Jess is a gorgeous 26-year-old with everything going for her, good job, lovely partner and some great friends and family around her.
She came to me as she had been diagnosed with Polycystic Ovarian Syndrome (PCOS) and had come off the pill but still had not had a period yet. It was not the first time that she had come off the pill – each time she came off the pill she did not get a period for months so each time she went back on the pill.
This time was different as she was thinking about her fertility….
Jess and her partner were considering that they would like to try for a baby in about a year so she wanted to seek help to see if she could attain a regular menstrual cycle.
Jess had been on the oral contraceptive pill on and off for the last decade and at one point had an Implanon. By my calculations she had not had a natural cycle for about 10 years which means she had probably not ovulated for that long as women do not ovulate when they have the Implanon inserted or take the pill.
I suspected there was something more than PCOS that was affecting Jess though….
Jess had been diagnosed with PCOS because she met the two of the medical criteria required to be diagnosed; she had amenorrhea (no period) and she had multiple follicles in each ovary on ultrasound. (in PCOS there is actually no cysts on the ovaries – they are multiple immature follicles that have a cyst like appearance on ultrasound).
Whilst this is enough for a diagnosis, its not enough to understand what the drivers are behind Jess’ PCOS because each woman is different. And – because we are more than a diagnosis.
When I took Jess’ full medical history she disclosed to me that about 5 years ago and for 2 years, she over exercised and under ate – by her reports she reached as low as 7% body fat. She also brought with her some pathology that had one of her hormones, Latinising Hormone (LH) as quite low which is unusual in PCOS as it is normally elevated. LH stimulates the ovaries to produce oestrogen but it also stimulates the ovaries to produce testosterone – this is often the mechanism behind high testosterone in women who have PCOS.
Low LH and under eating are often associated with another condition that looks a lot like PCOS – hypothalamic amenorrhea. It occurred to me that perhaps Jess may not have PCOS or, perhaps there was more to her PCOS.
We spent some time going through her diet and training and I could see that she was not under eating anymore but she didn’t have a lot of starchy carbohydrates. And she was fasted training. These are the things that can be uncovered in a Naturopathic appointment because they are so extensive!
Our treatment approach….
We increased Jess’ starchy carbohydrates so that she had some form in every main meal and talked about having something small before training. Starchy carbs are super important for menstrual cycle health and for women that have under eaten it can take a consistent and continual level of consumption over some time to assist in getting regular periods again. This is quite different to what would be done in “standard PCOS” as the general recommendation for PCOS women is to limit carbohydrates because of the link to insulin.
We also used a number of herbs that have traditional uses in menstrual health.
I also recommended to Jess that she might like to speak to another GP about her condition and get some further pathology, noting the 2 anomalies that I had discussed with her. Amongst this too was the suggestion that at this time she seek a referral for a gynaecologist that specialised in assisted reproductive technology. I think its really important when fertility is the goal of treatment that all options are undertaken and explored. There is often extensive wait lists for good ART gynaecologists.
The further testing confirmed that there was not high testosterone or insulin issues with Jess and her LH was now in normal. The GP agreed that there was more at play than PCOS for Jess.
We continued to focus on food quality plus great herbs and nutrients and ensuring that she was not overdoing it at the gym vs what she was eating.
Still no period though.
And then COVID hit….
I had been treating Jess for 6 months when COVID put us all in isolation.
Jess and her partner by this time had bought their own house – they were previously living with Jess’ partners parents house. They were loving having their own place.
When COVID hit, Jess was lucky enough to be able to keep her job and she was able to work from home. She decided at that time she would also go gluten free and diary free. She was doing a 20 minute at home work out because she couldn’t get to the gyms as they were closed. When I spoke to her, she was actually the most relaxed that I had ever heard her be. We were still supplementing with herbs and nutrients.
And then one Thursday night I got a text from Jess;
“Hey Wendy!!! I have some very exciting news. I got my period this afternoon”
Absolutely made my week.
Jess got her first real period in 10 years. Celebrations all round. For those of you that do have a regular cycle – there is nothing quite like speaking to a woman who is trying to get one to truly appreciate how lucky you are.
Its early days yet, and no doubt there is still hiccups to overcome, but now there at least there is a glimpse of an opportunity that she wasn’t sure that she had.
My firm belief is that the dietary modifications and the herbs put her body on the right track and then the low stress month she experienced put her brain in a place where menstruation was possible. The brain and the body came together and well, the rest is history.
Have a beautiful day peeps.
Wendy – The Healthy Hormone Naturopath