What is PCOS? A Fertility Doctor Explains Polycystic Ovarian Syndrome

hi friends today we are talking about pcos what it is it is such a common thing to be misunderstood i'm going to break down the facts for you right here [Music] hi friends welcome back today i'm going over pcos polycystic ovarian syndrome so pcos is a hormone disorder that causes you not to ovulate now trust me pcos gets commonly misunderstood and one of my biggest pet peeves as a fertility doctor is that many people out there who are not as trained as myself or maybe you just don't understand the physiology of pcos they will actually tell you that this is a problem of having low progesterone no no no no no okay but that is like understanding that the problem is secondary to something else yes that is a symptom but the true root cause is a hormone disturbance that leads you not to ovulate and if you don't ovulate you don't make progesterone so let's just go over what pcos is first of all i hate the name polycystic ovarian syndrome who named it it's a terrible name so i hate this name however what it really refers to is the cysts that we're talking about in pcos are tiny fluid-filled follicles a fluid-filled structure on ultrasound is assist by definition but really these cysts aren't problems follicles are normal in the eggs you just have more than a normal number so officially in order to diagnose pcos you need two out of three okay so if we talk about the three things that you need number one irregular periods so if your periods are irregular that's part of the diagnostic criteria number two high androgen symptoms androgens are like testosterone or dheas those are hormones made from the ovary or the adrenal gland and they can cause acne or hair growth so having either symptoms acne or hair growth or actually having your blood checked and having high levels of these that would also meet diagnostic criteria and number three is a special ultrasound appearance of your ovaries being polycystic meaning lots of little small follicles or a high antral follicle count that's the official rotterdam criteria this is how a doctor should diagnose your pcos that said if you have two out of the three so if you have irregular cycles in acne your doctor may not order an ultrasound because you've already met the criteria so depending on what you're presenting with and what your goals are doctors may do different things to me as a fertility doctor i do ultrasound all the time it is one of the top ways that i can evaluate you so you see me use ultrasound frequently but you don't always have to so even though that's the diagnostic criteria sometimes it doesn't really like make sense like what's the problem okay those things don't exactly explain the problem they are the symptoms so i'm going to draw you a picture so not the world's best artist but tana so what you have here is you have a pituitary gland and you have the ovary okay so that's normal then what's supposed to normally happen is the brain is going to send out a hormone called fsh fsh is a well-named hormone that stimulates follicles to grow so i always like to use the analogy there's a vault inside the ovary and inside the vault are all the eggs you're ever going to have so when you're born fault is full when you go through menopause vault is empty now every month you have a group of eggs all come out of the vault and you can see that group on ultrasound so you can't see into the vaults like a secret but you can see the group that comes out and that group each egg grows inside a follicle so if you were to go look on ultrasound you would see a lot of follicles in the ovary and those would be cysts fluid-filled structures each follicle has one egg inside now when the brain sends out fsh follicle stimulating hormone it talks to the ovary and if it's everything's working normal the ovary then responds and one follicle will grow and that egg will mature and that's the one you're ovulating now one of my favorite things about the ovary is that it's a hormone producing factory so when the ovary does its job it's making estrogen that's its hormone de jour but when things stop working it switches gears and it starts making another hormone which is testosterone so what really happens in pcos i like to be think of it as have being born with a full vault so with a full vault what that means is that your ovary has a lot of eggs and one cool thing about the body is that the more eggs that are in the vault the more that are released every month and the fewer eggs that are in the vault the fewer that are released every month and so when you go through this process if you have a lot of eggs more are going to come out every month that diagnostic criteria of lots of follicles it can look like that but what that means is there's a lot of follicles so a lot of eggs are coming out of the vault at once well your brain sends out a normal amount of fsh but now it's getting diluted between all of those small follicles and so none of them is chosen to respond they just sit there doing nothing okay what actually happens is they're not really doing nothing they're all making a teeny weeny bit of estrogen and estrogen is what talks back to the brain so normally estrogen is only made when the body is ovulating so high doses tell their brain cool don't send out any more fsh we're good we're making an egg but when all of these make a teeny little bit it is enough signal that tells the brain we're cool so the brain doesn't send out more fsh so you're stuck in this pathway with a little bit of fsh a little bit of estradiol and no ovulation and as i said hormone producing factory here so if this is stuck in sarca guess what start happening well fsh has a sister hormone called lh and what lh does is it is also released from the brain and it works on the ovary in a different way and what it starts to tell the ovary to do is make testosterone make testosterone so if the ovary is not ovulating it's not making estrogen hormone producing factory can't do it then it starts making you got it do you see it t it starts making testosterone okay and this testosterone is what leads to acne and hair growth so this is part of the problem other things that are really confusing about pcos is this whole overweight phenomenon and i like to describe there's really two forms of pcos there is your thin phenotype which has nothing at all to do with weight gain really pcos hormone issue here in the ovary it's just an ovarian endocrine disorder the ovary doesn't produce the hormones it's supposed to because it gets upset and kind of trapped by this pathway of not doing anything not enough fsh coming out and then it starts making the testosterone so it gets stuck here other things that happen is like high testosterone levels in the o3 also cause insulin resistance and can cause metabolic changes that we often see with pcos it can lead to diabetes high blood pressure high cholesterol all kinds of issues to complicate things fat cells also make estrogen okay so if you are overweight and you have a lot of fat cells those fat cells make estrogen and then that estrogen talks to the brain and tells the brain to not send out enough fsh and so you see pcos also in women who are overweight but the confusing thing there is women often hear oh well lose 10 of your body weight and you'll start to ovulate again okay that is true if you have extra estrogen being made because then in those cases that extra estrogen will drop if you lose weight however if you have thin pcos and it's just a hormone dysfunction do not go and lose weight because it's not going to make any difference that's not the root cause of your problem so if you've had irregular cycles your whole life when you're thin and now you're overweight weight loss may not be as big of a player in this game for you if you're thin you don't need to lose weight okay that's not going to help your problem here if you're overweight then trying to lose some weight is always going to be recommended now a quick note we're going to do a follow-up video about questions on pcos so ask them in the comments and also talk about different treatment options but the reason why when you look at this that birth control pills are so popular one is because it gives you constant levels of estrogen and progesterone one of the biggest risks with pcos you often hear about is endometrial cancer when we talk about risks on the large scale endometrial cancer is because all these small follicles making this little bit of estrogen it doesn't just talk to the brain it also talks to the uterus and when it talks to the uterus what it tells the uterine lining to do is fill up and grow preparing for an implantation that's never going to happen because you don't ovulate so if you just have this lining that's growing the whole time so it's getting really fluffy and you're not bleeding it off like you're supposed to because you never have that progesterone rise than fall that comes with ovulation and then you get it can be called hyperplasia and that can turn into cancer and so low progesterone on itself is just a sign that you're not ovulating it can actually lead to endometrial cancer so you'll hear doctors sometimes say protecting the endometrium is giving you some progesterone or inciting a withdrawal bleed or doing something so that those cells don't turn into cancer because we don't want you to get the worst outcome that could happen from this disease again low progesterone is not a problem the problem is all this stuff low progesterone is a symptom because if you don't ovulate you don't make progesterone that's the only hormone that is made simply from ovulation it's not going to exist in your body without ovulation if you are trying to get pregnant and your periods are irregular you need to see a doctor end a story if your periods are irregular and you have symptoms of pcos you may want to see a doctor even before you're trying to get pregnant sometimes lifestyle interventions like diet supplements or losing weight if applicable to you can help this phenomenon sometimes you're already really healthy and you just have really refractory pcos meaning you're gonna need medications to help you ovulate and that's okay that's what your friendly fertility doctors are here for we are here to help you get to that next step of the game what i don't want is all this stigma with pcos that we always see i want women to understand that low progesterone is not the problem here low progesterone is a symptom the problem is it's just a hormone dysfunction and when your other endocrine glands don't function well nobody goes and puts a big stigma on so let's break the stigma with pcos let's educate ourselves and others thank you guys so much for watching as always i would love it if you subscribe to the channel so i can bring more fertility related education and information to you you can follow me on instagram nataliecrawfordindy and you can check out the as a woman podcast the podcast has tons of fertility related episodes and also female empowerment where i work to bring information to you thank you guys so much

Channel: Natalie Crawford, MD

Views: 165,533

Keywords: Natalie Crawford, Natalie Crawford MD, As a Woman, fertility, pcos

Id: As4V7KyErZw

Length: 11min 10sec (670 seconds)

Published: Thu Sep 10 2020