Alternative PCOS Solutions:

Your complete source for

naturally vibrant health

Julie Renee Callaway

The PCOS Coach

1
 Alternative PCOS Solutions:
Your complete source for
naturally vibrant health

© 2004 Julie Renee Callaway, All rights reserved. If you purchased

this book, you may make one copy for your own use. Distribution or
storage in any form without express written permission is illegal and will
result in bad karma, plagues of locusts and possible prosecution.
Legitimate copies may be obtained through http://www.pcoscoach.com

2
Dedication
For my mother, who gave me the gift of books and for the thousands
of women with PCOS who have given me the story to tell.

Disclaimer
I am not a medical doctor. It is crucial that you talk with your health
care provider (doctor, naturopath, chiropractor or herbalist) before
attempting any new exercise or eating plan and before altering or
beginning any medication or herbal remedy. Do not read this book
unless you understand that the information here is intended for
educational purposes only and should not be taken as medical advice. Do
not read this book unless you are willing to hold blameless the author
and any others associated with its writing, production or distribution.

3
Table of Contents
INTRODUCTION ............................................................................................. 6
WHAT DO I KNOW? .......................................................................................... 6
MY STORY ....................................................................................................... 7
CHAPTER ONE .............................................................................................. 15
UNDERSTANDING PCOS................................................................................ 15
WHAT ARE THE TYPICAL TREATMENTS? ........................................................ 16
CHOOSING A DOCTOR .................................................................................... 17
WHAT IS INTEGRATIVE MEDICINE? ................................................................ 20
WHAT IS PCOS? ............................................................................................ 21
DIAGNOSIS- WHAT TESTS DO I NEED?............................................................ 28
WHAT ARE THE CONVENTIONAL TREATMENTS?............................................. 34
CHAPTER TWO ............................................................................................. 38
WHY ALTERNATIVE MEDICINE? ..................................................................... 38
CHAPTER THREE...........................ERROR! BOOKMARK NOT DEFINED.
WHAT ELSE COULD IT BE?........................ ERROR! BOOKMARK NOT DEFINED.
CHAPTER FOUR .............................ERROR! BOOKMARK NOT DEFINED.
DON’T TELL ME TO RELAX!...................... ERROR! BOOKMARK NOT DEFINED.
CHAPTER FIVE ...............................ERROR! BOOKMARK NOT DEFINED.
ENERGY AND SPIRIT ................................. ERROR! BOOKMARK NOT DEFINED.
CHAPTER SIX ..................................ERROR! BOOKMARK NOT DEFINED.
TO CARB, OR NOT TO CARB..................... ERROR! BOOKMARK NOT DEFINED.
CHAPTER SEVEN ...........................ERROR! BOOKMARK NOT DEFINED.
THE “E” WORD ........................................ ERROR! BOOKMARK NOT DEFINED.
CHAPTER SEVEN ...........................ERROR! BOOKMARK NOT DEFINED.
CLEANSING THE VESSEL .......................... ERROR! BOOKMARK NOT DEFINED.
INTERNAL CLEANSES ............................... ERROR! BOOKMARK NOT DEFINED.
OTHER TOXINS ......................................... ERROR! BOOKMARK NOT DEFINED.
CHAPTER EIGHT............................ERROR! BOOKMARK NOT DEFINED.
HERBS AND SUPPLEMENTS ...................... ERROR! BOOKMARK NOT DEFINED.
HERBS...................................................... ERROR! BOOKMARK NOT DEFINED.
CHAPTER NINE...............................ERROR! BOOKMARK NOT DEFINED.
SUPPLEMENTS .......................................... ERROR! BOOKMARK NOT DEFINED.
VITAMINS ................................................ ERROR! BOOKMARK NOT DEFINED.

4
MINERALS, AMINO ACIDS, AND OTHERS... ERROR! BOOKMARK NOT DEFINED.

5
Introduction

What do I know?
I have struggled with PCOS since I was 12, more than 20 years. I
spent a lot of time going doctor to doctor trying to find out why I was
sick. Even after I was diagnosed with PCOS I spent more than a decade
looking for information and treatment. Doctor after doctor told me my
symptoms were in my head; to them PCOS was a fertility problem.
I cried the first time I read through an online PCOS message board. I
was not alone! The descriptions of fatigue, weight gain, painful periods,
hair loss, hirsutism, disfiguring acne, and other symptoms were all too
familiar to me. I soon learned that there are millions of PCOS sufferers
around the world. I also learned that my fruitless march from doctor to
doctor was almost a symptom of PCOS, nearly every woman I met had a
similar story of ignorance and even rudeness from the very professionals
from whom they begged for help. This book grew out of the hundreds of
conversations and emails I have had over the last four years with women
who suffer from PCOS.
I finally learned that the only way to get well was to take charge of
my own health. I am the one who has to live in this body. It is my
responsibility to understand how it works and why it doesn’t. I have
found good doctors and their care has been crucial in my wellness
journey. But the greatest strides have come from what I have been able
to do for myself.
My own health has improved dramatically in the last four years as I
have learned to apply holistic healing methods in my own life. As I have
learned to care for my body I have lost weight, reduced the amount of
excess hair growth, stopped my hair loss, restored my periods and
lessened the fatigue that has plagued me for 14 years. This book is
intended to give you the same gift of healing.
I am still on the road to wellness. I have more weight to lose. I want
to have children and hope that I can do so without fertility drugs. I still
struggle with fatigue. But, despite the journey ahead of me, I feel better
than I have in more than a decade. For the first time I have confidence
in my future health. The progress I have made has brought me new
friends, given me faith in myself, and strengthened my faith in God.
6
My story
My cycles were long from the beginning (usually 35 days) and I had
very painful, heavy periods. I started putting on weight in my early teens
and my body hair became much thicker and more noticeable. Around the
time I turned 16 my periods stopped altogether. My doctor assured me
that it might take a while for “teenage hormones” to level out.
If I skipped a meal or had too much sugar I became shaky and got
migraines. My older sister was hypoglycemic, so I didn’t worry. I just
tried to eat every two hours. I stopped eating very sugary foods and
drank only diet sodas. I didn’t worry about the missed periods. When
they came the pain was so bad I could barely walk—so why worry if I
only had a few each year?
My doctor offered me birth control pills and massive doses of
ibuprofen to control the pain and heavy bleeding. I knew that being on
the pill would make my parents jump to conclusions so I simply lived
with the pain. I am now grateful that I turned down that first offer for
the pill as I know that birth control pills can wreak havoc on women with
PCOS.
By the time I started college the mood swings and depression were
seriously affecting my life. I was not sleeping regularly, I was exhausted
all the time, my weight began to creep back up. I felt surrounded by
blackness and my hypoglycemia was out of control. I had to eat exactly
every two hours or I would start shaking, sometimes even slurring my
speech. I carried food with me at all times to stop these frightening
episodes.
I could stand up from a class feeling fine and after walking only 100
yards my teeth would start chattering and I’d drop my backpack or trip
on tiny cracks in the sidewalk. Within seconds the headache would start.
I’d eat a granola bar or something and in a few minutes I’d feel better. I
began to accept this as “normal.” Any exertion would leave me collapsed
and drained for days afterwards. There were times I was so sick I
couldn’t leave my apartment.
I was diagnosed with depression and began taking an antidepressant.
This caused me to gain 35 pounds in just a few months. The psychiatrist
made me weigh myself in his office saying “look what you are doing to
yourself.” My mood swings didn’t get better and my health got worse.
The doctor at the student health center was alarmed that I was not
having periods. I agreed to go to see a fertility specialist at the University
7
of Utah Medical Center. I was completely unprepared for the diagnosis.
Even as the doctor spoke I knew this was life-changing information. He
told me that I had something called polycystic ovarian syndrome. He
explained something about FSH and LH hormones. No big deal, he
assured me. “Come back when you want to get pregnant. A little Clomid
will fix you right up.” Not one word about any of the other symptoms I
would be struggling with.
I knew in my heart that this was a big deal. I went back to my
apartment where, for once my roommates were all gone. I sat and
sobbed for hours. From my earliest memories I was drawn to babies. I
played with dolls and dollhouses and daydreamed of the day I would be a
mother. I had never dreamed that anything would stand between me and
my future as the best mother on the planet. I knew this would not be as
easy as “a little Clomid.”
The university library offered only two books on women’s health that
mentioned PCOS at all. Each offered only two lines about it. No
mention of the health effects, just a little info on fertility. For many years
after that I looked for information every time I was in a bookstore. I
never found more than a brief mention of PCOS.
The psychiatrist kept upping my dosage of antidepressants. When the
first one stopped working he put me through a grueling trial of a half
dozen different drugs. Most had side effects that were so awful I refused
to keep taking them. After three months of this experiment, I decided
that the antidepressants were doing me more harm than good. What I
needed was a change in my life. Three weeks later I was on a plane from
Salt Lake City to Washington, D.C., where I was to work as a nanny for
the next five years. I weaned myself off the antidepressants (I don’t
recommend doing this without the help of a doctor).
In D.C., I continued my slow, painful march from doctor to doctor.
“Lose weight” was the only answer I got from one doctor who refused to
even do one blood test, even after I told him I had been diagnosed with
PCOS. I managed to starve myself into losing 10 pounds but my
symptoms did not improve.
Without health insurance, I turned to a pregnancy prevention clinic
for healthcare. I was put on a high estrogen birth control pill to “regulate
my periods.” I ballooned 25 pounds in one year and I had chronic yeast
infections. When I returned for my annual check up the nurse
practitioner actually yelled at me, “How could you gain this much weight
so fast?” I replied that my mother and sister had similar responses to the
8
pill. “The pill can’t make you gain more than 5 pounds,” she said loudly.
“What is wrong with you? Are you depressed or something?”
Well, if I wasn’t before I saw her, I was after seeing her! She put me
on a different pill with less estrogen and the weight gain stopped. I
simply could not lose any weight, no matter what I did. Around this time
the fatigue got so bad I honestly have no idea how I managed to keep
going. I chalked it up to the fact that I was working too many hours,
attending night classes, and babysitting a temperamental boyfriend.
After two years on the pill, I developed a painful breast lump and the
doctors pressured me to have it removed. Thank goodness it was benign,
but I read that birth control pills may cause breast lumps. I went off
them and refused to take them anymore. I felt terrible about my weight,
the chronic fatigue, the excess hair, and the acne that was scarring my
face.
I changed careers and started working in an office where I finally had
good health insurance. Unfortunately the insurance was better than the
doctor I picked. She insisted that there was nothing wrong with me. I
begged her to help me with the fatigue and chronic hypoglycemia. She
tested my blood glucose levels and found them to be “normal.” She
offered me Prozac and a very low-carb diet. I refused the Prozac and the
diet made me so sick I couldn’t function. She shrugged and told me that
my excessively high triglycerides must be genetic (by now they were at
595, they are supposed to be under 150). I told her that I had recurring
pain in my abdomen. She said it was something I ate.
I did not yet have access to the Internet so I was limited in my ability
to do research. A friend saw the results of a study that indicated that
metformin (Glucophage) would help women with PCOS. Armed with
this information I went to see a new doctor in that same practice. She
also told me my abdominal pain was “something I ate.” She told me my
estrogen levels were borderline low and my testosterone levels were
borderline high, but assured me this was normal. She too insisted there
was little wrong with me that wouldn’t be fixed by a weight loss regimen,
but agreed to try me on Glucophage. After two days my blood sugar
levels were so low I was getting dizzy and I felt a migraine coming on. I
called her and she said, “Stop taking it.” I asked what the next step was.
She said, “Nothing. There is nothing I can do for you.” She finally agreed
to refer me to the endocrinologist in the same practice.
After a full blood work up then announced to me that there was
nothing wrong with me. “What about the hypoglycemia, missing periods,
9
all of that?” I asked. “There is nothing wrong with you, you don’t even
have PCOS,” she repeated icily, “If you want I can start testing for
infectious diseases.”
A few months later I was in a new job and had just changed health
insurance yet again. I had not had time to find a new physician. I was
getting ready for work one day when the pain in my lower right abdomen
flared up with a vengeance. I knew the doctor would tell me it was
nothing so I just went to work. All that day I was gritting my teeth and
trying to focus past the agony. I was afraid to take anything for the pain
because it was so much worse than usual. I was afraid that pain killers
could mask something really bad.
By 11 PM the pain was so bad I could barely walk. I allowed my
roommate to take me to the emergency room in one of the best hospitals
in Northern Virginia. I spent more than 5 hours there and they did not
even do an ultrasound. Women’s pain is considered so common, so
normal, that they didn’t take me seriously.
I had lived with intense pain and terrible cramps for seventeen years;
this was worse, but not new. So, I was joking with the nurses in an effort
to keep myself from screaming in pain. The ER doctor walked in and
said, “You can’t be in too much pain, you are laughing!” I assured him
that I was in a great deal of pain. He felt my abdomen and said he felt
nothing unusual. He ordered a white blood cell count and a pregnancy
test. I assured him that there was no possible way I could be pregnant.
He shrugged and said it was mandatory because I was female and
complaining of abdominal pain.
Before I knew it I was on a gurney in the hallway begging to leave
and trying to keep the stupid hospital gown from exposing me
completely. Three hours later when the pregnancy test came back
negative I was released and told “It is most likely a ruptured ovarian cyst.
It is no big deal.”
That morning I called my doctor’s office and asked for an
appointment. The only person available was the endocrinologist. She
began by telling me that the pain was something I ate. I said, “Look, I
have no fever, no stomach problems, no symptoms at all except pain.
The pain has not moved in 24 hours. It has to be my ovary.” She did a
very abrupt and forceful pelvic exam and announced that there was, “No
way it is your ovary.” She told me to go home and drink Gatorade for the
next 48 hours to flush out my system. I started crying. I begged for an

10
ultrasound. She finally said, “Ok, I’ll order one, but ONLY to rule out
appendicitis. There is nothing wrong with your ovaries.”
That afternoon, after 17 years of pain, I got my first ultrasound. The
technician was quiet and focused on one area over and over. Finally she
went to get a doctor. He showed me the 10 centimeter mass in my
abdomen that appeared to involve both ovaries. I was scared but thrilled
to finally have proof that the pain was not in my head! I also got another
interesting bit of info. The reason doctors never felt a cyst was that my
ovaries had been pulled behind my uterus by the weight of the cysts. I
endured all those pelvic exams for nothing!
The next morning I got a frantic call from the doctor at 8 AM. I
almost laughed because I thought her fear was more a legal one than a
real concern for my health. She insisted I see a GYN that day and told
me not to leave the house until her office managed to locate an
appointment for me. She further demanded that I do nothing at all
strenuous to avoid bursting the cyst.
I began my own research and found a wonderful GYN in Fairfax,
Virginia. Dr. Damon Hou was a breath of fresh air after the experiences I
had just been through. At my first appointment he asked why I had never
been told to go on a diet such as the Zone that moderates carbs. He
talked to me like a person and he explained things to me at his desk while
I was dressed instead of expecting me to converse intelligently while I
was in stirrups. He explained my options and I opted for surgery. He
even explained to me that my reaction to certain painkillers was likely a
narcotic sensitivity and prescribed an interim painkiller that would not
make me sick. While I was awaiting surgery I found a list of homeopathic
remedies and vitamins that were thought to increase healing from
surgery. Dr. Hou gave me the required permission to bring my
homeopathic pellets and vitamin C to the hospital.
I also found in my research that a common but drastic treatment for
PCOS is ovarian drilling or using a laser to make several small holes in
the outside of the ovary to reduce the number of active cysts. For some
women this enhances ovulation for some time after surgery. Dr. Hou and
I discussed the pros and cons and I decided to allow him to do this since
he was already going to be making a caesarean style cut (typically ovarian
surgery is done by laparoscope but due to my weight Dr. Hou felt it
would be better to go with a more invasive procedure).
Before surgery he carefully explained to me what he would do. He
told me that if he found unexpected problems he would stop the
11
operation and wait to discuss it with me. He promised that I would not
simply wake up missing my ovaries. This was a huge comfort after the
demeaning way I had been treated by previous doctors.
Dr. Hou found and removed nearly identical 5 cm cysts (about the
size of a hen’s egg) from each of my fallopian tubes. In another stunning
example of doctor-patient relations, at my follow-up visit Dr. Hou sat
next to me, showed me my chart and explained the results of the biopsy.
I was not treated like a child or as if I was too stupid to understand my
own health.
I felt somewhat better after recovering from my operation, and the
pain was gone. But I was still exhausted and my periods did not start. Dr.
Hou prescribed progesterone pills to kick-start my periods and referred
me to an endocrinologist. I was profoundly grateful to meet Dr. Suzanne
Rogacz.
Dr. Rogacz listened carefully to my symptoms and asked me a lot of
questions. I was so relieved when the blood tests showed my thyroid
antibodies were off the scale. Finally my long suspected thyroid problem
was diagnosed. I started taking thyroid hormones immediately and I was
suddenly able to actually leave the house on a Saturday instead of having
to rest all day to recover from the normal exertion of the week. Dr.
Rogacz confirmed that my hormone levels were still way out of whack
and that my triglyceride (“bad” cholesterol) levels were still sky high, 707
now!
I tried Glucophage again and gained 12 pounds. My cholesterol
remained high. I was still exhausted. Things were better, but not still not
quite right.
My job was becoming increasingly stressful. The harder I worked the
more work I was given and I found myself spending too many nights and
weekends in the office. My job description changed every few weeks to
few months. I was learning a lot, but I was burning out quickly. I decided
to buy my own home in August 2001. Before I could settle on the house
came September 11, 2001. I wondered whether I was making a huge
mistake buying a home in a time of such uncertainty, especially so close
to Washington, D.C. I finally decided that I was doing the right thing and
I went through with the purchase. A few hours later, I was informed that
I had gotten a hard-fought promotion. Things looked very good.
Along with the house came an increase in my commute from a 20
minute roundtrip to nearly 2 ½ hours. A few months later, just before I
turned 30, I decided that the time had come to resolve my childless
12
status. I began trying to adopt through the foster care system (there are
hundreds of thousands of adoptable kids in the US foster care system).
The adoption agencies played games, fought with each other, and strung
out red tape, dragging out the process to more than 18 months and still
no child. My stress level climbed daily. The debilitating fatigue began to
take over again. Something had to give.
I prayed for help and it came in a most unexpected way. My boss
came into my office in April 2003 and announced that I was leaving. I
was given a couple of months to find a new job or I would be fired. My
health, the adoption, and the demands of the position were taking their
toll on my performance and he wanted to replace me.
I cried for two hours, finally pausing long enough to walk out of the
office without embarrassing myself. The job loss was no big deal. I knew
there would be another job somewhere. What crushed me was that I
knew without a job I had no hope of adopting. A new job would mean a
1 year wait to qualify for maternity leave again. After 18 months of hard
labor there would be no baby. That night I was scheduled to teach a
workshop on foster care and adoption for the local PCOSA (Polycystic
Ovarian Syndrome Association) chapter.
I went to the library where the workshop was to be held. I got there
well over an hour before it was to start. I pulled out a stack of career
books and sat at a table. I simply sat and stared at the pile for half an
hour. Suddenly I knew that the answer to all of the health problems and
work problems and everything else was not going to be found in a book.
This time I had to look into my heart.
One step at a time I remade my entire life. I sold my house before
the month was out. I sent all my things to my mother’s house in Utah. I
stayed at the job until July and then I took the rest of the summer “off.”
I stayed with friends helping first one, then another to remodel their
homes. I helped one of my PCOS buddies with an adoption. All the
research I had done on adoption paid off in helping her bring her baby
girl home (despite the agencies saying it couldn’t work out). All the pieces
were beginning to make sense.
I have spent hundreds of hours researching PCOS and holistic
healing methods. I tried Glucophage one more time and decided
anything that was making me that sick couldn’t be good for me. I have
turned to herbs and supplements such as vitex (chaste berry) and inositol.
I am doing yoga for relaxation and to enhance my health. Most
importantly I have lowered my stress level by being careful what I allow
13
into my life and accepting that I have no control over some of the things
that are in my life.
I have lost 25 pounds. My triglycerides have dropped by more than
half (707 to 348). I have more energy. I am no longer struggling with
depression. I can exercise without getting sick. My allergies are almost
gone. My periods are becoming regular. I need fewer asthma medications
than I did before. My skin cleared. My hair stopped falling out. The
migraines and hypoglycemia are gone.
I am still working towards getting well. My health problems have not
all disappeared. But I have found many answers to the questions I was
struggling with. I hope that some of these answers will help you regain
your health.
Julie, Riverton, Utah
September 2004

14
Chapter One

Understanding PCOS
Be careful about reading health books. You may die of a misprint.
~Mark Twain
“I felt like a freak in high school,” Pam told the group. “I was
overweight. My skin was always breaking out. But the worst part was that
I had to shave twice a day or someone would see that I was growing a
beard. I was so afraid people would think I was not a ‘real’ woman.”
Everyone in the room nodded. While each of us had different symptoms,
the feelings Pam expressed were familiar to us all. We had come together
for a monthly PCOS meeting. For many of us, the experience of talking
openly about our symptoms was as good as any treatment. Feeling
“normal” for the first time, we were able to freely talk about how PCOS
affected us emotionally and physically.
The emotional effects of PCOS often start in the teenage years when
girls begin to experience weight problems, excess facial or body hair,
debilitating periods, acne, or other effects of PCOS. The journey to a
diagnosis is often long and painful. Kathy explained, “I was exhausted
from the search for answers. I went from doctor to doctor for eight years
in a desperate search for answers. I started to think it really was all in my
head!” Doctors often overlook the symptoms of PCOS or dismiss the
severity of its effects on a woman’s emotional and physical wellbeing.
Some doctors even blame women for their weight problems and accuse
them of not following instructions or of having “no self control.”
For many the diagnosis is both a relief and a shock. Often the
diagnosis is made as part of an infertility workup. Diagnosis brings a
name for the problem, but too often the diagnosis is not followed with
information about what PCOS is and how to minimize its effects.
“The doctors weren’t interested in solving the problem,” Lisa said.
“They just told me to take birth control pills to treat the acne and start
my periods. I had to do my own research, since I couldn’t find a doctor
who would listen.”
Getting healthy requires taking charge of your well-being. There is no
recognized cure for PCOS, yet many women have found ways to

15
dramatically improve their health and wellbeing. With diligence and the
right treatment some women experience complete remission of
symptoms. You may choose to work solely with natural, non-invasive
methods or you may choose to use alternative healing as a supplement to
treatments offered by your doctor.
Whatever path you choose, you are in control of your health. You
can choose to provide the optimum environment for healing or you can
choose to continue in unhealthy patterns. The more you know about
your body and PCOS, the smoother the road to wellness will be.
It is extremely important that you consult with a doctor and do your
own research. Learn all you can about any drug, herb, or supplement you
take. Prescription drugs can have many side effects and can even cause
death. Before taking any drug you should read the Physician’s Desk
Reference listing for that drug. Most pharmacists are happy to let you
read this or you can find it at the library. Know what you are taking, no
matter what the source. Be very careful about drug interactions. Even
herbs can have dangerous drug interactions.

What are the typical treatments?

At one time PCOS was treated almost exclusively with replacement
hormones or birth control pills. In recent years the discovery of the link
between PCOS and insulin resistance has lead to the use of insulin-
sensitizing drugs such as metformin (Glucophage). Doctors may also
prescribe cholesterol-lowering drugs, drugs to lower androgen levels,
creams to reduce facial hair, antibiotics for acne, and other symptom-
specific drugs.
Surgical treatments include ovarian drilling in which the ovaries are
either drilled several times with a laser to puncture the toughened outer
coating and reduce cysts, or wedge resection in which a small section of
the ovary is removed and the remainder stitched back together. Both are
known to be effective in inducing ovulation for a short time, but within a
year most women are right back where they started from. These
treatments temporarily lower testosterone, but soon the underlying
endocrine problems that created the cysts will cause them to return.
Doctors may also choose to deflate or remove larger fluid filled cysts that
are causing pain or are in danger of rupturing. These larger cysts may or
may not return.

16
 Diet and exercise are also recommended by most doctors as a way to
sensitize the body to insulin and reduce weight. These two keys are vital
to reducing PCOS symptoms. However, which diet is the “right” diet is
still quite controversial.
For overweight women with PCOS some doctors may prescribe
weight loss drugs or even gastric bypass surgery. A gastric bypass
removes part of the stomach so that it becomes impossible to overeat.
For some women this solves the weight problem, but the risks are high
and the surgery can also result in vitamin deficiencies and other side
effects—in some cases it can cause death.
Again, I am not opposed to using conventional medical care as
needed. However, I see many women suffering from “cures” that lead to
side effects worse than the original symptoms. Whatever method you
choose, please do your research so you know the risks. The wonderful
thing about alternative methods is that for most the risks are very low.

Choosing a doctor
Odds are, if you have PCOS you already know that the quality of care
offered by doctors varies. You will usually be better off with a doctor
who specializes in PCOS or who has experience in helping women with
PCOS. However, if your doctor is helpful, open to learning more,
communicates easily, and treats you well, you may find that educating
them is better than finding a new doctor. You might find that you are
best served by having a flexible primary care physician, a good
gynecologist (GYN), and a good endocrinologist who are willing to work
together. Unfortunately many primary care physicians and GYNs are not
well-versed in the finer points of the endocrine system and may overlook
thyroid, pituitary or other endocrine health problems.
When choosing a doctor it is always a good idea to ask around and
find out whether anyone you know has a good doctor to recommend. As
with anything else though there are few one size fits all solutions. If you
can’t communicate well with your doctor then it doesn’t matter if they
are a world-renowned expert. Don’t be afraid to ask for written
instructions.
A good doctor will encourage you to ask questions and will explain
things clearly. They will listen to you and treat you with respect. A good
doctor will be willing to explore disease prevention options in addition to
treating symptoms. It does no good to treat the symptoms of PCOS
17
without correcting the underlying problems. In some cases you might
find that you get more personalized care with a physician assistant, nurse
practitioner, or certified nurse midwife who is trained to offer primary
care. Physician assistants must practice in partnership with doctors. In
some states nurse practitioners and certified nurse midwives can work
independently.
Other sources of information about doctors include:
• Ask doctors or other health professionals who work with
doctors, such as hospital nurses.
• Find out if a consumer or other group has rated doctors in
the area where you live. Find out how reliable the ratings are
and what criteria are used.
• Information on doctors in some States is available on the
Internet at http://www.docboard.org. This Web site is run by
Administrators in Medicine—a group of State medical board
directors.
• The American Board of Medical Specialties (1-800-733-2267)
can tell you if the doctor is board certified. "Certified" means
that the doctor has completed a training program in a
specialty and has passed an exam (board) to assess his or her
knowledge, skills, and experience to provide quality patient
care in that specialty. Primary care doctors also may be
certified as specialists. You can also check the Web site at
http://www.certifacts.org. (While board certification is a
good measure of a doctor's knowledge, many excellent
doctors are not board certified.)
• Call the American Medical Association (AMA) at (312) 464-
5000 for information on training, specialties, and board
certification about many licensed doctors in the United
States. This information also can be found in "Physician
Select" at AMA's Web site: http://www.ama-
assn.org/aps/amahg.htm.

Contact the doctors' offices offices

When you have found a few names of doctors you might want to try,
call their offices. The first thing to find out is whether the doctor is

18
covered by your health plan and is taking new patients. If the doctor is
not covered by your plan, are you prepared to pay the extra costs?
Below are some questions you might want to ask the office manager
or other staff. Note that some of these items might have more to do with
the health plan than with the doctor's office.
• How long does it usually take to get a routine appointment?
• What happens if I need to cancel an appointment? Will I have
to pay for it anyway?
• Which hospitals does the doctor use?
• What are the office hours (when is the doctor available and
when can I speak to office staff)?
• Does the doctor or someone else in the office speak my
language?
• How many other doctors "cover" for the doctor when he or
she is not available? Who are they?
• How long might I need to wait in the office before seeing the
doctor?
• Does the office send reminders about prevention tests—for
example, Pap smears?
• What if I need urgent care or have an emergency?
• Will the doctor (or a nurse or physician assistant) give advice
over the phone for common medical problems?
• You may also want to talk briefly with the doctor by phone or
in person. Ask if you are able to do this and if there is a
charge.
• The next step is to schedule a visit with your top choice.
During that first visit you will learn a lot about just how easy
it is to talk with the doctor. You will also find out how well
the doctor might meet your medical needs.
Ask yourself if the doctor:
• Gave me a chance to ask questions?
• Really listened to my questions?
• Answered in terms I understood?
19
 • Showed respect for me?
• Asked me questions?
• Made me feel comfortable?
• Addressed the health problem(s) I came with?
• Asked my preferences about different kinds of treatments?
• Spent enough time with me?

What is integrative medicine?

Integrative medicine is the practice of combining traditional
(Western) medicine with alternative healing methods. I have included
here everything from energy theory and herbs to exercise and counseling.
There are so many tools available to us; it amazes me how many people
choose to ignore successful treatments because they are from an
“opposing” camp. Consider these three examples:

Leeann
Leeann uses metformin prescribed by her doctor. She has made some
attempt to lower her carb intake, but finds it difficult to find time to
prepare healthy foods. A friend recommended an herbalist who treats
infertility but Leeann is reluctant to try anything “weird.”

Holly
Holly follows a popular low-carb diet religiously. She won’t consider
herbs and she did not like the way metformin made her feel. She has one
child conceived while on metformin. Despite the low-carbing, her
periods are irregular and her acne is getting worse. She has little energy
and has trouble sleeping at night. She and her husband are saving for
infertility treatments to have a second child.

Cathy
Cathy follows a moderate carb diet and has lost some weight. She
needs to lose more so she has upped her weekly exercise from 3 days to
5. She uses the herb vitex to even out her hormones and takes inositol to
help regulate her blood sugar. Even with exercise and supplements she
feels tired and depressed much of the time. Her doctor suggests she

20
might need an antidepressant. Cathy decides to muddle through, unaware
that her thyroid level is dangerously low.
Each of these women is doing some things right, but they are all
struggling to feel better when there are options that would help them.
Consider the “ideal” scenario below:

Margie
Margie works with a number of professionals to optimize her health.
Her medical doctor monitors her hormone levels and provides a
prescription for thyroid hormone. She sees a naturopath twice a year to
make sure her herb and supplement use is in line with her needs. She
takes vitex to even out her hormones, chromium for her blood sugar
levels, and Omega-3 essential fatty acids to lower cholesterol and
improve her overall health. She has learned where the reflexology points
are to stimulate her ovaries and thyroid. She regularly massages these
points. She uses visualization and meditation to improve her overall
wellbeing.
She uses a yoga video 2 times per week to lower her stress level and
swims 4 days a week to provide cardiovascular and weight loss benefits.
She gets 7 hours sleep each night and drinks lots of water. She moderates
her carb intake and focuses her diet on whole foods: whole grains, lean
meats, vegetables and fruits. For the first time in her life she has regular
periods and is within a few pounds of a healthy weight. Her skin is
clearer and she has noticed a reduction in hair loss. Her moods are stable
and she feels more energy than she has had in years.
Ok, we all want to be Margie, right? While this is an idealized
scenario I know many women who have experienced dramatic health
improvement by using a variety of methods to reach their health goals. I
have seen profound changes in my own health as I have incorporated
these methods into my own life. You can take control of your life and
reach new levels of vitality and wellbeing. The keys are in your hands!

What is PCOS?
Polycystic ovarian syndrome (PCOS) is a collection of symptoms that
is not yet well-defined by medical science. This is part of the reason many
women go from doctor to doctor for years before they get an appropriate
diagnosis. Many doctors do not keep up with the latest research about
PCOS and they do not understand that PCOS is much more than a
21
fertility or reproductive problem. PCOS is often called a diagnosis of
exclusion. In other words, PCOS is what is left when you rule out
everything else.
Women who suffer from PCOS are much more likely to also have
heart problems, high cholesterol, diabetes, high blood pressure, fatigue,
autoimmune disorders such as thyroid disease and other health problems
related to obesity, high cholesterol levels, certain cancers, and insulin
resistance. To make it more confusing, not all women with PCOS have
cysts on their ovaries, many are not overweight, and some are able to
have children without intervention because they ovulate occasionally.
Diagnosing PCOS is not easy, but as they say “I know it when I see it.”
The following are just some of the symptoms that may be associated with
PCOS. Most women will have a few of the symptoms; rarely someone
has all of them.

Symptoms of PCOS can include:

• Irregular periods or no periods
• Painful or unusually heavy or light periods
• Irregular or absent ovulation
• Hirsutism (hair on face, stomach, thighs, arms, breasts, etc.)
• Alopecia (thinning hair or male pattern baldness)
• High blood pressure
• Infertility
• Obesity (especially around the stomach)
• Difficulty losing weight
• Insulin resistance or hypoglycemia
• Fatigue
• Depression or SAD (seasonal affective disorder)
• Mood swings
• Acne
• Ovarian cysts
• Skin tags

22
 • Acanthosis nigricans (dark skin patches, often found on the
nape of the neck, groin, under breasts)
• High cholesterol levels
• Decreased sex drive
• Excess "male" hormones, such as androgens, DHEAS, or
testosterone
• Decreased breast size
• Enlarged clitoris (rare)
• Enlarged ovaries
• Enlarged uterus
The medical community even disagrees about the name for this
syndrome. Once called Stein-Leventhal Syndrome, PCOS is also known
as polycystic ovary disease. Some say it should be called hyperandrogenic
anovulation. This simply means that there are too many male hormones
(androgens) and that ovulation is not occurring. But even this name
leaves out the fact that many women with PCOS do ovulate, although
not as often as normal.
Here is the explanation offered by Samuel S. Thatcher M.D., Ph.D.,
in his book PCOS: The Hidden Epidemic.
"The earlier term, disease, is not quite correct. A disease is a specific
and constant set of symptoms and physical findings.... The term disease
now has been abandoned in describing PCOS in favor of the term
syndrome, which is defined as a grouping of symptoms, including both
physical and laboratory findings....”
In an attempt to more clearly define PCOS, the European Society for
Human Reproduction and Embryology (ESHRE) and the American
Society for Reproductive Medicine (ASRM) cosponsored the 2003
Rotterdam polycystic ovary syndrome (PCOS) consensus workshop
group to revise the 1990 National Institutes of Health (NIH) guidelines
for diagnosis and management of PCOS. The Rotterdam panel
concluded that PCOS encompasses more types of ovarian dysfunction
than those included in the original criteria defined by NIH in 1990.
The Rotterdam criteria require two of three symptoms for a formal
diagnosis of PCOS: irregular or absent ovulation, elevated levels of
androgens, and/or one or two enlarged ovaries containing at least 12

23
cysts each. Other syndromes with similar symptoms, such as androgen-
secreting tumors or Cushing's syndrome, must be ruled out.
According to the Rotterdam group women with PCOS should be
evaluated for metabolic syndrome by measuring abdominal obesity,
triglycerides, high-density lipoproteins (HDL), high blood pressure, and
fasting and two-hour glucose tolerance.
PCOS symptoms are similar to some other disorders. Your doctor
should rule out congenital adrenal hyperplasia, Cushing's syndrome, and
androgen-secreting tumors. Tests should likely also be done for estradiol,
follicle-stimulating hormone (FSH), and prolactin levels.
Hirsutism is considered to be the best clinical marker of
hyperandrogenism, although different degrees of hirsutism should be
expected based on ethnicity. Women of Asian, Native American and
some other ethnic groups may have less body hair than women of
Western European heritage even with equally elevated androgens.
Free testosterone levels or the free testosterone index are the best
measures of hyperandrogenism. However, not all women with PCOS
have elevated circulating androgen levels. Insulin resistance can occur in
up to 50% of patients with PCOS, so the Rotterdam group recommends
oral glucose tolerance tests for all PCOS patients. LH levels are
frequently elevated in women with PCOS, especially when compared
with FSH. LH/FSH ratios can be elevated in up to 95% of women with
PCOS if women with recent ovulation are excluded. A 1999 article in the
Journal of Clinical Endocrinology and Metabolism detailed a study
showing that the risk of glucose intolerance was 2.76 times higher in
women with PCOS. The study also indicated that many women with
PCOS will meet the criteria for diabetes based on oral glucose tolerance
tests but would not be diagnosed only by results of fasting glucose tests.
Women with PCOS are at increased risk for diabetes. This risk is
higher for those who are anovulatory (not ovulating). Despite the
increased cholesterol and metabolic disorders, PCOS has not been
proven to increase risk of cardiovascular disease, endometrial cancer, or
death.
Dr. Thatcher gives these statistics:
• 20-30% of all women have PCO changes evident on
ultrasound
• 5-10% of all women have elevated androgens and chronic
anovulation
24
 • 90% plus of PCO patients show PCO on ultrasound
• 40-60% of PCOS patients have weight/obesity problems
• 60-90% of PCOS patients have skin and or hair problems
• 40-80% of those with PCOS have fertility impairment
• 40% of those with PCOS develop type 2 diabetes by age 40
This last point is downright scary. All women with PCOS need to
take extra good care of themselves and work to get lifestyle issues such as
diet and exercise under control as quickly as possible. Diabetes is
preventable in many cases. Even when it is not preventable, diabetics
who learn to manage their disease have much longer and healthier lives
and are less likely to become insulin-dependent.

What causes PCOS?

There are a number of theories about what causes PCOS. The most
commonly held theory right now is that insulin resistance is at the root of
PCOS. While it is true that many women control their PCOS symptoms
by controlling insulin resistance, many other women with PCOS do not
have insulin resistance and have no symptom improvement from the
standard insulin medications or diet and exercise treatment.
Other theories include:
• An underlying neuroendocrine defect that causes high
luteinizing hormone (LH) levels. One recent study University
of Virginia study confirmed that provoking high LH levels
lead to PCOS symptoms.
• A defect in androgen production that results in excessive
ovarian androgen production.
• A problem with cortisol metabolism leading to enhanced
adrenal androgen production.
The pituitary gland secretes luteinizing hormone (LH) and follicle-
stimulating hormone (FSH). In the ovary LH controls the production of
female hormones (estrogen and progesterone) and FSH controls the
development and release of eggs. The pituitary gland releases LH and
FSH in pulses in response to gonadotropin releasing hormone (GnRH)
released by the brain. Levels of LH and FSH typically vary throughout
the menstrual cycle. Research at the University of Virginia indicates that
differences in the pattern of GnRH pulses from the brain affect LH and
25
FSH secretion. Rapid GnRH pulses lead to more LH secretion and slow
GnRH pulses lead to more FSH secretion. Estrogen and progesterone
from the ovary regulate how frequently the brain produces pulses of
GnRH, and also the amount of GnRH secreted per pulse.
After normal ovulation the estrogen and progesterone levels change,
signaling the brain to slow GnRH pulses. This feedback is further
disrupted in PCOS when normal ovulation does not occur. Studies
indicate that this normal slowing of GnRH allows for FSH secretion
during menstruation, which leads to proper egg development in the next
cycle. If these GnRH pulses are not slowed down, University of Virginia
researchers suggest, FSH production is diminished.
The University of Virginia Center for Research in Reproduction
website offers this view, “Studies have shown that GnRH secretion in
patients with PCOS is relatively fast, and that it does not slow down very
well in response to estrogen and progesterone. We believe that this helps
to explain why PCOS patients frequently do not ovulate. Women with
PCOS often have high levels of LH secretion. High levels of LH
contribute to the high levels of androgens (male hormones such as
testosterone), and this along with low levels of FSH contributes to poor
egg development and an inability to ovulate. A lack of ovulation also
leads to relative deficiencies of progesterone production by the ovary,
which often leads to absence of menstrual periods.” More information
can be found at
www.healthsystem.virginia.edu/internet/crr/patientinfo.cfm.
Researchers are now considering the possibility that PCOS is not one
disease but several diseases that have similar symptoms. There is a lot of
evidence in favor of this theory. One indication of this is that some
women with PCOS are thin while others constantly battle the weight gain
typical of insulin resistance. This theory may also explain why some
women have great results from a particular treatment such as the herb
vitex while others have no improvement or even a worsening of
symptoms.
An excellent review of the potential causes of PCOS, entitled “The
Pathophysiology of Polycystic Ovary Syndrome” was published in the
medical journal Clinical Endocrinology (Tsilchorozidou et al, 60(1):1-17,
2004). It can be found at www.medscape.com.

26
What is insulin resistance?
Current research, and much of conventional and natural treatment,
seems to be focusing on the idea that PCOS is caused by insulin
resistance. It is possible that PCOS is caused by a defect in the action of
insulin or in the way insulin is produced. There appears to be a genetic
component and many women with PCOS can point to members of their
family who are clearly insulin resistant, have diabetes, or are infertile.
There is a link between obesity, male pattern hair loss and PCOS.
However, obesity is unlikely to be the cause of PCOS. Many women
develop the signs of PCOS before they gain weight. Losing weight can
improve the symptoms but weight loss is not a cure.
The hormone insulin is secreted by the pancreas. Insulin helps the
cells use blood sugar (glucose) by binding with receptors on the cells. Just
as a key unlocks a door, insulin unlocks the cells and allows glucose to
pass into the cell from the blood. The cell then uses glucose for energy.
Liver and muscle cells also store glucose for future use as glycogen.
When the cells do not respond to a normal amount of insulin they
are said to be insulin resistant. The pancreas must then create more
insulin to unlock the cells. About one in three people with insulin
resistance develop high blood sugar or diabetes type 2.

Excitotoxins
We know insulin resistance is part of the how, but there is another
theory about why PCOS develops. Endocrine disruptors, or
excitotoxins, are chemicals that are known to interfere with the
production or use of hormones in the body. These chemicals are found
in our air, water, food, and cosmetics. Pesticides, chemical dyes,
aspartame, monosodium glutamate (MSG) and many other chemicals
have been shown to interrupt the endocrine (hormone production)
system.
Most of these chemicals have only been used since just before World
War II. Where our mothers and grandmothers may have had a tendency
towards PCOS symptoms, their exposure to these chemicals began much
later in life. We are hit with full-blown PCOS because our bodies have
been swimming in these chemicals since conception. I address this issue
in much greater detail in the chapter on toxins. You can learn more about
these chemicals and their effect on our bodies by reading It’s My Ovaries,
Stupid! by Elizabeth Lee Vliet, MD.

27
Diagnosis-
Diagnosis- What tests do I need
need??
Symptoms may lead you or your doctor to suspect PCOS, but for an
accurate diagnosis it is important to have a variety of tests run. PCOS is a
complicated endocrine disorder that affects your whole body. Depending
on your symptoms, your doctor may order an ultrasound to check for
ovarian cysts or uterine problems such as fibroids or a thickened lining.
Polycystic ovaries are defined as those found on ultrasound to
contain 12 or more follicles measuring 2 to 9 mm in diameter and/or
have an increased volume of 10 mL or greater. Only one ovary meeting
these criteria is necessary to meet the definition of polycystic ovaries.
Blood tests can measure hormone levels and check for high cholesterol
levels. A family history and a personal medical history can offer further
insight.
These blood tests are often ordered:
• Androstenedione
• Cholesterol (HDL, LDL and triglycerides)
• Cortisol
• Dehydroepiandrosterone sulfate (DHEAS)
• Estrogen
• Glucose and Insulin
• Follicle stimulating hormone (FSH)
• Luteinizing hormone (LH)
• Progesterone
• Prolactin
• Complete thyroid panel (TSH, T3, T4, antibodies)
• Total and free testosterone

Androstenedione (ANDRO)
ANDRO is produced by the ovaries and adrenal glands. High levels
of ANDRO can affect estrogen and testosterone levels. Normal levels
are between 0.7–3.1 ng/ml. This steroid is most likely to be elevated in
women with PCOS, however, knowing it is high will rarely impact

28
treatment decisions so your doctor may not measure this. The Rotterdam
group does not recommend testing for ANDRO.

Cholesterol
Cholesterol is a fatty substance your body uses to form cell
membranes and certain hormones. Under normal conditions your body
uses enzymes to turn cholesterol into other hormones. When your body
does not process cholesterol well or creates too much cholesterol your
cholesterol levels can become dangerously high. A high cholesterol level
is considered greater than 200. Your doctor should also look at your
LDL (low-density lipoprotein), HDL (high-density lipoprotein), and
triglyceride levels.
The ratio between LDL and HDL is important. HDL is considered
“good” cholesterol; it seems to help protect your arteries. LDL is
considered “bad” cholesterol; too much and it can start to stick to your
artery walls, leading to heart disease. Your triglyceride levels can also
indicate future health problems! My doctor explained that my very high
triglyceride level could cause my pancreas to shut down over time,
throwing me into full-blown diabetes. This was a major motivating factor
for me to change my health!

Cortisol
Cortisol is not measured as a routine part of PCOS evaluations. Low
cortisol levels can lead to Addison’s disease which looks nothing like
PCOS. However, high levels of cortisol can lead to Cushing’s disease
which can mimic PCOS. Measurement requires one of two tests. The
first test is a 24 hour urine collection from which the total amount of
cortisol is determined. The second test involves taking a dose of
dexamethasone at night and drawing blood in the morning. There is
some argument as to which test is more reliable.

DHEA-
DHEA-S
DHEA-S or dehydroepiandrosterone is another “male” hormone or
androgen that all women have. DHEA-S is produced in the adrenal
gland. Normally women have DHEA-S levels between 35-430 ug/dl.
Most women with PCOS tend to have DHEA-S levels greater than 200
ug/dl. The Rotterdam group does not recommend testing DHEA-S
levels.

29
Estrogen
All estrogens are made from androgens, therefore androgens are vital
to women’s reproductive health. There are three forms of estrogen:
estriol, estradiol, and estrone. Estriol is produced in the placenta during
pregnancy. Estradiol is the most potent estrogen and is produced mostly
by developing follicles in the ovary. Estradiol can be used to measure
effectiveness of infertility treatment and to detect estrogen deficiency
where there are menstruation problems. Estrone is a byproduct of the
removal of estradiol from circulation. Estrone is weaker than estradiol
and can be produced in the liver, muscles, fat, and other tissues.
Estrogen and progesterone work together to promote monthly cycles
and menstruation. Women with PCOS usually have normal levels of
estrogen, between 25-75 pg/ml. Women with PCOS tend to be
“estrogen dominant” meaning that they produce more estrogen than
progesterone or that their progesterone levels are very low in relation to
their estrogen levels. One reason weight loss improves fertility is that it
decreases the amount of estrone created in the body.
If you have abnormal estrogen levels, or you have an estrogen-
dependent cancer, you may wish to avoid foods and herbs that have
estrogenic activity. Estrogenic herbs include alfalfa, anise, hops, fennel,
black cohosh, milk thistle, clover, red clover, Don Quai, licorice, ginseng,
royal jelly, peony, nettle, sage, fenugreek, evening primrose oil, burdock,
chamomiles, rhubarb. While foods tend to have a milder effect, you may
wish to avoid eating too much of any of these foods: dates, garlic,
pomegranate, apple, soybeans and soy products, chick peas, cherry, cow
peas, green beans, red beans, split peas, flaxseed, raspberries, carrots, and
squash.

Follicle Stimulating
Stimulating Hormone (FSH) and Luteinizing
Hormone (LH)
LH and FSH are the two gonadotropins produced by the pituitary
gland that cause the ovary to develop and release a mature egg. Levels
vary throughout the cycle. At the beginning of the cycle, LH and FSH
levels are usually between 5-20 mlU/ml. For most women LH and FSH
are about equal during the early part of their cycle. Twenty-four hours
before ovulation there is an LH surge causing LH levels to rise to 25-40
mlU/ml. Once the egg is released by the ovary, the LH levels go back
down.

30
 While many women with PCOS still have LH and FSH within the 5-
20 mlU/ml range, their LH level is often two or three times that of the
FSH level. For example, a woman with PCOS may have an LH level of
18 mlU/ml and a FSH level of about 6 mlU/ml (both levels still fall
within the normal range of 5-20 mlU/ml). This elevated LH to FSH
ratio may disrupt ovulation. If LH levels are elevated in the early part of
the cycle then PCOS should be suspected.
FSH levels rise as the body approaches menopause. It is important to
check FSH levels to rule out premature menopause, premature ovarian
decline, or other problems that could impact your health.

Insulin and Glucose

Numerous studies indicate that PCOS is affected by insulin
resistance. Insulin resistance is a diabetes-like condition in which your
cells stop responding to normal levels of glucose (blood sugar). Your
body produces more insulin causing an insulin “spike.” The excess
insulin encourages your body to store the blood sugar away as fat. You
may feel hungry soon after a starchy or sugary meal because your body
quickly converts the starch or sugar into glucose causing an insulin spike,
leaving your blood sugar levels lower then they should be. You may feel
shaky, dizzy, nauseated or have a headache if your blood sugar levels
drop too low. Even if your levels remain in the “normal” zone you may
have symptoms of low blood sugar if your levels drop too quickly.
Your doctor may test your fasting glucose and insulin levels or ask
for a fasting glucose tolerance test (GTT). The Rotterdam group
recommends that all women with PCOS have a glucose tolerance test to
check both insulin and glucose levels. The GTT is more effective if you
eat a lot of carbs in the few days prior to the test.
You may be insulin resistant even though these tests come out within
the normal range. Symptoms may develop when there is a significant
change in your insulin or blood glucose levels throughout the day, even if
they stay within the “normal” range. I tested within the normal range for
years before the condition got bad enough to show up as abnormal on a
test, despite the fact that I had the classic signs of insulin resistance:
weight gain around middle, thinning hair, hypoglycemia, and a very
difficult time losing any weight.

31
Progesterone
After ovulation occurs, the follicle develops into a small progesterone
factory called the corpus luteum. Progesterone prepares the uterine
lining for implantation of an embryo. Progesterone levels are checked
about 7 days after ovulation is thought to have occurred. If the
progesterone level is high (usually greater than 14 ng/ml) this means that
an egg was released from the ovary. Low progesterone levels may
indicate no egg was released. It is important to be sure that ovulation is
actually occurring and progesterone levels are a good indication. Women
with PCOS may have signs of ovulation but the egg may not actually be
released.

Prolactin
Prolactin is a pituitary hormone that helps women produce milk
when nursing. While prolactin levels are usually normal in women with
PCOS, it is important to check for high prolactin levels in order to rule
out a pituitary tumor or other problems that might cause PCOS-related
symptoms. Prolactin levels are generally less than 25 ng/ml. Some
women with PCOS have elevated prolactin levels, typically 25-40 ng/ml.

Testosterone
All women have testosterone in their bodies. Your doctor may order
tests to measure your total testosterone and free testosterone. Total
testosterone tests measure the total amount of all testosterone, including
the free testosterone, in your body. The typical range for total
testosterone is 6.0-86 ng/dl. Free testosterone is unbound and active in
your body. Free testosterone usually ranges from 0.7-3.6 pg/ml. Women
with PCOS often have an increased level of both total testosterone and
free testosterone. Slight increases in testosterone can suppress normal
menstruation and ovulation.

Thyroid hormones and antibodies

A recent study by Dr. Onno E. Janssen of the University of Essen
(Germany) showed that women with PCOS are three times more likely to
have autoimmune thyroiditis than other women. Dr. Janssen found that
27 percent of women with PCOS had elevated thyroid antibodies
compared with only eight percent in the control group. If you suffer
from fatigue, hair loss, irregular periods and other symptoms of low

32
thyroid you should ask your doctor about having your thyroid hormones
and thyroid antibodies checked.
In his presentation at the American Thyroid Association 2003 annual
meeting Dr. Janssen said, "All patients with PCOS should be screened
for autoimmune thyroiditis, even without evidence of overt thyroid
dysfunction.”
Thyroid stimulating hormone (TSH) is the most common level
checked. However, TSH levels that are “normal” can occur even when
there is an underlying thyroid problem. Worse, many doctors are not
aware that the American Thyroid Association (ATA) has changed their
recommendations for TSH levels. The new “normal” is between 0.3-3.04
instead of the old range of 0.5-5.0.
Also presenting at the 2003 ATA conference, Elizabeth N. Pearce,
MD, an instructor of medicine at Boston Medical Center and Boston
University School of Medicine in Boston, detailed the results of her
recent study on cholesterol and thyroid disease. The study found that
people with mildly high blood levels TSH may also have elevated blood
cholesterol levels.
Getting your thyroid levels checked is extremely important before
trying to conceive. If you have a thyroid problem and you become
pregnant you should have your thyroid levels checked frequently because
pregnancy changes your thyroid levels rapidly. Uncontrolled thyroid
disease during pregnancy can lead to brain damage and other health
effects in babies.
Understanding Hormone Levels
Hormone levels can vary widely, even in healthy women. Each lab
determines their own “normal” range. This can make it very confusing
when the lab says your levels are “normal” and they fall outside the
average accepted by other labs. It is important to remember that with all
women, hormone levels can very greatly. If your doctor is not well versed
in PCOS they might not understand that small differences can make a
huge impact on your symptoms. One doctor I saw insisted that since my
estrogen and testosterone levels were “within the normal range” that I
did not even have PCOS!
Be especially aware of differences in your testosterone, LH, FSH, and
estradiol levels. If your doctor insists that you don’t have PCOS yet your
FSH/LH levels are not equal, your LH level is much higher than your

33
FSH, your levels are low, or your testosterone level is >40 ng/ml you
may need to see a specialist.

What are the conventional treatments?

Conventional doctors have “treated” PCOS with birth control pills
for decades. More recent treatments include using insulin sensitizing
drugs such as metformin. In either case these treatments are covering up
symptoms, not treating the cause of the illness. I have nothing against
using these methods if they work and if you don’t have worse side effects
from using them. If you choose to use these methods there are a few
things you should know about them. Please do not stop taking any
medication without consulting your physician. Abruptly stopping some
drugs can cause serious health problems.

Metformin
Metformin
Metformin and other insulin sensitizing drugs are a fairly new
treatment for PCOS. Many women have great success with weight loss,
increased fertility and effectiveness of clomiphene citrate, and other
benefits of these drugs. Metformin has been shown to decrease the risk
of miscarriage and gestational diabetes if taken during pregnancy.
However, many women have serious side effects such as diarrhea,
stomach cramps, nausea and vomiting. For some women these effects go
away as the body adjusts, for others it is an ongoing problem.
If you decide to take metformin you should be aware that 10-30% of
metformin users show decreased vitamin B12 absorption. The stomach
creates a substance called intrinsic factor that makes it possible for B12
to be absorbed. Vitamin B12 is required for the proper growth and
function of every cell in your body as well as for DNA replication.
Decreased B12 is linked to cardiovascular disease. In one study this lack
of intrinsic factor continued after the use of metformin stopped.
Increased intake of calcium may counteract this problem (Bauman et al,
Diabetes Care. 2000;13(9):1227-1231).
Metformin raises homocysteine levels. Women with PCOS already
tend to have elevated homocysteine. An elevated level of homocysteine
in the blood means that your metabolic processes are not working
properly. High levels of homocysteine are associated with coronary artery
disease, heart attack, chronic fatigue, fibromyalgia, cognitive impairment,
and cervical cancer.

34
 Vitamin B12, vitamin B6 and folic acid are responsible for
metabolizing homocysteine. When metformin reduces absorption of
vitamin B12, you lose one of the nutrients needed to metabolize
homocysteine and thus increase your risk of cardiovascular problems.
Pre-eclampsia (high blood pressure and edema) can cause serious
complications in pregnancy. A study at the Center for Perinatal Studies at
Swedish Medical Center in Seattle, Washington, indicated that a second
trimester elevation of homocysteine was associated with a tripled risk of
pre-eclampsia.
The Dept. of Obstetrics and Gynecology, Nijmegen, The
Netherlands, concluded, upon review of a number of studies, that
elevated homocysteine is a risk factor for recurrent early miscarriage.
Liver and kidney function should be assessed before starting
metformin and reevaluated annually while taking metformin. Metformin
alters your liver function and causes your kidneys to work harder.
Some women report an increase in hair loss while taking metformin,
although no studies have confirmed this link.
A tiny percentage of people who take metformin will develop “lactic
acidosis.” Lactic acid is produced naturally in your body as a result of
metabolism. However, if it builds up faster than the body can eliminate it,
then it can become toxic. Those at greatest risk include those with
diabetes, kidney or liver disease, multiple medications, dehydration, or
severe chronic stress. Symptoms include rapid deep breathing, a slow,
irregular pulse, feeling weak, muscle pain, sleepiness, and a sense of
feeling very sick. If you suspect lactic acidosis, go to the emergency room
immediately.
According to the Diabetes Prevention Program, a major clinical trial
conducted by the United States National Institutes of Health (NIH),
exercise and diet changes were 38% more effective than metformin in
preventing diabetes in those with already elevated glucose levels. The
researchers divided 3,234 people with elevated blood glucose but no
diabetes into 3 groups. The first group received metformin alone with no
diet or lifestyle changes. The second group received only diet and lifestyle
education and support (no metformin). The third group received a
placebo and no diet or lifestyle support.
After 2.8 years, the placebo group had a diabetes rate of 11%. For
those taking metformin, diabetes developed in 7.8%. Those who changed

35
their diets and lifestyle had the best results with only 4.8% developing
diabetes.
If you take metformin, you should ask your doctor about taking a
good quality multiple vitamin and mineral supplement, calcium,
magnesium, a high-quality B-complex, and vitamin D.
A holistic approach to PCOS treatment offers greater effectiveness
than metformin alone. It is also cheaper, offers other benefits such as
reduced cancer risk, and is less expensive than metformin. There are no
adverse side effects to a healthy lifestyle. Lowering stress, improving your
diet, getting enough exercise, and getting the right nutrition can make
your whole life better. I know I prefer the benefits of a healthy lifestyle
over the side effects of medication.

Birth control pills

Birth control pills (BCP) and other hormone therapies vary widely in
their specific levels of estrogens and progestins (progestin is not the same
as natural progesterone). Different brands can have very different effects
on your body and your nutrient levels. Some brands use synthetic
hormones and others use hormones from horse urine or from precursors
found in plants such as wild yam.
Birth control pills can cause rapid weight gain, mood swings,
depression, and fluid retention. Many women with PCOS use Yasmin or
Diane 35 to regulate their cycles. If your doctor believes that birth
control pills are the best answer for your needs, be sure that you are on
the appropriate type of pill. Some pills do reduce acne and help with
PMS symptoms. Women who have heavy or painful periods may find
some relief on BCP.
Birth control pills can cause folic acid depletion and increase the risk
of cervical dysplasia and vascular thrombosis, and stroke.
Many B-vitamins are depleted by birth control pills, so nutritionists
recommend a B-complex supplement. Vitamin C levels are lowered by
BCP because they disrupt the metabolism of ascorbic acid. Insufficient
intake of vitamin C is linked with an increased risk of cervical dysplasia.
On the other hand, some nutrients are increased by BCP. Copper
levels increase as estrogen levels increase. Elevated copper is associated
with an increased risk of death from cardiovascular disease. Copper and
zinc tend to be antagonistic, so an elevated copper level will result in a
lower zinc level. Using BCP can increase iron levels. Too much iron can
36
be as dangerous as too little. Iron testing may be appropriate in long term
users.

37
Chapter Two

alternative
Why alterna tive medicine?
Formerly, when religion was strong and science weak, men mistook
magic for medicine; now, when science is strong and religion weak, men
mistake medicine for magic. ~ Thomas Szasz,
A 1998 report in the Journal of the American Medical Association
estimated that adverse reactions to prescription drugs kill about 106,000
Americans each year—roughly three times as many as are killed in car
accidents. This makes properly administered prescription drugs the
fourth leading killer in the U.S., after heart disease, cancer, and stroke.
This does not include deaths from accidental or deliberate overdoses or
medical mistakes.
Every culture has a history of natural medicine. Our ancestors used
herbs to treat illnesses and heal wounds. The fields and forests are full of
herbs that God put here for our use and previous generations learned to
use these herbs to treat everything from cramps to diabetes. Herbs can
have side effects. It is vital to know what you are taking and what it can
do. But there are only a handful of deaths from herbs each year. Most of
those are from herbs known to be dangerous such as ma huang
(ephedra). Natural does not always mean safe—arsenic is natural—but
the odds of becoming seriously ill from proper use of herbs is very low.
It is only in the last century or so that allopathic (conventional
Western medicine) treatments became the norm. Conventional medicine
has a lot to offer. If I have a serious infection or need surgery I am more
than happy to use conventional doctors, medicines and hospitals. I go to
an M.D. for blood tests and an annual physical. I make sure my doctor is
aware of my herb and supplement usage.
However, doctors are very rarely trained in nutrition or the use of
less-invasive treatments. The surgeon general reports that 8 of the 10
diseases Americans die of most often are diet related. Despite this most
doctors receive just a brief mention of nutrition in medical school and no
training about medicines natural medicine. Naturopaths receive extensive
nutrition training as part of their education. Clearly, modern medicine has
a lot of catching up to do.

38
 The pharmaceutical industry works hard (and spends billions of
dollars) to inform doctors about new medicines. This is great if you need
the medicine, but the danger becomes that some doctors start thinking
that everything they see must be a nail because they have a great new
hammer. The good news is that more and more research is being done
on alternative treatments and the results are finally being printed in even
the most well-known scholarly journals.
Carefully chosen alternative medicines and treatments have few side
effects, offer gentle healing, and allow the body’s natural healing
mechanisms to work properly. Your body wants to be well. With the
right tools, your body can be in optimum condition for healing.

Choosing a practitioner or treatment

Alternative medicine is a very broad field. There are treatments that
have stood the test of time and have been proven safe for hundreds or
thousands of years. There are other treatments that have been proven
safe and effective in studies funded by prestigious institutions like the
National Institutes of Health (NIH). Unfortunately there are also
dangerous treatments and providers who are unsafe.
The nutrition industry alone is estimated to be worth $25.7 billion
dollars a year. Clearly there is big money to be made from even poorly
studied herbs and supplements—and even from substances we know
have no effect or are even dangerous. In some cases (particularly in
weight loss and body building) very dubious substances are marketed as
health building. Not only are some of these substances unlikely to help
you, some of them can kill you. Never take a supplement until you know
what it can do. I try to use the rule of three. If at least three unrelated and
unbiased sources of information agree then I feel safe in taking a
supplement. It is important to pay attention to the source of information.
Some people make a lot of money recommending the same products
they sell. This is not always bad, but it does give you reason to make sure
their motives are pure.
When choosing a practitioner of any kind there are several things to
keep in mind. The same rules apply to choosing a medical doctor, a
naturopath, a massage therapist, or an acupuncturist.
• Do you feel comfortable with this person? If you get bad
vibes, find someone else.

39
 • What are their credentials? You want someone who has been
properly educated and knows the risks of treatment as well as
the potential benefits.
• How long have they been practicing? If they are new, is there
an experienced practitioner keeping tabs on them? One of the
best doctors I ever had looked like he had just finished Junior
High School. However, he knew his stuff, talked to me like I
was a real person, and listened to my concerns. The fact that
he was new meant that he was up-to-date on recent research
and willing to try new things.
• Can you ask them anything and get a complete answer?
• Do they understand your health needs? You are unique and
PCOS is complicated. If they don’t know at least as much as
you do, are they willing to learn? Will they read books or
articles about PCOS?
• Do they practice good cleanliness rules for patient
interaction? Whether a doctor or an acupuncturist, you need
to know that they are washing their hands, wearing gloves,
and using clean needles!
• Do they offer references? Find out if they are for real or if
they just talk a good talk.

What does it take to get healthy?

You already know that PCOS provides a confusing collection of
symptoms. In the smallest of nutshells, healing PCOS boils down to
making sure you can produce or supplement the right hormones,
optimizing metabolism, and reducing stressors.
The bottom line is that you will feel better, have more energy, and
may even be rid of your symptoms if your body is able to metabolize
food and nutrients properly, has the building blocks it needs, and your
stress is reduced.
You can optimize the chance of healing by eating the right foods,
getting the right amount of activity, getting enough sleep, eliminating
toxins, and providing the herbs and supplements your body needs.
Studies show that reducing weight and increasing exercise improves
ovulation and reduces male hormone levels. There are herbs, vitamins
and minerals, and other natural foods and supplements that can lower
40
your insulin levels and heal your body. Working with your body leads to
healing. Fighting symptoms will never make you well.

Your body is different

Keep in mind that your body is unique. What works for someone else
may not work the same way for you. Pay attention to the signs your body
gives you. Take changes slowly and a few at a time so you can easily
figure out if something new is causing allergies or other problems.
There is a solution for your symptoms! If you keep looking and
working on it you will find what works for your body. It can be very
discouraging if you are doing “everything” right and the pounds are not
melting off. Reading on a listserve how “everyone” loses 40 pounds on a
low carb diet and you just get migraines can make you want to scream (if
it didn’t hurt your head!). Be patient with your body. It wants to be
healthy and it will heal if it gets what it needs. Unfortunately, there is no
owner’s manual. Trial and error are the rule.
If you are moderating carbs, taking the right supplements and
exercising but the pounds stay put, try looking for other things you might
be missing. Are you getting enough sleep? Drinking enough water? Is
your period due? Some women have very strong set points for weight. It
might take you longer to convince your body that it is time to drop
weight. Don’t stress about it. Stress causes hormones that make you gain
weight! Continue your healthy new habits and the change will eventually
show. In the mean time, you can relax knowing that the internal changes
are still taking place, even if the visible changes aren’t there yet.

Fertility
For many women, the diagnosis comes as part of a fertility workup.
For others it is a shock to learn that fertility might be a problem. In any
case, infertility is a primary concern for many women with PCOS. The
statistics are not as grim as some would have you believe. Between 80-
90% of women with PCOS are able to have children. I suspect this
number is actually higher since so many women are undiagnosed. If a
woman gets pregnant without medical intervention, her doctor may
never even suspect PCOS.
Reducing your symptoms and improving your overall health will very
likely result in increased fertility. A recent study at Tufts University has
shown that even if an ultrasound shows you have polycystic ovaries, you
may be as fertile as other women. This study suggests that if you can
41
reduce your symptoms, you may become more fertile in spite of having
polycystic ovaries. (Hassan, M et al, Fertility and Sterility, 2003,
80(4):966-975).
Researchers used ultrasound to identify 210 women as having
polycystic ovaries. One-third of these women had none of the typical
symptoms of PCOS. The non-symptomatic women took no longer to get
pregnant than women with normal ovaries. In other words, the
asymptomatic polycystic women were just as fertile as women with
normal ovaries.
I do not focus on fertility in this book for three reasons. One,
improving your overall health will improve your fertility. Two, there is
too much information to include here, I will be putting together a book
about infertility and PCOS. And, three, many women are not trying to
conceive or are very emotional about their fertility issues. I did not wish
to force those who are not interested in conceiving right now to read
through constant references to fertility.

42