PCOS & NaProTECHNOLOGY

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: 

• Irregular menstrual cycles and/or long cycles: abnormally long cycles can increase your risk of endometrial hyperplasia (thickened inner lining of the uterus) and endometrial cancer. 
• Hirsutism: hair growth on upper lip, chin, chest or abdomen. 
• High insulin levels: most often go undetected. High insulin levels put you at high risk of developing diabetes. 
• Infertility: PCOS accounts for ~ 27% of infertility cases.
• Recurrent miscarriage: 70-80% of PCOS-Infertility cases are due to "ovulatory dysfunction". 
• Pregnancy problems: higher risk of ectopic pregnancies, gestational diabetes, pre-eclampsia and premature birth. 
• High cholesterol: puts you at risk of heart attack and stroke. 
• Sleep apnea: puts you at risk of heart attack, stroke, and sudden death. 
• Psychological problems: depression, anxiety, eating disorders and/or disordered eating are all more prevalent in PCOS pts. 

Your appointments at Natural Women's Health 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, a baseline ultrasound will ordered along with blood draws for FSH/LH and estrogen, which must be timed to day 3-5 of your next menstrual cycle.  I will be asked to begin charting your menstrual cycles using the Creighton Model System (CrMS). Please choose a Fertility Care Practitioner by clicking the button below and begin to chart your cycle. 

Note: An exception is made for patients with a pre-existing diagnosis of PCOS and who are not having periods or who are having very few periods in a year. In such a situation, the patient will be encouraged to begin "treatment" right away, ie: 100 mg progesterone injection will be given at the first visit and repeated every third day for a total of 3 injections. This protocol will bring on a  period within a a few days to a week for most patients. We would then continue oral progesterone replacement on days 18, 21, and 24 of your cycle.  

Second Appt:  You will be asked to return to Natural Women's Health  for a follow-up appointment with me after you have charted two full menstrual cycles. Together we will review your Creighton Model Chart, a GYN physical examination will be preformed, and additional laboratory and/or imaging tests may be ordered, which will be specifically timed to your Creighton model chart. We will look for certain "biomarkers" in your menstrual cycle to help guide your medical management. 

Third Appt:  You will return to the office two weeks later to review the results of your laboratory and imaging studies. Depending on your results, you may be asked to undergo additional testing, start medications and/or perhaps make an appointment with another specialist such as a dietician, a sleep specialist and/or a counselor. 

Follow Up Appts:  You will return to the office every two months to monitor and/or make adjustments to your medications and treatment plan. 

After 6 months, if medical management has been unsuccessful you will be referred to Dr. Naomi Whittaker, MD who is a NaPro surgeon. You will undergo an evaluation. Dr. Whittaker will review your Creighton Model Charting as well as the medical management you have received. Together you will formulate a surgical treatment plan.