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Foreign 50 Something podcast. I'm your host, Dr. Nicole Norris. Whether you are in the midst of midlife or you want to prevent the physical and mental signs of aging that occur in midlife, this is the podcast for you. This is a show where I share my knowledge gleaned in family practice, preventative medicine and aesthetic medicine to shed light on aging or better yet, how not to feel or look like you are aging when you we should be taking an active role in how we age from an early age. We should not settle with growing old gracefully or letting nature take its course. How we age directly affects our confidence, which impacts all of our relationships with those around us. The length of time in our lives that we feel really good in terms of energy, aches and pains and thought clarity has a definite impact on the mark we can leave on this world. My wish for my listeners is to always be mistaken for being 50 something or less in mind, action and appearance. Let's go. Welcome Back to the Dr. 50 Something Show. Today we are going to unravel the mysteries of Polycystic Ovarian syndrome, pcos. This is a hormonal genetic disease only seen in women. Now, if you are one of my loyal male listeners, don't you dare press pause. This episode is for you too. If you have any woman in your life that you care about, you need to help me spread this message. Now, all my female listeners absolutely need to learn about PCOS today because after this podcast, about 75% of you are going to have a sneaking suspicion that you might have it. First, I will start with a story. My speech coach shout out to Krista Dinargo, who helped me find my podcast voice, says stories are more powerful than any other words you utter. So here we go. My Mom, Ann is 75 years old. Last year, for her 75th birthday, I diagnosed her with PCOS. Happy birthday, Mom. I also diagnosed myself with PCOS just prior to that. When she was a young woman, she had some trouble getting pregnant, a miscarriage, irregular cycles, heavy cycles, and premenstrual dysphoric disorder. Her symptoms worsened as she got closer to menopause. She always struggled with sugar cravings and her weight. I remember her being on every diet imaginable, Weight Watchers, nutrisystem, Slim Fast, the Grapefruit diet, the Cabbage Soup Diet, you named it, she tried it. She she was also diagnosed with borderline blood sugars in her 40s and then type 2 diabetes in her 50s. She developed breast cancer in her 50s and then uterine cancer at age 70. Practically the only symptom or consequence of PCOS that she did not have were cysts on her ovaries. Well, she also did not have dark, coarse hair on her face or significant acne. But basically every other symptom I just listed is a symptom or an adverse outcome of PCOS. So at 75 years old, some of the hormone tests that we can use to diagnose PCOS won't come back positive because the ovaries have shut down production of those hormones at 75. But I knew when my testing came back positive for PCOS that I probably got it from her, especially knowing her health history. And on top of that, she really did have almost every symptom. And she is now finally, at 75 years old, being treated appropriately for her PCOS by Anya, my preventative medicine nurse practitioner. And she readily admits that she feels the best she has in 50 years. So that's, that's a happy ending to this story. But to me, that's kind of a sad story. It's sad because I believe that most of her health issues and struggles could have been prevented if doctors were just taught more about PCOS in medical school. At this time, I don't think there really is is a specialty of medicine that really treats PCOS and truly 100% understands it. It should be treated by all medical specialties because honestly, it can eventually affect every organ system. I was thinking about my medical school training the other day and I think PCOS was mentioned a grand total of two or three times in medical school and then maybe another two or three times in residency. So yes, over seven years of medical education, PCOS was probably brought up to me six times. And I think that it, when it was mentioned, it was because we were talking about a female with an ultrasound finding of cysts on the ovaries, or maybe it was a female with a full beard. Really, that's what I thought of when I thought of pcos. Until the last year when I really immersed myself in studying it and understanding it, I had never learned all the symptoms to look for, how to diagnose it with lab tests and, and most importantly, how to treat it and when to treat it. We are going to cover all of these things today, but first of all, how common is pcos? PCOS is definitely something that you can inherit from a parent and it is a hormone production disorder. And at this time, we believe it only affects women. So if you google what percentage of women have PCOS, the answer varies greatly. Anywhere from 10% to 30% depending on the country. They surveyed and which symptoms that are being used for the diagnosis. The weird thing is that in my hormone optimization practice I test every woman for it. Three, four of the tests that I do come back positives and sometimes the patient only really has one symptom on their symptom checklist that correlates. But there are usually other lab abnormalities that I find that correlate to their new diagnosis. The other crazy thing is the name polycystic ovarian syndrome. This actually means many cysts on the ovary and the only way to know if you have many cysts on your ovary is to have an ultrasound. So amazingly enough, only 50% or less of women with PCOS in studies actually have cysts found on their ovaries on ultrasound. And then not all women who have cysts on their ovaries have pcos. I would really like someone to rename this disorder since that is unlikely. We are just going to have to keep calling it pcos, but in my practice it stands for progesterone deficiency causing oodles of side effects. That's the new name for pcos. Underlying pathophysiology of PCOS is not enough progesterone production. Women with PCOS do not ovulate regularly and therefore do not make enough progesterone since progesterone is critical in maintaining pregnancy. Women with PCOS have as much as a 40% miscarriage rate and higher than normal premature delivery rate. They also miss out on the anti cancer cancer properties of progesterone. Women with PCOS have a three fold increased risk of breast cancer and a five fold increased risk of uterine cancer due to not making enough progesterone over their lifetime. Women with low progesterone often have symptoms of irregular cycles, heavy cycles or painful cycles. They are predisposed to premenstrual dysphoric disorder which is depression and anxiety around the week of their cycle. They are also predisposed to postpartum depression. If that is not bad enough, many women with PCOS also have an issue with their thyroid hormone not working like it should. This is called thyroid resistance. These patients can have a normal appearing thyroid lab test because their thyroid gland does make enough thyroid hormone. But the thyroid hormone their body makes is not effective in latching on to the thyroid receptors. Thyroid hormone is the key to our metabolic rate being normal. When our metabolic metabolism or metabolic rate is not normal, we become overweight, insulin resistant and have trouble losing weight no matter what we do. This thyroid resistance is actually what leads to patients with PCOS developing diabetes, sleep apnea, and therefore increased risk for heart attack and stroke. In some women, the insulin resistance causes them to have a low level of something called sex hormone binding globulin. This is a protein that keeps the level of testosterone in the blood appropriate. When there is low sex hormone binding globulin, there can be a higher level of free testosterone floating around in the blood, leading to acne and dark, coarse masculine facial hair as well as sometimes body hair. Not all patients with PCOS though have this issue. So back in med school, I was missing about 90% of PCOS patients by thinking they all had to have full beards in order to have a diagnosis of PCOS. Another problem with diagnosing PCOS is that only 50% of PCOS patients are actually obese and 25% of PCOS patients are thin with no obvious weight issue. Although these thin PCOS patients may be actually storing fat on their organs, which is called visceral fat. And this is not obvious at all from the looks of them, but can lead to serious problems like fatty liver, heart attack and stroke. Okay, so what are the tests for pcos? In my office we can get clues from checking your hemoglobin A1C, your blood sugar, your cholesterol, your free thyroid T3 hormone, and your ratio of production of luteinizing hormone to follicle stimulating hormone. Menstruating women with PCOS almost always have a two times higher level of luteinizing hormone compared to follicle stimulating hormone. All of these are simple blood tests. Next, we should talk about how we treat pcos. In my preventative medicine practice, my nurse practitioner and I use micronized progesterone in an oral capsule compounded at a compounding pharmacy that we have you take at bedtime. This micronized progesterone is body identical and gets absorbed far better than progesterone pills made by the drug companies. It also is far superior to progesterone creams and progesterone pellets, which we don't recommend because they are ineffective. We also do not usually use synthetic progestins like what is in birth control in order to treat pcos. We also do not use Provera, which is another synthetic progestin used to treat menopause. To treat pcos. I know this is very confusing because the words progesterone, progestin, they sound very similar, but they're not the same at all. The generic name for Provera is, which I said is used in menopause is methoxy Progesterone? Yes. The actual generic name of Provera has the word progesterone in it, but they are not the same. They are not the same chemical compound and they have absolutely different side effects. Provera and progestins that are also in birth control pills have a lot of possible side effects, to name a few. Bloating, swelling, breast tenderness, anxiety, depression, increased bad cholesterol, decreased good cholesterol, increased risk of breast cancer and other types of cancer, and increased risk of blood clots. Those side effects of synthetic progestins are not the same side effects of your body. Identical progesterone. Sometimes my patients have heard of these risks of synthetic progestins and are afraid to replace their natural progesterone because of this confusion. Synthetic progestins are definitely different. In fact, your body identical progesterone can help you sleep amazingly well, and that is its only side effect. It helps you sleep great. Now, that is not what I would call a negative side effect. Any woman with perimenopausal or postmenopausal sleep disorder, even if they don't have pcos, absolutely needs some supplementation with body identical progesterone. After we get the progesterone levels addressed with PCOs, then we like to optimize thyroid levels. We like to use desiccated thyroid hormone that replaces both your natural free T3 and your natural free T4. These are both forms of thyroxin. The only way to treat PCOS thyroid resistance is to increase those free T3 levels in the blood so there is more of it to attach to the receptors and therefore improve metabolism and improve insulin resistance. We do not use Synthroid or Levothyroxine for this as these medications only replace T4 and does not improve thyroid resistance. In PCOS patients with significant insulin resistance or diabetes, we are very aggressive with treating this with prescription medication such as GLP1s and other well researched supplements that are non prescription like berberine, fatty 15, vitamin D and magnesium glycinate are some of our favorites. Okay, so next, when and who do we screen for pcos? Well, the WHO I would say is everyone with two X chromosomes. We assume every woman we see has PCOS until proven otherwise. When we do a women's initial consultation and review her blood work, everyone gets screened for pcos and then if they have it, we give them all their options to treat and then a plan for her to monitor her blood work in our office every three months or so until she's optimally treated. Her symptoms are improving. And her lab values are better. So when should you be tested if you have any one of the symptoms that my mom Ann had as a young woman tomorrow and when is too late to be treated for pcos with hormone optimization? This you should have to go back to podcast four to get the answer to but I think my answer was 130. Might be a little late. So please, please please help me spread the word about progesterone deficiency causing oodles of side effects. We should be testing, diagnosing and especially treating women who have pcos to improve these women as far as their quality of life, fertility and long term health. Please share this episode with at least three women you love and check out the show notes if you are interested in being screened for pcos in my preventative medicine practice in Illinois. Thank you for joining this episode of the Dr. 50 Something Show. If you are intrigued by this show and never want to miss an episode, click the follow if you are a really great friend, share it. The content of this episode is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare provider to answer any questions you may have about your personal medical conditions. Until next time, get fit, get fabulous, get firm, and take care of yourself. Sam.