Episode #43: PCOS Ask Me Anything Volume 1

One of my favorite things about working with women who are learning to balance their PCOS hormones and to regain their health is hearing what questions you guys have, and so in today’s episode, I’m really excited to go through some of the questions that I have been getting through DMs on Instagram and through email and I want to start off by saying how much I love it when you guys reach out with your questions. And I am excited for this episode today where we get to go through all the questions that I’ve been getting in the last couple of weeks. So let’s get started.

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 our episode is Ask Me Anything and I’m going to be going through all of the questions that I have been getting, a lot of them are repeats, so I’m going to go through and talk about the different topics that you guys have been asking about. The first one and a big one that has been on a lot of women’s mind, I’ve gotten so many exciting and amazing emails of women emailing me when they’re about six or seven weeks pregnant, they don’t want to tell anyone else yet, and it’s a huge privilege to get these emails. But at the same time, I really feel for these women, and they are very fearful at this point. They are excited, they’re scared to be excited, and they’re worried about the PCOS risk of miscarriage. So let’s talk a little bit about first-trimester miscarriage as well as what’s going on with recurrent miscarriages and help you to maybe shift the mindset of being able to be a little bit more excited once you get that positive pregnancy test and what you can do to assist maintaining that pregnancy during your first trimester.

Okay, so first of all, PCOS or non-PCOS, the first trimester is a common time for miscarriages. A very large percentage of women will experience a miscarriage in their first trimester. And this has nothing to do with anything that you’ve done wrong. It has nothing to do with your body not being up for the job. This has to do with the fact that it takes a lot of precision to create a human and sometimes those cells from your partner and from yourself didn’t quite line up correctly, and it just wasn’t going to turn into what we wanted it to be and so your body can recognize that early on as the genetics of that embryo not being quite right, and it’s not going to be able to grow into a healthy baby, and so your body lets it go. This is sad, it’s disappointing, it has all the emotions with it. But what I want you to hear from this is that it was not your fault, this does happen, it’s sad, it’s disheartening, it has all of those emotions, but it wasn’t because of anything that you did or that your body wasn’t capable of and when we say it was a genetic issue, it has nothing to do with your genetics. Now, there can be genetic issues, but what I’m talking about here is simply it takes a lot of precision to create a human, and sometimes that precision doesn’t happen, and your body is smart enough to figure it out early and try again. If you are having a lot of reoccurring miscarriages, hopefully, you’re not. Hopefully, this is something where we can avoid the reoccurring miscarriages by the next couple of steps that I’m going to give you here. But because you have that diagnosis of PCOS and because PCOS is known to have a little bit more tendency or risk of miscarriage, it’s not a lot higher. I want you to be aware of that, it’s not like you have this huge risk of miscarriage, but it is a little bit higher. But because you have that diagnosis, you’re sitting in a really good place to ask your doctor to go a little bit further in the digging of why you may have had a miscarriage, or if you haven’t had a miscarriage before, a little bit more protection against possibly having one.

So the couple of things that you can do here if you’re concerned about a miscarriage, is that you can have genetic testing done prior to getting pregnant or once you’re pregnant, they can do genetic testing pretty early on. They can do that now through blood work, which is really cool. Also, you can ask them to test your progesterone and make sure that your progesterone is high enough to support a healthy pregnancy. During the first trimester, your body is creating the placenta. At some point, your placenta is going to take over towards the end of that first trimester, and it’s going to support the pregnancy for the remainder of the next two trimesters until delivery. But in the beginning, it’s not there yet, and you need to have high enough progesterone levels to really keep that uterine lining and to hold everything together while your body creates that placenta. So early on, those progesterone levels are really important. Women with PCOS oftentimes have lower progesterone. One of the best ways that you can elevate your progesterone naturally prior to getting pregnant is to get that cycle coming regularly. You’re going to do that by discovering your root cause, you’re going to be doing all the things that support that root cause that you’re struggling with and you’re going to get those periods to be regular and to be ovulatory and the more ovulations you have, the stronger that progesterone is going to be. There are some other ways that you can boost progesterone, but that’s the biggest one, that’s going to be the one that is the most beneficial to boosting your progesterone. Okay. So when we’re, again, looking at miscarriage, the best thing that we can do is to just make sure that our doctors are aware that we have PCOS to let them know as soon as we find out that we’re pregnant, to test those progesterone levels even prior to getting pregnant, to see if that’s going to be an issue for us. There’s medication and supplements that they can put you on to help boost that progesterone level, to help reduce the risk of reoccurring miscarriage, or to reduce the risk of miscarriage and then to remember that a lot of times with PCOS and not PCOS, there are just times where the precision of making a human doesn’t come together, and we can’t blame ourselves, you had nothing to do with it, you do get to feel all the emotions that you need to feel, but it wasn’t your fault.

The next question that we had was, Is metformin worth the struggle? Oh, my goodness, ladies, I know that metformin can be a struggle. Okay, here are my thoughts on metformin. The reason why it’s been more and more prevalent in the recommendation of physicians when you’re diagnosed with PCOS or when you’re talking to your doctors about PCOS is that we’ve really seen that link between women having the risk of developing type 2 diabetes as well as insulin resistance being a large factor in how bad your PCOS symptoms are. And so that is something that has become more and more recommended is to give metformin. Is it the only option? No. Is it helpful? For some. But if it’s making your life hell and you’re feeling awful while you’re on it, that’s not really getting us where we want to go. So here’s the metformin conversation, first of all, it’s really important to talk to your doctor, where are you on the spectrum of insulin and blood sugar control? Do you need medication? Because if you do need a medication, it may be a question of, well, maybe metformin is not the right one for you, but you do need something because you’re really crossed over onto that side of needing a medication for your insulin resistance or developing diabetes. If you don’t have any indication that you’re struggling with insulin resistance and pre-diabetes, and you’re really hating being on metformin, or you don’t like the idea of going on metformin, the biggest thing you’re going to want to do is the lifestyle changes. They’re going to do the same basic idea of managing all of this. In fact, ultimately, they’ll do a better job. They’ll do a more holistic, whole, well, well-rounded approach to your health. However, if you are struggling, you may need that medication and then the last thing with metformin is just that it is something that gets better and so over the first month if you’re really struggling, taper down the dose, talk to your doctor about the dosing, taking less and working up to more. It can be a really good approach to being able to handle being on metformin.

Okay, the other question I got asked actually a couple of times in the last month here is, how strict was I when I was trying to heal my PCOS and trying to get pregnant with my first baby? I went all in. I had four months until I was going to see the infertility specialist and so I felt like I had this deadline to do it all. We’ve talked about in recent episodes that you don’t have to do it all, that maybe that was a little bit overzealous. But at the same time, at that point in time in my life, I had the bandwidth, I had the ability, and I went pretty much all in. I cut out all refined sugars, I cut out most carbohydrates, and I ate tons of vegetables. I did not have enough protein, if I was going to go back and do this again, I would eat more protein. I was not taking any supplements for PCOS. There was not a lot of information on anything PCOS back when I was trying to do this and I did a lot of interval training with cardio, so I didn’t do a lot of weight training. I would definitely add that in if I was going to go back and do it again. I definitely add that in now. At the time, I would turn to run as one of my go-tos for physical health and movement and my husband and I started doing intervals training where we would go down to this road that was quiet and actually blocked off, so no one was using it and we marked out a quarter mile, and we would run quarter-mile sprints, and we would do a light jog down there, a light jog back, recovery in between while we timed the other person. So it was fun and it was great and between the two, over the four months, I lost, I think, about 15 pounds. And that was definitely all I needed to lose. That was for me, I wasn’t that overweight at the time and there had been times when I’ve been heavier, but I was at that point when I really hit it hard and I had no cycle, no consistency, not ovulating and over the four months, I regained my cycle, ovulated, got pregnant naturally. So I did go all in. It wasn’t just exercising and nutrition. It was a huge mindset piece where I really wasn’t focusing on getting pregnant. I was really focusing on creating health, mentally and physically to be ready for whatever was coming. That was really my mindset during all of this and to just care for myself, make it my time, put myself as a priority, and get enough sleep. I do all the things that just like if I was going to be caring for somebody that I would want to do for them.

The next question was, how is the PCOS diagnosis different from the root cause? This is a great question. So a PCOS diagnosis is almost a diagnosis of exclusion and what I mean by that is that we go through and we make sure you don’t have a thyroid problem. We make sure that you don’t have AMH levels that are too low, we make sure you have all these other things that are not going on, so we check everything else and then if you have all the right symptoms and nothing else is necessarily wrong, but you have some elevated androgens or you’re showing symptoms of elevated androgens and your periods are irregular, then we say, Oh, you must have PCOS. That is where the diagnosis comes from. Root causes are an entirely different thing. Root causes are where we look at the symptoms that you’re having and we look at them in a very holistic way and we look at them almost like dominoes. Which one is coming first to knock over the next domino, the next domino to create the next problem, the next problem, the next problem? Are we having a blood sugar spike and drop that’s leading to fatigue, or are we having a deficiency in something or a sleep problem or a cortisol problem that’s leading to fatigue and then also affecting our insulin on that end? So which direction are the dominoes falling, basically? And we’re really getting down to that root of the root of the symptoms that you’re having. And that may be that you’re having irregular periods, and we know these hormones are off, but why? Those are the tip of the iceberg. We want to go all the way down to the very bottom and see what is leading to that happening. So that’s the difference between a PCOS diagnosis and a root cause. And why when you’re looking at lifestyle adjustments, just having a PCOS diagnosis and then trying to follow what has worked for somebody else with PCOS is really throwing spaghetti at the wall? Whereas when you look at your root cause, you’re really tailoring your lifestyle adjustments to what’s going on with your specific body at a specific point in time.

And then another one was how to figure out what is going on with high LH or LH abnormalities and if you’re ovulating. Okay, so when it comes to the ovulation predictor kit, which is I think where this question was coming from when I draw it down here in my notes when we’re looking at an LH stick, the problem is that in PCOS, our LH is typically elevated. And so if we get a real true spike on our LH reader and we’re seeing a real big increase in the amount of LH and we get that huge spike, we can probably be pretty clear that that was an ovulation. However, if we’re just seeing an elevation in LH and not a true spike, that is probably a sign of not ovulating and I would tell you that over most women with PCOS, we ovulate late. And so you’re going to see that LH spike later than expected, and oftentimes, only a few days prior to your period starting. Well, we want to know when we’re ovulating, and I’m not going to discourage you necessarily from testing. The best way is going to be basal body temperature. So something like OvuSense can be helpful if you don’t want to just take your temperature manually every morning at the same time and remember that first thing before you get out of bed. The other thing, though, is that these are top-of-the-pyramid hormones and so we really want to see, okay, what raises LH? Well, LH is usually raised by testosterone and insulin and cortisol and work our way back down through that pyramid and so what are we doing that’s raising that LH? Let’s bring that LH down to normal levels, that’s going to help restore our cycle, that’s going to help restore ovulation, and then it’ll be a lot clearer if we’re ovulating or not because we’ve repaired our periods, we’ve repaired our cycles. And then when we take the ovulation predictor kits, they’re just going to be more clear. So while trying to get pregnant, I know you want to know when you’re ovulating, and the best way is going to be basal body temperature. But beyond that, the way that you actually approach LH and bring those hormones back into balance is going back to that root cause of LH is elevated because of a root cause. The approach that with lifestyle changes and you’re going to see a huge improvement there.

So, guys, I love hearing your questions. Drop more questions in my DMs on Instagram. Head over and find me @Nourishedtohealthy, and I’ll put the link in the show notes. Ask your questions. We’ll do more of these Ask Me Anything because I know you all have specific questions that you want to be answered. I love to answer them, and you know what? I really appreciate you putting yourself out there and asking these questions because other women have them too and that’s why I’m putting them in the podcast today.

So if you have found this episode helpful, please be sure to hit the subscribe button so that you can get notified each and every week when the next PCOS Health topic of this podcast becomes available. And until next time, head over to Instagram @Nourishedtohealthy and let me know your questions. I would love to connect with you over there. And until next time, bye for now.

Did you know that studies of PCOS epigenetics have shown that our environment can either worsen or completely reverse our PCOS symptoms? I believe that although PCOS makes us sensitive to our environment, it also makes us powerful. When we learn what our body needs and commit to providing those needs, not only do we gain back our health, but we grow in power just by showing up for ourselves. This is why I’ve created a guide for you to get started. My PCOS fertility meal guide can be found in the show notes below. I want to show you how to create an environment that promotes healing while still being able to live a life that you enjoy. This guide is completely free, so go get your copy now so that you can step into the vision that you have for your life and for health.