Polycystic ovarian syndrome or PCOS is a condition that affects 1 in 9 women. The symptoms include things like pimples, increased body hair, thinning of the hair on our head, missed periods (and the flow on effects that affect fertility and build up of the endometrium which is a risk factor for endometrial cancer), increased risk of developing metabolic syndrome (insulin resistance, diabetes and cardiovascular syndrome) and increased risk of mental health conditions. PCOS sucks! (You can probably tell who from the team is writing these episode notes). Keeshia was diagnosed with PCOS about 4 years ago so today Keeshia and Britt are joined by the wonderful Dr Izzy Smith!
Dr Izzy Smith is an endocrinologist who has special training in women’s health (PCOS, amenorrhea, menopause transition) thyroid dysfunction, eating disorders and athlete health.
In today’s chat we speak about:
- The large variety of symptoms & why it’s often misdiagnosed
- What’s going on with our hormones
- PCOS and fertility
- Lean PCOS v Overweight PCOS
- How insulin resistance develops
- Weight management
- Cortisol and stress
- Treatment options for PCOS
- What helps and what is marketing BS
- Endocrine disruptors
- Are weight loss medications an appropriate treatment for PCOS?
Find more from Dr Isobel Smith at her website
And her instagram
We referenced an episode about weight loss medications with Johann Hari that you can watch here.
Izzy also mentioned The Eco Well and the endocrine society website
You can watch us on Youtube
Find us on Instagram
Join us on tiktok
Or join the Facebook Discussion Group
Tell your mum, tell your dad, tell your dog, tell your friend and share the love because WE LOVE LOVE! Xx
See omnystudio.com/listener for privacy information.
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
This episode was recorded on Cameragle Land.
Speaker 2 (00:12):
Hi guys, and welcome back to another episode of Like
con Cat.
Speaker 3 (00:14):
I'm Brittany and I'm Keisha, and I'm here for a
special reason today because not only am I feeling in Flaura,
but I also have the condition that we're going to
talk about.
Speaker 4 (00:22):
Absolutely so we do have a very special guest and
friend of the podcast, doctor Eazy Smith with us.
Speaker 2 (00:27):
This is not Easy's first time on the podcast.
Speaker 4 (00:30):
We had Easy back in twenty twenty one where we
did an episode on PCOS and endometriosis. We then did
an episode on PMDD and today we're going to be
revisiting our episode in a way back in twenty twenty
one to talk about PCOS. The reason for that is
Avarian Keisha does have PCOS and Keish, you've been really
open about that over the last couple of years, spoken
(00:51):
about a lot on the podcast, and well, I shouldn't
say a lot.
Speaker 1 (00:54):
We've dabbled in it, but.
Speaker 4 (00:55):
This is one of those episodes and those topics that
has been requested so so much by you guys, and
it really made us realize that even though we did
touch on a couple of years ago, there's so much
misinformation and misunderstanding about I think a lot of women's issues,
but endometriosis and peacs together. A lot of people conflate
(01:16):
the two. A lot of people don't understand what they
are if maybe they have one. There's a lot of misdiagnosis.
And just to let you know who Isy is again
if you have forgotten, she's an endocrinologist who has a
specialist training in women's health, pea, coss a, menorea, menopause,
throid dysfunction, eating disorders. You really do do it all,
I Isy, And we're so grateful that you're back today
(01:36):
to talk about this very important topic.
Speaker 5 (01:38):
Thanks, Brede.
Speaker 6 (01:39):
Feel quite nostalgic thinking about that episode in twenty twenty one.
Speaker 1 (01:42):
In my podcast.
Speaker 5 (01:43):
Was a bit different then, a bit different.
Speaker 7 (01:46):
That's what we're your been friends it was.
Speaker 5 (01:48):
It was four years ago now, but here we are today, exciting.
Speaker 1 (01:51):
Thanks for coming in.
Speaker 3 (01:52):
My pigos story I think is not all that uncommon.
I was trying to think about this this morning, and
I actually cannot remember when I was diagnosed, but it
would have to be about I think it was about
four years ago.
Speaker 2 (02:02):
Now I have three and a half years.
Speaker 3 (02:05):
Yeah, and like I said, not an uncommon story in
the sense that I had been to at least three
different gps, many of them multiple times over the space
of I would say more than eight years with the
symptoms that I was experiencing, and I was kind of
I guess, I would say that I was going to
them with some complaints about a few things that we
will get into some symptoms I guess of PCOS. And
(02:28):
it wasn't until I actually went and saw a dermatologist.
And I went to see a dermatologist because I had
adult acne really bad along my chin line, that type
that's really sore, quite hormonal, and quite painful.
Speaker 7 (02:41):
And it was through the process of going on a
medication with.
Speaker 3 (02:44):
My dermatologist that I actually got some bud work done
and she was like, this is kind of symptomatic of something.
I want you to go and see an endochronologist. That
is how I ended up finding.
Speaker 7 (02:55):
Out that I had PECOS.
Speaker 3 (02:56):
And what I mean by this story of like a
lot of people find out that they have it through
ways that are not because they're going to their doctors
with PCOS.
Speaker 7 (03:03):
It's as they're.
Speaker 3 (03:04):
Investigating other symptoms or maybe other conditions that they might
be trying to rule out that I think that they
can go. Oh, hang on a second, this all makes sense.
PACs is often really misunderstood. Can you just give us
a brief overview of what the condition is and what's
happening in our body on a hormonal level.
Speaker 6 (03:22):
So pea COS stands for polycystic ovarian syndrome. It's a
bit of a silly name because the ovaries don't have cysts.
It's actually polyphilicular, so lots of followicles and the ovary.
Speaker 7 (03:32):
Pthos we're renaming today.
Speaker 6 (03:34):
Yeah, there's you know, it could be called you know,
ovulatory hyperandrogenism dysfunction syndrome doesn't really flow off the tongue though.
Speaker 1 (03:41):
No one's gonna no one's doing about We'll give it
an acronym.
Speaker 6 (03:44):
So with polycystic ovarian syndrome, it's a very broad spectrum
of different symptoms related to essentially ovulatory dysfunction, So our
ovaries whether they're making too much male hormones, so what
we call hyper androgenism, and that can cause simples increased
body hair, thinning of the hair in our head to
(04:06):
the hyper androgenism aspect. It also can cause ovulatory dysfunction
in terms of missed periods, so fertility or build up
of the endometrium, which is a risk fact for endometrial cancer,
can happen, and we also know its associated increased risk
of metabolic syndrome. There's insulin resistance, increased risk of developing
(04:26):
diabetes or kind of vascular disease down the track, And
really it all flows from abnormal communication from the peture tary,
so a gland in our brain that controls the ovaries
and the ovaries and also our adrenal glands at some point.
But it really is a very broad condition, and some
people might have really severe high levels of androgens, no
(04:46):
periods for years, type two diabetes, all of those metabolic syndromes,
or people might just have an occasional, slightly irregular period.
So I do see p toos in the popular kind
of media into one category, which of course you can't
give individual complex medical advice and explanations in media and
social media. But really it's such a broad condition and
(05:09):
each person's pcos would be kind of different.
Speaker 1 (05:12):
Is that why it's.
Speaker 4 (05:13):
So often misunderstood and misdiagnosed because everyone's symptoms vary so much.
And I guess in saying that. What are the other
variations that we're seeing from person to person. I know
you just gave us two. Why is it misdiagnosed? It's
interesting with Keisha telling me her story because I'm obviously biased.
Speaker 6 (05:29):
I'm an ntochronologist. I'm always thinking about hormones. But if
I had a young woman who was having acne, the
first thing I would think about would be checking her
testosterone levels and thinking about pcos. PCOS occurs in around
one in nine women in reproductive age group.
Speaker 5 (05:44):
So what's really common?
Speaker 6 (05:46):
When I explain PCOS to patients, I say, these are
the four domains I'm worrying about the high levels of androgens,
So increased body hair, you know, acne.
Speaker 3 (05:54):
And their sex hormones just exact.
Speaker 5 (05:56):
Correct androgens at testosterone.
Speaker 6 (05:57):
Okay, So we see with their poolicular all of these
little follicles develop and rather than one follicle develop into
the main one that's then ovulated, and that's how fertility happens.
We ovulate and if that is fertilized, it becomes a pregnancy.
If it doesn't, you make progesterone. Then those hormone that
wills drop and you have a mental period. If you
(06:18):
don't ovulate, you don't have that increase in progesterone, and
so you don't have the trigger to then have a
mental period. So in PC West you've got lots of follicles,
hence the name polycystic should be polypolicular, and they make
more testosterone compared to estrogen than normal. So the increased
you know, acne, body hair, that's what we call the
hyperandrogenism symptoms. And then the irregular periods because you're not ovulating,
(06:43):
so people might have you know, we say a period
more than thirty five days is abnormally long a cycle length,
so kind of or definitely if there's less than eight
periods per year, we call it oligomenarrhea, or they can
have the term amenarrhea, which is no periods.
Speaker 5 (06:58):
And then that's all.
Speaker 6 (07:00):
If you're not ovulating, you can't conceive your pregnancy, so
fertility is an issue. And then because there is this
insulin resistance associated with it, there is those metabolic syndromes
of diabetes challenges. You know, people find it hard to
lose weight with PCE your West. And the other fourth
domain that I always talk about is there is an
increased risk of mental health conditions anxiety and depression, and
for my patients with PCE.
Speaker 5 (07:21):
Your WES, I always do some type of.
Speaker 6 (07:22):
Validated mental health screen because we know that's really common.
It's a bit of chicken or egg. Is it the
abnormal hormones that are causing the piece your west or
is it the symptoms of PC your WES impacting someone's
mood and mental health. So in reality, I think it's
a bit of both. Why it's misdiagnosed. It's also because
they are non specific symptoms of you know, in saying that,
(07:44):
I can't believe it's misdiagnosed. If someone has a regular
periods that needs to be investigated and not someone just
put on the pill that's a band aid. It has
a useful role appeal in PC your WES, but we
need an underlying diagnosis.
Speaker 1 (07:55):
Well, you're not finding out the source of the issue.
Speaker 5 (07:57):
Ie you're like, oh, this will fix whatever it is exactly.
Speaker 6 (08:00):
And I think part of the issue is our medical system,
with fifteen minute appointment seeing a different doctor every time,
you can't have and I'm really lucky I have forty
five minutes with my patients the first time I meet them.
I also see p tos incorrectly diagnosed. Sometimes a young
woman might have irregular periods because she's developing an eating
disorder and she has one pimple and someone goes, oh,
(08:20):
you've got PCOS, and then she's told to lose weight
and just exacerbates the eating disorder more or it's also
because it's really common to have those polycystic findings on
ovary in young women, so their diagnostic criteria actually changed
twenty twenty three that we don't look at the overy
criteria for diagnosis in women who were, you know, less
(08:41):
than around ten years after their first period. And again
I often see women have an ultrasound at eighteen, they're
told they have PCOS when they really didn't. And I'm
often educating women later in life, no, you never had
this condition.
Speaker 1 (08:53):
You had a normal.
Speaker 6 (08:55):
Variant of polypolicular overrets, which is common in about thirty
percent of people, especially young women.
Speaker 7 (09:00):
That's really interesting because I remember getting that pelvic culture
sound and I remember looking at the screen and going.
Speaker 1 (09:05):
What are those bubbles?
Speaker 7 (09:07):
Policr slot is going on there?
Speaker 3 (09:09):
And it turns out that yes, they did also have
I thought it was PCO. So the polycystic ovaries maybe
it was poly.
Speaker 6 (09:17):
It is still called polycystic ovaries. It's just I'm being
a nerdy doctor who's pernickety about terms.
Speaker 1 (09:22):
But yes, I think it's used people. It's definitely PCOS.
Speaker 3 (09:26):
But I do think it's important. And the thing that
I thought was quite interesting that the time it was
you who told me this is is that having cystic
ovaries does not mean that you have polycystic avarian syndrome
and de vice versa. And I think this also kind
of comes into how it is quite a hard condition
to diagnose because I had elevated.
Speaker 7 (09:45):
Levels of androgens.
Speaker 3 (09:47):
But your hormone levels can change throughout the day, even
like not even from day to day or week to
week or month to month, it can be within the
same day based off of a lot of different things.
Speaker 5 (09:56):
And I do.
Speaker 6 (09:57):
Worry that there's this increase in at home hormone testing
or seeing a non medical practitioner who has in inverted commas,
done blood work analysis training, and there is so much
emphasis on a blood test result, and really a blood
test is one data point in time.
Speaker 5 (10:15):
It does not tell you the whole picture.
Speaker 6 (10:16):
And that's where the clinical experience is incredibly important. And
I do think doctors get a bit of a bad
rap at times, understandably, but we cannot expect gps who
are generalists who can relocate a shoulder, do a newborn
baby check, look after someone in pregnancy cut out of
skin cancer, to be experts in, for example, polycystic go
(10:36):
varian syndrome. But what we need is better education to
know when to maybe refer to a specialist if required.
But yes, large cysts are not pcos at all. Large
cysts are a large cyst and they're painful, whereas polycystic
go varian syndrome doesn't have large sists and isn't a
painful condition.
Speaker 5 (10:54):
We see that confused in the media all the time.
Speaker 4 (10:57):
So does PCs cause fertility issues? And if so, why
if you've still got your period? Sorry, I mean the
actual assists themselves.
Speaker 6 (11:05):
So if you are ovulating each month, you have a
chance to conceive a pregnancy. What I see with women
with PCOS is they might have a forty five day
length cycle, So that means for rather than twelve chances
per year to conceive a pregnancy, they've only got eight
chances per year to conceive a pregnancy. Now with PCO wes,
I'll just quickly briefly explain the diagnosis. We say people
(11:28):
need to have two of three things, and that is
the irregular periods, high levels of androgens, and the polycystic
over refindings on ultrasound. Now we also include a high
level of AMH the egg reserve test antimilarian hormone, so
you know two of those three. Then we also further
categorize it to lean pcos or overweight PCOS. It's a
(11:50):
bit of a silly definition because if someone has a
BMI of twenty four point nine, they're counted as lean pcos,
but if their bm is twenty five point one, they're
overweight PCs. In reality, it's more if there's that obvious
insulin resistance type two diabetes, So if someone is having
irregular cycle length, their fertility can be impacted. And also
if they have some of those associations, so you know,
(12:10):
insulin resistance, mild type two diabetes, carrying excess weight obesity,
that can also impact fertility as well. So fertility is
an issue with pcos. In saying that lots of people
with pcos have no fertility problems, they might more have
the high androgens whereas their menstrual cycle is fine is can.
Speaker 7 (12:27):
We talk about insulin resistance?
Speaker 3 (12:29):
And I think it actually kind of couples with this
whole fertility conversation. I think a lot of the peacos
things that all kind of goes hand in hand. Is
insulin resistant pea costs a separate condition to other pea costs,
or how does that work? And what is insulin resistance?
Speaker 6 (12:43):
So insulin is a hormone a pancreas makes to help
glucose get inside our cells. It's also important for fat
storage and energy balanced metabolism. Insulin resistance is when your
body doesn't respond to insulin properly and you need to
make higher levels of insulin to achieve, you know, the
job that inchulin does. Most people with pcos have some
(13:04):
degree of insulin resistance, and they're probably also sensitive to
insulin resistance. So we've done studies where we give people
high levels of insulin through a drip, high levels of glucose,
high levels of insulin, and we see the petuatory so
the gland that controls the ovaries, the balance of the
LH and the FSH, which we're getting pretty scienti here,
(13:25):
but that is part of the underlying cause of pcos
is high LH to FSH ratio. We see the high
levels of insulin cause that. So it's probably that people
who have insulin resistance and their petuittory is very sensitive
to that insulin resistance are the ones at risk of
developing pcos because lots of people have insulin resistance and
don't have pcos, and most people do have a degree
(13:47):
of insulin resistance the figures are quoted about seventy five
eighty percent, but some people it might be so mild
that it's not picked up in standard testing. The data
we have is based on these really fancy studies called
like a you know, insulin a hypoglycemic clap test, where
we get someone in the lab, we give them, you know,
a glucose and insulin infusion, and we can pick up
even mild insulin resistance. That's not appropriate for the everyday person.
(14:11):
They're not going to go and sit in a research
lab for six hours, but we do see people who
are you know, lean, are more likely to have insulin
resistance if they have pcos compared to someone who doesn't
have pcos. So, you know, the insulin resistance is a
part genetic and lifestyle factor, and most people with pcos
have some degree of insulin resistance, and that's why most
(14:32):
people respond so beautifully to a medication like met foreman
or you know, the supplements mino or in isatol and exercise.
Speaker 3 (14:40):
So I remember with my diagnosis, I got lots of
bloods done over the course of a couple of different months,
and I also had to do a glucose tolerance test.
And so I think a lot of women who are
pregnant will be familiar with this because it's just.
Speaker 5 (14:53):
Sure, it's chilled. Yeah, it's similar, exactly the same.
Speaker 1 (14:58):
Yeah.
Speaker 3 (14:58):
So basically, you go into the doctors off s, you
get your blood taken, you drink the most disgustingly sweet
drink I have ever had in my life. I actually
had to lay down multiple times because I thought I
was gonna vomit.
Speaker 1 (15:09):
It was disgusting.
Speaker 6 (15:10):
Imagine doing that I'm pregnant or me or my heart
goes out. People vomit sometimes and then poor things have
to go and do it again.
Speaker 3 (15:16):
Yeah, and so I had blood taken an hour later,
and then another hour later, so two hours post drinking
this syrup.
Speaker 7 (15:23):
And I remember being a little bit.
Speaker 3 (15:25):
Confused by this because I was told that I like
passed the test by the standard of type two diabetes,
so I knew that I didn't have type two diabetes.
But from what I remember, and this was years and
years ago, my endochronologist did say, like, you're showing quite
severe signs of insulin resistance, and this is why we
need to go down a bit of a medication path.
(15:45):
Can you explain how a medication that impacts insulin impacts
or I guess, alleviates a lot of the symptoms of
PCOS so Keysha.
Speaker 6 (15:55):
It's a great example that we need to have a
lot of experience when we look at test results, because
something can be just within normal range. That's very different
if the levels are right at the lower end of
the reference range. And your endochronologists probably also looked at
something called sex hormone binding globulin, which is lowered in
insulin resistance. It probably looked at your trackless rides, your
(16:17):
liver function tests, all of these things together and made
her think I know her because I work at her practice.
Speaker 3 (16:24):
Yes, And also I remember taking the sheet to you
and being like, is he I got my results?
Speaker 7 (16:27):
I got a patient coffee.
Speaker 1 (16:28):
Do you want to have a look at them?
Speaker 6 (16:30):
And so they would have put all of those things
together and said, you probably have some degree of engine resistance,
and so we give a medication. Usually it's met Foreman
is the first line we know. It has a lot
of evidence for lowering androgens and improving menstrual cycle, and
it improves our cells ability to respond to insulin. It
also decreases how much glucose our liver makes, and therefore
(16:53):
we are decreasing how much insulin we're making, and that
is improving the peturre tree from the message from the
brain to the ovary that LH to FSH ratio also
benefiting the ovaries themselves are sensitive to the high levels
of insulin, so lowering the insulin levels improves that dysfunction
that is causing the increased androgens and the irregular mental cycle.
Speaker 5 (17:16):
Also can help with weight loss as well. For patients
with pcos as well.
Speaker 4 (17:21):
Can you completely cure pa cores once you have it,
or do you just get it to a manageable, maintainable
let It's.
Speaker 5 (17:27):
A great question.
Speaker 6 (17:28):
So someone will always have a disposition to having pcos.
For example, Keisha, you probably have a degree of genetic
insulin resistance with a genetic predisposition to PCOS. We know
it runs in families. However, again it's individualized. But someone
can have lifestyle changes, maybe they lose a little bit
(17:49):
of weight or their own foreman and there is no
evidence of their PCOS. Could they develop PCOS again in
the future, definitely, But you can manage it and have
all of the symptoms managed, you still have that predisposition is.
Speaker 3 (18:01):
I'd love to talk about weight, and I just want
for everyone listening to be aware of the fact that
this is a pretty complex conversation to have because we
live in a society that is fat phobic. We have
had so much diet culture messaging. I even remember when
I was diagnosed with lean pea costs. I remember saying
to my doctor, firstly, I don't feel lean. I feel
like I can look at food, I could sniff it
(18:24):
and put.
Speaker 7 (18:24):
On weight from it.
Speaker 3 (18:25):
Like that's kind of the relationship that I had with
food to the point where I never felt as though
I had disordered eating from a psychological standpoint. I actually
felt it was though I needed to have that much
control so that I didn't put on excess amounts of
weight because my weight would fluctuate by ten to fifteen
kilos like a yoyo. It's hard to have these conversations
(18:45):
while also acknowledging that talking about weight is a tricky
thing to do. I just want people to be aware
that I know that this could be coupled with disordered
eating like conversation, and I don't want for it to be,
but it is such a hard thing for people with
PEA costs to manage. And I actually would go as
far to say that every single woman I've ever spoken
(19:06):
to who has PEA costs is kind of like, how
do you manage your weight?
Speaker 5 (19:10):
Is?
Speaker 3 (19:10):
How do we navigate these conversations with weight management with
PEA costs? And why is it so important for us
to be aware about weight management?
Speaker 6 (19:19):
Kisha, you've summed it up really well that it is complex,
and I often sign posts with my patients because often, firstly,
also the other association with PCO wears, apart from increased
risk of mental health disorders depression and anxiety, is an
increased risk of disordered eating. And I'm sure in part
that stems from going to doctors and them saying you've
(19:41):
just got to lose some weight, eat less, move more,
and the negative associations they've had with their healthcare system
or within their family. So often my patients are already
really stressed about talking to me about weight, and I
signpost that at the start and say, this is complicated
and and it can be a motive if you don't
(20:02):
want to talk about it today, we don't have to
if you do. And I explain that in PCs, we
have a lot of research that says, you know, I
always say to my patients, I don't care what size
someone is, what you look like in a bikini. I'm
trying to decrease your risk of cardive RASKI disease. I'm
trying to decrease your risk of fertility problems. I'm trying
to make sure don't get diabetes. And that's my goals
(20:25):
and trying to do that in a really health focus
with my patients. I never focus on restriction. I go,
what do we want to add to your life? Let's
add more veggies, fruits, water, exercise, and that's this more
positive mindset, because restriction is a punishment. This is exactly
what I say to my patients. If we restrict and
you have this restriction mindset, you feel like you're being
(20:45):
punished for being who you are. And we're simple creatures.
We don't like punishment, We're not going to do it.
This needs to be an empowering, positive thing. And I
discussed that some weight loss can help with managing the
symptoms of PCR wears. However, even if it doesn't result
in weight loss, increasing exercise, a Mediterranean diet that supports
that underlying insulin resistance can still benefit pcos. In terms
(21:07):
of why people with pcos do struggle with weight to
gain or finding it harder to lose weight, it's a
contentious issue. It's contentious of you know, is it the
PCOS itself that makes it difficult to lose weight or
people who are prone to gaining weight are more likely
to develop pcos. I do see usually for someone who
doesn't have PCOS, we have them on metform and they
(21:29):
don't lose weight. When you put some people on met forma,
and I've have patients who say I have not changed anything.
I went on met forman and I've found it easy
to lose weight for the first time.
Speaker 1 (21:39):
I was the second.
Speaker 6 (21:40):
Yeah, And so that does show that that insulin resistance
and that higher levels of insulin is likely a factor
of why people struggle to lose weight. And our bodies
aren't these simple closed systems the energy and energy out. Yes,
to some degree, that is true, but all of the
factors that impact how much energy is coming in and
how much energy is coming out out is really complicated.
(22:01):
We all know the person who lives off takeaway food
and skinny as a rake, and we believe them, but
we never kind of believe the person that struggles with
their weight who says I'm eating really healthily.
Speaker 3 (22:11):
Oh, I'm so glad you touch on that is because, honestly,
and I'm really also glad that you touch on the
psychological aspect of it, because there is a point where
you're you're sitting in front of it could be a GP,
it could be a partner, it could be a parent,
And I just remember being like, no, but I am,
I am exercising, I am eating well, Like I feel
like I'm being gas lip by my own body. It
(22:32):
was so confusing, and there's so much shame built into
having peacos as well. Like you think about the symptoms
of cystic acne or adult acne, excess hair growth around
your face like.
Speaker 1 (22:44):
Mustache, I'm lucky, unfair.
Speaker 7 (22:47):
Like people with dark hair.
Speaker 3 (22:48):
I can only bloody imagine how much you have to
deal with this. The side effects of peacos suck and
it really can make you play mental mind.
Speaker 6 (22:57):
Gating infertility for young people and about their future health.
So just quickly going back to the weight thing, though,
it is interesting. I was a conference in Boston last
year and they did have studies showing people with PCOS
if they did do the same weight loss intervention as
someone without PCOS, they did still lose similar amounts of weight.
Speaker 1 (23:17):
So that's interesting.
Speaker 3 (23:18):
So we are gasla and maybe, I mean my next
question on that study would be like, okay, what about
long term? You know, what happens after they go off
of this you know, controlled experiment eating plan, what happens next? Because,
like I said, my weight fluctuated so much like a yoyo.
I was able to lose it, but I was also
able to gain it so insanely quickly, and I just
(23:39):
felt like everything was inflamed all the time. I felt
as though I was running along the beach next to people,
but I was dragging a tire. You know, everything just
seemed to be that little bit more hard.
Speaker 1 (23:50):
That's definitely what I.
Speaker 6 (23:51):
Hear from my patience, and I think there needs to
be a lot more research in this area. We do
know that losing about five percent of body weight improves
insulin sensitivity, and that's the therapeutic goal I work with
with some of my patients, especially if they've got the
irregular menstrual cycles and they've got clear insulin resistance. In
saying that, I have like Olympic athletes who have pcos.
(24:14):
They are exercising twenty hours a week. If they exercise more,
it's not going to improve their PCOS. For some people,
this is clearly a strongly genetic issue that needs some medication,
and we haven't really touched on the underlying causes, but
we know things like our in utero exposure to androgens
potentially some endocrine disrupting chemicals.
Speaker 2 (24:33):
How do you have inutero exposure to androgens?
Speaker 6 (24:36):
So what your like mother's levels of androgens were sure
when you were in utero and now there's this humongous
ERAa of research related to endocrin disrupting chemicals. So, like
I said, I've got Olympic athletes with pcos. We know
a lot of sports people team sports. I look through
the Matilda's player I'm like, huh, I want her indochronologist
is you know a lot of women with team sports.
(24:57):
It's about twenty five percent of elite team sports players
have PCOS.
Speaker 1 (25:01):
We're genetically wired to be team players.
Speaker 6 (25:04):
I think maybe the slight high levels of androids in
some role could be beneficial for athletic performance, you know,
another area of research. But I guess what I'm trying
to say is it's not as simple as just eat
less and move more. Some people are Olympic athletes and
they still have PCOS. There is a role for medications
because a lot of people as well might carry some
extra right and they never develop PCOS.
Speaker 4 (25:25):
Having said that, what are some of the other external sources,
like cortisol and stress? What role does cortisol and stress
play in PCOS symptoms?
Speaker 5 (25:33):
That is a great question.
Speaker 6 (25:35):
And there is so much on social media demonizing cortosol
despite it being a life saving hormone. So cortisol is
made by our adrenal glands, and it's important for blood
pressure and blood glucose levels, and that's important for our
stress response. So if we didn't have cortisol, we would die.
Now what I see on social media and it really
(25:55):
upsets me because it's just so wildly wrong, is that
people with PCUS should not be doing high intensity exercise
because high intensity exercise increases corso and corsol causes insinent resistance.
Based on that mechanism, and that's a mechanism, there is
an actual study outcome showing this. Based on that mechanism,
anyone who did radio exercise would have intine resistance and
(26:17):
develop type two diabetes. Anywhere with type two diabetes shouldn't
do exercise. So it's a lot on social media we
see people talking about a mechanism without actual studies based
on people to prove that's correct.
Speaker 1 (26:31):
A few mongering.
Speaker 6 (26:32):
Yeah, but you hear that and you go, oh, that's truth.
It does cause insinal resistance. You know, it kind of
can make sense. But if you look at the outcomes,
you know, especially the who's the guy Huberman loves looking
at mechanisms of animal data and then making claims, you know,
does this massive jump one that that animal data is
consistent in humans, which is a big massive claim, and
(26:54):
then also claiming that that mechanism results in an outcome.
So there's a lot on social media based on mechanisms.
You really want to look at outcomes in people, and
we have lots of studies showing exercise improves pcos in
terms of cortisol. How much does it increase PCO wes
and its role in pcos hard to know because we
really don't have good data. You would have to do,
(27:15):
because cortisol is a home when that goes up and
down literally second to second, minute to minute. To get
good data on this, we would need to be doing
twenty for our your own cortisol collections on people.
Speaker 1 (27:24):
All the time, like every hour, all the.
Speaker 6 (27:26):
Time, yes, exactly, and then seeing how it translates to
their pcos, which we're never really going to do.
Speaker 2 (27:33):
We do know, I will we for you for twenty
four hours if you need to kiss you.
Speaker 6 (27:37):
Okay, but we need you to bridges volunteers there, but
you need to you'd have to do it continuously, so
right again, But I do see that stress does impact
reproductive health, both turning off periods and PCAL west stress.
We can't recover if we're constantly stressed, and if we're
not recovering, our levels of inflammation stay high. And yes, definitely,
(27:58):
I do think psychological stress would have an impact on
people's pcos and their functional hapsthomic aim and area. But
it's not the causal that's the problem. It's the behaviors
that are driving the chronic stress.
Speaker 4 (28:10):
It's frustrating, isn't it, Because and we've spoken about this
in other aspects when we talk about infertility, people trying
to feel pregnant. The impact that stress has on the
body is huge. But no one in the history of
ever stop stressing when a doctor says you need to
stop stressing. So it's one of those things that you
understand what stress tells to your body, and you understand
the negative impacts.
Speaker 1 (28:30):
It's very hard to tell yourself.
Speaker 6 (28:32):
And then it's hard as well because we don't have
clear tests to do to go, Okay, your stress levels
are seven out of ten, let's bring them down to
five out of ten. Because I can see X y
Z parameter. Sometimes I joke that I'm a fatiguologist. When
a patien sees a GP and they've done all the
tests and they're just still really tired all the time,
they refer to an endochronologist for in inverted commace hormonal imbalance.
(28:53):
Hormonal imbalance is not a diagnosis.
Speaker 1 (28:55):
It's a blanket state.
Speaker 5 (28:56):
It's a blanket statement.
Speaker 6 (28:58):
But I will see people for their fatigue and I'll
do all the tests. I'll make sure do they have
Celiac disease. I check them for sleep apnea, I'll check
for insulin resistances, all these thyrol and of course things
that can cause fatigue. But often then I have a
good chat with them. I go, Okay, so your dad
died a year ago. Then you were made redundant in
your job six months ago. Oh, and you've been doing
your MBA on top of this, and.
Speaker 2 (29:19):
You've had a miscarriage, and you've got yeah, all these things.
Speaker 6 (29:22):
And they really want a abnormal test result, and I go,
this is real. You know you have a condition, and
that's called chronic stress, unrelenting stress, and that has really
negatively impacted your health. Do I have a clear test
that I can go, Like I said, you're an eight
out of ten stress, let's bring it down to a six.
Speaker 5 (29:39):
No, I don't.
Speaker 6 (29:39):
But I am a doctor and I've had those stressful
periods and I know how much impacts your body. And
I don't need a test result because I'm so in tune.
I would say with my health to know, okay, this
is you know, this is bad. I need to make
some changes. So subjective, Yeah, and but It's hard because
we want to label, and as I always say to
my patients, my job isn't to tell you there's nothing
(30:01):
wrong with you at stress. My job is to exclude
absolutely everything that could be a medical condition and help
you with the managing the stress. Let's look through things
very objectively, so we shouldn't ever put someone's symptoms or
condition just down to stress. We need to exclude everything else.
But I guess what I'm trying to say is chronic
stress really does impact our health. We don't have clear
(30:22):
ways of measuring it, but it is real even if
there isn't an abnormal test result, and doesn't mean you
don't deserve to try and work on some you know,
intentional lifstyle changes to make things a bit less stressful.
Speaker 5 (30:33):
But again, you can't just you know, okay, cool, I'm stressed.
Speaker 6 (30:36):
Let me take this stress supplement and now I don't
have all these challenges in my life.
Speaker 3 (30:40):
Speaking of supplementation, I would love to get your take
on the amount of social media content that is, you know,
to target or monal imbalances. I'll put that in quotation
marks for everybody. And I guess all of these not
so much evidence based content or supplements and things that
you can purchase.
Speaker 7 (30:59):
How do you feel about them? And how do we
spot the difference.
Speaker 6 (31:01):
First thing, the reason why we're saying an inverted commace
hormone imbalance is because we have literally hundreds of hormones
and we either usually have a deficiency or an excess
of hormone. So there isn't really such a diagnosis of
a hormone imbalance. Yes, maybe we could say PCs is
slightly higher androgens than estrogen. Have a you have excess androgens.
(31:21):
That's the diagnosis. All three of us here me much
less than brit They have some degree of social media
platforms and we can just acknowledge we get messages from
companies going, hey, do you want to promote this supplement?
You know, we'll pay you this much to do a post. So,
just as an FYI, anytime you see an influencer who's
(31:42):
recommending a supplement, it's probably just because she's had a
DM asking her to, you know, promote that supplement. I
occasionally do pay to ads, but sounds wanky and I
sound like the influence er I'm bagging out, But it
would only ever be something I really believe in, and
as a doctor, I can't recommend any TGA approved supplement anyway,
So for mebe more something daggy like these are my
(32:03):
favorite runners, and I know running Shop gave me a
bit of a discount. You know, the whole new world
of advertising. Influencers have a lot of trust with their audience,
and that builds on that trust. So of course the
audience will go, they look great, their skin's wonderful. You know,
maybe I should have that supplement. It's not actually treating something.
You need to have a diagnosis and know what you're
(32:24):
trying to treat. There are definitely supplements that are beneficial,
but a generic supplement for a hormonial condition just doesn't
really make sense. Maybe some of them have insulin sensitizing agents,
they've got some cinnamon or you know, some other good things. However,
I have had patients who have taken general hormone supplements
and ended up in my clinic room profoundly low thyroid
(32:47):
hormones because they've taken a supplement with you know, whopping
doses of iodine, or I've seen people with the other
really high levels of fired hormones because of supplements.
Speaker 4 (32:57):
So that like I'm just thinking, now I've had these
people's asking me to advertise supplements, and I've advertised supplements
before in the past, but there's always been things that
I've already taken. Having said that, I might have been
taking supplements like you just said that I thought were
doing good for me and adding to my general supplements
that are like multi vitamins and stuff for women because
(33:18):
we're always told women should be taking multivibmins and stuff.
Speaker 2 (33:20):
I take multi vitamins.
Speaker 1 (33:22):
Is that not a thing for.
Speaker 6 (33:23):
My thoughts with supplements, I say to patience, if you're
lowing something, yeah, a multi vitamin is not going to
be enough to bring it up. And if you're not
lowing it, you probably don't need it. So a multivitamin
is lots of different things and a little bit of them.
They probably don't hurt. We keep doing studies of meta analysis.
Do multi vitamins help? They're probably not going to do
(33:43):
any harm?
Speaker 1 (33:44):
Yeah, right, So if it's going to place ebo you.
Speaker 6 (33:46):
Yeah, it's probably not going to do any harm. There
are definitely supplements I recommend, you know, vitamin D, magnesium,
sometimes zinc.
Speaker 1 (33:53):
I take magnesium.
Speaker 6 (33:54):
Yes, it's really good for praying that any women's health
issue you know peer mess, painful periods, perimenopause.
Speaker 5 (34:01):
Magnesium is great.
Speaker 6 (34:03):
So I do often prescribe supplements, but I'm prescribing a
specific supplement for a specific condition.
Speaker 5 (34:09):
Yeah.
Speaker 6 (34:09):
It's a bit like, oh, you've got a medical condition,
I'm just going to throw a handful of tablets at
you and hope it works.
Speaker 1 (34:13):
It will take.
Speaker 3 (34:14):
But it's also on the patient side. And I've been
this person. That's why I can say it.
Speaker 7 (34:17):
I was in a.
Speaker 3 (34:18):
Vulnerable place where I was just looking for help. I
just wanted answers, and I wanted something that was going
to make the inflammation and the side effects that I
was experiencing from peacos go away. Like I just wanted
them to reduce. And so I was like, I'll try
anything something that I know a lot of people, they
really like a lot of people with peacos. I mean,
is the innocatol Am I saying that right?
Speaker 7 (34:37):
Oh?
Speaker 6 (34:37):
I literally four years ago when I ran on this podcast.
I think I pronounced it wrong, and I'm still pronouncing
it wrong. My inercatole, okay, is a insulin sensitizing supplement
and it does have some evidence for PCOS. I would
usually use met Foreman, because it's funny how we don't
mind taking a supplement. We don't want to take a pharmaceutical.
(34:57):
When a pharmaceutical is highly regulated, we know what's in it,
whereas a supplement, depending on where it's made, it can.
Speaker 5 (35:03):
Be lots of other stuff.
Speaker 6 (35:04):
But yes, that is a supplement does have some evidence
for PCs, mainly through improving insinal resistance.
Speaker 3 (35:09):
So for anyone listening, I take met form at the
moment to improve my insulin sensitivity. What are some other
medicinal options for people, whether it be to alleviate a
side effect of pea costs or to actually try and
treat the underlying cause.
Speaker 5 (35:22):
Wonderful question.
Speaker 6 (35:24):
I'm going to briefly touch on lifestyle because there's heaps
on social media. It's not complicated. It's a Mediterranean diet,
moderate carbohydrate. Low carbohydrate diets haven't been shown to be
really more effective than a Mediterranean style diet. Then it's
exercise in line with the National Physical Activity Guidelines thirty
minutes of moderate figgro's physical activity most days, two strength sessioning.
(35:46):
So not rocket science, just you know, literally pretty much
the recommendations for the general populations.
Speaker 1 (35:52):
It well and move your body yeah.
Speaker 5 (35:54):
Exactly, and I really do.
Speaker 6 (35:55):
The Mediterranean diet does have quite a lot of evidence,
so I'd really recommend that.
Speaker 1 (36:00):
And it's delicious exactly.
Speaker 6 (36:01):
Olive oil, lots of veggies, not too much red meat,
some lean proteins, and good quality carbo hydrates, low GI carbohydrates.
Speaker 5 (36:09):
So that's the lifestyle. Then the exercise.
Speaker 6 (36:12):
High intensity exercise increases a protein called sex hormone barding globulin,
which is like this protein that is a sponge and
will sponge testosterone, which is great. The high levels of
exercise can also decrease LH and improve that LH to
fsh race theorem. So for most of my PCOS patients,
that's why I want to cry and bang my head
against a wall when they've said they've been too scared
to do high intensity exercise, because they're worried all worse
(36:33):
than the PCOS, so please do it well.
Speaker 3 (36:35):
I also think that there's a because we can sometimes
have excess testosterone. I always felt as though I would
put on muscle quickly, and because I was already kind
of trying to alleviate weight gain, I was like, I
don't want to look bigger, musty as well?
Speaker 6 (36:47):
Ask any you know, gym junkie guy who eats chicken
and broccoli and brown rice ten times a day and
works out four hours a day, you're not going to
get bulky.
Speaker 5 (36:57):
And the levels of testosterone, they're not that much higher.
Speaker 6 (37:00):
You might have had a testosterone of two point two
and normally is you know, about one point five. So
the absolute levels aren't that high in terms of pharmaceutical
and medication. So it's all about what we're trying to achieve.
So if I have a young woman who hasn't had
a period in two years and she's got a build
up of the lining of her endometrium, so that's the
(37:21):
lining of the uterus, which means she's at risk of
endometrial cancer. She doesn't want to have a pregnancy anytime soon,
I'm going to say, I think we should prop you
on the pill because we just need to look after
this endometrium right now, and that's my priority. If so,
you know, to get cancer, because pcos can be a
rispect for endometrial cancer. If someone is, you know, in
their early thirties and maybe wanting to conceive a pregnancy sometime,
(37:43):
of course I'm not going to put them on the
pill because we're trying to improve their ovulatory function. I'm
going to have the moon met foreman, I'm going to
be doing all of the lifestyle things. And you know,
that's really the evidence for improving menstrual cycles. If their
high levels of androgens are more of the problem, we
might talk about spirinalacton, which is an anti androgen medication,
(38:03):
so it blocks the testosterone receptor. And then after maybe
they've had their children, we might think about going back
on the pill. Yes, the pill is not going to
fix the underlying pc you're west. However, it will help
manage the symptoms. And that's why the pill understandably gets
a bad rap, because the eighteen year old girl with
PCOS gets put on the pill and he's told, don't
(38:24):
worry about your PCUS until you want to conceive it pregnancy.
She comes off at thirty four and her periods don't
come back, she's got acne, and she goes, holy crap,
I've got this terrible PCOS that I haven't worked and
I haven't managed and I didn't know about And at
thirty four, you know, we know fertility starts to decline
at thirty five. Maybe she would have tried to conceive
pregnancies earlier on if she knew she only had eight
(38:47):
chances per year crying to conceived, compared to most people
have twelve chances per year. Anyway, what I'm also saying
now it shows how individualized it is. It's all about
the individual in front of you and what their management
priorities are. So there's never going to be blanket advice
for everyone.
Speaker 3 (39:02):
What about pretty controversial one at the moment weight loss medications?
So doop ones Semaglue, tide is MPIC, we go v
Munjaro I think is another one. We've also done a
whole episode on these with Johan Hari that I will
link in the show notes for anyone about those weight
loss drugs? Are they an adequate or a.
Speaker 7 (39:20):
Good choice for a medication for someone with peacoss?
Speaker 5 (39:23):
Firstly, that episode you did was wonderful.
Speaker 7 (39:25):
Oh thank you.
Speaker 6 (39:26):
I think it explained the nuance of these medications so
well because we live in a society that likes to
be really divisive and reality things are much more complicated.
I do commonly prescribe these medications doop one agonists. They
have evidence for decreasing heart attacks, strokes, heart failure. Does
that mean they're right for everyone, of course not, but
(39:46):
they do have a really beneficial role for some people,
and they are very effective for weight loss and improving
insulin sensitivity, so acting on the liver to decrease the
glucose production from the liver, decreasing fat in the life
that's causing into the resistance. So they do have definitely
a role. You can't conceive a pregnancy on these medications.
(40:06):
We don't have safety data, so I will have For example,
if I had a young patient who was not wanting
to conceive a pregnancy for a while, maybe she was
twenty eight or thirty, and I know she has quite
a few years before her fertility really declines, and she
had pco wes and other complications from her weight, maybe
mild type two diabetes, high blood pressure, I might say
(40:28):
to her, how about we try and focus on a
little bit of weight loss to improve those things, improve
your fertility and decrease your risk of early miscarriage and
still birth. We do know a b CD, especially at
those quite higher levels, are associate with increased pregnancy complications.
And it's I'm going to say again, it's really complicated
and challenging discussing weight because you know, I never talk
(40:51):
about weight on my social media because it's such a
nuanced thing. And I will have talked to the individual
in front of me, and I'll have these balanced conversations.
But I will sometimes, as I said with that imaginary patient,
I might try and use a geo people and to
help some weight come down. Betwe improve fertility and improve
fertility outcomes, we would stop it before they were trying
to conceive.
Speaker 4 (41:10):
Interesting speaking about fertility, just so the people at home
listening right now really understand it. Because the one thing
you hear the most is people say, oh, I've got
pea cos I'm not going to be able to full pregnant.
Speaker 1 (41:20):
I've got peacos.
Speaker 4 (41:21):
It's going to be really hard to be in a
full pregnant even if they have their periods and a
regular cycle, they still are convinced.
Speaker 1 (41:27):
From the fumal road.
Speaker 4 (41:28):
And everyone that's just spreading this information, what would you
say is the best approach for somebody that is in
that situation that wants to conceive naturally.
Speaker 6 (41:37):
So my recommendations to my patients is if you have
a regular menstrual cycle and you are less than forty,
and definitely if you're less than thirty eight. You are
fertile until proven otherwise. And it's such an irony because
there's a market trying to get women to test their fertility,
which really we do not have accurate tests for. We
can test male fertility very easily, but hey, there's no
(42:00):
fear mongering businesses focusing on men's fear. Really, they just
do a semen analysis and you can test they're fatility
much more accurately than their females. So I would say
to my patience, and I say this all the time,
if you have a regular mental cycle, you are ovulating.
You don't have a fertility condition that you're aware of,
such a severe and demetriosis, And even if you do,
you know you are fertile until proven otherwise. The best
(42:22):
test of fertility is trying to conceive, and it's hard
because most things in life we have control over. We
can try and make some order from the chaos, but
fertility is much more challenging, and you've kind of just
got to wait until you try. You know, make sure
you are ovulating, you don't have any fertility disorders. But
the best test is actually wait until you conceive. The
(42:42):
biggest impact though of fertility is age. Unfortunately, most people
up until they're forty ken conceive a pregnancy. It just
might take them longer because more of their eggs have
DNA damage. So at thirty five, about fifty percent of
our eggs have DNA damage.
Speaker 5 (42:56):
So it needs each month.
Speaker 6 (42:57):
It's about a fifty to fifty chance of if it's
a inverted COmON good egg So yes, fertility, regular menstrual cycle.
Speaker 5 (43:04):
And if you are worried about.
Speaker 6 (43:05):
Your fertility, I would say talk to your doctor if
there's anything you can do or any concerns.
Speaker 3 (43:09):
Last one for me, I've seen a lot of social
media flodd about endocrine disruptors to the point where I've
actually been a little bit concerned about things like perfumes,
and I've tried to limit my use of perfumes knowing
that we were going to speak to you and I
could find out whether it was actually something I needed
to be worried about.
Speaker 2 (43:26):
And like incensors and things like burning your home, and.
Speaker 6 (43:29):
Endocrine disrupting chemicals EEDCS for short is a terminology we
use for things in our environment, either natural or synthetic,
that impact power or hormones work. So it could impact
the actual hormone or could block the receptor or activate
the recept.
Speaker 1 (43:46):
So just a smell in the home can do that.
Speaker 6 (43:48):
It's actually the things that have the main evidence is pesticides,
so you know if you're a farmer or exposed to
lots of pesticides. The next one is plastics, so increasing
research into kind of microplastics and forever plastics. There's a
great podcast actually on a science versus if anyone wants
on intercrind disrupting chemicals and plastics. And the other one
(44:10):
is kind of cosmetic products. Most of the cosmetic products
that do have proven endocrind disrupting chemicals, especially in Australia,
are not really available anymore. So there has been a
lot of change. Europe has really led the way in this.
But they are chemicals very very small that can impact
our natural you know, how our hormones work. So it's
hard because we don't have good evidence in terms of
(44:32):
what we call a randomized control trial. We can't say
to a group of people, okay, you wear pesticides and
eat out of microwave plastic containers for ten years and
this group don't. That would be a randomized control traer.
All we can do is what we call observational data,
where we have a group of people and ask them about, okay,
do you heat your food in this? Or look at
their levels of microplastics, and that's where we find associations.
(44:55):
But we can't find good causation in saying that we
do have in increasing data that you know, some of
these endocrime disrupting chemicals will impact fertility, probably through our reproductive.
Speaker 5 (45:06):
Hormones or our thyroid hormones.
Speaker 6 (45:07):
But it's mainly the people that have the very high
level of exposure.
Speaker 5 (45:11):
We live in our world.
Speaker 6 (45:12):
We can't live in a bubble and not have some exposure.
Speaker 2 (45:15):
Can't avoid it in this damage, can you.
Speaker 6 (45:16):
But the recommendations I say is try and avoid plastics.
Speaker 1 (45:20):
So like here up food.
Speaker 6 (45:22):
Here I am with my plastic water bottle, but don't
microwave food in plastics. Try and stall things if you
can in glass containers. If you've got a plastic water bottle,
if the water's been sitting there for hours, it's been
in your car for twenty four hours and it's sat
in the sun, I wouldn't drink out of that water.
Speaker 2 (45:37):
God, I've done that so many times.
Speaker 5 (45:39):
And you know obviously pesticides.
Speaker 6 (45:41):
My family a farmers, so this is relevant, maybe less
relevant to many other people. But you know, if you're
own gardening and you're using pesticides, very clear safety and
then you know checking your makeup products. But again most
makeup products in Australia now the mums manufacturing has changed.
Speaker 1 (45:57):
Is that the same for perfume.
Speaker 3 (45:58):
I don't know why I've seen so much specifically on
fragrance in terms of endigrine disruptor social media content.
Speaker 6 (46:04):
I think probably because it's women who use makeups, so
that would be getting a lot more attention. I can't
give specifics on makeup and perfumes as much because there's
so many different types of products.
Speaker 5 (46:17):
There's a few great people on social media. Can I
mention some? Yeah, there's someone.
Speaker 6 (46:21):
Called the eco World that does great posts on this,
and the Endocrime Society website that's getting pretty sciencey.
Speaker 1 (46:28):
But seems like a good place to go. Yeah, that's the.
Speaker 5 (46:31):
US Ndocrime Society. I'm going to a conference there soon.
Speaker 6 (46:34):
Have some great resources, as do almost Australia website. But yes,
the main things would be, you know, really plastics and
for pesticides are where most of the research is at.
Speaker 3 (46:43):
Okay, Well, I Isy, I think you're just the most
wonderful person. You are someone who has helped me so
much in my peacos journey. I really appreciate you just
being able to turn to you and ask you a
lot of questions. And I hope today's episode for anyone
listening has either been really validating in the sense that
you might have peacos and you just wanted to learn
a little bit more about it. Maybe we've kind of
dispelled some of the myths about peacos, of which I
(47:05):
just think there are so so, so many.
Speaker 4 (47:08):
Well, it goes back to again, like we say it
all the time, but just to be media literate, just
to know where to look and where you're getting your
information from. There are going to be people sprouting information
that look like really reliable sources and the way they
say things so confidently. But as long as you're going
back to these genuinely reliable sources, there is.
Speaker 5 (47:25):
Like media literacy that is such a good term.
Speaker 2 (47:27):
It is it's like, just be in control of what
you're consuming.
Speaker 6 (47:30):
Yeah, I always say to people, do they have qualifications
and are they working in the field. Someone who did
a medical degree twenty years ago and has never worked
as a doctor or even in women's health.
Speaker 5 (47:41):
That's actually not a good source.
Speaker 6 (47:43):
They need to be recognized by their peers working in
the area involved in research. Contact professional develops a good source.
But no, thanks so much, Keisha, that lovely comment. Maybe
blush before.
Speaker 5 (47:56):
I guess.
Speaker 6 (47:57):
Just to summarize, I would say pos thesis common one
in nine, one in eight women of reproductive age. If
any of those symptoms sound familiar, get them checked out
by your GP. Find a GP with an interest in
women's health. You know, the guy that wanted to do
orthopedic surgery and now does mainly skincats or removals. He's
not the person to go to about your PCUS.
Speaker 5 (48:19):
And that's not blaming him. We just can't be experts
in everything.
Speaker 6 (48:22):
So see a GP with an interest, maybe seen end chronologist,
and you know, hopefully they can help with some of
those symptoms or getting answers.
Speaker 3 (48:29):
And for anyone wanting to learn more from Izzy her instagram.
Her brand new website will also be linked in our
show notes.
Speaker 7 (48:36):
Thank you, you're the best.
Speaker 5 (48:37):
Thanks Keishan Britt. It was really fun
This episode was recorded on Cameragle Land.
Speaker 2 (00:12):
Hi guys, and welcome back to another episode of Like
con Cat.
Speaker 3 (00:14):
I'm Brittany and I'm Keisha, and I'm here for a
special reason today because not only am I feeling in Flaura,
but I also have the condition that we're going to
talk about.
Speaker 4 (00:22):
Absolutely so we do have a very special guest and
friend of the podcast, doctor Eazy Smith with us.
Speaker 2 (00:27):
This is not Easy's first time on the podcast.
Speaker 4 (00:30):
We had Easy back in twenty twenty one where we
did an episode on PCOS and endometriosis. We then did
an episode on PMDD and today we're going to be
revisiting our episode in a way back in twenty twenty
one to talk about PCOS. The reason for that is
Avarian Keisha does have PCOS and Keish, you've been really
open about that over the last couple of years, spoken
(00:51):
about a lot on the podcast, and well, I shouldn't
say a lot.
Speaker 1 (00:54):
We've dabbled in it, but.
Speaker 4 (00:55):
This is one of those episodes and those topics that
has been requested so so much by you guys, and
it really made us realize that even though we did
touch on a couple of years ago, there's so much
misinformation and misunderstanding about I think a lot of women's issues,
but endometriosis and peacs together. A lot of people conflate
(01:16):
the two. A lot of people don't understand what they
are if maybe they have one. There's a lot of misdiagnosis.
And just to let you know who Isy is again
if you have forgotten, she's an endocrinologist who has a
specialist training in women's health, pea, coss a, menorea, menopause,
throid dysfunction, eating disorders. You really do do it all,
I Isy, And we're so grateful that you're back today
(01:36):
to talk about this very important topic.
Speaker 5 (01:38):
Thanks, Brede.
Speaker 6 (01:39):
Feel quite nostalgic thinking about that episode in twenty twenty one.
Speaker 1 (01:42):
In my podcast.
Speaker 5 (01:43):
Was a bit different then, a bit different.
Speaker 7 (01:46):
That's what we're your been friends it was.
Speaker 5 (01:48):
It was four years ago now, but here we are today, exciting.
Speaker 1 (01:51):
Thanks for coming in.
Speaker 3 (01:52):
My pigos story I think is not all that uncommon.
I was trying to think about this this morning, and
I actually cannot remember when I was diagnosed, but it
would have to be about I think it was about
four years ago.
Speaker 2 (02:02):
Now I have three and a half years.
Speaker 3 (02:05):
Yeah, and like I said, not an uncommon story in
the sense that I had been to at least three
different gps, many of them multiple times over the space
of I would say more than eight years with the
symptoms that I was experiencing, and I was kind of
I guess, I would say that I was going to
them with some complaints about a few things that we
will get into some symptoms I guess of PCOS. And
(02:28):
it wasn't until I actually went and saw a dermatologist.
And I went to see a dermatologist because I had
adult acne really bad along my chin line, that type
that's really sore, quite hormonal, and quite painful.
Speaker 7 (02:41):
And it was through the process of going on a
medication with.
Speaker 3 (02:44):
My dermatologist that I actually got some bud work done
and she was like, this is kind of symptomatic of something.
I want you to go and see an endochronologist. That
is how I ended up finding.
Speaker 7 (02:55):
Out that I had PECOS.
Speaker 3 (02:56):
And what I mean by this story of like a
lot of people find out that they have it through
ways that are not because they're going to their doctors
with PCOS.
Speaker 7 (03:03):
It's as they're.
Speaker 3 (03:04):
Investigating other symptoms or maybe other conditions that they might
be trying to rule out that I think that they
can go. Oh, hang on a second, this all makes sense.
PACs is often really misunderstood. Can you just give us
a brief overview of what the condition is and what's
happening in our body on a hormonal level.
Speaker 6 (03:22):
So pea COS stands for polycystic ovarian syndrome. It's a
bit of a silly name because the ovaries don't have cysts.
It's actually polyphilicular, so lots of followicles and the ovary.
Speaker 7 (03:32):
Pthos we're renaming today.
Speaker 6 (03:34):
Yeah, there's you know, it could be called you know,
ovulatory hyperandrogenism dysfunction syndrome doesn't really flow off the tongue though.
Speaker 1 (03:41):
No one's gonna no one's doing about We'll give it
an acronym.
Speaker 6 (03:44):
So with polycystic ovarian syndrome, it's a very broad spectrum
of different symptoms related to essentially ovulatory dysfunction, So our
ovaries whether they're making too much male hormones, so what
we call hyper androgenism, and that can cause simples increased
body hair, thinning of the hair in our head to
(04:06):
the hyper androgenism aspect. It also can cause ovulatory dysfunction
in terms of missed periods, so fertility or build up
of the endometrium, which is a risk fact for endometrial cancer,
can happen, and we also know its associated increased risk
of metabolic syndrome. There's insulin resistance, increased risk of developing
(04:26):
diabetes or kind of vascular disease down the track, And
really it all flows from abnormal communication from the peture tary,
so a gland in our brain that controls the ovaries
and the ovaries and also our adrenal glands at some point.
But it really is a very broad condition, and some
people might have really severe high levels of androgens, no
(04:46):
periods for years, type two diabetes, all of those metabolic syndromes,
or people might just have an occasional, slightly irregular period.
So I do see p toos in the popular kind
of media into one category, which of course you can't
give individual complex medical advice and explanations in media and
social media. But really it's such a broad condition and
(05:09):
each person's pcos would be kind of different.
Speaker 1 (05:12):
Is that why it's.
Speaker 4 (05:13):
So often misunderstood and misdiagnosed because everyone's symptoms vary so much.
And I guess in saying that. What are the other
variations that we're seeing from person to person. I know
you just gave us two. Why is it misdiagnosed? It's
interesting with Keisha telling me her story because I'm obviously biased.
Speaker 6 (05:29):
I'm an ntochronologist. I'm always thinking about hormones. But if
I had a young woman who was having acne, the
first thing I would think about would be checking her
testosterone levels and thinking about pcos. PCOS occurs in around
one in nine women in reproductive age group.
Speaker 5 (05:44):
So what's really common?
Speaker 6 (05:46):
When I explain PCOS to patients, I say, these are
the four domains I'm worrying about the high levels of androgens,
So increased body hair, you know, acne.
Speaker 3 (05:54):
And their sex hormones just exact.
Speaker 5 (05:56):
Correct androgens at testosterone.
Speaker 6 (05:57):
Okay, So we see with their poolicular all of these
little follicles develop and rather than one follicle develop into
the main one that's then ovulated, and that's how fertility happens.
We ovulate and if that is fertilized, it becomes a pregnancy.
If it doesn't, you make progesterone. Then those hormone that
wills drop and you have a mental period. If you
(06:18):
don't ovulate, you don't have that increase in progesterone, and
so you don't have the trigger to then have a
mental period. So in PC West you've got lots of follicles,
hence the name polycystic should be polypolicular, and they make
more testosterone compared to estrogen than normal. So the increased
you know, acne, body hair, that's what we call the
hyperandrogenism symptoms. And then the irregular periods because you're not ovulating,
(06:43):
so people might have you know, we say a period
more than thirty five days is abnormally long a cycle length,
so kind of or definitely if there's less than eight
periods per year, we call it oligomenarrhea, or they can
have the term amenarrhea, which is no periods.
Speaker 5 (06:58):
And then that's all.
Speaker 6 (07:00):
If you're not ovulating, you can't conceive your pregnancy, so
fertility is an issue. And then because there is this
insulin resistance associated with it, there is those metabolic syndromes
of diabetes challenges. You know, people find it hard to
lose weight with PCE your West. And the other fourth
domain that I always talk about is there is an
increased risk of mental health conditions anxiety and depression, and
for my patients with PCE.
Speaker 5 (07:21):
Your WES, I always do some type of.
Speaker 6 (07:22):
Validated mental health screen because we know that's really common.
It's a bit of chicken or egg. Is it the
abnormal hormones that are causing the piece your west or
is it the symptoms of PC your WES impacting someone's
mood and mental health. So in reality, I think it's
a bit of both. Why it's misdiagnosed. It's also because
they are non specific symptoms of you know, in saying that,
(07:44):
I can't believe it's misdiagnosed. If someone has a regular
periods that needs to be investigated and not someone just
put on the pill that's a band aid. It has
a useful role appeal in PC your WES, but we
need an underlying diagnosis.
Speaker 1 (07:55):
Well, you're not finding out the source of the issue.
Speaker 5 (07:57):
Ie you're like, oh, this will fix whatever it is exactly.
Speaker 6 (08:00):
And I think part of the issue is our medical system,
with fifteen minute appointment seeing a different doctor every time,
you can't have and I'm really lucky I have forty
five minutes with my patients the first time I meet them.
I also see p tos incorrectly diagnosed. Sometimes a young
woman might have irregular periods because she's developing an eating
disorder and she has one pimple and someone goes, oh,
(08:20):
you've got PCOS, and then she's told to lose weight
and just exacerbates the eating disorder more or it's also
because it's really common to have those polycystic findings on
ovary in young women, so their diagnostic criteria actually changed
twenty twenty three that we don't look at the overy
criteria for diagnosis in women who were, you know, less
(08:41):
than around ten years after their first period. And again
I often see women have an ultrasound at eighteen, they're
told they have PCOS when they really didn't. And I'm
often educating women later in life, no, you never had
this condition.
Speaker 1 (08:53):
You had a normal.
Speaker 6 (08:55):
Variant of polypolicular overrets, which is common in about thirty
percent of people, especially young women.
Speaker 7 (09:00):
That's really interesting because I remember getting that pelvic culture
sound and I remember looking at the screen and going.
Speaker 1 (09:05):
What are those bubbles?
Speaker 7 (09:07):
Policr slot is going on there?
Speaker 3 (09:09):
And it turns out that yes, they did also have
I thought it was PCO. So the polycystic ovaries maybe
it was poly.
Speaker 6 (09:17):
It is still called polycystic ovaries. It's just I'm being
a nerdy doctor who's pernickety about terms.
Speaker 1 (09:22):
But yes, I think it's used people. It's definitely PCOS.
Speaker 3 (09:26):
But I do think it's important. And the thing that
I thought was quite interesting that the time it was
you who told me this is is that having cystic
ovaries does not mean that you have polycystic avarian syndrome
and de vice versa. And I think this also kind
of comes into how it is quite a hard condition
to diagnose because I had elevated.
Speaker 7 (09:45):
Levels of androgens.
Speaker 3 (09:47):
But your hormone levels can change throughout the day, even
like not even from day to day or week to
week or month to month, it can be within the
same day based off of a lot of different things.
Speaker 5 (09:56):
And I do.
Speaker 6 (09:57):
Worry that there's this increase in at home hormone testing
or seeing a non medical practitioner who has in inverted commas,
done blood work analysis training, and there is so much
emphasis on a blood test result, and really a blood
test is one data point in time.
Speaker 5 (10:15):
It does not tell you the whole picture.
Speaker 6 (10:16):
And that's where the clinical experience is incredibly important. And
I do think doctors get a bit of a bad
rap at times, understandably, but we cannot expect gps who
are generalists who can relocate a shoulder, do a newborn
baby check, look after someone in pregnancy cut out of
skin cancer, to be experts in, for example, polycystic go
(10:36):
varian syndrome. But what we need is better education to
know when to maybe refer to a specialist if required.
But yes, large cysts are not pcos at all. Large
cysts are a large cyst and they're painful, whereas polycystic
go varian syndrome doesn't have large sists and isn't a
painful condition.
Speaker 5 (10:54):
We see that confused in the media all the time.
Speaker 4 (10:57):
So does PCs cause fertility issues? And if so, why
if you've still got your period? Sorry, I mean the
actual assists themselves.
Speaker 6 (11:05):
So if you are ovulating each month, you have a
chance to conceive a pregnancy. What I see with women
with PCOS is they might have a forty five day
length cycle, So that means for rather than twelve chances
per year to conceive a pregnancy, they've only got eight
chances per year to conceive a pregnancy. Now with PCO wes,
I'll just quickly briefly explain the diagnosis. We say people
(11:28):
need to have two of three things, and that is
the irregular periods, high levels of androgens, and the polycystic
over refindings on ultrasound. Now we also include a high
level of AMH the egg reserve test antimilarian hormone, so
you know two of those three. Then we also further
categorize it to lean pcos or overweight PCOS. It's a
(11:50):
bit of a silly definition because if someone has a
BMI of twenty four point nine, they're counted as lean pcos,
but if their bm is twenty five point one, they're
overweight PCs. In reality, it's more if there's that obvious
insulin resistance type two diabetes, So if someone is having
irregular cycle length, their fertility can be impacted. And also
if they have some of those associations, so you know,
(12:10):
insulin resistance, mild type two diabetes, carrying excess weight obesity,
that can also impact fertility as well. So fertility is
an issue with pcos. In saying that lots of people
with pcos have no fertility problems, they might more have
the high androgens whereas their menstrual cycle is fine is can.
Speaker 7 (12:27):
We talk about insulin resistance?
Speaker 3 (12:29):
And I think it actually kind of couples with this
whole fertility conversation. I think a lot of the peacos
things that all kind of goes hand in hand. Is
insulin resistant pea costs a separate condition to other pea costs,
or how does that work? And what is insulin resistance?
Speaker 6 (12:43):
So insulin is a hormone a pancreas makes to help
glucose get inside our cells. It's also important for fat
storage and energy balanced metabolism. Insulin resistance is when your
body doesn't respond to insulin properly and you need to
make higher levels of insulin to achieve, you know, the
job that inchulin does. Most people with pcos have some
(13:04):
degree of insulin resistance, and they're probably also sensitive to
insulin resistance. So we've done studies where we give people
high levels of insulin through a drip, high levels of glucose,
high levels of insulin, and we see the petuatory so
the gland that controls the ovaries, the balance of the
LH and the FSH, which we're getting pretty scienti here,
(13:25):
but that is part of the underlying cause of pcos
is high LH to FSH ratio. We see the high
levels of insulin cause that. So it's probably that people
who have insulin resistance and their petuittory is very sensitive
to that insulin resistance are the ones at risk of
developing pcos because lots of people have insulin resistance and
don't have pcos, and most people do have a degree
(13:47):
of insulin resistance the figures are quoted about seventy five
eighty percent, but some people it might be so mild
that it's not picked up in standard testing. The data
we have is based on these really fancy studies called
like a you know, insulin a hypoglycemic clap test, where
we get someone in the lab, we give them, you know,
a glucose and insulin infusion, and we can pick up
even mild insulin resistance. That's not appropriate for the everyday person.
(14:11):
They're not going to go and sit in a research
lab for six hours, but we do see people who
are you know, lean, are more likely to have insulin
resistance if they have pcos compared to someone who doesn't
have pcos. So, you know, the insulin resistance is a
part genetic and lifestyle factor, and most people with pcos
have some degree of insulin resistance, and that's why most
(14:32):
people respond so beautifully to a medication like met foreman
or you know, the supplements mino or in isatol and exercise.
Speaker 3 (14:40):
So I remember with my diagnosis, I got lots of
bloods done over the course of a couple of different months,
and I also had to do a glucose tolerance test.
And so I think a lot of women who are
pregnant will be familiar with this because it's just.
Speaker 5 (14:53):
Sure, it's chilled. Yeah, it's similar, exactly the same.
Speaker 1 (14:58):
Yeah.
Speaker 3 (14:58):
So basically, you go into the doctors off s, you
get your blood taken, you drink the most disgustingly sweet
drink I have ever had in my life. I actually
had to lay down multiple times because I thought I
was gonna vomit.
Speaker 1 (15:09):
It was disgusting.
Speaker 6 (15:10):
Imagine doing that I'm pregnant or me or my heart
goes out. People vomit sometimes and then poor things have
to go and do it again.
Speaker 3 (15:16):
Yeah, and so I had blood taken an hour later,
and then another hour later, so two hours post drinking
this syrup.
Speaker 7 (15:23):
And I remember being a little bit.
Speaker 3 (15:25):
Confused by this because I was told that I like
passed the test by the standard of type two diabetes,
so I knew that I didn't have type two diabetes.
But from what I remember, and this was years and
years ago, my endochronologist did say, like, you're showing quite
severe signs of insulin resistance, and this is why we
need to go down a bit of a medication path.
(15:45):
Can you explain how a medication that impacts insulin impacts
or I guess, alleviates a lot of the symptoms of
PCOS so Keysha.
Speaker 6 (15:55):
It's a great example that we need to have a
lot of experience when we look at test results, because
something can be just within normal range. That's very different
if the levels are right at the lower end of
the reference range. And your endochronologists probably also looked at
something called sex hormone binding globulin, which is lowered in
insulin resistance. It probably looked at your trackless rides, your
(16:17):
liver function tests, all of these things together and made
her think I know her because I work at her practice.
Speaker 3 (16:24):
Yes, And also I remember taking the sheet to you
and being like, is he I got my results?
Speaker 7 (16:27):
I got a patient coffee.
Speaker 1 (16:28):
Do you want to have a look at them?
Speaker 6 (16:30):
And so they would have put all of those things
together and said, you probably have some degree of engine resistance,
and so we give a medication. Usually it's met Foreman
is the first line we know. It has a lot
of evidence for lowering androgens and improving menstrual cycle, and
it improves our cells ability to respond to insulin. It
also decreases how much glucose our liver makes, and therefore
(16:53):
we are decreasing how much insulin we're making, and that
is improving the peturre tree from the message from the
brain to the ovary that LH to FSH ratio also
benefiting the ovaries themselves are sensitive to the high levels
of insulin, so lowering the insulin levels improves that dysfunction
that is causing the increased androgens and the irregular mental cycle.
Speaker 5 (17:16):
Also can help with weight loss as well. For patients
with pcos as well.
Speaker 4 (17:21):
Can you completely cure pa cores once you have it,
or do you just get it to a manageable, maintainable
let It's.
Speaker 5 (17:27):
A great question.
Speaker 6 (17:28):
So someone will always have a disposition to having pcos.
For example, Keisha, you probably have a degree of genetic
insulin resistance with a genetic predisposition to PCOS. We know
it runs in families. However, again it's individualized. But someone
can have lifestyle changes, maybe they lose a little bit
(17:49):
of weight or their own foreman and there is no
evidence of their PCOS. Could they develop PCOS again in
the future, definitely, But you can manage it and have
all of the symptoms managed, you still have that predisposition is.
Speaker 3 (18:01):
I'd love to talk about weight, and I just want
for everyone listening to be aware of the fact that
this is a pretty complex conversation to have because we
live in a society that is fat phobic. We have
had so much diet culture messaging. I even remember when
I was diagnosed with lean pea costs. I remember saying
to my doctor, firstly, I don't feel lean. I feel
like I can look at food, I could sniff it
(18:24):
and put.
Speaker 7 (18:24):
On weight from it.
Speaker 3 (18:25):
Like that's kind of the relationship that I had with
food to the point where I never felt as though
I had disordered eating from a psychological standpoint. I actually
felt it was though I needed to have that much
control so that I didn't put on excess amounts of
weight because my weight would fluctuate by ten to fifteen
kilos like a yoyo. It's hard to have these conversations
(18:45):
while also acknowledging that talking about weight is a tricky
thing to do. I just want people to be aware
that I know that this could be coupled with disordered
eating like conversation, and I don't want for it to be,
but it is such a hard thing for people with
PEA costs to manage. And I actually would go as
far to say that every single woman I've ever spoken
(19:06):
to who has PEA costs is kind of like, how
do you manage your weight?
Speaker 5 (19:10):
Is?
Speaker 3 (19:10):
How do we navigate these conversations with weight management with
PEA costs? And why is it so important for us
to be aware about weight management?
Speaker 6 (19:19):
Kisha, you've summed it up really well that it is complex,
and I often sign posts with my patients because often, firstly,
also the other association with PCO wears, apart from increased
risk of mental health disorders depression and anxiety, is an
increased risk of disordered eating. And I'm sure in part
that stems from going to doctors and them saying you've
(19:41):
just got to lose some weight, eat less, move more,
and the negative associations they've had with their healthcare system
or within their family. So often my patients are already
really stressed about talking to me about weight, and I
signpost that at the start and say, this is complicated
and and it can be a motive if you don't
(20:02):
want to talk about it today, we don't have to
if you do. And I explain that in PCs, we
have a lot of research that says, you know, I
always say to my patients, I don't care what size
someone is, what you look like in a bikini. I'm
trying to decrease your risk of cardive RASKI disease. I'm
trying to decrease your risk of fertility problems. I'm trying
to make sure don't get diabetes. And that's my goals
(20:25):
and trying to do that in a really health focus
with my patients. I never focus on restriction. I go,
what do we want to add to your life? Let's
add more veggies, fruits, water, exercise, and that's this more
positive mindset, because restriction is a punishment. This is exactly
what I say to my patients. If we restrict and
you have this restriction mindset, you feel like you're being
(20:45):
punished for being who you are. And we're simple creatures.
We don't like punishment, We're not going to do it.
This needs to be an empowering, positive thing. And I
discussed that some weight loss can help with managing the
symptoms of PCR wears. However, even if it doesn't result
in weight loss, increasing exercise, a Mediterranean diet that supports
that underlying insulin resistance can still benefit pcos. In terms
(21:07):
of why people with pcos do struggle with weight to
gain or finding it harder to lose weight, it's a
contentious issue. It's contentious of you know, is it the
PCOS itself that makes it difficult to lose weight or
people who are prone to gaining weight are more likely
to develop pcos. I do see usually for someone who
doesn't have PCOS, we have them on metform and they
(21:29):
don't lose weight. When you put some people on met forma,
and I've have patients who say I have not changed anything.
I went on met forman and I've found it easy
to lose weight for the first time.
Speaker 1 (21:39):
I was the second.
Speaker 6 (21:40):
Yeah, And so that does show that that insulin resistance
and that higher levels of insulin is likely a factor
of why people struggle to lose weight. And our bodies
aren't these simple closed systems the energy and energy out. Yes,
to some degree, that is true, but all of the
factors that impact how much energy is coming in and
how much energy is coming out out is really complicated.
(22:01):
We all know the person who lives off takeaway food
and skinny as a rake, and we believe them, but
we never kind of believe the person that struggles with
their weight who says I'm eating really healthily.
Speaker 3 (22:11):
Oh, I'm so glad you touch on that is because, honestly,
and I'm really also glad that you touch on the
psychological aspect of it, because there is a point where
you're you're sitting in front of it could be a GP,
it could be a partner, it could be a parent,
And I just remember being like, no, but I am,
I am exercising, I am eating well, Like I feel
like I'm being gas lip by my own body. It
(22:32):
was so confusing, and there's so much shame built into
having peacos as well. Like you think about the symptoms
of cystic acne or adult acne, excess hair growth around
your face like.
Speaker 1 (22:44):
Mustache, I'm lucky, unfair.
Speaker 7 (22:47):
Like people with dark hair.
Speaker 3 (22:48):
I can only bloody imagine how much you have to
deal with this. The side effects of peacos suck and
it really can make you play mental mind.
Speaker 6 (22:57):
Gating infertility for young people and about their future health.
So just quickly going back to the weight thing, though,
it is interesting. I was a conference in Boston last
year and they did have studies showing people with PCOS
if they did do the same weight loss intervention as
someone without PCOS, they did still lose similar amounts of weight.
Speaker 1 (23:17):
So that's interesting.
Speaker 3 (23:18):
So we are gasla and maybe, I mean my next
question on that study would be like, okay, what about
long term? You know, what happens after they go off
of this you know, controlled experiment eating plan, what happens next? Because,
like I said, my weight fluctuated so much like a yoyo.
I was able to lose it, but I was also
able to gain it so insanely quickly, and I just
(23:39):
felt like everything was inflamed all the time. I felt
as though I was running along the beach next to people,
but I was dragging a tire. You know, everything just
seemed to be that little bit more hard.
Speaker 1 (23:50):
That's definitely what I.
Speaker 6 (23:51):
Hear from my patience, and I think there needs to
be a lot more research in this area. We do
know that losing about five percent of body weight improves
insulin sensitivity, and that's the therapeutic goal I work with
with some of my patients, especially if they've got the
irregular menstrual cycles and they've got clear insulin resistance. In
saying that, I have like Olympic athletes who have pcos.
(24:14):
They are exercising twenty hours a week. If they exercise more,
it's not going to improve their PCOS. For some people,
this is clearly a strongly genetic issue that needs some medication,
and we haven't really touched on the underlying causes, but
we know things like our in utero exposure to androgens
potentially some endocrine disrupting chemicals.
Speaker 2 (24:33):
How do you have inutero exposure to androgens?
Speaker 6 (24:36):
So what your like mother's levels of androgens were sure
when you were in utero and now there's this humongous
ERAa of research related to endocrin disrupting chemicals. So, like
I said, I've got Olympic athletes with pcos. We know
a lot of sports people team sports. I look through
the Matilda's player I'm like, huh, I want her indochronologist
is you know a lot of women with team sports.
(24:57):
It's about twenty five percent of elite team sports players
have PCOS.
Speaker 1 (25:01):
We're genetically wired to be team players.
Speaker 6 (25:04):
I think maybe the slight high levels of androids in
some role could be beneficial for athletic performance, you know,
another area of research. But I guess what I'm trying
to say is it's not as simple as just eat
less and move more. Some people are Olympic athletes and
they still have PCOS. There is a role for medications
because a lot of people as well might carry some
extra right and they never develop PCOS.
Speaker 4 (25:25):
Having said that, what are some of the other external sources,
like cortisol and stress? What role does cortisol and stress
play in PCOS symptoms?
Speaker 5 (25:33):
That is a great question.
Speaker 6 (25:35):
And there is so much on social media demonizing cortosol
despite it being a life saving hormone. So cortisol is
made by our adrenal glands, and it's important for blood
pressure and blood glucose levels, and that's important for our
stress response. So if we didn't have cortisol, we would die.
Now what I see on social media and it really
(25:55):
upsets me because it's just so wildly wrong, is that
people with PCUS should not be doing high intensity exercise
because high intensity exercise increases corso and corsol causes insinent resistance.
Based on that mechanism, and that's a mechanism, there is
an actual study outcome showing this. Based on that mechanism,
anyone who did radio exercise would have intine resistance and
(26:17):
develop type two diabetes. Anywhere with type two diabetes shouldn't
do exercise. So it's a lot on social media we
see people talking about a mechanism without actual studies based
on people to prove that's correct.
Speaker 1 (26:31):
A few mongering.
Speaker 6 (26:32):
Yeah, but you hear that and you go, oh, that's truth.
It does cause insinal resistance. You know, it kind of
can make sense. But if you look at the outcomes,
you know, especially the who's the guy Huberman loves looking
at mechanisms of animal data and then making claims, you know,
does this massive jump one that that animal data is
consistent in humans, which is a big massive claim, and
(26:54):
then also claiming that that mechanism results in an outcome.
So there's a lot on social media based on mechanisms.
You really want to look at outcomes in people, and
we have lots of studies showing exercise improves pcos in
terms of cortisol. How much does it increase PCO wes
and its role in pcos hard to know because we
really don't have good data. You would have to do,
(27:15):
because cortisol is a home when that goes up and
down literally second to second, minute to minute. To get
good data on this, we would need to be doing
twenty for our your own cortisol collections on people.
Speaker 1 (27:24):
All the time, like every hour, all the.
Speaker 6 (27:26):
Time, yes, exactly, and then seeing how it translates to
their pcos, which we're never really going to do.
Speaker 2 (27:33):
We do know, I will we for you for twenty
four hours if you need to kiss you.
Speaker 6 (27:37):
Okay, but we need you to bridges volunteers there, but
you need to you'd have to do it continuously, so
right again, But I do see that stress does impact
reproductive health, both turning off periods and PCAL west stress.
We can't recover if we're constantly stressed, and if we're
not recovering, our levels of inflammation stay high. And yes, definitely,
(27:58):
I do think psychological stress would have an impact on
people's pcos and their functional hapsthomic aim and area. But
it's not the causal that's the problem. It's the behaviors
that are driving the chronic stress.
Speaker 4 (28:10):
It's frustrating, isn't it, Because and we've spoken about this
in other aspects when we talk about infertility, people trying
to feel pregnant. The impact that stress has on the
body is huge. But no one in the history of
ever stop stressing when a doctor says you need to
stop stressing. So it's one of those things that you
understand what stress tells to your body, and you understand
the negative impacts.
Speaker 1 (28:30):
It's very hard to tell yourself.
Speaker 6 (28:32):
And then it's hard as well because we don't have
clear tests to do to go, Okay, your stress levels
are seven out of ten, let's bring them down to
five out of ten. Because I can see X y
Z parameter. Sometimes I joke that I'm a fatiguologist. When
a patien sees a GP and they've done all the
tests and they're just still really tired all the time,
they refer to an endochronologist for in inverted commace hormonal imbalance.
(28:53):
Hormonal imbalance is not a diagnosis.
Speaker 1 (28:55):
It's a blanket state.
Speaker 5 (28:56):
It's a blanket statement.
Speaker 6 (28:58):
But I will see people for their fatigue and I'll
do all the tests. I'll make sure do they have
Celiac disease. I check them for sleep apnea, I'll check
for insulin resistances, all these thyrol and of course things
that can cause fatigue. But often then I have a
good chat with them. I go, Okay, so your dad
died a year ago. Then you were made redundant in
your job six months ago. Oh, and you've been doing
your MBA on top of this, and.
Speaker 2 (29:19):
You've had a miscarriage, and you've got yeah, all these things.
Speaker 6 (29:22):
And they really want a abnormal test result, and I go,
this is real. You know you have a condition, and
that's called chronic stress, unrelenting stress, and that has really
negatively impacted your health. Do I have a clear test
that I can go, Like I said, you're an eight
out of ten stress, let's bring it down to a six.
Speaker 5 (29:39):
No, I don't.
Speaker 6 (29:39):
But I am a doctor and I've had those stressful
periods and I know how much impacts your body. And
I don't need a test result because I'm so in tune.
I would say with my health to know, okay, this
is you know, this is bad. I need to make
some changes. So subjective, Yeah, and but It's hard because
we want to label, and as I always say to
my patients, my job isn't to tell you there's nothing
(30:01):
wrong with you at stress. My job is to exclude
absolutely everything that could be a medical condition and help
you with the managing the stress. Let's look through things
very objectively, so we shouldn't ever put someone's symptoms or
condition just down to stress. We need to exclude everything else.
But I guess what I'm trying to say is chronic
stress really does impact our health. We don't have clear
(30:22):
ways of measuring it, but it is real even if
there isn't an abnormal test result, and doesn't mean you
don't deserve to try and work on some you know,
intentional lifstyle changes to make things a bit less stressful.
Speaker 5 (30:33):
But again, you can't just you know, okay, cool, I'm stressed.
Speaker 6 (30:36):
Let me take this stress supplement and now I don't
have all these challenges in my life.
Speaker 3 (30:40):
Speaking of supplementation, I would love to get your take
on the amount of social media content that is, you know,
to target or monal imbalances. I'll put that in quotation
marks for everybody. And I guess all of these not
so much evidence based content or supplements and things that
you can purchase.
Speaker 7 (30:59):
How do you feel about them? And how do we
spot the difference.
Speaker 6 (31:01):
First thing, the reason why we're saying an inverted commace
hormone imbalance is because we have literally hundreds of hormones
and we either usually have a deficiency or an excess
of hormone. So there isn't really such a diagnosis of
a hormone imbalance. Yes, maybe we could say PCs is
slightly higher androgens than estrogen. Have a you have excess androgens.
(31:21):
That's the diagnosis. All three of us here me much
less than brit They have some degree of social media
platforms and we can just acknowledge we get messages from
companies going, hey, do you want to promote this supplement?
You know, we'll pay you this much to do a post. So,
just as an FYI, anytime you see an influencer who's
(31:42):
recommending a supplement, it's probably just because she's had a
DM asking her to, you know, promote that supplement. I
occasionally do pay to ads, but sounds wanky and I
sound like the influence er I'm bagging out, But it
would only ever be something I really believe in, and
as a doctor, I can't recommend any TGA approved supplement anyway,
So for mebe more something daggy like these are my
(32:03):
favorite runners, and I know running Shop gave me a
bit of a discount. You know, the whole new world
of advertising. Influencers have a lot of trust with their audience,
and that builds on that trust. So of course the
audience will go, they look great, their skin's wonderful. You know,
maybe I should have that supplement. It's not actually treating something.
You need to have a diagnosis and know what you're
(32:24):
trying to treat. There are definitely supplements that are beneficial,
but a generic supplement for a hormonial condition just doesn't
really make sense. Maybe some of them have insulin sensitizing agents,
they've got some cinnamon or you know, some other good things. However,
I have had patients who have taken general hormone supplements
and ended up in my clinic room profoundly low thyroid
(32:47):
hormones because they've taken a supplement with you know, whopping
doses of iodine, or I've seen people with the other
really high levels of fired hormones because of supplements.
Speaker 4 (32:57):
So that like I'm just thinking, now I've had these
people's asking me to advertise supplements, and I've advertised supplements
before in the past, but there's always been things that
I've already taken. Having said that, I might have been
taking supplements like you just said that I thought were
doing good for me and adding to my general supplements
that are like multi vitamins and stuff for women because
(33:18):
we're always told women should be taking multivibmins and stuff.
Speaker 2 (33:20):
I take multi vitamins.
Speaker 1 (33:22):
Is that not a thing for.
Speaker 6 (33:23):
My thoughts with supplements, I say to patience, if you're
lowing something, yeah, a multi vitamin is not going to
be enough to bring it up. And if you're not
lowing it, you probably don't need it. So a multivitamin
is lots of different things and a little bit of them.
They probably don't hurt. We keep doing studies of meta analysis.
Do multi vitamins help? They're probably not going to do
(33:43):
any harm?
Speaker 1 (33:44):
Yeah, right, So if it's going to place ebo you.
Speaker 6 (33:46):
Yeah, it's probably not going to do any harm. There
are definitely supplements I recommend, you know, vitamin D, magnesium,
sometimes zinc.
Speaker 1 (33:53):
I take magnesium.
Speaker 6 (33:54):
Yes, it's really good for praying that any women's health
issue you know peer mess, painful periods, perimenopause.
Speaker 5 (34:01):
Magnesium is great.
Speaker 6 (34:03):
So I do often prescribe supplements, but I'm prescribing a
specific supplement for a specific condition.
Speaker 5 (34:09):
Yeah.
Speaker 6 (34:09):
It's a bit like, oh, you've got a medical condition,
I'm just going to throw a handful of tablets at
you and hope it works.
Speaker 1 (34:13):
It will take.
Speaker 3 (34:14):
But it's also on the patient side. And I've been
this person. That's why I can say it.
Speaker 7 (34:17):
I was in a.
Speaker 3 (34:18):
Vulnerable place where I was just looking for help. I
just wanted answers, and I wanted something that was going
to make the inflammation and the side effects that I
was experiencing from peacos go away. Like I just wanted
them to reduce. And so I was like, I'll try
anything something that I know a lot of people, they
really like a lot of people with peacos. I mean,
is the innocatol Am I saying that right?
Speaker 7 (34:37):
Oh?
Speaker 6 (34:37):
I literally four years ago when I ran on this podcast.
I think I pronounced it wrong, and I'm still pronouncing
it wrong. My inercatole, okay, is a insulin sensitizing supplement
and it does have some evidence for PCOS. I would
usually use met Foreman, because it's funny how we don't
mind taking a supplement. We don't want to take a pharmaceutical.
(34:57):
When a pharmaceutical is highly regulated, we know what's in it,
whereas a supplement, depending on where it's made, it can.
Speaker 5 (35:03):
Be lots of other stuff.
Speaker 6 (35:04):
But yes, that is a supplement does have some evidence
for PCs, mainly through improving insinal resistance.
Speaker 3 (35:09):
So for anyone listening, I take met form at the
moment to improve my insulin sensitivity. What are some other
medicinal options for people, whether it be to alleviate a
side effect of pea costs or to actually try and
treat the underlying cause.
Speaker 5 (35:22):
Wonderful question.
Speaker 6 (35:24):
I'm going to briefly touch on lifestyle because there's heaps
on social media. It's not complicated. It's a Mediterranean diet,
moderate carbohydrate. Low carbohydrate diets haven't been shown to be
really more effective than a Mediterranean style diet. Then it's
exercise in line with the National Physical Activity Guidelines thirty
minutes of moderate figgro's physical activity most days, two strength sessioning.
(35:46):
So not rocket science, just you know, literally pretty much
the recommendations for the general populations.
Speaker 1 (35:52):
It well and move your body yeah.
Speaker 5 (35:54):
Exactly, and I really do.
Speaker 6 (35:55):
The Mediterranean diet does have quite a lot of evidence,
so I'd really recommend that.
Speaker 1 (36:00):
And it's delicious exactly.
Speaker 6 (36:01):
Olive oil, lots of veggies, not too much red meat,
some lean proteins, and good quality carbo hydrates, low GI carbohydrates.
Speaker 5 (36:09):
So that's the lifestyle. Then the exercise.
Speaker 6 (36:12):
High intensity exercise increases a protein called sex hormone barding globulin,
which is like this protein that is a sponge and
will sponge testosterone, which is great. The high levels of
exercise can also decrease LH and improve that LH to
fsh race theorem. So for most of my PCOS patients,
that's why I want to cry and bang my head
against a wall when they've said they've been too scared
to do high intensity exercise, because they're worried all worse
(36:33):
than the PCOS, so please do it well.
Speaker 3 (36:35):
I also think that there's a because we can sometimes
have excess testosterone. I always felt as though I would
put on muscle quickly, and because I was already kind
of trying to alleviate weight gain, I was like, I
don't want to look bigger, musty as well?
Speaker 6 (36:47):
Ask any you know, gym junkie guy who eats chicken
and broccoli and brown rice ten times a day and
works out four hours a day, you're not going to
get bulky.
Speaker 5 (36:57):
And the levels of testosterone, they're not that much higher.
Speaker 6 (37:00):
You might have had a testosterone of two point two
and normally is you know, about one point five. So
the absolute levels aren't that high in terms of pharmaceutical
and medication. So it's all about what we're trying to achieve.
So if I have a young woman who hasn't had
a period in two years and she's got a build
up of the lining of her endometrium, so that's the
(37:21):
lining of the uterus, which means she's at risk of
endometrial cancer. She doesn't want to have a pregnancy anytime soon,
I'm going to say, I think we should prop you
on the pill because we just need to look after
this endometrium right now, and that's my priority. If so,
you know, to get cancer, because pcos can be a
rispect for endometrial cancer. If someone is, you know, in
their early thirties and maybe wanting to conceive a pregnancy sometime,
(37:43):
of course I'm not going to put them on the
pill because we're trying to improve their ovulatory function. I'm
going to have the moon met foreman, I'm going to
be doing all of the lifestyle things. And you know,
that's really the evidence for improving menstrual cycles. If their
high levels of androgens are more of the problem, we
might talk about spirinalacton, which is an anti androgen medication,
(38:03):
so it blocks the testosterone receptor. And then after maybe
they've had their children, we might think about going back
on the pill. Yes, the pill is not going to
fix the underlying pc you're west. However, it will help
manage the symptoms. And that's why the pill understandably gets
a bad rap, because the eighteen year old girl with
PCOS gets put on the pill and he's told, don't
(38:24):
worry about your PCUS until you want to conceive it pregnancy.
She comes off at thirty four and her periods don't
come back, she's got acne, and she goes, holy crap,
I've got this terrible PCOS that I haven't worked and
I haven't managed and I didn't know about And at
thirty four, you know, we know fertility starts to decline
at thirty five. Maybe she would have tried to conceive
pregnancies earlier on if she knew she only had eight
(38:47):
chances per year crying to conceived, compared to most people
have twelve chances per year. Anyway, what I'm also saying
now it shows how individualized it is. It's all about
the individual in front of you and what their management
priorities are. So there's never going to be blanket advice
for everyone.
Speaker 3 (39:02):
What about pretty controversial one at the moment weight loss medications?
So doop ones Semaglue, tide is MPIC, we go v
Munjaro I think is another one. We've also done a
whole episode on these with Johan Hari that I will
link in the show notes for anyone about those weight
loss drugs? Are they an adequate or a.
Speaker 7 (39:20):
Good choice for a medication for someone with peacoss?
Speaker 5 (39:23):
Firstly, that episode you did was wonderful.
Speaker 7 (39:25):
Oh thank you.
Speaker 6 (39:26):
I think it explained the nuance of these medications so
well because we live in a society that likes to
be really divisive and reality things are much more complicated.
I do commonly prescribe these medications doop one agonists. They
have evidence for decreasing heart attacks, strokes, heart failure. Does
that mean they're right for everyone, of course not, but
(39:46):
they do have a really beneficial role for some people,
and they are very effective for weight loss and improving
insulin sensitivity, so acting on the liver to decrease the
glucose production from the liver, decreasing fat in the life
that's causing into the resistance. So they do have definitely
a role. You can't conceive a pregnancy on these medications.
(40:06):
We don't have safety data, so I will have For example,
if I had a young patient who was not wanting
to conceive a pregnancy for a while, maybe she was
twenty eight or thirty, and I know she has quite
a few years before her fertility really declines, and she
had pco wes and other complications from her weight, maybe
mild type two diabetes, high blood pressure, I might say
(40:28):
to her, how about we try and focus on a
little bit of weight loss to improve those things, improve
your fertility and decrease your risk of early miscarriage and
still birth. We do know a b CD, especially at
those quite higher levels, are associate with increased pregnancy complications.
And it's I'm going to say again, it's really complicated
and challenging discussing weight because you know, I never talk
(40:51):
about weight on my social media because it's such a
nuanced thing. And I will have talked to the individual
in front of me, and I'll have these balanced conversations.
But I will sometimes, as I said with that imaginary patient,
I might try and use a geo people and to
help some weight come down. Betwe improve fertility and improve
fertility outcomes, we would stop it before they were trying
to conceive.
Speaker 4 (41:10):
Interesting speaking about fertility, just so the people at home
listening right now really understand it. Because the one thing
you hear the most is people say, oh, I've got
pea cos I'm not going to be able to full pregnant.
Speaker 1 (41:20):
I've got peacos.
Speaker 4 (41:21):
It's going to be really hard to be in a
full pregnant even if they have their periods and a
regular cycle, they still are convinced.
Speaker 1 (41:27):
From the fumal road.
Speaker 4 (41:28):
And everyone that's just spreading this information, what would you
say is the best approach for somebody that is in
that situation that wants to conceive naturally.
Speaker 6 (41:37):
So my recommendations to my patients is if you have
a regular menstrual cycle and you are less than forty,
and definitely if you're less than thirty eight. You are
fertile until proven otherwise. And it's such an irony because
there's a market trying to get women to test their fertility,
which really we do not have accurate tests for. We
can test male fertility very easily, but hey, there's no
(42:00):
fear mongering businesses focusing on men's fear. Really, they just
do a semen analysis and you can test they're fatility
much more accurately than their females. So I would say
to my patience, and I say this all the time,
if you have a regular mental cycle, you are ovulating.
You don't have a fertility condition that you're aware of,
such a severe and demetriosis, And even if you do,
you know you are fertile until proven otherwise. The best
(42:22):
test of fertility is trying to conceive, and it's hard
because most things in life we have control over. We
can try and make some order from the chaos, but
fertility is much more challenging, and you've kind of just
got to wait until you try. You know, make sure
you are ovulating, you don't have any fertility disorders. But
the best test is actually wait until you conceive. The
(42:42):
biggest impact though of fertility is age. Unfortunately, most people
up until they're forty ken conceive a pregnancy. It just
might take them longer because more of their eggs have
DNA damage. So at thirty five, about fifty percent of
our eggs have DNA damage.
Speaker 5 (42:56):
So it needs each month.
Speaker 6 (42:57):
It's about a fifty to fifty chance of if it's
a inverted COmON good egg So yes, fertility, regular menstrual cycle.
Speaker 5 (43:04):
And if you are worried about.
Speaker 6 (43:05):
Your fertility, I would say talk to your doctor if
there's anything you can do or any concerns.
Speaker 3 (43:09):
Last one for me, I've seen a lot of social
media flodd about endocrine disruptors to the point where I've
actually been a little bit concerned about things like perfumes,
and I've tried to limit my use of perfumes knowing
that we were going to speak to you and I
could find out whether it was actually something I needed
to be worried about.
Speaker 2 (43:26):
And like incensors and things like burning your home, and.
Speaker 6 (43:29):
Endocrine disrupting chemicals EEDCS for short is a terminology we
use for things in our environment, either natural or synthetic,
that impact power or hormones work. So it could impact
the actual hormone or could block the receptor or activate
the recept.
Speaker 1 (43:46):
So just a smell in the home can do that.
Speaker 6 (43:48):
It's actually the things that have the main evidence is pesticides,
so you know if you're a farmer or exposed to
lots of pesticides. The next one is plastics, so increasing
research into kind of microplastics and forever plastics. There's a
great podcast actually on a science versus if anyone wants
on intercrind disrupting chemicals and plastics. And the other one
(44:10):
is kind of cosmetic products. Most of the cosmetic products
that do have proven endocrind disrupting chemicals, especially in Australia,
are not really available anymore. So there has been a
lot of change. Europe has really led the way in this.
But they are chemicals very very small that can impact
our natural you know, how our hormones work. So it's
hard because we don't have good evidence in terms of
(44:32):
what we call a randomized control trial. We can't say
to a group of people, okay, you wear pesticides and
eat out of microwave plastic containers for ten years and
this group don't. That would be a randomized control traer.
All we can do is what we call observational data,
where we have a group of people and ask them about, okay,
do you heat your food in this? Or look at
their levels of microplastics, and that's where we find associations.
(44:55):
But we can't find good causation in saying that we
do have in increasing data that you know, some of
these endocrime disrupting chemicals will impact fertility, probably through our reproductive.
Speaker 5 (45:06):
Hormones or our thyroid hormones.
Speaker 6 (45:07):
But it's mainly the people that have the very high
level of exposure.
Speaker 5 (45:11):
We live in our world.
Speaker 6 (45:12):
We can't live in a bubble and not have some exposure.
Speaker 2 (45:15):
Can't avoid it in this damage, can you.
Speaker 6 (45:16):
But the recommendations I say is try and avoid plastics.
Speaker 1 (45:20):
So like here up food.
Speaker 6 (45:22):
Here I am with my plastic water bottle, but don't
microwave food in plastics. Try and stall things if you
can in glass containers. If you've got a plastic water bottle,
if the water's been sitting there for hours, it's been
in your car for twenty four hours and it's sat
in the sun, I wouldn't drink out of that water.
Speaker 2 (45:37):
God, I've done that so many times.
Speaker 5 (45:39):
And you know obviously pesticides.
Speaker 6 (45:41):
My family a farmers, so this is relevant, maybe less
relevant to many other people. But you know, if you're
own gardening and you're using pesticides, very clear safety and
then you know checking your makeup products. But again most
makeup products in Australia now the mums manufacturing has changed.
Speaker 1 (45:57):
Is that the same for perfume.
Speaker 3 (45:58):
I don't know why I've seen so much specifically on
fragrance in terms of endigrine disruptor social media content.
Speaker 6 (46:04):
I think probably because it's women who use makeups, so
that would be getting a lot more attention. I can't
give specifics on makeup and perfumes as much because there's
so many different types of products.
Speaker 5 (46:17):
There's a few great people on social media. Can I
mention some? Yeah, there's someone.
Speaker 6 (46:21):
Called the eco World that does great posts on this,
and the Endocrime Society website that's getting pretty sciencey.
Speaker 1 (46:28):
But seems like a good place to go. Yeah, that's the.
Speaker 5 (46:31):
US Ndocrime Society. I'm going to a conference there soon.
Speaker 6 (46:34):
Have some great resources, as do almost Australia website. But yes,
the main things would be, you know, really plastics and
for pesticides are where most of the research is at.
Speaker 3 (46:43):
Okay, Well, I Isy, I think you're just the most
wonderful person. You are someone who has helped me so
much in my peacos journey. I really appreciate you just
being able to turn to you and ask you a
lot of questions. And I hope today's episode for anyone
listening has either been really validating in the sense that
you might have peacos and you just wanted to learn
a little bit more about it. Maybe we've kind of
dispelled some of the myths about peacos, of which I
(47:05):
just think there are so so, so many.
Speaker 4 (47:08):
Well, it goes back to again, like we say it
all the time, but just to be media literate, just
to know where to look and where you're getting your
information from. There are going to be people sprouting information
that look like really reliable sources and the way they
say things so confidently. But as long as you're going
back to these genuinely reliable sources, there is.
Speaker 5 (47:25):
Like media literacy that is such a good term.
Speaker 2 (47:27):
It is it's like, just be in control of what
you're consuming.
Speaker 6 (47:30):
Yeah, I always say to people, do they have qualifications
and are they working in the field. Someone who did
a medical degree twenty years ago and has never worked
as a doctor or even in women's health.
Speaker 5 (47:41):
That's actually not a good source.
Speaker 6 (47:43):
They need to be recognized by their peers working in
the area involved in research. Contact professional develops a good source.
But no, thanks so much, Keisha, that lovely comment. Maybe
blush before.
Speaker 5 (47:56):
I guess.
Speaker 6 (47:57):
Just to summarize, I would say pos thesis common one
in nine, one in eight women of reproductive age. If
any of those symptoms sound familiar, get them checked out
by your GP. Find a GP with an interest in
women's health. You know, the guy that wanted to do
orthopedic surgery and now does mainly skincats or removals. He's
not the person to go to about your PCUS.
Speaker 5 (48:19):
And that's not blaming him. We just can't be experts
in everything.
Speaker 6 (48:22):
So see a GP with an interest, maybe seen end chronologist,
and you know, hopefully they can help with some of
those symptoms or getting answers.
Speaker 3 (48:29):
And for anyone wanting to learn more from Izzy her instagram.
Her brand new website will also be linked in our
show notes.
Speaker 7 (48:36):
Thank you, you're the best.
Speaker 5 (48:37):
Thanks Keishan Britt. It was really fun
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