Episode 30: Confused about PCOS? Here’s what you need to know
Polycystic Ovarian Syndrome (PCOS) is one of the most common hormonal conditions affecting women – but is it really what you think it is?
In this episode of Women of the Well, Dr Peta, Dr Thea, and Sam break down what PCOS actually means, why it’s often misunderstood (even by medical professionals), and what you really need to know if you’ve been given this diagnosis.
They discuss:
They discuss:
🌿 The real meaning behind “polycystic ovaries” – why the name is misleading and how it can result in overdiagnosis and misdiagnosis.
🌿 Why PCOS isn’t a one-size-fits-all condition – understanding the different causes behind ovulation issues and how factors like insulin resistance, inflammation, and stress play a role.
🌿 The impact of birth control on PCOS diagnosis – why going on the pill young can mask underlying issues and what happens when you stop taking it.
🌿 How lifestyle, stress, and nutrition affect ovulation – the key factors that can restore your cycle naturally and what to focus on instead of weight loss.
🌿 Why your period is a monthly “report card” for your health – and what irregular, heavy, or absent cycles are telling you about your body.
If you’ve been diagnosed with PCOS (or suspect you might have it), this episode will help you understand what’s really happening in your body – and how to support yourself with the right approach.
Additional resources:
💡 Unlocking the Power of Your Cycle – A self-paced course to help you understand and work with your cycle for better health, energy, and hormonal balance.
We would love to hear from you.
If you have any questions about you’d like us to answer on a future episode of the podcast, please email them to hello@verawellness.com.au or contact us on Instagram @verawellness.com.au.
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Episode transcript:
E30: PCOS explained – What you need to know
Peta: Hello [00:01:00] and welcome to another episode of Women of the Well. I'm Dr Peta Wright. I'm Dr Thea Bowler. And I'm Sam Lindsay-German. So today after a little bit of a break due to cyclones and other floods and no power, we are back to talk about something mildly gynecological. Again, we thought we would talk about polycystic ovarian syndrome or PCOS, you know, many people might be familiar with that term, and I think it's a syndrome that is often not well understood by women and even often not well understood by health professionals.
I think, like, I actually wrote a thesis on this when I was doing my masters in reproductive medicine actually, on why it was a really stupid name because in essence what it is referring to is ovulatory dysfunction. Or the ovaries not ovulating regularly as they should. And when, when we think about the name polycystic ovarian [00:02:00] syndrome, we think it. All about the ovaries and that's the main problem. But it's most of the time a result of other systems in the body being out of alignment and the interplay between the environment and the body.
There are genetic factors, there are epigenetic factors involved, and it's actually much more nuanced and com and complicated than what people often think. And there's very often people are misdiagnosed, either diagnosed with. PCOS when they don't have it, yeah, they might have another cause for their ovaries not working as they should. It's probably commonly overdiagnosed. I think so,
Thea: Yes. And I think misdiagnosed as well, because there are other reasons why we cannot be ovulating, which really PCOS is just an umbrella term for. The body having difficulty ovulating for one reason or another. Yes. But I guess there is a separate condition, which we've talked about a little bit in previous episodes, where our body shuts [00:03:00] down ovulation because of insufficient calories, excessive exercise stress, and I think it's quite often confused with that, which is a big problem.
And we'll talk about that condition called hypothalamic ga amenorrhea in another episode. But the treatments are. Very vastly different, like almost opposite. And if you try and treat hypothalamic a amenorrhea in the way that you would suggest someone do for PCOS, you can actually make that condition worse.
Sam: Can you, just, before you do anything else, just break down PCOS. So polycystic ovarian syndrome, why is it called that? What is it even talking about?
Thea: Well, even that is. Um, mis misleading, a bit of a misnomer and misleading because really that's just talking about the appearance of the ovaries, not alluding to anything to do with whether a person is ovulating or not.
What's going on hormonally underneath what's going on genetically. In terms of inflammation in the body. Anything else? So polycystic ovarian syndrome refers to the [00:04:00] appearance of the ovaries on an ultrasound, and I guess what historically was found is that in a large proportion of women who had irregular periods, so infrequent periods, and I guess clinical features of polycystic ovarian syndrome, which can be signs of high testosterone, so weight gain.
Hair growth on the face. Um, skin changes like acne as the three major ones that those people were found to have. Ovaries that didn't have lots of cysts, which is what the name suggests.
Sam: Yeah.
Thea: But multiple tiny follicles in the ovary. So immature baby follicles. That's right. So when we talk about follicles, that's the little tiny cyst that forms around an egg that has all the.
Fluid that has growth factors in all the things that bathe our egg to help it develop. And polycystic ovarian syndrome refers to the presence or the, or being able to visualize more than 20 immature small follicles on the ovary, all of which have to be less than one centimeter in size. They have to be [00:05:00] nine millimeters or less, so they're not cyst.
They're like tiny little pockets of fluid. And the presence or the fact that we can visualize multiple follicles on the ovary like that really only tells us that that ovary is having trouble ovulating for one reason or another. It doesn't tell us anything more than that. So if it was ovulating, those cysts, what would they be doing?
There would be fewer of them often. Yeah. And we would see a, see signs that the ovary was. Either going on to develop a egg that was gonna ovulate or had recently ovulated. Mm.
Peta: Yeah. So you would see a bigger one. Yeah. But also you can have ovaries like that. And this is part of the complexity of the diagnosis.
So maybe we'll just talk about the diagnosis, which is. Having two out of three things and usually just infrequent periods and the clinical signs. Mm-hmm. So the high testosterone or high testosterone on, on bloods mm-hmm. Is really enough to diagnose it. Yeah. You don't really need the ultrasound. The other [00:06:00] thing about the complexity of diagnosing this in adolescence, so young women is that about 70% of young women will actually have polycystic ovaries on an ultrasound.
So if you scanned a hundred women within eight years of their first period, like 70% of them would have that appearance of their ovaries because it's a normal appearance of ovaries that are in that maturing process. Which is why like often we would see people who'd had a scan and they didn't have any of the other features, and they might have the ultrasound report says polycystic ovaries, and then they think they have this syndrome, which they don't have, which, so, you know, we would be very, very careful.
Unless someone had overt high testosterone in adolescence, then you know, you'd be very careful with diagnosing polycystic ovarian syndrome in that time because much of the symptoms like acne, irregular cycles and polycystic ovaries, and weight changes and weight changes. Are all really common and part of that normal maturation and [00:07:00] development of the brain ovary axis.
So if those things persisted post adolescence, then that's when you would be thinking there might be something else going on. Or if there was like rapid and significant weight gain, other signs of insulin resistance or prediabetes or overt high testosterone. And I think the other thing with the diagnostic criteria is that.
People often forget that. It's like you need to have those things. So the irregular cycles, the high testosterone or symptoms. Mm-hmm. And excluding other diseases or other diagnoses. So like that's where you have to look at because as Thea said, you can have somebody who is, has an eating disorder, who's not eating enough, who's doing too much exercise at the gym, and they're not getting their period at all, or they're getting really irregular cycles and they might have Polycystic ovaries on ultrasound. Mm-hmm.
Sam: And then
Peta: they could get that diagnosis without thinking, actually get the diagnosis of PCOS when really it's their brain [00:08:00] that's gone into shutdown to protect them.
Sam: Does that make sense? Yes. So, so why do we need the diagnosis? If someone comes to you and says, I've been given this diagnosis.
What is it that they're trying to get from there? Is what I'm trying to say. Yeah. 'cause what you're saying to me is it could come from a. Various different reasons. Mm, that's right. What's the benefit of saying I've got
Thea: PCOS? There can be acute issues. Yeah. So if people aren't ovulating regularly in the setting of PCOS, the lining of the uterus is exposed to more estrogen.
Because estrogen is, um, the hormone that we make. In the lead into ovulation, and then progesterone is the hormone that we make after ovulation. So they're not really making progesterone, they're making lots of estrogen. And then when they eventually do ovulate, which you know, can happen infrequently and go on to have a period, that period can be very, very heavy and prolonged because the lining of the uterus has built up over time.
So they can have trouble with infrequent, but very. Difficult to manage periods. And they can also [00:09:00] have, I guess, the aesthetic features of high testosterone that can be troubling for people. So hair growth on the face, acne, weight gain, and often people are seeking assistance in managing those. And then we also know that, you know, there are some long-term conditions associated with PCOS as well, and a lot of those are driven by the underlying.
Um, inflammatory and hormonal changes of the condition. So, which is really the driver of the condition. Yeah, totally. Which is, which is what is driving all of it. And that tends to be insulin resistance. So higher levels of insulin in the body, higher levels of inflammation in the body. And both of those things, in addition to the weight gain and that kind of thing, can predispose people to developing diabetes, cardiovascular disease, and those metabolic conditions over the course of their life.
The other thing that's common is that if a person isn't ovulating regularly and they're in a time of life where they wanna have [00:10:00] a baby, then falling pregnant is much more difficult because you're just not putting out an egg as frequently or at all. Mm-hmm. And so I guess people would. Be looking at treatment for any of those reasons. Often if it's younger people, it's more around helping to manage kids. What is,
Sam: what's the, what's the most common age that you receive this diagnosis? Or does it come across the board?
Peta: Probably late teens, twenties. Yeah. Yeah. Or thirties when someone's trying to have a baby. That's right.
Thea: And I think talking about the pill as
Peta: well. Yeah. What happens after that? I think the main thing is that, and I think this is what I argued for in my thesis, is that we should be saying, this is. Ovulatory dysfunction, right? Yeah. And then rather than this name, which is kind of really confusing, and many people are like, oh my God, my ovaries have got these horrible growths on them, and how can I reduce the growth?
And I should also say the high testosterone comes from. The little follicles that aren't growing like one follicle, they just produce a whole lot of testosterone so that because they're getting [00:11:00] stimulated from the brain from one of our brain hormones that called LH or luteinizing hormone, instead of what normally happens in a, in a normal cycle is that we get low LH most of the time, and then it spikes.
When we have a follicle that's growing and then in response to high estrogen and then it goes down again, and that's when ovulation happens. But also a lot of these women have high LH all the time, and that can lead to the stimulation of all those little follicles that don't actually do what they're supposed to do.
Sam:Do we know why that occurs for some women?
Peta: Lots of different reasons. Yeah, and that's the thing. So I think about like if you have someone who's been diagnosed with PCOS or ovulatory dysfunction or you have any of the symptoms, um, that we're talking about. Think about that as the umbrella term and then think about the, well, what's going on, and why are you having that ovulatory dysfunction?
So a lot of the time, I would say for the classical PCOS people who have the signs of high testosterone, hair, acne, infrequent periods, et cetera, there [00:12:00] can be probably. 80% of those people have high insulin and that pre sort of diabetic thing. And that can be genetic and also environmental. And usually a combination of both of those things.
So, you know, maybe a family history of diabetes or that propensity to be more insulin resistant, which is a lot of like some ethnic groups as well can be more predisposed to that. And then combined with, you know, some people might say, oh, my periods are totally regular. And then. You know, for whatever reason I put on 10 kilos, like, you know, around Covid.
There was a, a lot of the time, you know, exercise would stop or there was a lot more. Eating of food that maybe wasn't the best. Mm-hmm. Then after they'd put on some weight, so there was an environmental change that prompted more ins, insulin resistance, um, and more inflammation, then the hormones start to change and we get, um, we start to have ovulatory dysfunction. Mm-hmm. So it's almost like a response to the environment. And that's probably, I reckon, like 80% of people, right?
Sam: Yeah.
Peta: And so [00:13:00] we can do things like, so test for insulin resistance. So I usually do a fasting insulin test. And sometimes a glucose tolerance test to check if someone has since resistance. We would normally do cholesterol.
Mm-hmm. And like lipids. So fat's in the blood, look at blood pressure and things like that as well. I would always do like vitamin D 'cause so many of these women have really low vitamin D and there are lots of vitamin D receptors
Sam: on the ovaries. So vitamin D comes up time and time again, doesn't it?
Mm-hmm. It really is something that. It's, I mean I find that just so shocking in a place like Australia that we are not absorbing enough. But so many people aren't. Also, so many people don't, they're not going outside in No. That right. That's, no, anyway, I'm just saying 'cause it constantly comes up that vitamin and D is something that we are struggling to get enough of and it's actually quite hard even to get it from a tablet or something as well. Yes.
Peta: And if you're not then ovulating, then you're not making the peaks of [00:14:00] estrogen, then your LH starts to change. Right. So that's probably the mechanism there. Yeah. But there can be other women who don't have the insulin resistance, who are a normal body weight or haven't changed weight, and they can have a high lh.
And there's a theory that LH has made in a part of the. Hypoth, the, the bit that makes, that's made in the pituitary glam, but the bit that prompts LH to be made is in the hypothalamus G and yeah, the GNR in GRH, which does, um, cause LH to be released. And it in, um, some cases where women in, when they're embryos in their mum's tummies, they might have been exposed to androgens or other chemicals or endocrine disrupting chemicals in the environment.
That may change the puls ity of that. Yeah. Um, the GnRH, which then controls LH
Thea: most commonly, I think if the mom herself has had PCOS. Yeah. So it's just been a higher lh higher, higher androgen environment Yeah. For the
Sam: developers. And so actually, as we know that [00:15:00] we have many more of those sort of toxins in our environment, then.
That's going to cause potentially more of those problems.
Peta: Yeah. And then the ongoing, not ovulating 'cause progesterone, which you make after you ovulate, it actually decreases the lh um, pulsatility. But if you're not, if you're in a chronic, not ovulating state, then that further exacerbates that. It becomes a bit of a vicious cycle.
Sam: Cycle. I'm just gonna ask, so really out there, and you can just shut it down, but is that, have you, do you notice or have you seen as well that some of those women also struggle with thyroid? Gland issues. Do we notice that it's to do with those sort of glands linked together and like not working,
Thea: not so much like severe thyroid disease can make your periods irregular, but not so much going hand in hand with pcfs.
Sam: Yeah, but just that whole, because all those, you know, it is like thinking about all those glands. They're so important to us functioning as women, and yet, I don't know, it just seems that. [00:16:00] More and more we, we don't really think about them or talk about them. People rarely talk about pituitary glands. We talk about pituitary glands, but I know you do don't.
I know,
Peta: but also they're all interrelated. Yeah, that's right. So that's the thing, like you might be presenting with irregular heavy periods and the cause might be. Hypothyroidism. Mm-hmm. And so that's why in order, even when you're working this up, you don't go straight for this is PCOS. It's like, could be that.
So we need to look for all of those things.
Sam: It's exactly the same. When I was talking to um, Alicia last week, we were talking about, it's all about forensic. It is actually, it's
Thea: because I would say like PCOS was one of my peak frustrations when I was a training. Me too gynecologist. Because literally all we could, all we were taught to do is take the pill.
I
Sam: was gonna ask that. Do you, you have these
Thea: problems, you not getting a period
Sam: periods acne? That's a
Thea: comment.
Sam: Pimples. Yeah.
Thea: Like, just take the pill. And I was like, but we don't even know why. Like, we don't even understand what's [00:17:00] going on underneath it all. So to be able to actually try and flesh out exactly why a person isn't ovulating and then actually tailor the treatment to help with that.
Mm-hmm. Or like my greatest joy is when a patient comes to see you. You know, two years out from when they wanna have a baby in a situation like this where they're not having regular periods and you have lots of time to actually find out why they're not ovulating and manage that.
Sam: Mm.
Thea: So that they can then start ovulating regularly, regularly, and conceive naturally.
Peta: Because it's also very much like how we keep saying and how Laura Bryan says the period is a report card for the rest of your body if you're not. Getting a period regularly or they're really heavy, or it's showing that you're not ovulating and ovulating is the main event of the cycle. And then that's where we need to explore.
Well, if you're not ovulating, there's something out of alignment with the body. Yeah. Whether it be the thyroid ovulatory dysfunction from high insulin, which is the other hormone, which is like, again, the primary. Most common probably PCOS one. Yeah. And the thing is, is [00:18:00] exactly as Thea said, yeah, we were told, okay, just go on the pill.
Maybe a bit about diet and exercise, but then the person's like, well, I then get this pill bleed. Okay. And yes, my testosterone levels go down because the pill shuts off my any ovarian function. Um, but I'm not. It's not fixed. It's not, no, it's not that. The cycle is now having a cycle and you're having the benefits of those hormones, or even that the underlying thing that was causing the ov dysfunction has been addressed.
'cause very often none of that stuff would be addressed. You'd go on the pill, which actually, if you have insulin resistance, can increase insulin resistance. And then even though you're getting this. Bleed and yes, you're protecting your endometrium. You're not actually being able to work on the underlying high insulin, which can lead to diabetes. Hypo pressure. That's right. Like they're not
Sam: addressing hormonal. So if you ever decide to come off the pill, you're back. Everything is back there to square away. So it's just masking Yes. Something. And effectively doing [00:19:00] that clearly because these women are, are able then to eliminate some of what they're experiencing externally.
But actually. It's not doing anything for the long term. So then health isn't restored.
Peta: No, that's right. And I feel like there are some people who that's really good for them, like that works for them. Yeah. But for the, I still, I think now actually the vast majority of women, and there's good research that if there is an insulin resistance component that you know.
Having a healthy diet, like a whole Foods low refined carbohydrate, high protein, good fats, resistance training, lowering stress, because stress is another important part of this. Mm-hmm. 'cause high cortisol increases insulin as well, and inflammation, um, not getting enough sleep shift work. All of that actually is associated with more irregular cycles Then.
If you do that, you can start to put the body into an optimal state where it will ovulate itself.
Sam: Yeah.
Peta: And then you get your cycle and then you not, don't have any of that. No. Like [00:20:00] the other things. So I, they used to say, and I don't really necessarily talk about weight loss so much. Mm-hmm. I just talk about doing those things that,
Thea: um, like just joyful movement.
Yeah. Joy. I'm always movement. I'm like, just do some
Peta: movement that brings you pleasure, nourishing food.
Sam: Yeah.
Peta: Doing the things that you love. But you know, studies in the past would tell us that if you had gained weight and through those healthy means, you had lost, you know, five or 10% of your body weight.
Yeah. Often women's cycles will come back completely to normal because it's a reflection of this sort of overabundance in the environment. Um, so for those women and, and without like shaming them and telling them they have to lose weight, because obviously I think this is really interesting too. There is a really high link between childhood adv adversity, developmental trauma, chronic stress, and um, PCOS probably because as well of that change in the.
Adrenal system and the, and cortisol and insulin and [00:21:00] all of that. Mm-hmm. And changes. And then the gut microbiome. Yep. Which can make, firstly, like sometimes eating is a way of reducing that stress and calming your cortisol. Mm-hmm. Um, it becomes a coping mechanism. And also all of those changes can make it really difficult to maintain or lose weight or have a healthy weight too.
Thea: Absolutely. And I think there are studies that show, mm. That actually, like some binge eating behaviors can be associated with really high insulin levels, um, and fluctuating glucose levels. And so I think, like you say, it's not to shame anybody, it's that actually the, the life events can lead to the hormonal changes that we see and the hormonal changes that we see in PCOS are what make losing weight.
More difficult eating healthily, more difficult as well.
Peta: Yeah, and so then to come at it through a trauma informed lens and a way that isn't you needing to lose as much weight, but how can you support [00:22:00] yourself and love yourself more and learn even maybe some, you know, maybe address some of those things that perhaps have been pushed down.
Learn some coping strategies that are not. Harmful and it can be a really, this is why it can be a really. It's like, it's obviously not, nothing's as easy as eat this, no, move more, you know, because it's so emotional and like, there's so much other stuff there. And I think anybody that you see has to have a really sensitive awareness to it.
Mm.
Thea: And lots of compassion. Yeah. And
Peta: sometimes seeing a dietician in the, for women, if this is you, is, um, really, really, really helpful. But seeing someone who's trauma informed who is gonna help you without. Shame. Absolutely. And sometimes. So sometimes psychological support or other therapy can be helpful too.
Thea: Yeah, because I like, we see it quite a lot, which is like you have a patient who has polycystic Arian syndrome who's been told to lose weight. Mm-hmm. [00:23:00] And these people probably just have a very narrow set point for. You know when their body is happy to ovulate, and so they can easily tip into an ovulation.
And I've seen it in a number of patients where they've been told to exercise and eat well, and they've gone really gung-ho with that, and then very quickly tipped themselves into the opposite. The opposite, which is now your body's so stressed that it can't ovulate. Mm. And so being really gentle on our bodies and having lots of compassion is so important.
And
Peta: absolutely dealing with the stress stuff. Yeah. Because sometimes women will then say, but I'm eating like a thousand calories a day and I'm not losing weight also. Yeah. They've gone into like almost freeze mode in their nervous system and it's holding on because they're essentially starving. That's right.
Yeah. They're holding onto every single calorie and they're feeling more depleted and Yeah. So it is really about. Very first and foremost, the body feeling safe and nurtured the whole time. And also knowing, and I think this is really important as well, [00:24:00] that not everybody is supposed to be a size six.
Like I think that's the thing. And you can be healthy and be in a larger body. You can be healthy and well and be in a larger body. And our aim shouldn't be for someone to be a size six or a size eight. No. Um, it should. And that's why I'm very, like, I never say anything about. Numbers or
Sam: no,
Peta: it's about how and, and it's about seeing what happens with your body.
Like if you start ovulating and you are size, whatever, it doesn't matter because that's all you need. Your body, that's where your body's happy. The report
Sam: card is saying, yeah. Mm-hmm. This is working for me. Mm-hmm. Yeah. So it's a whole process of reeducation.
Thea: Mm. Yeah.
Sam: You know, around how to care for ourselves when things like this are happening.
And I just think, again, it's always, like you said, coming back to. We've got to listen to what we're being told by our body. Mm-hmm. Mm-hmm. And our body is trying to communicate, I am not able to do the right thing. Mm-hmm. Help me. Mm-hmm. And it's in those moments that that's what we need to do. And think about it as if someone was saying, help me.
[00:25:00] Yeah. Not that someone's doing something wrong or not, you know? No. Not punishing, working hard, not punishing the body. That's right. Yes. And it's that, it's actually the body is saying, help me. I want to work well for you, and I can't. Yes. The environment that is not, is not working. Totally.
Thea: And I think really like getting the basics right is so important because no medicine or fertility treatment is gonna help if.
We're not sleeping and we're not eating nutritious food, and we are not moving in a way that feels really good and we're incredibly stressed and hating our job or whatever. So I think like really looking at all of those basics first is so important. Should we talk about other forms of treatment?
Peta: Yeah. I would also just say that it's another one of those things where, again, in terms of the diagnosis.
Or it can change at certain times. Like you may have PCOS or have that picture or stop ovulating because you've, you know, had an enormous period of stress. You've, uh, haven't been caring for your body or because you've been through, you [00:26:00] know, a whole lot of stuff that's made it more difficult. And then in another part of your life where you are more able to do that, you don't even have any aspects of this that.
Mm-hmm. So I would say like not to be attached to the label. Yeah. And to be really thinking if this is because some people do have things. Genetically or epigenetically that are really more difficult to change. Mm. And but that I would say is the much less like a, a, a smaller proportion of people who have, who get griped into the PCOS umbrella, the vast majority of people, it's a tendency towards ovulation if the.
Environmental circumstances aren't optimal, but I don't think it's something that you need to carry as part of your identity or as a, a sick label.
Sam: Not at all. Yes. And then, and these words syndrome. Yeah.
Peta: Yes. Always
Sam: a, you know, it
Peta: just,
Sam: it just makes it
Peta: feel such a label, doesn't it? It's just a collection of, it's important to remember a syndrome is just a collection of symptoms.
Yep. That's it. It's not even describing. It's describing a collection of symptoms that can [00:27:00] be driven by a number of pro disease processes. Yes. Which means isn't not even a
Sam: definitive answer, correct? No, it's not. Right. Definitely not a definit. That's a really good way of breaking and not a permanent
Thea: situation.
This is wonderful to, and I think we can also, you know, in the same way we talk about pain. Being a tap on the shoulder or menopausal. Mm-hmm. Symptoms being a tap on the shoulder to have a look around at our own life and how we're living and how our stress is and everything. But like periods are exactly the same.
Like often, you know, people will have been given a diagnosis of PCOS and get on top of it all, and periods might be regular and then they might notice after several years Oh. Oh, they're starting to space out again, or I haven't had a period for three months. And I think that's a really beautiful opportunity as well to then think, okay, well why, why has my period spaced out?
And I have lots of patients who are like, I know I just have been like, really stressed with work. Or, you know, they, they then realize and tune into their own body and their own life and can. Almost have the self-efficacy to figure it out themselves. Yeah. What's
Peta: [00:28:00] changed in my environment? I know, I remember having a lady who was a lawyer and she was working in a law firm and she was so stressed out and she was working like, I don't know, 12 hours a day and she wouldn't even leave her desk to go and have lunch because her boss didn't have lunch.
And so she thought that if she didn't have, if she went and had lunch, then you know. She wasn't working hard enough and she didn't go outside. Her vitamin D was super low. She wasn't sleeping, um, she wasn't exercising and her periods were really irregular. And we had this whole conversation and I was like, but do you like, do you think you can keep going like this?
And if you wanna get your cycle back, these are the things you probably need to change. Either you say, I'm sorry, I have to. Work less. Yeah. And I think she, I remember her looking at me and I thought, she's probably never gonna come back to me at all, actually. And she came back to me like six months later and she'd actually moved from her job, moved to another law firm where it was much more flexible.
And her periods had, were regular and her symptoms [00:29:00] had amazing, um, had gone away. Yes. And I think that's just so many, like our bodies know our bodies, body goes, yay, this is where I should be. Yeah, exactly. And we just have to listen to them. And it just, it's just
Thea: having this, the courage to listen. Exactly.
Peta: Yeah. So, and I guess the other thing that can sometimes be helpful for people who have high insulin is there are some medications and stuff, which would be, you know, after you've dealt with diet psychological factors, stress, nervous system. And like movement and mm-hmm. Re, which we would hope, hope to have some resistance training.
Mm-hmm. Whether it's body weight or lifting weights or yoga. Mm-hmm. Um, because that helps bring insulin down some supplements and some medications can also be helpful for some people. So things like in Acetol, which is a B vitamin mm-hmm. Has been shown in some studies to be as effective as metformin.
Yeah. Which is a medication that's often used for diabetes or for insulin resistance. When do you use [00:30:00] metformin in your patients?
Thea: Well, like you, I always measure fasting insulin and glucose. Mm-hmm. And I suppose. Like, I would always talk to my patients about the options and we know that lowering insulin is a very, very effective way of, um, restoring ovulation.
My acetol in yeah, in a recent study was shown to be as effective as metformin, but without the gastrointestinal side effects. So metformin can sometimes cause nausea and loose bowel motions often. So I guess I would present those options to my patients and often they would elect to start within Oce Hall first.
Mm-hmm. And if that. Wasn't doing anything then I would probably add Metformin in.
Sam: Yeah.
Thea: Is the way I would do it. Unless their insulin was super duper high and perhaps they were really keen to get on with trying to have a baby or something. Mm. Then probably expedite it with metformin. But yeah, I would usually start with an ceal.
Yeah. And what are the supplements? Do you? Um, so definitely an acetol, magnesium, zinc, vitamin [00:31:00] D are all very important, um, sort of co-factors for ovulation and also help to lower. Inflammation. I also sometimes use NAC because it's the antioxidant kind of anti-inflammatory effect and an Omega-3 supplement as well, because it's anti-inflammatory.
Yeah, yeah. And ubiquinol, if they're trying to get pregnant,
Peta: if they're as well, which is good for mitochondrial function in the egg as well. I think that would be the medication. And then we would, yeah, then we would consider metformin as well. And then sometimes if someone is. Yeah, if they're having really infrequent periods, sometimes using progesterone.
Yep. So cyclical progesterone, which is natural progesterone. So not like the pill. It's exactly the compound that your body makes after you ovulate. So sometimes, um, like we were talking about how the LH like increase stays high when you don't get that feedback from progesterone. And progesterone's also an anti testosterone too, so it can help with those symptoms of high testosterone.
You can actually use progesterone in a cyclical fashion. Mm-hmm. [00:32:00] Especially if someone's main things are heavy bleeding or infrequent bleeding, so that if you give them. Two or 300 milligrams of Prometrium just for the two weeks. Once a month kind of mimicking a natural cycle, but not turning anything off at the level of the brain.
Um, it can feed back to the brain and then hopefully decrease that lh, which can sometimes, if you use it for say, six months or so. Maybe Kickstart, ovulation. Retrain. Yeah. And also in the And, and I've also found for some people, they even use it as a long-term solution because it's almost creating more of a physiological cycle.
Cycle. They've still got their estrogen and they, they're getting their progesterone, which has benefits in terms of. Sleep and brain health and um, bone. And they often feel so
Thea: much better, feel better, and
Peta: then they're getting that withdrawal bleed. So they're protecting their endometrium, which is one of the reasons why, like other doctors might say, just go on the pill because you get that bleed every month, but it's not turning off their cycle.
They [00:33:00] don't get the side effects of the pill either. 'cause you just replacing your natural hormone.
Sam: Yeah. Okay. Yeah,
Peta: and that's probably more of a newer treatment and, um. What was the name of Thery? Daryl and Pryor and Laura Bride and have got a really great paper about that. Yeah. And the mechanisms of how that can potentially work.
And to me, to be quite honest, unless someone really wants the contraception from the pill, it makes so much more sense physiologically. Absolutely.
Thea: And I think, you know, for so many of these people, they don't wanna go on something that's gonna turn their cycle off because they want to know if their cycle comes back.
Yeah. You know, so they actually want to know that things have got better. Yeah, that's right. Which is why, you know, if people are thinking about contraceptives, like I would normally talk to them about a marina or a Lina rather than a pill, because the pill, as we've learned before, totally shuts down.
Brain to ovary communication switches off ovulation, so you get no bleed, though the bleed that you get on the pill is just a hormone withdrawal when you take the sugar tablets. [00:34:00] So again, it's shutting everything down. Whereas if you, if you're using an IED that's locally acting, not switching off the ovaries.
So if you are going to have a period, you will have a period most of the time, and you'll know what your body's doing underneath it all.
Peta: Mm. And I think the other time that you can get misdiagnosed is say if you were a woman who went on the pill when you were like 13 after a year of having periods, which is really common.
So you started it before your reproductive system was mature? Yeah. And said, stay. Then you're on it until, I don't know, you come off it at 32, you wanna try and have a baby and then. Your periods are super irregular and you might have some acne, because often that happens when all of a sudden your ovaries are actually making testosterone, which they haven't done for the whole time.
You're on the pill and your skin's like, oh my God, I haven't seen testosterone like ever. And so you'll have high testosterone, or at least clinically, and you'll have irregular cycles. And, and even [00:35:00] many of these women will have polycystic ovaries on a scan because they're, it's like their ovaries are back when they were 13, even though the eggs aren't the same quality.
Um, so they'll often get a diagnosis of PCOS when I actually think their real diagnosis is an immature. Hypothalamic pituitary ovarian axis. Yeah, so an immature reproductive system. But what happens is they get slapped with the diagnosis of PCI, so it has go down that rabbit hole and then often because they're kind of running out of time fertility wise, get put into getting IV for having ovulation induction when really, when if
Thea: you just, what if they'd had more time the.
Hormonal pathways would've recalibrated and ovulation would've, yes. Resumed normally. Mm-hmm. Mm-hmm.
Peta: Yeah. Yeah. I think that's actually what happened to me. But I didn't get diagnosed with PCOS 'cause I wouldn't have obviously gone to an oncologist when I went off the pill at 35 crazily, I didn't have a period for like six [00:36:00] months and say like all of the things that were, the pill was masking, like probably not eating enough, probably doing too much exercise.
Weren't there anymore. And then if it hadn't kicked in, then I would've been going down that pathway. Mm-hmm. So I think what we would always say is try not to go on the pill at 13. Yes. Um, and if you're the mother of a, of a teenager listening, just if you're considering that actually make sure you see someone who offers you other supportive therapy and options because there are lots of other things to do before that.
Sam: Yeah.
Peta: And secondly, if you are gonna do that, or you are, or someone who has been on the pill for a long time. Go off the pill like at least
Thea: 12
Peta: months. I say at least 12 months or by 30 even if you're thinking about wanting to have babies and see good advice, what's happening.
That's good advice. Yeah. Yeah.
Sam: To give your body some time. I think that's really good advice. Like actually think, how old am I? How long have I been on the pill? Because Yeah, you're have to, right. There might be. Young, um, women who want to go on the pill for [00:37:00] various reasons or have to, you know.
Thea: Mm-hmm.
Sam: But then, yeah, even around sort of 26, 27, this is a good time to say what is actually happening.
Mm-hmm. Yeah. And not when they're trying to get pregnant or not the reason apart from, as a sort of check up of their period health.
Thea: Yeah. And even, like even if you were 26, 27 and you just wanted to see
Sam: Yes.
Thea: Go back on the pill again for a bit if you want. That's right. But just to check in with what your body's up to.
Sam: Mm. And just to get used to that whole Yeah. What it is to be, yeah. Cycling. Yes.
Thea: If you have an idea in your head about when you wanna have a baby stopping it at least 12 months
Peta: before Mm
Thea: mm
Peta: Definitely. Yeah. Or even if you're someone who just wants to see actually, how is my body working? I think you can have a break from it and see what's going on and you know, just compare the difference.
Especially if you're someone who went on the pill. Because you were offered no other options and you just felt like that was the only thing that was gonna address your problem at the time. There are other things that you can do, and I think [00:38:00] with more knowledge and more power and more informed, more information, you might be in a position where you would make a different choice and things might be different if you come off the pill.
Thea: Well, that's it as well. Like I think so many people are scared of their periods because they've been on the pill since they were 13, which signals to them that there's something. Scary going on, and they've never experienced a period. I saw a lady just before we started the podcast, who's 43, and she's been on the pill since she was 13, 14.
Really? Yep. And never had a non pill bleed. And she was referred to me with breakthrough bleeding, which is just what happens when you've been on hormones for a very long time. And we talked about it, and I was like, why don't you just get to know your cycle again? Mm-hmm. And I saw her today and she was like, it's great.
Sam: I love it. Aw.
Thea: Like totally manageable, not scary, not painful, not heavy. Like, yeah. This
Sam: is, is such an important conversation. Mm-hmm. And as well, just that having the, like you were saying with self-efficacy, to be able to actually know that you can say. I just want to know the options. Mm-hmm. Rather than, yes, [00:39:00] let's just put my daughter onto the pill or the daughter saying, I want to go on the pill.
Just actually being able to say, what, what else could I do? Yes. And I think there's more and more of that being asked. There must be, because there's so much more publicity around the pill now. Yes. I think. But it's still quite shocking.
Peta: But even so, you still see, like there was an article in one of the major newspapers, like a co, like within the last few months I think that was saying, um, you know, all these like social media influences talking about that the pill isn't good or, um, that a natural cycle is better and you know, then.
Using quite alarm is scary language about unplanned pregnancies and things not, but, but failing to recognize that a huge amount of unplanned pregnancies actually happen on the pill. Absolutely. Um, and it was a really dismissive Unvalidating article that was really sort of being derogatory to people who were saying, actually, there is something important about a natural [00:40:00] cycle.
Sam: Mm-hmm. I
Peta: had a ve I've like got so many stories, but like another patient. Was put on the pill when she was like 12 because her very first period coincided with the diagnosis of like leukemia or something where she had super, super low platelets. So she bled a lot. And so the doctors at the time, very normally and wisely put her on the pill.
So she didn't lead to death, but then she just got stuck there. And when I saw her at 30 something and she was having problems, um, from the pill with the low estrogen, with her, with vulval pain and stuff. No one had ever revisited that again. And so, and she was terrified to come off it. 'cause all she could remember was the trauma of that very first period.
Yeah. Which had nothing to do with, it wasn't the period's fault, it was her leukemia, but she just had this PTSD response and was terrified of her body and then she went off the pill and. Is now like completely fine and you know, so surprised that her periods are fine. And so many people like that who've been put on the pill for say, painful periods when they're really young.
Young. And then [00:41:00] you help to support them and give them tools around their nervous system and. Then they're just like, I can't believe anyone didn't, no one talked to me about this as an option. Absolutely.
Thea: And I think like that whole revisiting thing's so important because like I have patients sometimes who have really, really painful periods and despite doing lots of hard work with physio and nervous system and stuff, they might be in grade 11 and 12 and really struggling.
And sometimes they say to them, well, why don't we just do the pill until you finish school? Mm. You know, to help. These last few
Sam: years of school, how good would it be if there was a actual checking in? Yeah. After a period of time. And then in
Thea: fact, when you finish school and all of that stress melts away.
What I normally find is we stop the pill and it's like a totally different ball game. Mm-hmm. Because they're not having that. Heightened nervous system that's contributing to pain signaling.
Peta: Mm-hmm. Yeah. I think just making sure people know that it's not their bodies, it's all the other stuff going on around it.
And I think for a long time, the simplest thing was to say it's your body that's doing the wrong thing, but [00:42:00] as women who have a cycle and like capacity to hold it all, it's not our bodies, it's the mm-hmm. It's the environment, it's the, it's the situation
Sam: we're in, but that's a much more empowering way to use the contraceptive is to actually say, I'm going to do this for this period of time because this will help me with this, rather than meeting someone where they are.
That's right. Rather than what tends to happen, which is yes, we'll just shut this all down and not worry about it again. And you don't really need to know much about it. Mm-hmm. Just off you go do this. And that's that. And also that blanket idea of this is gonna stop unwanted pregnancies. Uh, really the best thing to stop unwanted pregnancy is better sex education.
Mm-hmm. Absolutely. And actually understanding of cycle, which you can do. If you're having a cycle. Mm. And condoms have quite a good efficacy rate and that's put the ES back on a man. Yeah. Rather than consistently being Yes, absolutely. And condoms. Exactly. But it's also just in that education of if young people were actually going through their cycle, [00:43:00] they would start to understand when they were ovulating.
Mm-hmm. So therefore they would just naturally be understanding. Mm-hmm. Uh, better how it is that their, um, like, well, the likelihood of them getting pregnant is mm-hmm. And I know it can happen outside, ovulation and all those different things, but still mm-hmm. Yeah. We know that that is a very good way of knowing that you're likely to get pregnant.
Absolutely. And if you knew that, if you were just naturally working with your body in that way, it would just be much more effective
Peta: and
Sam: empowering.
Peta: That's completely right. I would say one more thing about if you have been diagnosed with PCOS, this is something that I see often where. People Google, and then they think they're going to have troubles with fertility and then they might not.
Like use protection. And then they, there've been so many women that I know personally and um, professionally where they don't use contraception and then they're like surprised that they've fallen pregnant and it's either been a disaster for them at the time, you know, or perhaps a happy surprise. But when you ovulate, you'll be as fertile [00:44:00] as anybody else.
It's just the problem is like, if you are having a period seven times a year. Then your chances of, um, pregnancy are seven times a year rather than 12 times a year if someone's having that type of cycle. So you can still fall pregnant and it only takes one ovulation. That's right. And if you have, um, had trouble falling pregnant and you've been diagnosed with PCOS, generally it is one of the situations with fertility that is.
Pretty easy and treatable to make through all the things we've talked about, either to get you ovulating yourself or, um, sometimes using some medications, either oral or injections to help trick your body into ovulating. And then IVF for some people, but you know, usually not, usually not IVF.
Sam: Yeah.
Peta: But they're a definite, uh, like it's, it's definitely not that you are not gonna be able to have children, so that's really important to remember.
Thea: No, which, which seems to be something that people aren't told as much anymore. No. But they used to be, I hope. Yeah. Anyway, that
Peta: was really interesting. Yeah, [00:45:00] so if there are any questions about this episode, 'cause we know it can be confusing, please send us an email, visit our Instagram page, which is verawellness.com.au, and we will see you back next week.
See you next time. Bye.
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DISCLAIMER:
This podcast is for information and educational purposes only and is not intended as a substitute for medical advice, diagnosis, or treatment.
