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Your PCOS Questions Answered: Q&A with Dr. BreAnna Guan

Your PCOS Questions Answered: Q&A with Dr. BreAnna Guan

Catherine Poslusny | October 7, 2020 | Women's Health

Polycystic ovary syndrome (PCOS) is now so widespread that it’s starting to be referred to as a hidden epidemic. One out of 10 women of childbearing age is affected by this syndrome (1). Birth control is one of the top-prescribed treatments for PCOS, but many women would prefer to address their symptoms naturally. 

To learn more about PCOS symptoms, diagnosis, and natural treatments, we asked our top questions to Dr. BreAnna Guan, a licensed naturopathic doctor specializing in integrative family health and fertility.

Watch the Webinar

What follows is an edited transcript of the webinar, hosted by Kindara’s Jackie Vinyard, MS.

I don’t have cysts on my ovaries. Does that mean I don’t have PCOS?

I’ve had a lot of women come into my office with this question. They’ve had ultrasounds with their doctors, and there were no cysts on their ovaries, so they think they can’t have PCOS. That’s simply not true. 

You don't have to have cysts on your ovaries to be diagnosed with PCOS, and many women don't. If you or your doctor ruled out a PCOS diagnosis because you didn’t have cysts on your ovaries, it’s worth reviewing and getting it checked out again.

For a PCOS diagnosis, doctors look for at least two of the following: delayed ovulation or menstrual cycles (anovulation), high androgenic hormones, like testosterone, and polycystic ovaries on ultrasound.

One of the most frustrating parts of PCOS is often getting the diagnosis in the first place. If I think I may have PCOS but am not sure, what symptoms should I look for?

One of the most common symptoms of PCOS is irregular periods or missing menstrual cycles. Signs of androgen excess are also common. This typically includes hair on the face, chin, upper lip, chest, legs, or other parts of your body. High levels of androgens, including testosterone, androstenedione, and DHEA, can also show up in blood tests.

Some women with PCOS will experience acne, especially around the jawline and cystic type acne. Other potential PCOS symptoms include thinning hair, problems with blood sugar or insulin insensitivity, and polycystic ovaries.

Can I have regular, or normal, cycles and still have PCOS?

This can be really confusing because some women can have a 28-day cycle but not be ovulating. It can seem like everything’s fine, but when an egg isn’t released, you’re not getting the progesterone surge that would normally happen each cycle. Instead, you have what’s known as breakthrough bleeding.

Do you have resources or recommendations to help me get a proper diagnosis?

One of the best things that women can do is start to track their symptoms and their cycles. Kindara is a great app to do that. When you keep track of symptoms like cystic acne, irregular periods, and thinning hair, it gives you a record of data that you can show to your doctor. 

If your providers aren't willing to help you and look into these situations, you might want to look to others to interview. With PCOS, you really need somebody to help you get that diagnosis so you can start to work on your treatment plan.

Note from Kindara: For more information about getting a PCOS diagnosis, Dr. Guan recommends checking out the PCOS Challenge website. You can get traditional information on PCOS diagnosis and treatment from the American College of Obstetricians and Gynecologists. And Laura Briden’s book, The Period Repair Manual, goes deeper into treating PCOS without using synthetic hormones.

Can PCOS be treated naturally, or should I use birth control?

Birth control is the most common recommendation for women struggling with PCOS. Although it can be helpful for certain cases, it's not going to bring your hormones back into balance. Many things can be done to address the root cause of the issues, such as balancing blood sugar, genetic testing, improving hormone balances, addressing nutritional deficiencies, and resolving inflammation. If you just cover it up, you leave those imbalances brewing underneath.

It sounds like, for many, birth control may not be the right first step. The first step should be finding the root cause of the symptoms. When is birth control the right treatment plan?

Birth control can be the right answer for women with PCOS with heavy cycles that are causing a risk for serious anemia. It can also help when a woman hasn’t had her period in a while and she needs to induce a bleed. Women might also choose birth control if they aren’t willing or able to make the necessary lifestyle changes to address their symptoms, or if they’re looking for a short-term solution while they wait for those changes to start to take effect.

If I have PCOS, will that mean I have difficulty with getting pregnant?

I find that many women’s biggest fear after they get the diagnosis is that they're not going to be able to get pregnant or that they’ll have a difficult time conceiving. Sometimes that’s true, but all women have different types and levels of PCOS, and you can do a lot to restore ovulation. The great thing is, if you make lifestyle changes to improve androgen levels, balance blood sugar, and correct hormone imbalances, you're going to be in a much better place if you do need medical assistance when you’re trying to conceive.

Does PCOS put me at risk for other health conditions?

It does. That's why it's so important to get a proper diagnosis and start to manage things like blood pressure, hormones, and inflammation. If those aren't improved, PCOS can increase the risk for diabetes, heart disease, and even cancer, especially uterine cancer. Fortunately, there’s a lot you can do to prevent these conditions, such as making dietary and lifestyle changes, which we’ll discuss in a moment.

Note from Kindara: PCOS can also increase your risk of high blood pressure, unhealthy cholesterol, sleep apnea, depression, and anxiety (1).

Is PCOS permanent?

Some women may struggle with PCOS and its repercussions well into menopause or later. This is especially true when the underlying issues, such as hypothyroidism or blood sugar irregularities, aren't resolved. However, other women find that lifestyle changes can resolve their symptoms and help their bodies move back into a balanced state. 

What foods should someone with PCOS be eating or not eating?

Making the right dietary changes is one of the top things women can do to support their ovulation and hormonal balance. Everyone's different, so everyone's going to need a unique approach and different foods to support their unique underlying causes. 

Foods to include in your diet are high fiber foods, flaxseeds, berries, and cruciferous veggies. Avoiding dairy may also help with PCOS symptoms, especially acne. Moving towards organic foods and avoiding processed foods are great first steps. I like the Clean 15 and Dirty Dozen lists from the Environmental Working Group’s website.

Are there herbs or supplements that can help support hormonal balance?

Absolutely. One of my greatest desires in my work is to help women connect with these resources again. I feel like somehow we've lost track of them. Herbs can be used to reduce inflammation, support hormone balance, balance the thyroid, and do so many other things.

One of the most famous supplements is inositol, which helps improve ovulation and balance blood sugar. It's been compared to Metformin [a medication that helps control blood sugar levels], and it’s really safe and quite effective for supporting ovulation. 

Later in the webinar, Dr. Guan notes that the usual dose of inositol is 4 grams, but it varies. 

Berberine is another great compound that's been more popular recently, and it helps improve insulin insensitivity. Cinnamon is another one that’s so easy to include. Most of us have that at home, and it also helps to balance blood sugar. There are so many more herbs and natural substances that could be used, but you need to work with a qualified provider and find the right supplements for your unique root causes.

What lifestyle changes can help support hormonal balance with PCOS?

When you’re looking at making lifestyle changes to manage PCOS, the main goal is to find and address the imbalances in your life. I like to recommend things to support insulin sensitivity, balancing androgens, and restoring ovulation. Those are the three key things that are really going to help resolve PCOS symptoms, and we can impact those via lifestyle.

If it sounds overwhelming, don’t worry. You can totally start with baby steps if you need to. Dr. Guan recommends these lifestyle changes that can help with PCOS:

Fixing your sleep schedule. Sleep is one thing that's often left out of our life. Often, we don't get enough sleep, but it’s important for restoring our energy. We feel better, and we're more likely to make healthy choices when we feel rested.

Being more active. Movement is essential for building lean muscle and balancing our blood sugar. I especially like weight-bearing exercises for women who struggle with insulin insensitivity because muscle mass will help improve that.

Fasting at night. Our bodies and biological clocks aren’t really used to having food for most of the waking hours into the night, which has unfortunately become quite common. So we can all work towards a minimum of 12 hours of fasting.

Managing stress. Cortisol and stress do a lot for women's hormones and can impact ovulation. If you're dealing with stress and PCOS, that's going to be two factors against your ovulation success. Try to really make time for activities that help you feel like yourself.

Finding a supportive community. You'll want to surround yourself with positive people who really care about you and support you to make healthy choices and uplift you. Who we surround ourselves with has a tremendous impact on our health.

Avoiding toxins. The level of chemicals in our environment can have a huge impact on our hormones. I recommend taking steps to clean up your home and environment using green products. The EWG website (linked above) has a lot of resources, including a really handy app that lets you scan barcodes and see how clean your product is.

Getting your hormone levels checked. If we don't know what your hormone levels are, then we're just guessing. Addressing your whole health, not just your reproductive health, is really important. It can help you find other factors, such as an underactive thyroid or digestive issues, that could be impacting your PCOS. It's all connected, and I think it's important to take a holistic approach.

What are your thoughts on medication to induce your period?

If a woman hasn't bled for a long time and her estrogen levels are abundant, she's going to build up a thick lining in her uterus. It’s important to shed that lining and prevent a buildup. So, if there isn't a natural bleed happening and it's been a long time, medication can induce a period so you can prevent that build up.

What do PCOS charts look like?

Often, PCOS charts will show a lot of variability in temperature between a narrow range. So it'll just kind of look like a sawtooth, and it can be quite long. You'll also see irregular temperatures going up and down and then a bleed without seeing a clear spike and definition between the two phases.

Do I have to specifically ask for a PCOS test, or is it detectable in a regular checkup?

I would recommend telling your provider you're concerned about PCOS. If you present your symptoms that you're worried about, your doctor can take the lead to look into further testing. You can’t tell if someone has PCOS just by looking at them. You're going to need to have some blood work done to confirm those things.

What are the different symptoms of thyroid distinction versus PCOS? Do they often correlate or overlap?

Your thyroid is like the gas in your car—it accelerates your metabolism and allows all of your systems to function at a certain rate. If your thyroid is working at a high level, everything's going to be sped up. Hypothyroidism is the exact opposite; it slows everything down. PCOS is mainly the symptoms of hormonal imbalance we talked about above, but thyroid issues could complicate the picture or set the stage for those imbalances to develop.

Can you talk a little bit about what it means to have a high sugar diet?

When I say high sugar, I really mean a large intake of carbohydrates. The modern diet can be really carbohydrate centric, especially if you're using prepared foods with a lot of added sugar. A lot of women consume way more carbohydrates and processed sugars than they're aware of. Reading labels and doing a diet diary is a really great place to start finding and cutting out sugar from your diet.

If I’m hoping to regulate my cycle and ovulation, what are some ways it can be done naturally? What type of doctors or professionals should I seek out?

Natural methods are a really great way to optimize your hormone balance because botanicals, diet, and lifestyle can really support hormone health. And, like we said, the birth control suppresses ovarian function. 

I'm a naturopathic doctor, so I'm probably biased, but I think naturopaths are really great for supporting women's health and using natural substances. But you could really go to anyone with functional medical training, as long as they have an open mind and experience with natural treatments. You may also look to a nutritionist, personal trainer, or counselor to help you make lifestyle changes to treat your PCOS. I really love for women to have a team of providers who can all support them in different ways. 

How should I manage “skinny” PCOS when I’m already at a healthy weight and lifestyle?

The lean type of PCOS is common, and sometimes treating it can be tricky because it isn’t usually accompanied by insulin insensitivity. Sometimes it's caused by genetics instead of hormones, environment, or lifestyle. With those cases, botanicals can be really helpful because they can impact how you metabolize hormones. For lean PCOS, you want to take a really broad approach, including getting bloodwork done, to see what other symptoms could be bringing things out of balance.

I read that PCOS makes the risk of miscarriage higher. Is that true and, if so, are there supplements to support early pregnancy?

Miscarriage is quite common for women who have dealt with PCOS, especially early-term miscarriage. I like to let women know that there's no blame in those situations. It's often quite painful, and you can feel like you did something wrong, but it's very common. 

Hormone imbalances can be an issue during pregnancy for women with PCOS. If you’re having recurrent pregnancy loss, getting your progesterone levels checked can be helpful. If your levels are low, your doctor may recommend progesterone supplements to help support your pregnancy. It’s also important that you're on a great multivitamin and eating really well leading up to pregnancy.

Do you have to take Metformin for life?

Metformin helps to improve insulin levels and blood sugar. It does help with ovulation for when those things are causative. Sometimes, you can improve those things with diet and lifestyle and not need Metformin anymore. Also, there's been studies that compare inositol with Metformin. I recommend inositol for almost all my PCOS clients, and it's similar in activity and very effective.

How does alcohol affect PCOS?

Alcohol and estrogen are both metabolized in the same liver pathways. Your body's either going to metabolize estrogen or alcohol. When women with PCOS don't ovulate, they don't have progesterone production. This causes them to be estrogen dominant and have symptoms of estrogen excess. If you add alcohol to that, you're going to worsen those situations and increase estrogen levels even more. It also could raise blood sugar and cause inflammation.

Can you develop PCOS later in life?

You can, and it can be brought on by environment and lifestyle. However, women often get better with time. When we're younger, we have more androgen production. Many women, especially those with the genetic type of PCOS, find that their symptoms die down after they have their first baby, or after they get through their 30s.

Have more questions about PCOS and fertility? Read our post on testosterone, PCOS, and female infertility.