September is PCOS Awareness Month. It’s all about getting ahead of this condition to optimize your fertility and general health.
What do Victoria Beckham, Emma Thompson and reality TV star Kate Gosselin have in common?
Contrary to its name, having PCOS doesn’t mean your ovaries have cysts, but rather that your ovaries have a high number of follicles containing eggs
Apart from their celeb status, these women belong to a particular group that wields an evolutionary advantage, which strangely enough comes disguised as a disease.
They’ve all given birth, and they’ve done so despite having a condition that affects their fertility known as PCOS.
Polycystic ovary syndrome is a hormonal disorder that can make it difficult for women to get pregnant. Contrary to its name, having PCOS doesn’t mean your ovaries have cysts, but rather that your ovaries have a high number of follicles containing eggs that are often unable to mature.
Symptoms of the condition include irregular or absent periods, high testosterone, excessive hair growth (hirsutism), and acne. While it presents challenges, having PCOS does not mean you’ll never have children or that your eggs cannot produce a healthy, beautiful baby.
You’re also not alone. The American College of Obstetricians and Gynecologists (ACOG) reports that this endocrine disorder occurs in approximately 7% of reproductive-age women.
The Key: Manage Your PCOS Early
Extensive research on the condition has helped us, doctors, to develop many strategies that improve the symptoms, your overall health and increase your chances of having a baby now, and in the distant future. You know that I’m a big fan of planning for your future family, which means understanding and managing your PCOS as early as possible.
But before we go further, we need to dispel some of the myths surrounding this disease. There are so many misconceptions about PCOS that I like to call it “Please Confirm this Ovary Syndrome.”
PCOS Doesn’t Mean You’re Infertile
Women with PCOS are highly fertile because the high level of follicles (more than 14) on an ovary means that your body is producing a large number of eggs. The problem is that PCOS comes with a hormone imbalance (too much testosterone) that makes it difficult for those eggs to mature.
An Evolutionary Advantage
Don’t let a diagnosis of PCOS get you down. Scientific research indicates that PCOS can be beneficial in some circumstances. Since ancient times (writings about the condition date back to 460 BC), sturdy women who have been able to give birth in challenging conditions have tended to have the disease. It’s thought to have persisted because it provides a paradoxical advantage to some women: despite being less likely to become pregnant, women with PCOS outlived others when food was scarce. It also helped them to space out their births, which meant lower maternal mortality and better resources for their children.
Steps to Take if you have Symptoms
1.Confirm Your PCOS with a Blood Test
An ultrasound alone isn’t enough to diagnose PCOS because having a lot of follicles doesn’t mean you have it. The only way to prove you have PCOS is by getting your blood tested. A reproductive endocrinologist can interpret your levels of anti-mullerian hormone (AMH), follicle-stimulating hormone (FSH), luteinizing hormone (LH), thyroid-stimulating hormone (TSH), estradiol, prolactin, Vitamin D, and insulin as well as doing a full lipid profile and androgen panel. (If you suspect you may have PCOS, you can start with my Egg Awareness panel.)
Blood tests — taken into consideration with other symptoms — are required to truly know if you have PCOS.
Many women are falsely diagnosed with PCOS after they complain of long gaps between periods, and are perhaps showing signs of excessive hair growth, acne or obesity. Sometimes teenage girls are erroneously diagnosed with PCOS since young brains tend to process hormones irregularly. Blood tests — taken into consideration with other symptoms — are required to know if you have PCOS.
2. Diagnosis Before Treatment
When it comes to PCOS treatment my motto “diagnosis before treatment. ” Just as no two people alike, no two fertility patients are alike, and this means that no two PCOS patients alike either. The key is to balance the hormones first before treatment and control the symptoms. That’s because both low vitamin D and high testosterone when you’re pregnant can increase the risk of autism in your baby.
3. Optimize Your Chances for a Healthy Pregnancy with Lifestyle Changes
Unlike those hardy ancient women who faced difficulty after difficulty, you can take advantage of every possible resource to optimize your chances of a successful fertility journey — and better health.
If you have PCOS, consider yourself a warrior princess. And start assembling your army of support, or your TEAM, which could include a nutritionist, a trainer, an endocrinologist, and possibly a therapist. I like to think of it like this:
- T = therapy
- E = exercise and help with eating
- A = acupuncture
- M = meditation
Women with PCOS can increase their chances of getting pregnant by making some lifestyle adjustments. These adjustments include:
- Regular Exercise and Weight Loss: Two-thirds of women with PCOS fall into the obesity category, which means that these patients also experience insulin resistance or pre-diabetes. I often recommend that patients lose weight to increase their chances of pregnancy. This will also improve your overall health, especially if you have dyslipidemia (this means having an excessive amount of LDL cholesterol, the bad kind, and not enough of HDL, the good kind.) These underlying metabolic issues can affect overall health as well as fertility. It’s often a challenge to lose weight, but for women with PCOS, it can be a bigger challenge, so I recommend enrolling in a formal weight loss program
- Eating a high protein — low carb diet: A paleo-type diet, which is similar to that of the hunter and gatherer days, may improve the metabolic parameters and symptoms of PCOS.
- Make sure your Vitamin D, Prolactin and Testosterone levels are normal.
- Get your Thyroid checked
- Taking Prescription Drugs: One of the most common ways of reducing testosterone, and therefore PCOS, is birth control pills. But if you’re a fertility patient, and trying to get pregnant, you don’t want to be on the pill. The steroid Spironolactone and Metformin have been shown to reduce testosterone. I also prescribe Letrozole at doses of 7.5 and 10 mg with another steroid called Dexamethasone. I continuously check hormone levels to make sure that the dosages are optimal. (Some doctors also use Clomid, but I don’t because of its side effects. I also don’t use injectables because of the high risk of ovarian hyperstimulation syndrome, which leads to swollen and painful ovaries.)
- Consuming supplements: Often I will recommend Dexamethasone in conjunction with supplements like Ovasitol, NAC, lipoic acid, which help naturally reduce fasting glucose levels and testosterone levels, and also leads to improved chances of ovulation. I also recommend CoQ10 and Resveratrol, another vitamin and potent antioxidant that can also help with heart health for women with PCOS.
If I Have PCOS, Should I Freeze My Eggs?
Women with PCOS tend to make a good egg supply in their lifetime. They tend to have a better than average egg supply — even if they’re not ovulating. So freezing your eggs won’t improve your chances of pregnancy. But age is still a factor when it comes to egg quality, and this can be a determining factor in choosing to freeze your eggs, even if your supply is still high. So the decision should be based on age rather than a diagnosis of PCOS.
PCOS is a life-long condition, so the time to start optimizing it is right now, especially if you’re in your twenties. The symptoms of PCOS will get worse over time. But while you’re addressing your symptoms and getting your hormone levels checked, don’t get down. Think of yourself as dangerously fertile and evolutionarily powerful!
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