PCOS stands for polycystic ovary syndrome. Many people interpret it to mean you have big cysts on your ovaries. That’s not the full story. When I hear PCOS I think of it as a call to, “Please Confirm this Ovary Syndrome”. So much is misunderstood about PCOS! Often women are told things like, “oh you don’t need to worry about it until you’re ready to have babies. That could not be further from the truth. If you have PCOS you’re wise to manage it immediately, irrespective of your future family plans.
In my experience, PCOS is most like an autoimmune disease — and that’s not something I was necessarily taught in medical school. It’s highly hereditary. No two PCOS patients are alike. It may mean your symptoms are different from what others experience. Or it may mean you may have a couple of symptoms or all of them. Once you are diagnosed with PCOS it is something that can be understood and controlled. The important thing is to know what you’re treating.
The TUSHY Method
When you’re given a diagnosis like PCOS, especially when you’re trying to get pregnant, people have the tendency to only focus on your PCOS. But guess what? There could be something else going on too. It’s why the TUSHY method is helpful.
I don’t want you to forget about the fallopian tubes. I want you to make sure your uterus doesn’t have a fibroid or polyp, that the sperm is healthy, and that all of your hormones are checked — not just PCOS labs. Look at other things like vitamin D, cholesterol, testosterone, hemoglobin A1C. Get all the hormones checked. You may have PCOS, but that may not be the full story. I want you to avoid being labeled as the “PCOS patient.” There could be other things going on. You could have a lower egg count or a higher thyroid level that’s causing you to have irregular periods. So please, confirm your ovary syndrome (be sure to watch the YouTube show I did on this topic too). Get your TUSHY checked. It’s imperative if you’re going to do fertility treatment or have a desire to start a family when diagnosed with PCOS.
If you’ve been diagnosed with PCOS, I recommend you assemble your TEAM.
I talk about the importance of assembling your fertility TEAM all of the time, but it’s so important no matter what medical condition you’re dealing with. This is especially if you’ve been diagnosed with PCOS.
T for Therapist: When you have PCOS you may be at higher risk for depression. When your testosterone and insulin are high this can affect your mood. Talk to a therapist while you’re going through treatment so you don’t feel alone and know that what you’re experiencing is normal and treatable.
E for Exercise: The next thing I want to talk about is diet and exercise. Get a trainer. I have patients that email me all of the time and ask me if it’s safe to exercise. Yes! Of course, it is. Be active. Go on a walk. You don’t need to belong to a gym. You can just be outside — or even inside if you prefer! You can find a mall to walk around (you know you’ve seen mall walkers), or a local park. It really doesn’t matter where just get moving!
A for Acupuncture: There are so many researched and validated benefits to acupuncture treatment for PCOS and those hoping to get pregnant. I’ll talk in more detail about this later in the article.
M for Mindfulness and Meditation: This is all about finding ways to calm your mind and letting things go once you know you’ve done all that you can. Apps like Headspace and Calm are great resources to find immediate calm or to set a healthy habit of meditation for as little as a few minutes each day.
Now that you know the importance of getting your TUSHY checked to confirm your diagnosis and understand what a supportive TEAM entails, I want to dive into more treatment options.
1. Prescription Drugs
With PCOS you can have elevated testosterone and high insulin fasting glucose levels. These things can be treated with prescription drugs. Do you have to use drugs? No, but some people will benefit just from a short course of drugs just to get the hormones balanced and that’s key when you have PCOS. What I like to do is to get the baseline labs done. I use these to see what the testosterone levels are, what the lipid panel is, and then to set a goal with my patients on what we want to change over the course of treatment.
You want to map out a plan to see how hormones can adjust. Get monitored. Stay on top of getting your levels checked so you know what works for you.
Let’s talk through each of the prescription drugs.
Birth Control Pills: Can help with lowering testosterone levels. They can help with regulating your periods, but it’s called birth control. If you’re trying to get pregnant that seems kind of counterintuitive. But, believe it or not — just taking a short course of birth control pills can help bring the testosterone levels down. Once levels are down you can stop the pills and begin fertility care.
Metformin: A drug that can just tear up your tummy. I like to prescribe 500 mg a night (extended-release) and then go up slowly if indicated. I make the decision to go up based on the starting testosterone and hgba1c levels, and my patient’s body size. I got up slowly: Two tablets after two weeks, then go up to another tablet for another two weeks and then go up to four tablets two weeks after that. Talk to your doctor about what your dosage needs are, but trust me — you don’t want to start out at the max dosage. If you do you’re likely to be having poop emergencies left and right and you’ll be really pissed that someone didn’t tell you this!
I know. I’m not talking like any other doctor. But, I hope I’m getting your attention!
My patients also tell me that if they take a probiotic with their Metformin that it can help manage some of the GI side effects. About 60% of patients experience GI side effects. By figuring out what works for you then you can tolerate it better.
As an aside, I think I should take Metformin. Why do I say that? It’s been identified as a drug that maybe we all should be on as it does have anti-aging and anti-cancer properties. Pretty cool, right?
Spironolactone: This is a drug that should not be taken when you’re pregnant. I prescribe it up until the point of ovulation. Or in certain cases, it may be prescribed up until the fertility drugs start, like Femara and Clomid. I pair it with the birth control pills if needed to lower testosterone levels. It’s so important for me to ensure that my patients have normal testosterone levels before they start fertility treatments.
High testosterone levels in utero have been linked to autism babies born in women who have PCOS. This is treatable. It’s preventable. There’s an action you can take to reduce the risk of this happening, so why wouldn’t you do it?
Preconception testing is so important. This is true for everyone, not just those that have been diagnosed with PCOS. Most people spend more time planning their vacation then they do their next pregnancy!
When you have PCOS it’s super important to see a specialist and talk to them about these things. If they’re not bringing them up then seek help from a medical endocrinologist or an OBGYN who is passionate about PCOS and women’s hormonal imbalances. You may also want to find a naturopath in your area as they can understand PCOS and help you. Or consider finding someone like me, a reproductive endocrinologist, who is extremely excited to help people with PCOS. Whatever your path, find a doctor that is committed to helping people reach their goals not only with family planning but also with living the healthiest life possible while having PCOS.
Victoza: It is somewhat similar to Metformin, however, it’s an injectable form of a similar family of drug that helps with insulin resistance. Studies have shown that taking Victoza with Metformin can help decrease testosterone levels and even help with weight loss. Victoza is FDA approved under a different name for actual weight loss. So that’s something to talk with your doctor about. If your fertility doctor is not comfortable prescribing it then a medical endocrinologist will the be the doctor you can see so that they can evaluate to see if it is suitable for you.
It is not something that we use in pregnancy so it’s not something that I’d use when you’re trying to get pregnant. However, I do want you to realize that when you do have PCOS these drugs do help. Sometimes that means taking a time-out or break from trying to get pregnant. Get in the best shape of your life and then continue back on your path to pregnancy.
Femara and Clomid: These are not new prescription drugs, but for someone that’s not ovulating regularly, they may appear to be novel solutions. The goal is to help to get someone with PCOS ovulating regularly. The way we do that is fertility or ovulating inducing drugs — Femara or Clomid. You can even use them together. This combination of drugs can help women ovulate regularly. Remember that ovulation is the goal. Ovulating 6–8 eggs is not the goal. My intention for my patients is to have one extremely healthy pregnancy, one at a time. We are not trying to break any records on babies carried at one time.
Remember how I said you don’t have to take prescription drugs if you have PCOS? There are other ways. You want to manage the symptoms as soon as you’re aware of the symptoms. If you get the diagnosis when you’re 18 then don’t wait until you’re 35 to treat it. Don’t wait until you want to get pregnant. If you avoid managing it and significant time passes then there’s a risk that you could develop overt diabetes, hypertension, and uterine cancer. These are things that we want to avoid.
coQ10: Is an anti-inflammatory that can be taken as a capsule and it’s also been shown to prevent preeclampsia. Women with PCOS have a higher chance of developing preeclampsia in pregnancy. For that reason, I even have some of my patients take coQ10 during pregnancy. Please talk with your doctor and ask if this option may be right for you. Go to this link and use PRC code 105401 for the lower price.
Resveratrol: This supplement hasbeen shown to lower testosterone levels in women with PCOS. These studies can be found in PubMed. I want you to look them up and read about them. Print them out. Bring them to your doctor.
Ovasitol: This is the brand name for a supplement that contains both Myo-Inositol and Chiro-Inositol. It also reduces testosterone and glucose levels which is what we look to reduce in women with PCOS. Go to this link and use PRC code 105401 for the lower price.
NAC (N-Acetyl Cysteine) and Alpha-Lipoic Acid: Both improve glucose homeostasis and reduces testosterone levels. For NAC: Take 1, 600 mg capsule, 2–3 times per day. For lipoic acid: Take 1, 200–400 mg tablet daily.
Vitamin D: It is a very commondeficiency in all of us. I like patients to have a level closer to 50. Make sure you’re not taking too much.
Dexamethasone: This is a steroid medication that helps my patients ovulate. I use it to prevent the frustration of showing up for that follicle check and not having a follicle there — or at least a dominant one. It can make you feel jittery and for that reason recommend to my patients that they take it in the morning. I have patients take this on cycle day 1 as they are taking Clomid/Femara. I ask that they stop taking it when they’re ready to ovulate. Talk to your doctor about using this in combination with Clomid/Femara. It has been a huge help in my patients that have PCOS.
Naltrexone: This is another drug that I frequently use in patients with PCOS. If you go to PubMed you can see where I helped publish one of the studies related to Naltrexone in women who have PCOS. This is something that can help the ovaries be more responsive. I prescribe around 25 milligrams daily (half of a 50 mg tablet) and use it with Dexamethasone and Femara. My patients don’t report any bad symptoms at all from it. In fact, they actually feel pretty good on it. I have tried it successfully in my patients who have taken Femara or Clomid and their body wasn’t as responsive. Adding Naltrexone can sometimes help. Suggest it to your doctor and see if it may be helpful for you.
I’ve seen it for myself how helpful acupuncture can be a complement to western medicine. I’ve tried all the four things I’ve listed above, and I had one patient that would still not ovulate. Then we tried acupuncture. And it helped. Talk to your doctor about a fertility acupuncturist in your area. Again, there is more research to be found on PubMed on the power of acupuncture when combined with western medicine for PCOS patients hoping to get pregnant. But don’t expect acupuncture to help all the time. It’s a nice adjunctive treatment to add but I truly think doing it in parallel with other things is the most beneficial.
I hope that if you have PCOS you’ll find this informative. Please review this information and discuss it with your doctor. My goal is to help you stay informed and to take ownership of your own health. I want everyone that has PCOS (or not) to be able to live their best life and have a healthy pregnancy.
As always, please send me a note at firstname.lastname@example.org if you have any further questions or you’d like to recommend a topic for a future show.