Dr. Nathan Goodyear

After my last post on Polycystic Ovarian Syndrome (PCOS or PCO), a reader from Arizona emailed us and said: “My doctor prescribed metformin for me and my periods came back after 5 months of no periods!! It also is helping me lose some weight. Keep in mind, I am overweight, hypertensive, and have slightly elevated cholesterol. Ugh!”

Let’s focus on her two implied questions. First, why did her periods return when she started taking metformin? Second, why she has lost weight? As we address those two questions, you’ll learn more about our treatment strategy for PCO at Seasons Women’s Care.

As I explained in my last post, PCO is characterized by

• High insulin levels and insulin resistance
• High androgen levels (think testosterone)
• Irregular cycles (due to anovulation)

Additionally, many women gain weight.

At Seasons we focus on alleviating these three areas without introducing any side effects. You work with the body, the body will work for you! Let’s go over them one at a time.

Elevated Insulin

Elevated insulin is the result of poor insulin sensitivity, or insulin resistance. The most commonly prescribed insulin medicine used today is the drug metformin. This is a diabetes medicine that improves insulin sensitivity and reduces the liver production of glucose. Metformin can also be associated with significant gastrointestinal side effects, though.

Metformin isn’t the only treatment to reduce insulin resistance. Alpha-lipoic acid also works, and it doesn’t have the side effects associated with metformin.

However, the easiest way to improve insulin resistance is through weight loss. You read that right. Merely losing weight will result in improved insulin sensitivity. At Seasons, we help all women with PCOS to lose weight through nutrition.

One final note about insulin. High insulin levels appear to be a primary factor in testosterone production (discussed below) because insulin binds to specific receptors in the ovaries that augment testosterone production.

Our strategy at Seasons: We work to improve insulin resistence and lower insulin levels, using weight loss, Lipoic acid, and metformin (if necessary).

Elevated Testosterone

Many drugs today are prescribed to lower testosterone. These include spirinolactone, finesteride, cyproterone acetate, dexamethasone, Lupron, flutamide, and finesteride. These are big drugs, and they can have big side effects.

At Seasons, we attack the cause at the source: lack of progesterone and elevated insulin.

OK, this part is a bit technical. Progesterone dominates the last two weeks of a cycle, following ovulation. When you don’t ovulate, your body lacks progesterone. When your progesterone levels decrease, your body stimulates more testosterone production. Raising progesterone levels again can reduce the stimulation to the ovaries for more testosterone production.

Even more important for most women, progesterone lowers the testosterone to dihydrotestosterone conversion. This will reduce the facial hair, hair loss, and acne so commonly associated with PCO.

Progesterone also improves a women’s estrogen dominance (high estrogen to progesterone ratio), and thus improves weight loss.

Our strategy at Seasons: We work with your body to lower testosterone levels more naturally by addressing the root causes of decreased progesterone levels and elevated insulin levels.

Irregular Cycles

Irregular cycles are a hallmark of PCOS. They are, however, just a symptom of the hormone problem. A woman’s uterus will only do what her body tells her to do. You might call the uterus a “Yes, Ma’am” organ. This is why removing a woman’s uterus won’t fix the problem.

The problem is hormone imbalance: high testosterone, high insulin, and low progesterone. When we add progesterone back in, we can address the high testosterone and the low progesterone problems. Additionally, we help women eat better and encourage them to eliminate their exposure to environmental toxins. This helps a woman lose weight, and it helps her body’s insulin sensivity and estrogen dominance.

Now, what about birth control pills? Most of your friends are probably on birth control pills to treat PCOS. Birth control pills do correct the cycle issues, but they replace a hormone imbalance with a hormone overload. This can be a big band-aid with dangerous consequences.

Of course, band-aids aren’t solutions. But we’re more concerned about the consequences of long term birth control. It has been shown to increase your chances of breast cancer and weight gain.

Our strategy at Seasons: When we treat PCOS, we look to the root causes, not quick fix band-aids. Treating the causes—high testosterone, high insulin, and low progesterone—results in long-term solutions that restore your overall health.

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It isn’t a disease, so much as a collection of conditions. However, it can still be dangerous if left untreated, possibly leading to the diseases listed above: peripheral vascular disease, heart disease, stroke, and type II diabetes.

The identification of metabolic syndrome provides a window of opportunity for treatment to prevent disease.

The following risk factors co-exist in metabolic syndrome…

• abdominal obesity
• blood fat and cholesterol disorders
• elevated blood pressures
• insulin resistance
• pro-blood clot state
• pro-inflammatory state

Abdominal obesity and insulin resistance are the dominant risk factors. Other conditions that affect metabolic syndrome include physical inactivity, aging, hormonal imbalances, and genetic predisposition.

Since it isn’t a disease, we diagnose metabolic syndrome by looking for co-existing symptoms. Any three of the following are required to meet the classification of metabolic syndrome…

• abdominal obesity (waist circumference >35 inches)
• elevated triglycerides (>150)
• low HDL (<50)
• elevated blood pressure (> 130/85)
• elevated fasting glucose (>110)

Metabolic Syndrome is not uncommon. It is estimated that over 50 million Americans have it. We treat it by managing a patient’s weight loss, increasing physical activity, treating hypertension, prescribing daily aspirin therapy to reduce pro-blood clot states, and treating elevated triglycerides and/or low HDL levels.