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Symptoms of Polycystic Ovarian Syndrome, or PCOS, can start as early as menarche (a young woman’s first menstrual cycle) and can include irregular or absent periods, acne, obesity, severe PMS, hirsutism (excess body hair and/or facial hair), anxiety, fatigue, thinning scalp hair, insomnia, migraine headaches, brain fog, depression, sugar/carbohydrate cravings, night sweats, and the appearance of masculine features. In approximately 30% of cases, ovaries also form multiple small cysts that appear on ultrasound in a classic manner that is often called a “string of pearls,” thus the name “Polycystic” Ovarian Syndrome. These cysts can contribute to, but are not solely responsible for, infertility issues. (Since 70% of patients do not have cystic ovaries, the name and diagnosis can be confusing.) The timing of PCOS symptom development can be unpredictable. Some women who have the genetic predisposition for PCOS do not get any symptoms until after childbirth.
PCOS isn’t just about infertility. That said, the incidence rate for miscarriages in PCOS patients is also very high (50-60%) in the first trimester of pregnancy. Proper medical intervention after conception is necessary to help prevent a miscarriage, as certain hormone levels are too low. During a successful pregnancy, naturally elevated hormone levels (after the first trimester) are effective at lessening PCOS symptoms and patients usually feel great! After giving birth, though, hormone levels gradually return to their previous levels and the miserable symptoms return. Why isn’t treatment continued? Fertility specialists typically stop treating the patient after conception. Generally speaking, there are very few doctors who are up to date with the proper treatment of PCOS patients.
PCOS is among the most misdiagnosed medical conditions in our country. Contrary to what most doctors and patients believe, PCOS is not a disease of “cystic ovaries.” PCOS is actually an inherited disorder of Insulin Resistance, which causes higher insulin levels that can lead to elevated blood levels of DHEA, testosterone and aldosterone, as well as some pituitary hormones. Other hormone levels, like progesterone and triodothyronine (active thyroid hormone), may be decreased. “Insulin Resistance” means the body lacks a normal sensitivity to insulin, so it needs more insulin to adequately reduce serum glucose levels. Insulin resistance usually leads to Type 2 Diabetes; but for patients with the predisposition for PCOS, it usually does not cause diabetes. Instead, these patients develop PCOS symptoms.
At least eight to ten percent of American women have PCOS with varying degrees of severity. Only 60% of PCOS patients are obese. PCOS can be very difficult to diagnose as most patients do not have all the symptoms. The ideal method of confirming the diagnosis is to perform lab tests before the patient is taking any synthetic hormones (including birth control pills, most IUDs and hormone releasing vaginal rings). The evaluation of certain Pituitary hormone levels, then, can confirm the diagnosis of PCOS. Pelvic ultrasound can also be helpful, but can miss up to 70% of cases.
PCOS is often undiagnosed because many women just accept their symptoms, and few physicians have the experience or training to recognize it, (The fact that 70% of PCOS patients do not have “cystic ovaries” often makes diagnosis more difficult). Many patients suffer for years and see numerous doctors before being diagnosed – and then are rarely treated properly. Check it out for yourself: Most treatment options are only directed at ovulation and conception. These treatments frequently include synthetic hormones, which may have harmful side effects (conversely, bio-identical hormones are just as effective without the side effects). A prescription for oral contraceptive pills is the most common “traditional treatment” used by doctors. While this may regulate the monthly cycle and lessen PCOS symptoms, it only scratches the surface of effective, long-lasting treatment. Unfortunately the most effective birth control pills are rarely even prescribed.
Proper PCOS treatment begins with adjustments to lifestyle and nutrition as well as the knowledgeable inclusion of bio-identical hormone replacement therapy and prescription medications. The results of this treatment often include dramatic improvement or elimination of PMS symptoms and “brain fog,” the return of “psychological health,” elimination of acne and unwanted hair, a more feminine appearance, weight loss, healthy energy levels and the return of regular menstrual cycles. Normal fertility is also restored in many cases. Depression, insomnia, and anxiety are most often dramatically improved, and many patients discontinue their anti-anxiety medications and antidepressants (with the assistance of a medical professional). We often see dramatic weight loss from patients just adhering to the treatment plan.
Effective and experienced PCOS treatment must address the patient, her multiple unpleasant symptoms, and most importantly, the root cause of these symptoms. Often, treatment only deals with the infertility often caused by PCOS, and is mainly handled by fertility specialists. When patients receive treatment for their symptoms, it’s usually in the form of anti-depressants, antianxiety medications, diet pills and/or “ADHD” medications to improve energy and focus. This treatment approach is almost always ineffective. Patients either continue suffering or may only have slight improvement in their symptoms. Dependencies frequently develop from these medications.
Most of Dr. Hirsch’s patients feel better within just a week or two after starting treatment. Another important reason to optimally treat PCOS is that PCOS sufferers carry a 200% to 400% greater risk for strokes, breast cancer, heart attacks, uterine cancer and ovarian cancer. Skilled, experienced, educated treatment can dramatically reduce these risks.
If the symptoms mentioned above sound familiar or you have already been diagnosed with PCOS, we encourage you to schedule a consultation with Dr. Hirsch. PCOS patients at Hirsch Clinic are typically categorized as patients receiving Bio-identical Hormone Replacement Therapy. Although insurance will pay for some prescriptions and most lab tests, BHRT patients are billed a quarterly fee for Dr. Hirsch’s continuing services. We look forward to the opportunity of helping you finally feel “normal” (often for the first time) and reducing your risk of cardiovascular disease and cancer.
Endocrinologists and gynecologists are specialists who may be unfamiliar with or new to understanding the effectiveness of using bio-identical hormones for enhancing the quality of life for patients. Doctors have to have the time and desire to learn how to incorporate these revolutionary medical solutions into their practices and the lives of their patients. Many medical care providers lack the time and are unfamiliar with this beneficial yet sophisticated approach that is part of comprehensive, effective PCOS treatment.
A note from Dr. Hirsch: “I have been a practicing physician for more than three and a half decades. Since 2007, my Preventive Medicine practice has focused on areas that traditional American medicine has neglected. PCOS Treatment, Bio-identical Hormone Replacement Therapy, Weight Management and Age Management are my specialties and now account for 100% of my practice. I have many menopausal female patients who have returned to their premenopausal youthful function, health, and “selves.” I also have many patients who have lost over 100 pounds, and hundreds who have lost 40-50 pounds or more. These individuals, both male and female, have not only lost weight, but have increased their energy and experienced a return of their youthful libidos and sexual functioning. This is, and continues to be, extremely rewarding. The improvement in these patients’ quality of life, however, pales in comparison to the dramatic life transformation that many of my PCOS patients experience! Imagine the opportunity to have a healthy libido, conceive ‘naturally,’ and have a reduced risk for miscarriage after expensive, failed fertility treatments because your PCOS has finally been treated correctly! Seeing patient’s significant weight loss after multiple unsuccessful ‘diets’ is also quite rewarding.”
Successful treatment of PCOS requires diligent, strict compliance to nutrition that does not stimulate insulin. Deviation from “optimal PCOS nutrition” renders prescription medications, bioidentical hormones, and other aspects of properly addressing PCOS much less effective. PCOS patients usually struggle with sugar/carbohydrate cravings, which can be controlled with medications, hormones and eating only clean, healthy foods that are “allowed” on our program. Only highly motivated patients with a determination to succeed “need apply”. Please note: A limited number of applicants are accepted into our PCOS treatment program. Completed patient medical history forms must be submitted and reviewed prior to new patient appointment scheduling.
Some PCOS patients, even with strict adherence to our treatment protocol, still have difficulty losing weight. We are pleased to announce that we have finally found a successful way to integrate a modified version of our weight management program into the PCOS treatment protocol for these patients. This enables PCOS patients to lose weight/fat much more rapidly, and, remarkably, even enhances the results of PCOS treatment.
Images on this site may be models, not actual patients.