Episode #86: PCOS and Polycystic Ovaries: Exploring the Connection

Back in the history of PCOS, the symptoms of not being able to get pregnant, facial hair, and being overweight were linked to women that had these small cystic-like structures on their ovaries. We pointed the term polycystic ovaries, but we didn’t know a whole lot about the disease, we didn’t know a whole lot about what was causing it and so at the time, it was named that because we thought that these polycystic ovaries were linked to why we were having these other symptoms, why we weren’t able to get pregnant and all these other findings that we had. But now, if you think about the way our hormones work, what’s really happening to create polycystic ovaries, or ovaries with multiple little pseudocysts, they’re not real cysts, they’re these little cyst-like-looking structures, is because we are trying to mature a follicle, but we’re not able to fully mature it to the point of ovulation where the follicle is matured to an egg and releases such during ovulatory event. Really, polycystic ovaries are just another finding or a symptom of having our hormones out of balance. That’s why in today’s episode, we are going to be looking at lots of details about why ovaries get cysts and the different kinds of cysts and all the different causes. So let’s dive in.

You’re listening to the PCOS Repair podcast, where we explore the ins and outs of PCOS and how to repair the imbalances in your hormones naturally with a little medical help sprinkled in. Hi, I’m Ashlene Korcek, and with many years of medical and personal experience with polycystic ovarian syndrome. It is my joy to watch women reverse their PCOS as they learn to nourish their body in a whole new way. With the power of our beliefs, our mindset, and our environment, and the understanding of our genetics, we can heal at the root cause.

Welcome back to the PCOS Repair podcast, where today we’re going to be talking about PCOS and cysts on the ovaries. This is a very, very, very often confused topic when it comes to PCOS. I want to help you understand better what we’re dealing with, why this is happening, and what actually is related to PCOS and what is not related to PCOS. So that you have a better understanding of what’s going on with your body. If you go and you see your doctor and they tell you various things, you know why. Sometimes you may have polycystic ovaries, why sometimes you may not have polycystic ovaries, and so forth. The criteria for PCOS is that you need to have two of the following three. You either need to have elevated androgens, so that could be either on laboratory values or symptoms of. I think that’s really important to remember is that the symptoms are enough. You don’t have to have abnormal labs because if you’re having symptoms of elevated androgens or imbalanced androgens, chances are they’re abnormal for you, even if they fall in the normal range for the majority because a small difference in our laboratory values can still make a huge difference in our symptoms.

Even a small fluctuation inside of the normal range for laboratory values can affect how we actually show up with our PCOS and what symptoms we are or are not having. That’s important to remember, symptoms should lab work, they don’t always… Doctors will listen to your symptoms and then they’ll be like, Let’s check your labs. Oh, your labs came back normal, therefore, must not be relevant. That’s not a good way to look at PCOS. If the symptoms are there, we should We shouldn’t really treat the symptoms, not necessarily with medication, not necessarily with birth control, but we should take a lifestyle adjustment approach to discovering why are you having those symptoms. That’s looking at the root cause and then looking at what does your body need in order to feel better, to alleviate those symptoms that are bothering you, and so forth. Okay, so back to the criteria. Science of elevated androgens, polycystic ovaries, irregular periods. Two of those three are required to be diagnosed with PCOS. In that sense, what is this whole polycystic ovary thing? What does that even mean? Some people will be like, Well, I’ve had cyst on my ovaries. They’ve ruptured, they’ve caused pain.

That’s a different cyst. Now, painful periods, all of those things are usually separate from PCOS. They can go hand in hand very commonly. Certain hormones being elevated, if you’re estrogen dominant, you can have some more painful periods because you may have heavier periods. But for the most part, painful periods is not specific to PCOS. Cysts that rupture, single large cysts that rupture, are not PCOS. That’s a huge myth that people think, Oh, I had a cyst in my ovaries, I must have PCOS. A cyst that ruptures a large single, solitary cyst is like getting a cyst anywhere else on the body. A true cyst is something that you’re going to have a single. Sometimes it’s painful, It can fluctuate, sometimes someone will have a cyst in their breast tissue or under their skin. Those are things where it’s one cyst. It’s usually tender. It’s something that needs to be removed. It’s actually a little sac that has almost what looks like a pimples bowl inside of it, that type of a fluid, almost white, ricotta cheese-looking stuff. Some people think they’re nasty, but I worked in dermatology for a long time, so we saw lots of cystic tissue.

That’s a true cyst. That has nothing to do with polycystic ovaries. What we’re talking about with polycystic is many cyst-like structures, and they’re not true cyst, they’re cyst-like structures on the ovaries. You have more of these clusters of grapes or many little tiny nodules on the creating this polycystic ovarian appearance. Why does that happen? I alluded to it earlier, but the point here is that it happens because your FSH levels do not go high enough to fully mature a follicle. During the first part of your cycle, so you have your period, and then your first part of your cycle is your follicular phase, your FSH, your follicular stimulating hormone, is on the rise, telling your ovary to select a follicle and begin maturing it into an egg for ovulation. Now, if this happens month over month over month where you don’t fully mature an egg, you start to have many partially matured follicles. You have all these, you could say, teenage follicles hanging out on your ovaries, creating this polycystic ovarian appearance. That is where that comes in. But really, truly, that’s just a FSH-LH ratio problem, which comes down to an elevated androgen because having high levels of testosterone tends to throw off this LH, FSH ratio.

Again, having polycystic ovaries really just points to an androgen imbalance than it does anything else. True cysts, on the other hand, you could get one with PCOS, but they would not be related. It’s just like you could have other non-related issues. You can get an ingrown toenail with polycystic ovarian syndrome and it has nothing to do with it. Going back to the practical, why does any of this even matter? Number one, we want to feel good in our bodies. We’re having symptoms of PCOS that we are not enjoying, and we want to know why so that we can figure out what we need to do to feel better. Correct? At least that’s how I’ve always approached PCOS. Now, we want our bodies to work with us. We don’t want them working against us. We also want to have an understanding of what would work because one of the most frustrating things when it comes to PCOS is that we feel like nothing works. We feel like all of the information must work for somebody, but it doesn’t work for me. Being able to finally understand what it is that your body is needing, and then you get to choose to the degree at which you want to put that effort in to do it to the degree that you want your body to feel better.

Usually, This is something where we find that balance, we find that sweet spot, we find what works for us in the lifestyle approach of our body working the way we want and achieving the goals that matter to us. I think it’s important with this conversation today because I’ve been getting a lot of a lot of DMs about, I have an appointment to see my doctor. What do I need to ask my doctor for help with? I think it’s really important to point out here that the diagnosis criteria does not help us to determine what is going on in the root cause of our hormones. It helps us to determine whether or not we are dealing with something other than PCOS. This is actually a backwards thing. When it comes to the diagnosis of PCOS, really what clinicians are looking at is something else going wrong. They’re not really looking to see, do you have PCOS? They’re making sure that you don’t have a thyroid disorder. They’re making sure that you don’t have some other issue going on that needs to be dealt with more acutely or needs to be taken care of. If you have type 2 diabetes, it may be showing up as PCOS symptoms, and that type 2 diabetes needs to be taken care of.

That’s really where your clinician is the most concerned. They don’t have a lot to offer you for PCOS. At the end of the day, they give you the diagnosis because it’s like, Well, this is what you probably are dealing with, and that’s the end of the road of what we need to look into. When it comes to your doctor, they have very limited resources to help you beyond diagnosing PCOS, continued monitoring to make sure the risk factors aren’t showing up, and to potentially offer you some birth control to help override the hormone imbalance. It’s a bandaid. It can cause more problems for some women than it helps. Tread lightly with that one. Look into the options there. We’ve talked about it on other episodes, so I’m not going to go into it in great detail here. The other thing they can offer you is something like Metformin. Then, of course, if you want assistance with fertility, they can assist you there. That’s where your doctor can help you. They do not get into why are you having these symptoms from a root cause standpoint. These have to do more with your metabolic health and the overall nurturing environment that you’re providing your body of if it’s working or if it’s not working.

Those are really where we get into with the root causes, but that has a lot more to do with life lifestyle adjustments, nutrition, movement habits, mindset habits, and things that doctors just don’t really get into. They weren’t trained about it in medical school. They were trained to treat acute problems. They weren’t trained very much in preventative health. Now, they’re beginning to be trained maybe a little bit more in preventative health. Hopefully, they keep talking about it a little bit more. But when you think about all of the different topics that they have to learn about and all of the different diseases that they would have to learn preventative health about, it’s still very minimal And so when it comes to PCOS, your doctor is a very important part of your healthcare team, but they’re not going to be able to give you a great deal of assistance when it comes to the lifestyle adjustments in the root causes of your PCOS health. They can help you monitor they can help you with some medications if that’s the route you want to take, and that’s about it. So this is where in conclusion today, recapping, I think that it’s interesting whether or not you have polycystic ovaries.

I think that’s something that can be An interesting fact about as interesting and probably a little less annoying than finding that you have hairs on your chin. So it really amounts to about the same thing. What is more important in your ultrasound, and so what you really want to pay more attention to, and hopefully your doctor is evaluating during an ultrasound, is sure it’s great that they looked at the ovaries and commented on whether or not they had this polycystic appearance or not. But what you want to see is, do they see any concerns with the anatomy as far as fallopian tubes and making sure everything is there and making sure everything appears to be as expected. Now, sometimes there’s a limit to what we can see on ultrasound, but they want to get at least a first scan to make sure everything looks anatomically correct and so there shouldn’t be anything blaring that they see that would be a cause for concern in the ability to get pregnant or carry a healthy baby to term. So that would be a good thing for them to be able to look at. But other than that, the ultrasound is just one more way of determining like they would do a physical exam, like they’re looking to see, do you have extra hair on your chin? Do you have a thinning pattern on the top of your head, et cetera?

So I hope that makes the cystic question a little bit more clear. Also, we went a little off topic and talked about what your doctor can help you with and where their area of expertise is in this whole puzzle of PCOS. Any follow-up questions, I welcome those over on Instagram, the best place to reach me, my DMs, because that’s where I tend to spend the most time chatting I welcome your questions there. Until next time, bye for now.