Episode: “Your Most Burning PCOS Questions Answered With Dr. Farrar Duro”
Welcome to Episode 10 of Season 2 of the The PCOS Revolution podcast.
In this episode, I answer your most burning questions about PCOS from listener emails.
So if you want to know what type of PCOS you may have, learn what type is the hardest to recognize and treat, and find out if it really matters whether or not you address your PCOS symptoms if you’re NOT trying to get pregnant, tune in now!
[00:00] I’m Farrar Duro and you’re listening to the PCOS Revolution podcast. Hello everyone and welcome to our final episode of season 2! For today’s episode, I decided to do something a little different and change it up a little bit. I decided to go solo and take on some of the questions that maybe haven’t been answered throughout our episodes of the first two seasons and these are questions that some of you have been e-mailing me that might not a been addressed yet. I’ve just been so happy to read all of your reviews and e-mails and I’m really grateful for the positive feedback too!
[00:44] When I started this podcast in December of last year, I never imagined we’d have so many fellow “cysters” listening in over 56 countries and that just confirms again that you’re not alone. Everyone who has emailed and reviewed has just been so helpful in really reaching out and helping us focus on how to get the message across about things that you might really want to hear. So, if you haven’t reached out yet I encourage you to leave a tip for another cyster in our review section on iTunes. I would just love to hear how you’re coping with your PCOS symptoms in whatever part of the world you’re living in. You never know, you just might help someone else who really needed to hear what you had to say.
[01:52] I’m just really excited to actually dive into some of these questions! I want to read one of the e-mails that I was sent from someone who is actually in their early 20’s, she says:
“I’m in my early 20’s and I’m not trying to get pregnant and I’m not sexually active. But I wonder if there’s a reason for me to worry about my PCOS. My diagnosis came from irregular periods.”
Basically there were less than 8 cycles each year that she was experiencing and also she was diagnosed with a cyst. She really didn’t want to do birth control because she hated the way it made her feel.
[02:42] Her question was “Is it really a big deal if you’re not trying to get pregnant and it’s causing some irregular cycles and cysts, but otherwise you’re really not experiencing much?” I thought today because we had so many questions that came up about the different types of PCOS that I am going to go into that a little bit. To answer this question, I think that it’s such a great opportunity to find out that you do have something that you can correct and it’s a little bit easier to correct when you’re younger, especially if it’s something on a spectrum. PCOS is definitely on a spectrum. So if your symptoms are not as severe as others, those symptoms actually can be controlled with diet and exercise.
[03:33] Quite possibly this listener actually could start by tweaking her diet a little bit and boosting exercise, incorporating certain nutrients as we’ve talked about and then looking into helping regulate her cycles on our own because the cysts can be painful. We’ve had a lot of our patients in the clinic feel severe pain from ovarian cysts that rupture. That’s something that we definitely would love to address naturally, because as an acupuncturist who works with PCOS every day and who struggles with it myself, I just think that addressing the underlying condition early on is better.
[04:23] To answer your question, I definitely would. Put a little bit of lifestyle tweaks in there just to kind of see if you do feel better even if you’re not trying to get pregnant. PCOS isn’t always about getting pregnant. A lot of things that you read are constantly talking about fertility but many women suffer with PCOS in all different age ranges and many are not trying to get pregnant. Let’s say you do want to try to get pregnant in the future, at least if you do have more balance cycles, less symptoms, less cysts showing up then it might be a little bit of an easier process and hopefully that can happen on its own.
[05:08] Another question we got was from a listener who says, thanks for the podcast, so she has been listening to all the episode back-to-back and she was just told by her gynecologist and this came up again that “Unless I’m trying to get pregnant, PCOS shouldn’t impact me. But I know it does and I also looked for natural alternatives. When I was trying to get pregnant, I also found an Arvigo practitioner and made my own herbal drinks. I was so happy to get pregnant naturally after about 9 months after being diagnosed with PCOS.” So congratulations for that, that’s awesome! “I would have tried acupuncture had I known it was an option. I know it’s hard to provide resources in every state but if you could offer advice on finding help, I would appreciate it. So far, I’ve resorted to using Yelp which is not extensive even in a large metro area like Los Angeles.”
[06:05] So, I would say that we do have an organization called the ABORM and I’m actually a fellow of that, it’s actually an organization of acupuncturists who have to pass a board for Reproductive Medicine and that board encompasses both Eastern and Western knowledge and it is a certifying body. So, you can look on their website aborm.org. I think that that’s a great resource because that shows not only in the United States but also different countries, the different fellows that are certified and that means that that practitioner has had extensive training and knows and speaks the language of eastern and western medicine and can integrate their treatments into perhaps someone who’s going through fertility treatment with an IVF doctor or who is seeking information. Are these herbs going to be appropriate or can I incorporate acupuncture naturally or with a medicated cycle? In that respect I think that that website would be very helpful to go to and as far as finding an acupuncturist who is also knowledgeable about PCOS.
[07:32] If you have any other resources definitely post them in our Facebook group. You can go to our Florida Complete Wellness Facebook group or our PCOS Revolution one. I hope that answered the question. I also have another question here from a listener who is interested to see how acupuncture and Chinese medicine helps with PCOS and infertility and if it’s something worth investing in. I guess for some of you who have listened to my story in the beginning, I emphasized how Chinese medicine did change my whole life as far as dealing with my symptoms and getting my cycles back and regulated and helping to conceive my children ultimately. I guess, I’ll be a little bit biased here and saying that I do think it’s helpful if you you can dedicate at least 3 to 6 months to improving your overall health and going with an acupuncturist who is knowledgeable about PCOS.
[09:07] Working with Chinese herbs as well I think is very important and it can have tremendous benefits. I see it every day, when we work with patients. Basically our rule of thumb is that everyone has their own timeline. So, if you are trying to get pregnant and most of the time we think okay, it needs to happen by tomorrow. But unfortunately our bodies work a little differently where we do need a time span to actually help even things out a little bit and help with circulation and reduce stress levels and hopefully get our cycles back on track. That can take 3 to 6 months so if you have that time, I think even if you’re preparing for a medicated cycle give yourself a little bit of time. Looking at the strategy of whatever we do now if you get pregnant naturally that’s wonderful and if you don’t, whatever you’re doing as far as getting your body healthier is only going to be beneficial during pregnancy whether you go with an ART treatment like IVF treatment or you’re trying on your own.
[10:20] We also want to say that we can’t underestimate the effect that stress can play on us. One of the biggest misconceptions that we see in our clinic when someone’s trying to conceive and they do have PCOS is thinking “I’m running out of time because I’m not ovulating, I’m getting older and my egg quality is going downhill. I’m just scared that I’m not it’s not going to happen for me.” So those fears can also create a lot of stress. Acupuncture flips a switch on our nervous system and it basically goes from a fight-or-flight to more of a feed-and-breed response and that’s our sympathetic to parasympathetic response.
[11:02] When we have the effect of combining that with a good treatment plan by checking the vitamin D levels, checking to see if our insulin is high or not or if our blood glucose needs to be addressed, that sort of thing then and also looking at our diet obviously and all those [lifestyle] aspects…that’s what acupuncture and oriental medicine really focus on the most. A lot of it is lifestyle and a lot of it is learning different techniques to really get through a medicated cycle as well. So hopefully that’s helpful for you. I also want to say that if you have any questions about that for sure go to our website as well at floridacompletewellness.com. We have a lot of information on all just all kinds of recommendations if you are pursuing fertility treatment and just want some references studies and that sort of thing.
[12:10] We have another question here from someone in the medical field. She was diagnosed with PCOS about a month ago after realizing her menstrual cycles were irregular and longer than average. She’s been trying to get pregnant for about 6 months and she also started a medication called Letrozole to help her ovulate and she is still kind of waiting to see if that’s happening. She’s confused really about the pathology of the diagnosis. Being in the medical field having an advanced degree in nursing and still being confused is pretty typical because PCOS can be very confusing even to those that work in the medical field. So, imagine if you don’t work in the medical field how confusing is that to you! So, she said basically “I’m learning there are more people like me who don’t fit the typical mold for PCOS. So what does that mean with the studies out there, do they still apply to me?”
[13:21] “For example, I exercise every day my B.M.I. is 23, my hormone labs are all normal except AMH,”[a hormone that’s usually really elevated when you have PCOS. It’s usually a measure of how you respond to fertility medications too.] “I passed my fasting glucose test yet I do have cysts on a vaginal ultrasound. Would a diet change help and what is the difference in treatments in lean PCOS vs higher B.M.I. PCOS? I’m hoping that the next season can address some of this and I look forward to listening to other women with PCOS”. This actually involves a whole lot because there are so many women that do have just the lean-type PCOS where it doesn’t present classically in a way that most people think about PCOS.
[14:35] So I wanted to kind of go into a little bit about the different types of PCOS. So, in general how is it still diagnosed because that always needs to be reiterated. The criteria now states if you have 2 of the 3 following symptoms then you can be diagnosed with PCOS. The first one is basically lack of ovulation, irregular menstrual cycles or an absence of a menstrual cycle. That is one clue there and can be one of the criteria, it’s called oligomennorhea. The second one is hyperandrogenism, which is a state where there’s too many male hormones or androgens in the body and for PCOS diagnosis you can either have high levels of androgens in the blood or symptoms suggesting high androgen levels such as acne, abnormal body hair growth or thinning hair. If you have irregular cycles and you also have thinning hair or hair loss or abnormal hair growth or acne, then you already have 2 out of the 3 criteria.
[15:44] So, that’s what lot of people are confused about, and maybe they just don’t have the physical polycystic ovaries present on an ultrasound. But that would be the third one so. So polycystic ovaries are present if there are 12 or more follicles present on a single ovary or if there’s an increase in size of at least 1 ovary. So if they say your ovaries a pretty large that could be one thing that on the ultrasound they don’t look like they have typical follicles, they have actually a lot of follicles that are kind of half-developed that are hanging around the ovary. If you have those 3 or 2 out of 3 and then you have met the criteria of having PCOS. You can go to your OBGYN and get an ultrasound too and tell them your symptoms and also have labs drawn as well.
[16:45] We posted our most common recommendations for lab work with PCOS on The PCOS Revolution Facebook page. That has the document I believe, save it and you can take it and to your doctor, your primary doctor or any nurse practitioner, whoever you’re working with and you can get those test ordered as well. Just remember to check your insulin resistance and also your testosterone levels as well.
There are five types really that are most prevalent in PCOS. The first is the classic type which basically means that it’s insulin-resistant PCOS which we call type 1 PCOS. This is a type that everybody kind of associates more with PCOS because it’s most visible. You have ovulatory dysfunction so either no periods or very irregular cycles, insulin resistance and elevated testosterone.
[18:00] So if you fit in that category then you are going to have symptoms of high testosterone or you’re definitely going to have your lab work showing elevated testosterone. Also your insulin levels are going to be often elevated with elevated glucose too. That shows up. The second one is non-insulin resistant PCOS, which is type 2 PCOS, where you have ovulatory dysfunction (so irregular cycles or no cycles), elevated testosterone but no insulin resistance. So if you have abnormal body hair or thinning hair or you have irregular cycles but your insulin levels look fine and your glucose looks good then really this would be the type of PCOS that you would have.
[18:53] The third one is a non-traditional PCOS Type I, so you have ovulatory dysfunction and you have insulin resistance but you do not have elevated testosterone. So that one would not be showing up in blood work, it would be when your testosterone is normal and we do see sometimes looking into it that DHEA could be slightly elevated. That’s a precursor to testosterone but the testosterone is still normal and also DHEA is usually normal but you do have insulin resistance and irregular cycles or no cycles. The next one is non-traditional PCOS Type II, which would be that you actually do get your period every month, you ovulate every month are pretty regularly but you have insulin resistance and elevated testosterone.
[19:05] So those are showing up and it’s almost like we can look at this and say a lot of teens with early type 2 diabetes are showing up in our office with this so they already are developing insulin resistance, already have a lot of acne. Their parents are bringing them and saying that their mood swings are all over the place. Sometimes when you’re a teenager, you’re expecting that your cycles are not going to be regular because your hormones are still adjusting. It could take a few years really for your cycles to be like clockwork or slightly more regular. But if you have gone without your period even if you’re a teenager for over 6 months then there’s a red flag, that’s a warning sign there so definitely that’s something that you look at. Now with this type that we’re talking about you do have your period every month but you’re having insulin resistance. So that can turn into it later on, I have seen this where the insulin resistance and testosterone being elevated leads to irregular cycles but this type does not have that right now.
[20:57] The next is idiopathic hirsutism which basically means that there’s no ovulatory dysfunction, there’s no insulin resistance but you have elevated testosterone. How many of you have really been the detective in getting your blood work done and all that and said “I don’t know what’s going on. I know something’s off because my hair is falling out and I have acne but I’m getting my cycle every month and I’m thin, I’m not gaining weight but something’s off.” That’s category number 5. Usually you do see that there is elevated testosterone, I kind of look at it like maybe this is kind of the earlier stage where we can actually just work a little bit on the testosterone and hopefully a supplement along with acupuncture and hopefully get things back in place with that. When you’re looking at these types you can kind of break them down into insulin resistance are not.
[21:57] A lot of women with PCOS do not have insulin resistance, if you don’t then you know all the medications that are given for insulin resistance are not going to really do much. So you do need to ask about your insulin levels before you would start something like Metformin or an insulin regulator. That’s why it’s really important to ask for your labs. I would say that with type 2 PCOS or non-insulin resistant PCOS the weight loss and blood sugar lowering medications and supplements are just not going to have any effect on their symptoms or their fertility. So if you have this do not be frustrated if you take Metformin and see no results or you are taking a lot of supplements to help regulate insulin or blood sugar and nothing has changed because you didn’t have that in the first place. Actually you should be careful with that too, so your glucose doesn’t get too low.
[22:58] You’re in a little bit more complicated area because it’s not as straightforward as women who do have insulin resistance where they can just take Metformin or a supplement to help with regulating their insulin/glucose levels and everything falls into place. This is a little different. We have to look at the thyroid or adrenal glands and nutrient deficiencies like iodine and vitamin D or zinc deficiencies. We see this a lot. We test everybody’s vitamin D levels and sometimes they’re in the teens, they’re really low and there’s an issue with the cycle not being as regular. I think if you look at low vitamin D and zinc, those are important. In some women we also have to look at environmental changes going on, like sometimes chemical dioxins in the environment like BPA and all kinds of these hormone-disrupting toxins could be at the root of the problem as well. So you have to kind of really just peek into the environment and see what’s going on there.
[23:57] That type is an inflammatory PCOS and this particular type has signs of inflammation like joint pain, they’ll complain about headaches very often and acne, autoimmune disease, C-reactive protein levels are elevated. So that’s one of those inflammatory, I think very overlooked PCOS types. If you have PCOS hopefully you can download the blood work to ask for, it’s on our Facebook page and you can you can check that out as well and reach out to a gynecologist or a midwife who’s very familiar with the PCOS or a reproductive endocrinologist or an acupuncturist or nutritionist. But definitely start with the blood work.
[24:57] So that was my little breakdown of the complicated PCOS patterns that we see every day. The last question that we got, I really want to bring this up because this is from a listener who basically said that she would love to hear on the show how lonely PCOS can be. I bring this up because she said something that just really struck me and I just felt like I wish I could just reach out to her. I actually did email her back saying you’re really not alone!
She says “For me it’s how people don’t believe PCOS is real and that I haven’t tried my hardest”. If there’s anything that we can do to help make people more aware that it’s not your fault that you have this. It’s just something that we look at like a crystal ball. Like we can do something, we’ve been given a chance to really look into the future and see things that I can do now that can actually prevent those other things from coming down the road like perhaps type 2 diabetes and the cardiovascular risk and pregnancy side effects that can come up with PCOS.
[26:24] If I know this now I can really make some changes. I still to this day I know that you can reverse this. So I just want you guys to really know if there’s anything that these podcasts have helped with, it’s that it has made you feel like you’re not alone and also know that you can take action. You don’t have to let it own you and this is not something that is going to rule your life and ruin your life. It’s something that I’m going to continue to reach out to women who have overcome their PCOS to prove my point. But I think that there’s a lot of help needed and there is no shame in reaching out.
[27:26] I’m thinking about for season 3 to do some topics that sometimes we don’t talk about as much. Those are what happens when your energy and your libido and your weight are just kind of getting you down every day. We’re going to talk about how to help with those things. Of course we’ll still talk about fertility but I don’t think we need to over focus so much on it. I really think that I see women and girls coming into our office that are younger and younger now with PCOS. So this needs to start basically from puberty to talk about these things. I’ve really enjoyed these two seasons and I can’t wait to come back!
[28:41] That’s the end of this episode of the PCOS Revolution podcast. If you’ve enjoyed the show and want to help me spread the word about how women with PCOS and hormonal imbalances can lead happier healthier lives please head over to iTunes and leave us a review, they really do make a difference. If you like to have a question answered on the show or would like to recommend a guest, please go to floridacompletewellness.com/podcasts. If you’re on social media you can follow me at Facebook.com/floridacompletewellness and twitter.com/floridacomplete where I post a lot of interesting research webinars and articles on our blog about really getting to the root of hormonal imbalances like PCOS. So it’s a great way to stay in touch with the latest developments. Thanks so much for listening and see you soon.
About The Host
Farrar Duro is an expert in PCOS whose accomplishments include:
– Currently practicing reproductive acupuncture, Arvigo Techniques of Maya Abdominal Therapy™ and herbal medicine at Florida Complete Wellness in Fort Lauderdale, Florida
– Becoming a board-certified acupuncture physician, graduating from the Florida College of Integrative Medicine and performing her post-graduate training at Shandong University of TCM in Shandong, China
– Becoming a Fellow of the American Board of Oriental Reproductive Medicine (ABORM) in 2008
– Specializing in the treatment of PCOS, infertility and hormonal imbalances with acupuncture and Chinese herbal medicine for over 15 years
Learn more about how you can improve your results with PCOS with support from our clinic (for distance and local patients) by visiting us at www.floridacompletewellness.com.
PCOS Links & Mentions From This Episode:
American Board of Oriental Reproductive Medicine (www.aborm.org)
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