PCOS (Polycystic Ovarian Syndrome) with Dr. Jordan Robertson

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In this episode of The Functional Medicine Radio Show, Dr. Carri’s special guest Dr. Jordan Robertson explains PCOS – Polycystic Ovarian Syndrome – which is a very common cause for sporadic or no menstrual cycles..

Dr. Jordan Robertson is a naturopathic doctor and women’s health author. Through her experience in medical literature review, critical appraisal and research, Dr. Robertson has published over 12 literature reviews on women’s health, and has worked closely with McMaster University, writing and facilitating courses on integrative medicine for the last 10 years, speaking for their medical school and working off-site for the Endometriosis Clinic at McMaster Hospital. Dr. Robertson has most recently lectured for the Ontario Association of Naturopathic Doctors convention on PCOS, PMS, PMDD and Endometriosis, and has published a book for women, Carrying to Term, on reducing miscarriage risk. In her clinical practice she focuses on women’s health issues including PMS, PCOS, infertility, menopause and breast cancer recovery.

Main Questions Asked about PCOS:

What is PCOS?
What are the signs and symptoms of PCOS?
Why is making the diagnosis for PCOS so hard?
What are the treatment options available?

Key Points made by Dr. Robertson about PCOS:

PCOS is essentially a metabolic disease that shows up as a hormonal disease in women where the crux of the issue is centered around insulin impacting ovulation and influencing testosterone and the expression or regulation of normal female hormones.
Symptoms include cycles where women don’t ovulate so they may not get a period for some time or have sporadic periods.
It may also show up as elevated testosterone, so for women that shows up often as unwanted hair growth, as acne, and may have almost a male pattern hair loss on their head.
We often find that women, even if they sort of appear as if they have a normal body weight, they actually carry higher fat mass than women without POCS and so they may actually have elevated BMI or they may be a normal body weight.
I think that if women are seeing those changes to their cycle or they’re maybe looking back thinking, “you know what, my cycle was never really regular ever,” they should approach their physician to be assessed because there is such a delay in making an accurate diagnosis for women.
Women with PCOS are at risk for more cardio metabolic disease, they’re at risk for unique cancers like endometrial cancer, and so if they’re not well treated and not well identified, we’re really missing an opportunity for preventative medicine for the future.
Even the name, Polycystic Ovaries, is slightly misleading because we used to only make that diagnosis if women had cysts on their ovaries, and what we’ve found over time is that’s not a necessary feature to struggle with the metabolic disturbances of PCOS.
Diagnosing PCOS involves looking for a collection of symptoms,versus a definitive list of symptoms, so we struggle to either put people in that category or not , when truthfully, we shouldn’t really be declining treatment for women just because they don’t quite fit the diagnosis.
Even women who half fit the diagnosis for PCOS would benefit from some of the diet, lifestyle, and supplement interventions that we use.
Some symptoms of PCOS get dramatically worse during that perimenopausal period, so certainly if women noticed a rapid change in any of those symptoms, that would maybe lead to an assessment.
We have even studies that show that depending on how we apply the diagnostic criteria, we get different answers. So, some studies show eight percent of women have PCOS, some show as high as 15 or 17 percent, and it depends on which diagnostic criteria we use.
Metformin or oral contraceptives are conventional treatments which do have good evidence for reducing cancer risk in women with PCOS.
The greatest clinical benefit comes from diet and weight loss.
Only a few supplements have been shown to have dramatic clinical benefit in PCOS, fish oil being one of them. It improves insulin sensitivity, lowers inflammation, and improves mood in women with PCOS.
Inositol is probably one of the best studied nutritional supplements out there. Inositol improves insulin sensitivity and actually helps encourage better ovulation rates.
The third most important supplement would be vitamin D
Birth control pills induce a withdrawal bleed, or at least prevent women from having endometrial growth which does give them a reduction of risk of endometrial cancer over their lifetime. It also reduces the risk of ovarian cancer over their lifetime, which is also higher in women with PCOS.
But, oral contraceptives are not addressing the underlying cause and they worsen insulin sensitivity, so often these women gain weight on this treatment, or it’s worsening their triglycerides and some of their cardio metabolic risk.
There is no easy way to diagnosis PCOS and there is no easy to treatment for PCOS, either. Be patient.
My biggest take home is if you think you have PCOS, you might. It’s easier for us to rule out a diagnosis of PCOS than it is to rule it in, and if you’re curious about your symptoms, it really warrants being well assessed by someone who’s experienced in hormonals.