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PCOS is the most common hormonal problem in women of reproductive age, affecting approximately 9% -13% of women (some experts think as much as 21%). Although PCOS is most commonly seen in younger women, it can also present for the first time in women who are in their 40s and 50s. We also know this condition runs in families. There is a 20-40% chance of a PCOS-patient having a mother or sister who is also affected.
The cause of PCOS remains unclear, but experts do agree that Polycystic Ovarian Syndrome is a very complex condition which is most likely caused by both genetics and environmental factors.
Many women will have no symptoms at all or very mild symptoms. However, some more common symptoms are:
For more information on PCOS and Infertility & RPL scroll to the bottom of this page where I have posted some recent research articles on treatments. For more in-depth information on Infertility and RPL see my webpage here.
Most providers will make a diagnosis of PCOS by using the Rotterdam Criteria.
A women must have only 2 of the 3 criteria mentioned below:
1. Oligoovulation OR anovulation
2. Clinical and/or Biochemical Hyperandrogenism (affects 60-90% of pts)
3. Polycystic Ovaries (diagnosed by ultrasound on Cycle day 5)
The Rotterdam Criteria recommends AGAINST doing an ultrasound to diagnoses PCOS in women until they are 8 yrs past their first period. However, many providers choose to do an ultrasound, which I will also want to do for you.
The reason is because your HPO-axis has not yet had time to fully mature, and oftentimes there will be many follicles present in one or both ovaries. Younger women are also more likely to have large ovaries and irregular menstrual cycles. Thus, most experts agree to give a diagnosis of "LIKELY PCOS" until the pt is beyond 8 years past her first period, and monitor her over time.
Sharon presented a lecture on PCOS via a MyCatholicDoctor LIVE Webinar on September 22, 2022. The aim of this lecture was to compare current mainstream medical literature and the 2018 International Guidelines for Diagnosis and Management of PCOS to NaPro Technology protocols. Over 40 publications were cited during this talk.
You are welcome to watch the PCOS lecture for medical professionals here.
Your appointments at MyCatholicDoctor with me will be one FULL HOUR in length. Generally speaking, NaPro appts will follow a typical protocol as outlined below. However, every individual is different and your situation may warrant a more expeditious process. Please know, the Creighton Model Charting is very important. Your CrMS chart will help direct me to what diagnostic tests and imaging tests should be done and what treatment plan would be most appropriate.
First Appt: I will take a comprehensive medical history and provide you with education about normal healthy reproduction and oftentimes about a condition I suspect you may have after we have talked a while.
I will order a pelvic ultrasound which I will ask you to schedule on day 5 of your next menstrual cycle. I will order a series of laboratory tests. Click the "laboratory tests" button below to learn more.
You will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner (FCP) by clicking the "Fertility Care Practitioners webpage" button below to learn more about scheduling an Introductory Session to get started.
Note: An exception is made for patients with a pre-existing diagnosis of PCOS and who are not having periods or who are having only 1-2 periods a year. In such a situation, I will offer a "progesterone challenge". You will be given 200 mg of bioidentical progesterone to take for 10 days at bedtime. A "withdrawal bleed" should ensue approximately 3-6 days after the progesterone is stopped. If a bleed does not occur, we may try another challenge with 400 mg of progesterone for another 10 days.
Second Appt: You will be asked to return to the office in 2 mos for a follow-up appointment to review the results of your imaging and laboratory tests. Together we will also review your Creighton Model System (CrMS ) chart to look for specific biomarkers which will help me make a diagnosis.
Please upload an image of your CrMS chart two days prior to all follow up visits and send to me via the portal.
Please add the length of your post-peak phase and your mucus cycle score (MCS) to the R-hand margin of the chart. Your Fertility Care Practitioner (FCP) will calculate your MCS for you.
During this appointment, you may be asked to begin some supplements and/or medications. We will also discuss drawing a full set of hormone panels. We will make a decision if you should have a peri-ovulatory estradiol panel, a post-Peak estradiol & progesterone panel, or both panels.
Many patients will be asked to consider working with a dietitian or a nutritionist to help optimize your reproductive health. Oftentimes I may also recommend a Psychotherapist or Health Coach to help with anxiety, depression and or disordered eating habits.
Third Appt: You will return to the office in 2 mos to review the results of your hormone panels as well as the biomarkers on your CrMS chart. Most often at this time I will have made one or more more diagnoses to identify the root cause of your symptoms. Together we will discuss a treatment plan, which will be implemented.
Follow Up Appts: You will return to the office every 2 months. During this time, I will conduct a comprehensive medical interview to ensure your symptoms have resolved, and to ensure you are responding well and not having any negative responses to the management plan. Depending on the individual patient and your individual diagnosis, I may need to monitor your progress with serial laboratory tests and/or serial imaging.
After 6-9 months: If medical management has not been successful, it is likely you will need a diagnostic laparoscopy. Therefore, I will refer you to a NaPro surgeon. On occasion, I may come to know a surgical evaluation will be of benefit to you earlier on in this process, and an expedited surgical referral will have been recommended. NaPro surgeons typically book out 5 mos to one full year. At any time, if you feel you would like an expedited surgical referral, please feel free to discuss this with me.
Please review my laparoscopy page. You will notice NaPro surgeries are done very differently as compared to laparoscopies done by mainstream medicine surgeons. We use a near contact approach and a near adhesion-free technique", which has been described as pelvic surgery of the pelvis.
At any point in time, if a diagnosis has been made, treatment initiated, and/or you are satisfied with the medical management we have implemented, you can schedule annual or biannual visits, per your choice.
As mentioned above, women with PCOS have a higher rate of rate of miscarriage and RPL, with the rate of miscarriage is about 20-40% higher. (1)
Below are a few clinical trials, published between 2001 and 2002, which indicate women with high insulin levels and PCOS may derive a benefit from taking a medication called metformin, in that the incidence of miscarriage was significantly reduced. (1, 2, 3)
The studies indicated that about 62 to 73 % of woman with PCOS experienced a miscarriage when not taking metformin. Whereas, only 9 to 36 % of women who were taking metformin experienced a miscarriage. We also have very good data over the years that indicates metformin is safe, it reduces blood glucose and insulin levels, and it can help to reduce androgen levels in women with PCOS.
There are some more recent studies that indicate taking myoinositol can be almost as effective in reducing glucose, insulin, and androgen levels as compared to metformin (4, 5, 6). However, most research done over the years indicates myoinositol is bit less effective. Myoinositol has also been shown to improve ovulation rate and "clinical pregnancy" (beta HCG blood levels rise, but these trials did not report on the outcome of live birth rates. (4, 5, 6). The research I am citing can be found by scrolling towards the bottom of this page.
Thus, if you have PCOS and we find high glucose, high insulin and/or high androgen levels in you blood, we will discuss treatment with either myoinositol or metformin (please click the "pharmacological treatment" button below for more information). Also, if you are currently tying to achieve a pregnancy, metformin may be a good choice.
For more information on Infertility and Recurrent Pregnancy loss see my webpage here.
As mentioned, acne is often experienced by women with PCOS, so you may be wondering if your acne medications are safe for your baby. Well, it is likely you may wish to change your current regimen when you are pregnant, or better yet, prior to your pregnancy when you trying to achieve a pregnancy.
Isotretinoin is the most concerning of all acne medications. Even one single dose can cause serious birth defects, to include but not be limited to malformations in your baby's facial bones, heart, and neurological system. Isotretinoin is sold under many brand names, eg: Absorica, Accutane, Amnesteem, Claravis, Myorisan and Zenatane.
Topical retinoids are another type of commonly used acne medication, which is found in many different gels, creams, washes, and lotions. Topical formulations are those that are applied to the skin surface. Some retinoid products require a prescription. Whereas, others can be purchased over-the-counter. However, they are all not recommended for pregnant women. Some examples of retinoid products are: adapalene (Differin), tazarotene (Tazorac) and tretinon (Retin-A)
Oral antibiotics are also sometimes prescribed to treat acne. Common antibiotics used are: clindamycin, doxycycline and minocycline. Again, none are recommended for pregnant women.
ACNE MEDICATIONS SAFE FOR YOU IN PREGNANCY:
There are some topical antibiotic creams, lotions and washes that are safe for you to use during pregnancy. Here is some advice from Dr. Andrea Pearson, MD a dermatologist, friend, and colleague from MyCatholicDoctor:
Dr. Pearson also offers the non-pharmacological tips to help with acne:
I will be asking you to tell me very specifically how much you are bleeding. An example of a "detailed flow" is: M, M, H, L, L, VL/B
TAMPON or PADS:
MENSTRUAL CUP MEASUREMENTS
**The Diva Cup comes in 20, 30 and 32 ml cups 32 being the largest but other cups may vary. 1 ml = roughly 1 cc
Other important information about your flow:
1. Pregnancy outcomes among women with polycystic ovary syndrome treated with metformin. (pdf)Download
2. Effects of metformin on early pregnancy loss in the polycystic ovary syndrome. (pdf)Download
3. Continuing metformin throughout pregnancy in women with polycystic ovary syndrome appears to safely reduce first-trimester spontaneous abortion- a pilot study. (pdf)Download
4. Randomized, double blind placebo-controlled trial- effects of Myo-inositol on ovarian function and metabolic factors in women with PCOS (pdf)Download
5. Insulin sensitiser agents alone and in co-treatment with r-FSH for ovulation induction in PCOS women (pdf)Download
6. Inositol treatment of anovulation in women with polycystic ovary syndrome (pdf)Download