we usually use pills like Letrozole, for example. We know that sometimes women who have PCOS, or HOPE syndrome, might have a harder time getting pregnant with these pills, and we call them Clomid-resistant or Femara-resistant. But I just say I have to work a little harder to talk to your ovaries.

Sometimes I add steroids like Dexamethasone and Naltrexone, and sometimes we add a whiff of injectables to get the ovaries to grow eggs. In some cases, we consider IVF as an option, because if a woman is very sensitive to the drugs and has a very robust response, she might be at risk for having more than twins. That’s when doing IVF might make sense, so we can create a single embryo to put into the uterus, so that we’re not dealing with lots of babies at once.

Now the E, exercise and eating. Eye roll, please, I know. I want you guys to thrive, not just survive, and I want you to be the best version of you each and every single day. That’s why talking about eating is so important for women with PCOS.

I have great nutritionists and exercise specialists, personal trainers, that I refer my patients to. If you don’t have one, find them. Find your team, the therapist, the exercise specialist, the nutritionist, the acupuncturist, the mindfulness apps, and do all of those things with your PCOS, or HOPE syndrome, so that your condition is controlled.

I don’t necessarily know that we’re going to find a treatment in my lifetime. I really hope we can. Until then, HOPE syndrome and understanding all of these things will hopefully help you so that you can understand your PCOS and HOPE syndrome, and so that whatever you do as far as pregnancy and beyond is always going to be healthy and a lot less frustrating. So, let’s start a PCOS revolution, let’s think of it as HOPE syndrome. I really hope this show helped.

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Fertility Doctor, Reproductive Endocrinologist, Egg Whisperer: www.eggwhisperer.com