PCOS Explained: How to Identify and Diagnose

Summary

In this podcast episode, Dr. Brendan McCarthy, Chief Medical Officer at Proa Medical Center, discusses polycystic ovary syndrome (PCOS). He explains the normal menstrual cycle, the role of hormones like estrogen and progesterone, and how they can go awry in PCOS. Dr. McCarthy emphasizes the importance of understanding why women with PCOS aren't ovulating, highlighting factors like high prolactin levels, stress, and insulin resistance. He stresses the need for a comprehensive approach to treatment beyond just managing symptoms.

Takeaways

• 🎙️ Dr. Brendan McCarthy is the chief medical officer of Protoa Medical Center and discusses his practice's mission to provide rewarding patient care.
• 💊 He emphasizes that medicine should be about service and joy, not just a business to make money.
• 🌱 He recounts his initial inspiration to practice medicine came from witnessing the positive impact of progesterone on a patient.
• 📈 The podcast discusses polycystic ovary syndrome (PCOS), emphasizing the importance of understanding the condition's complexity.
• 🔄 Dr. McCarthy explains the normal menstrual cycle and how hormonal fluctuations, such as estrogen and progesterone, play a critical role.
• 🚫 In PCOS, the issue arises from a lack of ovulation, leading to consistently high estrogen levels without the balancing effects of progesterone.
• 🧪 He stresses the importance of investigating why ovulation isn't occurring, which can involve issues with luteinizing hormone (LH) or prolactin levels.
• 📉 High prolactin levels can inhibit ovulation and might be caused by stress, certain medications, or even a pituitary tumor.
• 🌐 The podcast also touches on the impact of diet, specifically gluten, on prolactin levels and suggests it as a potential factor in PCOS.
• 📚 Dr. McCarthy plans to delve deeper into the biochemistry of PCOS in future episodes to help listeners better understand the therapies and treatments.

Q & A

What is the role of Dr. Brendan McCarthy in ProTa Medical Center?

Dr. Brendan McCarthy is the Chief Medical Officer of ProTa Medical Center in Tempe, Arizona.

Why is Dr. McCarthy moving to a new office?

The script does not provide specific reasons for the move, but it is implied that it could be for expansion or improvement of the practice.

What is Dr. McCarthy's view on medicine as a business?

Dr. McCarthy finds the idea of pursuing medicine purely as a business and for making money off-putting. He emphasizes that his practice is focused on providing rewarding care to patients.

How did progesterone's impact on a woman influence Dr. McCarthy's career?

Witnessing the positive impact of progesterone on a woman with chronic anxiety and a life out of control inspired Dr. McCarthy to focus his practice on providing such rewarding medical services.

What does Dr. McCarthy believe brings joy in life?

Dr. McCarthy believes that acts of service, like engaging with patients and providing helpful care, bring joy rather than money.

What is the main focus of Dr. McCarthy's practice growth?

The growth of Dr. McCarthy's practice is focused on meeting and working with like-minded doctors and people who share his philosophy of being helpful to every patient.

What is the significance of the normal menstrual cycle in understanding PCOS according to Dr. McCarthy?

Understanding the normal menstrual cycle is crucial for comprehending PCOS because it highlights how hormonal imbalances can disrupt the cycle and lead to conditions like PCOS.

What is the role of estrogen in the menstrual cycle as explained by Dr. McCarthy?

Estrogen plays a significant role in the menstrual cycle by stimulating various fertility-associated tissues and preparing the body for potential pregnancy.

Why does Dr. McCarthy emphasize the importance of understanding the role of progesterone in PCOS?

Progesterone is essential for maturing the uterine lining and balancing estrogen's effects. In PCOS, the lack of progesterone due to anovulation can lead to various symptoms and complications.

What is the connection between high prolactin levels and PCOS discussed by Dr. McCarthy?

High prolactin levels can inhibit ovulation, which is a characteristic of PCOS. Dr. McCarthy suggests that even micro-elevations in prolactin can impact ovulation and should be considered in PCOS diagnosis and treatment.

How does Dr. McCarthy approach the treatment of PCOS?

Dr. McCarthy emphasizes understanding the underlying causes of PCOS, such as hormonal imbalances and prolactin levels, rather than just suppressing symptoms with medication, to provide effective treatment.

Outlines

00:00

🎙️ Podcast Introduction and Practice Philosophy

Dr. Brendan McCarthy opens the podcast by introducing himself as the Chief Medical Officer of ProTa Medical Center in Tempe, Arizona. He mentions the upcoming move to a new office and his producer, Justin. Dr. McCarthy clarifies that while he leads a medical practice, the podcast is not a marketing tool but a platform to discuss medicine and its impact. He shares his pride in his practice, which has grown due to a shared philosophy of service and helping patients. He emphasizes the joy he finds in acts of service, such as Q&A sessions with the audience, over the pursuit of money, which he finds less fulfilling. The doctor also briefly touches on the topic of PCOS (Polycystic Ovary Syndrome), indicating a deeper discussion to follow.

05:00

🧬 Deep Dive into PCOS and Hormonal Imbalances

Dr. McCarthy delves into the complexities of Polycystic Ovary Syndrome (PCOS), emphasizing the importance of understanding the female menstrual cycle and the role of hormones like estrogen, progesterone, and cortisol. He explains how the pituitary gland acts as a thermostat, regulating hormone levels. The doctor outlines the normal cycle, starting with low hormone levels at menstruation and the subsequent release of follicle-stimulating hormone (FSH) to stimulate estrogen production. He discusses the rise of estrogen levels and the feedback loop it creates, leading to ovulation triggered by a luteinizing hormone (LH) surge. The summary also touches on the role of progesterone post-ovulation and its effects on the body, setting the stage for a more detailed exploration of PCOS in the next episode.

10:03

🌡️ Hormonal Dynamics in PCOS and Ovulation

In this segment, Dr. McCarthy focuses on the hormonal imbalances characteristic of PCOS, particularly the persistently high levels of estrogen due to lack of ovulation. He explains how the absence of a luteinizing hormone (LH) surge, which normally triggers ovulation and progesterone production, results in a continuous estrogen-dominant state. This leads to a thicker uterine lining and over-stimulated body tissues. The doctor also discusses the role of LH in stimulating androgen production and its connection to insulin resistance, which can cause weight gain. He emphasizes the need to understand why ovulation is not occurring, as this is key to addressing PCOS effectively.

15:04

🚫 Prolactin's Role in PCOS and Ovulation

Dr. McCarthy discusses the overlooked role of prolactin in PCOS and its impact on ovulation. Prolactin, a hormone associated with nursing, can inhibit ovulation when elevated, even without nursing. The doctor points out that high prolactin levels can be caused by pituitary tumors or other factors, including gluten sensitivity and pharmaceuticals. He shares a case study where a patient's elevated prolactin, initially thought to be due to a pituitary tumor, was later found to be related to severe stress. Through therapy and stress reduction, the patient's prolactin levels normalized, illustrating the importance of considering stress in the treatment of PCOS and related ovulation issues.

20:07

💊 Impact of Pharmaceuticals on Prolactin and PCOS

In this paragraph, Dr. McCarthy expands on the impact of pharmaceuticals on prolactin levels, which can contribute to PCOS symptoms. He specifically calls out oral contraceptives, which are often prescribed to manage PCOS symptoms but can also elevate prolactin levels, counteracting their intended effect. The doctor stresses the importance of understanding the root causes of hormonal imbalances and addressing them holistically rather than relying on symptom suppression. He also highlights the significance of patient feedback and the commitment to providing valuable, accurate information to help those struggling with PCOS.

25:28

🔬 Upcoming Discussions on Progesterone and PCOS

Dr. McCarthy concludes the podcast by expressing his dedication to the topic of PCOS and his commitment to continue the discussion in future episodes. He plans to delve deeper into the role of progesterone and its significance in PCOS. The doctor also encourages audience engagement through comments and feedback, valuing the community's input as crucial to improving the content and its impact. He ends on a positive note, looking forward to the next episode and thanking his audience for their support.

Keywords

💡Polycystic Ovarian Syndrome (PCOS)

PCOS is a hormonal disorder common among women of reproductive age, characterized by the presence of multiple cysts in the ovaries. In the script, Dr. Brendan McCarthy discusses the complexities of PCOS, emphasizing the importance of understanding its root causes rather than just treating symptoms. He mentions that PCOS involves a disruption in the normal menstrual cycle due to hormonal imbalances, particularly affecting the levels of estrogen and progesterone.

💡Progesterone

Progesterone is a hormone that plays a crucial role in the menstrual cycle and pregnancy. It is highlighted in the script as a key factor in the menstrual cycle, where it is responsible for preparing the uterus for a potential pregnancy after ovulation. Dr. McCarthy explains that in PCOS, the lack of progesterone due to anovulation can lead to an over-stimulation of body tissues by estrogen.

💡Estrogen

Estrogen is a primary female sex hormone that controls the development of female reproductive tissues. In the context of the video, Dr. McCarthy discusses how estrogen levels rise during the menstrual cycle and its role in preparing the body for potential fertilization. However, in PCOS, persistently high estrogen levels due to lack of ovulation can lead to various symptoms.

💡Anovulation

Anovulation refers to the absence of ovulation, which is a hallmark of PCOS. Dr. McCarthy explains that in a normal menstrual cycle, ovulation is triggered by a surge in luteinizing hormone (LH). However, in PCOS, this process is disrupted, leading to a lack of ovulation and consequently, no progesterone production.

💡Luteinizing Hormone (LH)

LH is a hormone produced by the pituitary gland that triggers ovulation in women. In the script, Dr. McCarthy delves into the role of LH in the menstrual cycle and how its dysfunction can lead to PCOS. He mentions that high LH levels can contribute to the overproduction of androgens, which can exacerbate PCOS symptoms.

💡Prolactin

Prolactin is a hormone that, among other functions, can inhibit ovulation. Dr. McCarthy discusses how elevated prolactin levels, which can be caused by various factors including stress and certain medications, can contribute to anovulation and thus to PCOS. He emphasizes the importance of investigating and addressing elevated prolactin levels in patients with PCOS.

💡Follicle Stimulating Hormone (FSH)

FSH is a hormone that stimulates the growth of follicles in the ovaries. In the script, Dr. McCarthy explains that FSH initiates the menstrual cycle by promoting the development of ovarian follicles, which then produce estrogen. An imbalance in FSH can contribute to the development of PCOS.

💡Corpus Luteum

The corpus luteum is a structure in the ovary that forms after ovulation and produces progesterone. Dr. McCarthy mentions corpus luteum in the context of normal menstrual cycles, where it is essential for preparing the uterine lining for a fertilized egg. In PCOS, the formation of corpus luteum is often impaired due to anovulation.

💡Insulin Resistance

Insulin resistance is a condition in which the body's cells do not respond properly to the hormone insulin, leading to high blood sugar levels. In the script, Dr. McCarthy connects insulin resistance with high LH levels, which can be a feature of PCOS. He suggests that addressing insulin resistance is an important aspect of managing PCOS.

💡Menstrual Cycle

The menstrual cycle is the regular natural change that occurs in the female reproductive system. Dr. McCarthy uses the menstrual cycle as a framework to explain the normal hormonal fluctuations and how disruptions in these, as seen in PCOS, can lead to various symptoms and health issues.

Highlights

Dr. Brendan McCarthy introduces himself as the chief medical officer of Proactive Medical Center and discusses his new office.

He emphasizes that his podcast is not a marketing tool for his practice but a platform to share valuable medical insights.

Dr. McCarthy shares his initial motivation for medicine, which was inspired by the impact of progesterone on a patient's life.

He discusses the business of medicine, expressing his disapproval of those who pursue it solely for financial gain.

Dr. McCarthy explains his pride in his practice, which has grown due to a shared philosophy of service and patient care.

The podcast delves into Polycystic Ovarian Syndrome (PCOS), a condition that Dr. McCarthy considers complex and multifaceted.

A detailed explanation of the normal female cycle, including the roles of estrogen and progesterone, is provided.

The role of the pituitary gland as a 'thermostat' in regulating hormone levels is discussed.

Dr. McCarthy explains the significance of follicle-stimulating hormone (FSH) and its role in the menstrual cycle.

The importance of estrogen in various bodily functions and its role in fertility is highlighted.

The function of the luteinizing hormone (LH) surge and its impact on ovulation is explained.

The transition of follicles into Corpus luteum and the release of progesterone are described.

Dr. McCarthy outlines the multifaceted role of progesterone in the body, including its impact on the uterus and other tissues.

The podcast addresses the issue of PCOS, focusing on the lack of ovulation and the resulting hormonal imbalances.

The impact of high estrogen levels due to lack of ovulation and the associated risks are discussed.

Dr. McCarthy talks about the role of luteinizing hormone in PCOS, including cases where it is high but not leading to ovulation.

The significance of prolactin in the context of PCOS and its potential causes, such as stress and certain medications, is explored.

The podcast concludes with a call to action for listeners to engage with the content, like, share, and subscribe.

Transcripts

[Music]

welcome to my podcast my name is Dr

Brendan McCarthy I'm the chief medical

officer of prota Medical Center in Tempe

Arizona by the time this airs I believe

I will be in the new office if not I

will be there in a couple weeks but we

are moving into to new office um Justin

our our producer is uh going to be

working with us there as well and we

should be putting out some cool videos

from that location um I know I don't

talk about my practice very often in

here and I lead with saying I'm the

chief medical officer of proa and I know

if you've listened to any of my videos

you know I'm not using this as a

marketing tool for my practice at all

even a little um I'm still super proud

of my practice it's just been my life's

wor and uh I was just speaking Justin I

were just talking about this and some

people pursue medicine as a

business and and I've done some recent

reels on that where people go into this

because they just want to make money and

I've actually spoken to other Physicians

and they'll say things like this is

going to be my money maker and I and

it's they just I that is not that's

really off-putting to me to be honest

with you

um I started this originally

because I saw the impact progesterone

had on one woman

once who was it and I thought to myself

how can I keep doing this how can I keep

playing this

role because it was so

rewarding to sit there with someone who

wasn't sleeping chronic anxiety her

life's out of

control and those of you out there who

experienced this you know what I'm

talking about and those of you who have

family members that have experienced

this you know what I'm talking about

imagine being on the other side of that

as a care provider and writing a

prescription for something that is

benign

natural inexpensive it was relatively

very inexpensive when I first started

practicing

progesterone and so the business was

primarily about how can I bottle that

lightning so to speak how can I continue

being in this space with these people

and providing that service so the

business for me of medicine is how can I

create a system where I'm able to

continue providing something that is

that

rewarding that is that act of

service and brings that kind of

joy you know it is a it is a a not even

worthy of arguing this that you know we

all know that money is not what brings

us joy in life it's it's um people will

then come back and say well money does

it but it helps you buy the things that

will bring

joy I want to say that it it really for

me my what brings me joy I could speak

for myself are those acts of service

like the like when we do the q&as and

and when we um engage with you so I'm

very proud of my practice growing

because it's grown not because of me but

because I've been able to meet more

doctors with like-minded approach and

able to work with some really wonderful

creative and thought ful people and so

my practice has grown due to that

mission and due to that bringing people

around me that share my philosophy and

that belief of like this is something we

want to do to be helpful with every one

of our patients it's it's such a

rewarding thing so I'm proud of my

practice and um and I want you to know

that when I do this podcast it's not

marketing it but I just would like to be

proud of it for a moment so

anyway PCOS it's a big deal

let's talk about it before we do down

scroll down and

subscribe like and share we already did

one episode on this and I was watching

it last night

and I want to add to it sometimes I

watch a real that we do a video weo

excuse me or I watch the reals

associated with it and I'll see what I'm

saying but also see how my brain works

and how my brain works is not always ask

my my wife my brain is not the easiest

one to follow sometimes cuz I'll just

jump ahead of things I'll just take

these steps and I I make those leaps um

why I'm saying that is because polyiso

Varian syndrome is a very complex thing

it has so many moving parts to

it and in order for us to understand it

for you to understand it and when I say

us I mean knowledge is only as valuable

as you're able to share it you know

that's the only value in knowledge

there's only value in things is what you

could share from it so the only true

value of this is my ability to share it

in a way that's meaningful to you so I

thought a lot about rewarding things a

little bit or just repeating it because

I believe as you repeat things you

create a depth of understanding so I'm

going to go down a little bit further

into what I discussed last episode I'm

going to detail it a little bit further

be a little bit more into the

biochemistry not too much I promise not

to get too dragged into the biochemical

nuances of this but just enough so you

get an understanding of the therapies

and why they do what they do and why I'm

going to recommend what I'm going to

recommend so I'm going to do that today

on today's episode um so I'll be to dive

into that now in order to understand

polycystic ovarian syndrome we really do

need to understand the cycle of a woman

and all the parts of the endocrine

system that are at play during a cycle

and how they go wrong or go arai in PCOS

and that way I can discuss with you do

how to correct it so let's start with a

normal cycle normal cycle for a woman

begins when estrogen and progesterone

everything's at a low State that's

around menstration everything that

that's low level and when that occurs

your brain reads that now your brain the

pituitary is like a thermostat and that

thermostat is always looking for a

temperature it's like in your house you

know if it gets too hot the air

conditioning turns on gets too cold the

heater turns on but that's because the

pituitary is sending the signal to turn

things up or turn things down because

has a fine range so your pituitary is

always trying to assess how much you

have of estrogen how much you have a

progesterone thyroid uh cortisol it's

always looking at your endocrine system

and it's trying to regulate the levels

of hormones you have order to keep

things in their tight range and that's

the signal they send down so when your

brain sees no estrogen or low estrogen

which is the beginning of a cycle it's

going to release something called

follicle stimulating hormone or FS H now

an FSH surge goes down to the ovaries

and says

hey let's have some some estrogen let's

do this so it's sends out to those

follicles in each ovary it stimulates

your body to generate more follicles or

bring follicles to the four now those

follicles are being stimulated by

follicle stimulating hormone then starts

to secrete

estrogen so estrogen levels start to

rise throughout the body now that

estrogen that's coming from these

follicles starts stimulating all those

parts of you associated with fertility

the breasts the uterus the cervix the

ovaries vaginal tissue collagen it's

also there for your bone density it's

good for cholesterol neurological

function I mean it is

everywhere and that estrogen does the

job it does and we like that we love

that estrogen has such a bad reputation

from the from the past few decades and

we really need to get rid of that bad

reputation because it's an important

part of you and just like anything too

much is not good too little is not good

what what's good is what's right and

that's where you're supposed to be so

your brain sends that signal down FSH to

the ovaries the ovaries then return F

the the follicle stimulating hormone

stimulates the follicles the follicles

then make estrogen estrogen levels are

higher now and they keep going up as

they keep going up the follicles

releasing estrogen the other thing it

does the estrogen from the follicles

goes back to the ovaries and stimulates

the follicles more it's a feed forward

pathway so these follicles are growing

and becoming more full there will be one

follicle maybe two that are going to

become dominant follicles those are the

ones that have the eggs that you're

going to be releasing at that cycle when

you ovulate now when you hit a certain

level of estrogen in your brain you hit

a certain height it goes up to a certain

point you have something called a

lutenizing hormone surge so if your

estrogen gets too high your brain's like

whoa all right that's it hit Heights of

estrogen let's calm it down so you send

out LH from the P because that's the

thermostat it seees estrogen go too high

message gets sent down so now now LH

goes down to the ovaries and it

stimulates the ovaries to shift those

follicles are now converted into

something called Corpus ludia or white

bodies that's a Latin term for it it's

very creative white body Corpus ludia

because when you look at our microscope

it's white and it's a little body inside

you get it those Corpus ludum they start

to release

progesterone now with that said the

dominant follicle on each side they

ovulate one or both or sometimes neither

but it happens but you you have

ovulation at that point that's what

luminizing hormone does so now these

follicles are involuted they now release

progesterone now progesterone goes back

to all that parts of you all the parts

of your body associated with fertility

and it matures them it it and it plays a

complex role here and I can spend hours

talking about progesterone with your

endocrine system and your brain and

everything but I'm going to try and do

my best to be very surface with it

because we're going to do another

episode out here I think second from

this next after this or maybe the one

right after that we're still not sure

many more I need to do on this but but

progesterone progesterone it's the thing

that matures the line of the uterus and

when I say that the line of the uus is

growing growing growing with the idea

you're going to get a egg here pretty

soon we need to make this ready to

nurture that egg so you need thicker

lining progesterone goes back to that

and calms that down helps structure that

tissue better it gets blood flow to the

tissue okay that's the critical thing it

improves blood flow or profusion to line

of uterus remember that we're going to

come back to this in a sec it goes back

to the breast tissue it lobules that

tissue it helps maintain its health and

its Integrity it does it prevents the

estrogen from over stimulating that

tissue progesterone plays that important

role it plays a role throughout your

body with balancing out the impact of

estrogen causing growth when it comes to

collagen and fat distribution you know

estrogen is what gives a woman curves

because that's the impact estrogen has

on that adipocytes located at your hips

and breast tissue yes

progesterone plays a role in that as

well because progesterone inhibits that

from being excessive there's been so

many studies that show that when you

give a woman per menopause and

post-menopause if you normalize woman's

progesterone it really plays a role with

with improving the waist hip ratio

brings that waist tip ratio in because

that's the benefit of progesterone so

progesterone plays a role also with

lipolysis lipogenesis are just basically

uh um adapost um signaling and and and

growth and distribution Etc

progesterone is a key part of this then

when you go a certain period of time and

there hasn't been a a implantation that

has been a signal from the uterus that

you're you're pregnant then everything

drops off the lutenizing hormone and

follicle s hormone they drop off excuse

me Ling hormone drops off estrogen is

already lower progesterone drops off and

then you have menstration that's what

that point

is

so what on Earth

is happening with

PCOS good

question I love this dog polyan syndrome

is in essence you're not ovulating

you're just not ovulating so you get

stuck with the estrogen levels sorry you

get stuck with the estrogen levels being

higher because that's the follicular

phase that's say first two weeks and as

the estrogen levels are higher it stays

higher imagine you didn't ovulate there

was no signal there's no LH surge that

went down to the ovaries and saying hey

guys that's enough estrogen let's make

progesterone no so all month long you're

going to have that estrogen that line of

the uterus because I'm stable and keeps

getting

thicker you're going to see body tissue

being over stimulated by that

estrogen now there's a couple things

that go on with the lutenizing hormone

that I want to bring up here luteinizing

hormone in some cases are not going to

be elevated

but you're still diagnosed with PCOS

I've seen this this drives me crazy see

a characteristic that we should be aware

of with with with ovulation is are you

are you not

ovulating PCOS is in essence you're not

ovulating so estrogen is allowed to stay

dominant and and and run Buck Wild

through your body all month long now

here's where it gets funky you may not

be ovulating because your ovaries are

not responding to luteinizing

hormone you may not be ovulating ating

due to um lutenizing hormone being

blocked at the pitutary due to

prolactin no matter what you're not

ovulating there's genetic components to

this there's all these other things that

they associated with being you know

vicious cycle of what causes it but at

the end of the day at the end of the day

the point is you're not ovulating and we

need to know why you're not ovulating

when you're not ovulating and you have

high lutenizing hormones say lutenizing

hormones high you're not ovulating due

to a progesterone a regular seem lacked

in irregularity you're not ovulating for

some other reason so say you have

luteinizing hormone insensitivity that's

that's when you're have high luteinizing

hormone so that's where things get spicy

when luteinizing hormon is allowed to be

elevated luteinizing hormon is going to

go back to the the the ovaries and the

theal cells and that's going to

stimulate your body to start making more

androgens that's where you see that

testosterone and andion you see those

are regulars first and then testosterone

Downstream from that but that's how

you're going to find this is these

lutenizing hormone elevation luteinizing

hormone also stimulates insulin and your

insulin level is getting high enough

there's your weight gain and high levels

of insulin uh um create that insulin

resistance that you see with these women

so women who have

PCOS with with this issue they're going

to have high insulin fasting and they're

going to have normal glucose because

that's being stimulated insulin is being

stimulated through that LH pathway

lutenizing hormones doing that I want to

focus a little bit more on prolactin

before I talk about the high LH causes

and what does that but I want to talk

about prolactin just a little bit more

today because that is a a key part of

this that gets overlooked and when I see

patients coming to my clinic who've been

diagnosed with polycystic ovarian

syndrome they are not ovulating truth

they're not ovulating I get that what I

have a thing with is that why aren't

they ovulating was never fully

investigated and so they weren't always

had the lab work done to understand that

this is a key part of diagnosing and

treating in the normal clinical setting

all you want to do as a as a standard

physician who's just kind of going there

and just doing like kind of lazy

medicine is you're just going to give

her birth control to suppress everything

and and you're going to give her you

know something to block testosterone and

you give something to improve insulin

sensitivity and you call it a day but

that's just punching those holes the the

problems it's just basically that's

checking off the boxes okay I got these

symptoms you're good goodbye

and I mentioned that in my last episode

this very frustrating to me as a doctor

to see that because that's not real

medicine that's stabilizing the care of

a patient sure but real medicine I

believe is stabilizing care of the

patient and understanding the cause and

doing everything in your power to to to

to heal cure fixed whatever you can do

for this person that's our

job so when a person is not ovulating we

want to know why because that helps us

find a cure so say the person has they

they have prolactin elevations they're

elevated and prolactin as I mentioned

before in a previous episode prolactin

is a message that comes from Tut ter

saying I'm nursing it's basically

stimulat nursing it's something you

release as a woman when you're nursing

men should not release it but it's one

of those those uh endocrine signals that

happen and why it's important is because

it stops you from ovulating that's not

perfect but it does a pretty darn good

job so when you're nursing this is why

women who are nursing don't conceive or

should not be able to conceive sometimes

they do and that's not the best thing to

do during that time because if you're

nursing and you're trying to you know uh

uh um you're pregnant with a baby

there's going to be some nutritional

irregulators start happening here

they're not good so prolactin is one of

those natural birth control things that

stops ovulation that way now sometimes

prolactin is high even though you're not

nursing and that will stop ulation we

want to know this this is the part where

it's going to get heretical for you

which means I'm going to go a little off

the beaten path and most medical doctors

hearing me will kind of not like this

but if you sit down and you think about

it with physiology and pathology you sit

down and then also you apply it

clinically you realize now this do

actually Mak

sense so prolactin if it's very elevated

let me talk about that one first if it's

very elevated that could be due to a

tumor pituitary tumor pituitary adenoma

it's is not death sentence but it's

important to know because you want to

diagnose that you do an MRI you look at

the patient and and you'll find out

whether this is a pituitary adenoma and

then there's medications you prescribe

for that that brings it down so that's

one cause of prolactin being elevated

it' be high it be like 100 or higher 50

or higher that's what happens and you

want to screen for that but sometimes

your prolactin is in the range but it's

the high end of the range it's at a

level that's equivalent of

Nursing and you shouldn't be nursing if

you're not pregnant or didn't have a

baby that shouldn't prolactin shouldn't

be that high I've seen this in my clinic

before enough to drive me out of my mind

because it's such a important thing to

address so if your prolactin has a range

up to I think the new range is higher

now but you know the range stays 25 or

something is the upper end of the range

lower end of the range is four the more

you move towards 25 on that range even

though you're in the normal range the

less likely you are to

ovulate so if you have a patient

presenting to Clinic who's not ovulating

and their prolactin is four you want to

look at other reasons why they're not

ovulating but if you see their prolactin

somewhere around you know 12 13 you want

to understand that because that would

cause her to have an ulatory

Cycles so what that would mean is that

her prolactin while not high enough to

be a tumor it's high enough to inhibit

this cycle and and in turn ultimately

fertility and all the things that go

along with

ovulation so what causes those

elevations those micro elevations in

prolactin you know what causes that you

know um I'm very fond of pointing out

how gluten does this and I don't see it

every time but gluten does that wheat

does that there's nothing wrong with

gluten or wheat just like there's

nothing wrong with pollen but sometimes

we react to it

inappropriately and is important for

your physician to find that so if your

prolactin is above four you're not

ovulating say it's like 12 or 13 14 you

want to take gluten out of your diet and

then rerun the lab after a month if the

prolactin went down that's what it is

now if we're not sure you want to prove

it again eat a bunch of gluten rerun the

prolactin huh then do no no gluten again

test it again whatever as many times you

need to see that that's the case do that

that's important to rule that out right

away always with women any woman who's

not ovulating well any woman who has low

progesterone symptoms anything like that

whatsoever prolactin where is it why is

it why is it where it is what else could

cause prolactin elevations

Pharmaceuticals there's a lot lot of lot

of medication that'll do it you know and

and if you're taking one of those

Pharmaceuticals I'm sure they educated

you on I hope they did but I want to

want to pick out of this a little bit

not go too far into it uh is oral

contraceptives oral contraceptives have

been in my clinic obvious causes of

elevated prolactin they do that not

every contraceptive but enough to and

that's something they don't tell you

about so so oral contraceptive which is

ironic because we use oral

contraceptives with PCOS to suppress you

know their their their estrogen

and suppress that that that excessive

level of estrogen it's also increasing

your prolactin which is not something we

want increased what else causes elevated

prolactin and this is what I want to

drill into today more prolactin can be

elevated when you're under severe

stress real stress prolactin is a stress

hormone as well there's a lot of

research I think I'm going to do an

episode on prolactin by itself as a

stress hormone because it's important to

discuss I've known that prolac is

elevated in times of severe stress you

know since I started practicing medicine

I think in uh I remember a case and I

know this was in about 2004 2005 I

remember this one case a young lady who

was just having prolactin elevations

fluctuated and she had really an

unhealthy home you know a lot of lot of

lot of stress lot of is really traumatic

and um I knew it plays a role but I was

never able to kind of isolate the the

case and say you're stress reduction in

your life has improved prolactin cuz she

had so much going on and I did not see

her long enough to see that movement in

her life but recently I had a case that

just sits in my

heart there's one case of of a patient

just and it really does sit in my heart

because as a physician our goal always

is to try and find a cure for you

without you needing us ever again kind

of thing that's like you you feel like

you won you win you're winning I'm a

winning a doctor you know that's it so

so this patient you know had a lot of

stress in her

life and a lot of trauma that she's

working

through she went into deep therapy

self-care a lot of internal work be let

me before that when I first saw her you

know not cycling a lot of PMS a lot of

pmdd a lot of those emotional components

and and I'm running her labs and I see

her proac is elevated she's not a PCOS

case but I'm saying if she had high

enough prolactin would have been but

still not specific PCOS she didn't have

all the other symptoms but just she

presented to me for an ovulation and

she's presented to me for anxiety

depression and so prolactin elevation

and I did uh uh MRI and we saw there was

a it seemed like a microadenoma was

going there it was very small and so I

prescribed cabergoline you know which is

the medication that you use to stop that

and I relab to make sure my her

prolactin hit the right level and it

worked brought it down we're good 6

months later she came to clinic and had

no prolactin

whatsoever no prolactin whatsoever she

should with the cabergoline have had

some I didn't stop it to zero there's

reasons why you don't want to fully

suppress the pituitary unless you know

what you're doing with that I did not

fully suppress the prolactin with the

dose of cabgan I gave her it should be

four but it went to unmeasurably

low and so I I asked what's what's

different what's going on and she had

gone to

therapy she just a wonderful human she'

gone to therapy and she had really dug

in the dirt really did a really

extensive in her work here and it had

changed her life she'd done a lot of

changes to her life and so we have the

suspicion what if I we were wrong that

it's prolactinoma what if this only was

severe stress causing this so I had her

stop

cabergoline and I reand her prolactin

prolactin went to about three that was

it 2.6 that was it

so that was a case I was able to see how

stress impacts and the reduction of

stress Improvement of mental health

improves that prolactin levels and how

it's going to play a big role in

someone's future fertility but also how

it plays a role with PCOS type symptoms

where women aren ovulating and they have

the anovulation they have the animetal

liting thickening and all the other

symptoms so that was important to to be

aware of that so again when you have a

diagnosis of PCOS and you may not have

all the

because I think those are things that

are very often overlooked that I've

witnessed in my practice and those are

some easy things to solve with using

those those three things I hope this

helps I hope this helps next episode

we're going to come back we're going to

talk a little bit more about

progesterone we're to keep talking about

PCS because it's so important I want you

to know I'm with you with this and I

care about this I've been reading your

comments Justin I love the comments and

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episode

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