Lisa, a 29 year old clinical nurse, came to see me a year ago because she had been trying to get pregnant for twelve months.  She was tearful and expressed frustration with the process, felt anxiety over her inability to lose weight and the continued “teenage acne” that she just didn't seem to be growing out of.  She had been treated with oral contraceptives for a few years for the acne and irregular menstrual cycles during her teens and early 20’s.  She stopped a few years ago as she was ready to consider starting a family.  She was feeling depressed and overwhelmed and had not been sleeping well.  A twelve hour shift plus commute time meant she ate fast food, snacks, and soda, had gained weight but had little time for exercise. She and her husband of 3 years were happy, but she wondered if he really wanted to have kids because he wasn’t as interested in the process as she was.

Lisa had very specific symptoms for her, but this story is one that I see so often in women in my practice.  I recognized we were dealing with some primary hormonal imbalances that may have been present for more than 10 years now. In addition, the symptoms had started to develop into some depression, anxiety, and sleep issues. Her busy, sedentary lifestyle, plus a poor diet was adding fuel to the fire.  

I conducted saliva testing for hormones and ran blood work to evaluate metabolic dysfunction and nutritional deficiencies. I was fairly certain we were dealing with inadequate progesterone, possibly anovulation, and likely insulin resistance which is an early indicator of an increased risk for diabetes and heart disease, even some cancers. She likely had a diagnosis of PCOS. Her testing came back consistent with my initial thoughts: low progesterone, suboptimal cortisol levels, low Vitamin D, a high range fasting blood sugar, and an elevated insulin level. 

We began immediately with topical progesterone cream, 25mg applied to the inner arms at night during days 14-28 of her cycle.   A supplement with chromium, cinnamon, alpha lipoic acid, green tea extract, and gymnema for the insulin resistance and 10,000 IU Vitamin D3 with K2 to support the Vitamin D deficiency.  In addition, we began coaching on nutrition, lifestyle, mindset, and sleep support.  

Fairly quickly, we saw improvement in her overall sense of well-being.  She was so pleased to have a team that understood her frustrations and that had experience with PCOS,  and to have an action plan rather than a band aid approach that she had previously been prescribed.  She continued with the supplementation and lifestyle changes, we made small adjustments along the way as we saw improvement in her symptoms as well as a positive response in follow-up blood work.  

I recently received an email from her with a beautiful, black and white ultrasound picture of her baby on the way. We are so excited for her and so grateful to be part of this amazing journey with her!

The connection between androgen hormones and blood sugar regulation is one that is often missed by family care practitioners, however ELEVATIONS IN WOMEN can provide an especially important early indicator of dysfunction that may lead to more overt disease processes including PCOS, metabolic syndrome, or frank diabetes. PCOS is the most common female endocrinopathy in developed world. In the US, 25-30% of reproductive age women have polycystic ovaries but only 7% have frank symptoms of the syndrome.1 As many as 50% of these women are not yet diagnosed. Insulin resistance, impaired glucose tolerance, Type 2 diabetes mellitus, obesity and dyslipidemia are more common in women with PCOS than in age-comparable women without PCOS. PCOS is the most common cause of anovulatory infertility.