So it’s time to go off birth control and expand your family. You’ve got all your ducks in a row… a hot career… check. Taking the stairs, not the elevator… check. Dropped the McDouble, because you know #healthy…check, check. Those ducks haven’t moved and still… nothing. This is an all too common tale in the IF world, but Amanda Fagan is proof that there is light at the end of the tunnel. Amanda (wh0 just happens to be a Doctor) helps us figure out what the heck PCOS is and explains what she did to get her body back on track. SPOILER ALERT! Amanda is pregnant with not one, but TWO baby boys, due this summer.
Polycystic Ovarian Syndrome- poorly understood and under diagnosed. But most importantly in my mind, it’s definitely miss-treated. I was diagnosed with PCOS at the age of 25, after just finishing 4 years of Medical School and learning all about this “disease”. I was confused, as most other females are when they are initially diagnosed. The biased conception is that all PCOS woman are overweight, diabetic, hairy, and are unable to bear their own children. I’m here to paint a different picture for you, and to give my experience of dealing with PCOS.
The actual medical definition of PCOS is defined by something called the Rotterdam criteria. You need 2 of the following 3 criteria to be diagnosed:
- Oligo/anovulation (irregular or absent peroids)
- Clinically- through increased hair growth
- Biochemical- through blood work showing increased testosterone
- Polycystic ovaries on ultrasounds
It’s a big misconception that obesity and diabetes is a criteria for PCOS, neither of which I have. I have personally never struggled with weight. I grew up a dancer, and once I got into college I found a love for fitness and staying active. I’ve maintained a BMI around 19-20 most of my entire life and spent 8 years on hormonal birth control pills for control of my hormonal acne. Little did I know, I was masking a problem that would eventually become noticeable once I stopped the pill in 2015.
Knowing that we wanted to start a family while I was in my Family Medicine residency post- Med School, I stopped the pill in 2015 only to watch the months go by with no bleeding. It took me 8 months before I took the situation in my own hands and decided to seek a different opinion. My OBGYN constantly told me to keep giving it more time, and that it would return on its own, but I knew deep down that 8 months was not normal. It can take 1-3 months for your cycles to return after cessation of a birth control pill, I was almost 3x past that period of “normal”. This is when I decided to seek care of an Infertility Endocrinologist, who performed an ultrasound and lab workup on my very first visit and had my diagnosis that very week. My ultrasound showed 40+ follicles in each ovary, and my labs showed an elevated testosterone level. I actually had met all 3 criteria for PCOS, something I never thought I could actually ever have.
I have a fairly long blog post regarding my infertility journey that you can find here, it’s definitely worth the read if you’re struggling! But one thing I didn’t touch on in my post was the treatment I’ve done to help my PCOS.
- Metformin. This has to be prescribed by a physician, and is confusing when you read that it’s a medication for diabetics. Truth be told, PCOS patients typically do have insulin sensitivity, but this does not mean they are diabetic. Insulin is in our bodies to help lower our blood sugar levels. When we have elevated insulin levels, it’s a sign that your body has to work a little harder to lower your sugar compared to the normal individual. Yes, this technically gives you an increased risk of diabetes in the future if you fail to watch your diet, but it by no means makes it a guarantee you’ll get it. High insulin levels signals your body to produce more testosterone, which coincidentally leads to decrease in estrogen levels. This is where Metformin comes in. Metformin is designed to increase insulin sensitivity, thereby lowering our insulin level over time. Therefore many specialists use Metformin as a first line treatment for PCOS. By decreasing insulin level, decreasing testosterone, and increasing our estrogen- our bodies start to ovulate again and menstrual cycles come back. I’m not saying everyone with PCOS should be on this medication, but it’s considered first line therapy and something that personally helped me regulate cycles.
- Diet. It’s all about the lifestyle you choose to live. When I found out about PCOS and the recommendation to try more of a low carb higher fat diet, I did a lot of research before giving it a try. Research shows that healthy monosaturated fats actually help aid in fertility, and following a low carb/higher fat diet results in lower sugar intake. Did you know the American Heart Association recommends a max of 25g of sugar daily for women? I really focused on my sugar intake, consuming only those in natural fruits and veggies. Focusing on a whole foods diet alone is definitely key in my opinion, and I firmly believe it helped regulate my body as a whole to prepare me for conception and pregnancy.
- Regular Exercise. Something I always practiced, but I firmly believe increasing your endorphins daily helps significantly with mood and the way you feel. Not to mention, it helps keep your body at a healthy weight! I bounce between Tone it Up, Beach Body, and BBG by Kayla Itsines. I love them all, and I love the variety they all put in my routine.
- Educate yourself! This is key. Find forums, talk to your physician, talk with your spouse. Do what you can to educate yourself and those around you, especially if your PCOS is affecting fertility. Having open communication is key, and your spouse should always be your biggest supporter. I’m so thankful Jason has always been there to listen to my worries, my fears, and support me through all my appointments and struggles.
I hope opening up gives others out there a better insight on PCOS. But most importantly, if you as well are also a PCOS fighter- I want you to realize that it’s not life limiting. I’ve fought it, I’ve worked around it, and found ways to make myself healthier because of it. I’m currently in my second trimester with my first pregnancy, and I couldn’t feel more blessed to be carrying two babies. Learn to love yourself, have the motivation to better yourself, and PCOS won’t seem like such a setback! – Dr. Amanda Fagan