The patient: “Simona,” a 35-year-old dancer and business executive.
Why she came to see me: Simona came to my clinic because of infrequent periods that were suddenly causing her concern. Throughout adulthood, her periods had arrived every other month; in the last two years, however, her periods had dwindled down to three or four annually. While her primary care physician had urged her to take birth control pills to help regulate her cycle, she was keen on taking a different approach—one that would not only feel more in tune with her health-centric, organic lifestyle, but would also address the reason beneath her irregularity. She and her fiancé were also planning on trying for a child in the next year or two, and the Pill simply didn’t fit into their “long-term plans.”
How I evaluated her: An in-depth discussion revealed that irregular periods were not the only source of Simona’s distress. She was also experiencing mood changes, headaches, an increase in facial hair that sent her to her esthetician more frequently, and sporadic acne. She further complained of extremely tender breasts 10 days to two weeks before her period started…bloating…day-time fatigue and nighttime insomnia…increased anger and “the blues”…and dark patches of skin. When her period did arrive, it was the heaviest it had ever been. Having spent much of her life on the slender side, she was also shocked to find that she’d recently gained 12 pounds—a “mystery” to her given that neither her diet nor her commitment to dancing had changed.
Five years earlier, she and her ex-husband had stopped using birth control because they were open to the possibility of getting pregnant but nothing happened. At the time, she hadn’t thought that there was anything particularly wrong and chalked it up to lifelong irregular cycles, problems in her relationship and the feeling that it “just wasn’t meant to be.” After the stress of her divorce coupled by an increase in her workload, she noticed that her periods “made an appearance” less and less. She “managed to ignore this”—that is, until her recent inexplicable weight gain, even less frequent periods and changes in appearance compelled her to take action. That, and the man she’d recently gotten engaged to dreamed of having children with her—a dream she “passionately shared.”
Simona followed a low-fat, vegetarian diet that included a lot of rice, pasta, potatoes, beans, salads, protein bars and shakes. She also claimed to have constant sugar cravings, which she would often try to satisfy with fruit, “healthy” cookies and cereal.
Following our discussion, I gave her a full pelvic exam, including a PAP smear and a pregnancy test for which she tested negative. I also ordered a blood test to evaluate her estrogen, progesterone, testosterone and DHEA levels as well as her fasting insulin, fasting glucose and hemoglobin A1c (HbA1c). Finally, I ordered a thyroid panel and a transvaginal ultrasound.
What my evaluation revealed: I called Simona immediately after receiving the results from her ultrasound as the images exposed multiple small cysts on her ovaries. Dubbed a “string of pearls,” these cysts are often indicative of a hormone disorder. Further, while her thyroid test was normal, she had low levels of estrogen and progesterone as well as elevated androgens—namely, high testosterone and DHEA levels. She was also showing sign of insulin resistance, or metabolic syndrome, as revealed in her fasting insulin, glucose and HbA1c.
The combination of Simona’s symptoms and results led me to diagnose her with Polycystic Ovarian Syndrome. Commonly known as PCOS, the hormonal condition, which affects 1 in 10 women of childbearing age, is characterized by a surplus of androgens (what we consider “male hormones”) and often results in infertility, metabolic problems and weight gain. In addition to irregular periods, acne, hirsutism (excessive body hair), headaches and mood issues, PCOS can cause precisely these type of cysts—fluid-filled sacs that are prevalent among women in their reproductive years.
How I addressed her problem: As with all of my patients, I outlined a strategy to manage Simona’s PCOS from a natural, holistic perspective.
PCOS—which is often referred to as “the silent disorder”—may not only exhibit complications in the present but can also lead to issues down the line, including high blood sugar, mood disorders, heart disease and type-2 diabetes. This is because insulin resistance underlies nearly all cases of PCOS. By supporting Simona’s ability to increase insulin sensitivity, she would have enhanced hormone balance, improved ovulation—and, thus, a better chance at getting pregnant when she and her fiancé were ready.
We began with a look at her diet. While her daily salads were admirable, there was room for improvement. Given that women with PCOS often have higher rates of inflammation and oxidative stress, I urged Simona to shift away from the high carbohydrate foods (rice, pasta, potatoes, protein bars, shakes) that had served as cornerstones of her diet to an eating regime that would support insulin sensitivity. To that end, I encouraged her to religiously fill her plate with anti-inflammatory, blood sugar-stabilizing foods such as organic vegetables, wild-caught fish, organic lean chicken, nuts and seeds, and “quality” fats like avocados and olive oil. I also instructed her to rid herself of sugar, high-glycemic fruit, preservatives and excessive caffeine—all of which can impact hormone levels.
We turned to other aspects of her lifestyle next. On average, she slept five to six hours a night—an amount that’s far below what’s prescribed (and ideal). I urged her to start prioritizing sleep as much as she prioritized dancing as sleep deprivation can result in elevated cortisol, which can disturb hormone equilibrium. To address her level of stress in general, Simona agreed to start delegating work tasks when she could and to take on only as many classes per week as she could realistically handle.
I also prescribed botanical medicines. First, I urged her to get a daily of dose of spearmint tea. As the National Institutes of Health reveals, spearmint tea can have anti-androgen effects, which help foster hormone harmony. It also aids with acne.
Second, I put her on an herbal formula called Ovablend. Created by Vitanica, Ovablend was formulated by the esteemed naturopathic physician Dr. Tori Hudson to support women with PCOS. The formula contains nutrients to support healthy insulin response, blood sugar control and herbs to balance hormones. It’s used along with Soy Choice, a product containing non-GMO soy isoflavones to facilitate better hormone regulation.
Next, I recommended a supplement called Sensitol. This form of inositol (classified as one of the B vitamins) can help “pop open” insulin receptors, which could further encourage hormone balance.
I also prescribed two months of weekly acupuncture sessions. In Traditional Chinese Medicine, PCOS is considered a damp condition with stagnant energy in the lower pelvis, and I have seen acupuncture profoundly influence women’s ovulation and fertility. (Research substantiates this by showing that acupuncture can be an effective treatment in regulating menstrual cycles.)
Finally, I explained that if she didn’t respond to this approach, we would need to consider taking a prescription medication called Metformin. Primarily used in the treatment of type-2 diabetes, it can also significantly impact healthy ovulation and fertility in women with PCOS.
The patient’s progress: Simona responded beautifully to her treatment protocol—so much so we were able to shelve the idea of medication (while also remaining watchful of her progress). She returned to her “normal” body weight, her acne diminished and, within a few months, she started having cycles every 40 days. A follow-up ultrasound also revealed that her cysts had disappeared. Furthermore, her hormone test demonstrated that while her androgens were still elevated, they were much less so—a solid indication that she was well on her way to greater hormone balance. As such, the litany of symptoms she first reported—from mood changes to heavy periods—had also subsided. While not “cured” of her condition, she claimed that the lifestyle changes she’d implemented were buoying her hope for the future—and allowing her to handle PCOS with the very grace she practiced on the dance floor.
To learn more, visit Dr. Laurie Steelsmith’s website, https://drsteelsmith.com, or click her to read her most recent book, Growing Younger Every Day: The Three Essential Steps for Creating Youthful Hormone Balance at Any Age.