PCOS Explained: How to Identify and Diagnose
Summary
TLDRIn 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
- đïž Dr. Brendan McCarthy is the chief medical officer of Protoa Medical Center and discusses his practice's mission to provide rewarding patient care.
- đ He emphasizes that medicine should be about service and joy, not just a business to make money.
- đ± He recounts his initial inspiration to practice medicine came from witnessing the positive impact of progesterone on a patient.
- đ The podcast discusses polycystic ovary syndrome (PCOS), emphasizing the importance of understanding the condition's complexity.
- đ Dr. McCarthy explains the normal menstrual cycle and how hormonal fluctuations, such as estrogen and progesterone, play a critical role.
- đ« In PCOS, the issue arises from a lack of ovulation, leading to consistently high estrogen levels without the balancing effects of progesterone.
- đ§Ș He stresses the importance of investigating why ovulation isn't occurring, which can involve issues with luteinizing hormone (LH) or prolactin levels.
- đ High prolactin levels can inhibit ovulation and might be caused by stress, certain medications, or even a pituitary tumor.
- đ The podcast also touches on the impact of diet, specifically gluten, on prolactin levels and suggests it as a potential factor in PCOS.
- đ 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
đïž 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.
𧏠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.
đĄïž 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.
đ« 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.
đ 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.
đŹ 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.
Mindmap
Keywords
đĄPolycystic Ovarian Syndrome (PCOS)
đĄProgesterone
đĄEstrogen
đĄAnovulation
đĄLuteinizing Hormone (LH)
đĄProlactin
đĄFollicle Stimulating Hormone (FSH)
đĄCorpus Luteum
đĄInsulin Resistance
đĄMenstrual Cycle
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
the and the YouTube is the best you know
I see the ones on the reals I see them
all and I want you to know your feed
back means everything to us because we
do this as a labor of love because this
this is something we love to do so so
please continue with your comments
please continue with your input please
help us continue making this to be
helpful to you and then um like share
and
subscribe and I will see you at the next
episode
[Music]
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