PCOS and Adrenal Fatigue

So it has been over a month since I had my appointment with Dr. Brie at Direct Osteopathic Primary Care.  I love the direct primary care model.  We pay a montly membership to be a part of the practice ($70/person).  We have direct access to Dr. Brie at any time via e-mail or phone.  Direct Primary Care takes out the insurance "middle man" and facilitates a direct connection between doctor and patient...and I love that!

The cost deterred us originally, but once I crunched the numbers, we will actually save money...what?!  Dr. Brie gives us her wholesale cost for prescription, supplements, and labs, so we actually pay much less than with insurance.

It has taken me about a month to process what we covered in our hour-long appointment.  We talked extensively about my health history, medications, supplements, diet, and concerns.  Due to our upcoming move, I decided to wait on the labs until after April 15, but Dr. Brie had a pretty good idea about what is going on in my body.

So here it goes:

At age 20, a doctor diagnosed me with Polycystic Ovarian Syndrome (PCOS) due my irregular cycle and hormone levels (androgen excess).  That doctor told me to "have kids now" or that I may never have kids.  Wow.  I remember being with my dear friend Allegra in the days following that appointment and I grieved and grieved.  Over the following years, I "never met the criteria again".  Dr. Brie informed me that the experts in the field do not agree on the criteria, so diagnosis can be subjective.  Thankfully I easily got pregnant with James and breastfeed without trouble (other than my early return to work and James' desire to breastfeed every one to hour hours for the first seven and a half months).

As a Mom/Baby nurse and lactation consultant, I know that PCOS typically has a specific physical profile, which I have never met.  Many doctors would tell you that the ovaries drive PCOS, but PCOS can be powered by the adrenals (which sit on your kidneys).  Without the labs, we cannot know which "powers" mine.  However, based on my symptoms, my adrenals stand out as the cause.

"One of the most pronouncedly unique expressions of PCOS involves women who have high levels of a hormone known as DHEA-S.  This androgen is only produced by the adrenal glands, and it’s been found that women with high DHEA-S have rather different characteristics than other women with PCOS.

Up to 50% of women with PCOS have high levels of the adrenal hormone DHEA-S in their blood. This can easily fly under the radar because the DHEA-S reference ranges on standard blood tests are very large and don’t reflect the natural drop of this hormone which occurs with age. 

In a woman with adrenal androgen excess PCOS, [the] normal [DHEA-S] pattern ends up disrupted. Often, DHEA-S levels are above the reference range when compared to other women without PCOS of the same age.  DHEA-S levels can also fluctuate greatly in women with this type of PCOS, whereas in other women they tend to steadily decline with age." | Read more on PCOS Diva

So why would the adrenals malfunction like this? STRESS.  Without going into the pathphysiology of it all, stress causes your adrenals to excrete more cortisol, which directly and indirectly turns into testosterone (the primary androgen).  Excess androgens (testosterone) equal PCOS.

Many women with PCOS get treated for symptoms, but to improve adrenal driven PCOS, the root cause must be addressed: the adrenals and stress!

The adrenals control the fight or flight response.  Biologically our stress response relates to survival. In a life or death situation, the adrenals flood the body with cortisol.  Our adrenals were not designed for continuous day to day stress.  When faced with this day to day stress, the adrenals become fatigued.  Reading the signs and symptoms of adrenal fatigue feels like reading about myself, which really validates my experience (and make me feel a little less crazy).  Not only that, but identifying the root cause brings hope for improvement!

THE PLAN:
1. Reduce stress by increasing self care
2. Diet changes -

"Things like BPA’s in the plastics that we consume, act as estrogen disruptors. Genetic modified organisms (GMO’s) in the foods you eat every day, like gluten (wheat), soy, corn, and other grains, are not only estrogen disruptors, but they are hidden sources of inflammation production, and therefore stress, in your body."        | Read more on Adrenal Fatigue Society

3. Supplements:
           - Ashwaghanda: Supports adrenals to manage a healthy stress response
           and anxiety, helps curb carbohydrate cravings and stress eating
           - Saw Palmetto: Helps process and eliminate androgens causing PCOS
          - Inositol: Mood and cycle regulation related to PCOS
          - B Complex: Supports adrenals to regulate stress response and energy level

I must emphasize that my labs must be done to confirm all of the above.  All of this is presumed based on my symptoms.  I share here on this blog because the more I share, the more women I meet with similar struggles who have not sought out help, have been told "it is all in your head", or have only had their symptoms addressed (not the root cause).  We need to band together, get the help we need, and THRIVE again!




(Many of you know I needed high levels of glucocorticoids (steroids) to keep me out of respiratory failure.  Additionally, I used a steroid inhaler from age 3 through midde school; topical steriods from age 3 to present; and I have needed oral or intramuscular steroids once or twice a year for eczema and asthma exacerbation most of my life.  That has played a major role, but I do not understand it well enough at this time to share about it.)