In this episode of The Dr. Hedberg Show, I discuss healing PCOS with Amy Medling. Amy Medling, best-selling author of Healing PCOS and certified health coach, specializes in working with women with Polycystic Ovary Syndrome (PCOS), who are frustrated and have lost all hope when the only solution their doctors offer is to lose weight, take a pill, and live with their symptoms. In response, Amy founded PCOS Diva and developed a proven protocol of supplements, diet, and lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness.
Here is the transcript of Healing PCOS with Amy Medling
Dr. Hedberg: Well, welcome everyone to the Dr. Hedberg Show. This is Dr. Hedberg. I’m excited today to have Amy Medling on. She’s the founder of PCOS Diva. And I just wanna tell you a little bit about her bio. She is the best-selling author of, “Healing PCOS.” She’s a certified health coach, and she specializes in working with women with polycystic ovarian syndrome also known as PCOS who are frustrated and they’ve lost all hope when the only solution their doctors offer is to lose weight, take a pill and live with their symptoms. So, Amy founded the PCOS Diva and developed a proven protocol of supplements, diet, lifestyle programs that offer women tools to help gain control of their PCOS and regain their fertility, femininity, health, and happiness. So, Amy, thanks for coming on the podcast.
Amy: Oh, thank you so much for inviting me. I’m so happy to be here.
Dr. Hedberg: Right. So, why don’t we just lay some of the bedrock for our listeners? Why don’t you just cover the basics of PCOS? What it is? What are the symptoms? And why do you think so many women are misdiagnosed?
Amy: Sure. So, PCOS, as you mentioned, stands for polycystic ovary syndrome. It’s the leading cause of infertility in women and it’s also the most common endocrine disorder in women. And since I wrote the book, the statistics I used was 1 in 10 women have PCOS, but that number has increased to as many as 1 in 5 women worldwide can be affected with PCOS. And some of the common symptoms of PCOS are driven by kind of what I talk about in the book as the three root factors: insulin resistance, hormonal imbalance, and inflammation. So, things like waking and difficulty losing weight, sort of that centralized obesity or kind of like an apple shape is hallmark of PCOS although a 20% to 30% of women with PCOS have normal BMI or low BMI. So, also most women with PCOS have some level of increased androgens or male hormones, and those drive symptoms like hair loss kind of that male pattern hair loss, hair growth, or hirsutism. So, typically like hair on your chin or chest or upper lip. And that now if you do have hair where you don’t want it, that’s a very common symptom, and now it’s recommended that women with hirsutism be screened for PCOS.
And also mood disorders are very common with women with PCOS. About 60% of women have some level of anxiety or depression with PCOS. So, there’s many more symptoms. This whole myriad of symptoms can be present in women with PCOS although not everyone presents the same way, and I think that that can make it very difficult to diagnose. So, when I was trying to figure out what was going on with my body, I was very tall, very slender. I didn’t really present myself as the classic PCOS and it made it very difficult for me to get a diagnosis. So, I think that that’s one of the reasons why it’s hard to get a diagnosis. I think another reason is a lot of women sort of chalk their symptoms up to genetics and, “Well, my mother had very thin hair and my grandmother had thin hair,” or, “My relatives and my family all have trouble getting pregnant.” And in fact, PCOS it definitely has a genetic component. So, perhaps your mom or grandmother had PCOS as well. So, I think that’s another reason why it’s difficult to get a diagnosis that women just sort of chalk it up to their genetics.
Dr. Hedberg: Yeah. And there’s also this term skinny fat, so that circulates and I sort of see it in practice where it’s very low lean body mass but weight gain especially around the mid-section. Have you seen that?
Amy: Yes, definitely. And women with PCOS who are thin can still have some level of insulin resistance and are still at risk down the road for things like type 2 diabetes and cardiovascular disease, if they don’t get their lifestyle factors under control.
Dr. Hedberg: So, the diagnosis depending on what you read it’s kind of variable, it could be issues with the menstrual cycle and high androgens, and things like that. For the women out there that aren’t sure if they have it or not, what do you think are some of the best ways to really pinpoint if you have PCOS or not?
Amy: Well, doctors are still using what we call the Rotterdam criteria to diagnose PCOS. So, if you have two out of the following three criteria then you would have a PCOS diagnosis. So, the first would be irregular menstrual cycles and ovulatory cycles for regular ovulation. And then the second would be those elevated androgens. And the third would be polycystic ovaries as seen on an ultrasound. And that can be kind of tricky because not all women with polycystic ovaries have PCOS and vice versa. You can have PCOS without having the polycystic ovaries. So, that’s really how you would advocate for yourself to get a diagnosis, asking a doctor to screen you according to the Rotterdam criteria.
Dr. Hedberg: Yeah. Isn’t it somewhere around 20% or 30% of women with PCOS don’t have any cysts?
Amy: Yes, exactly.
Dr. Hedberg: Right, right. So, let’s just talk briefly about conventional approaches to PCOS once it is diagnosed. And it doesn’t seem like there’s much to offer there other than birth control pills or Metformin and things like that. What are you seeing used mainly for PCOS from a conventional treatment side and why do you think those aren’t effective?
Amy: Well, I do think that most women are offered the pill especially at an early age. I think most women show signs and symptoms of PCOS in adolescence although it can be a little tricky to diagnose them because a lot of girls, young girls have irregular menstrual cycles and they can also have elevated androgens in their teen years. So, I do think that a lot of girls are put on the birth control pill and it does mask symptoms. It kind of acts I think of it as a band aid. It will kind of help normalize those androgens and can help alleviate acne. And then you kind of feel better because you are having a bleed but it’s really a pill bleed and you’re not ovulating, obviously, and it’s not a true period. But I do think that the pill is problematic for women with PCOS. And I’ll just go through some of the reasons. While the risk for blood clots is still low, women with PCOS are two times the risk, and I can tell you, I hear from women monthly, probably like one a month of young women in their 20s, early 30s having life-threatening blood clots as a result of the pill and women that have PCOS.
Also, the pill can increase insulin resistance. And insulin resistance is really one of the root factors of PCOS, and so I do think that it tends to make the insulin resistance worse. That also can worsen the mood disorders and the depression, causes low libido. And it also leads to nutrient deficiencies. And I think a lot of women with PCOS already are low in nutrients and deplete, and the pill just sort of adds to that and can kind of exacerbate symptoms especially when you’re low in B vitamins, magnesium, zinc.
And then the other pharmaceutical drug that is often recommended for PCOS is Metformin and that’s a diabetic drug, but it’s used off-label for women with PCOS to sort of treat that insulin resistance. And I think for a lot of women, it can really help them lose weight, but again, it’s sort of acting as a band-aid. And for me I was put on both the pill and Metformin and I couldn’t tolerate either and that’s what really led me into trying to find another way to manage my PCOS. Metformin caused a lot of GI issues for me. It’s also widely acknowledged to deplete B12, and so it’s so important for women with PCOS that are on Metformin to supplement with B12.
The other drug that’s often used to help with the androgens is spironolactone. It’s a diuretic and it helps with some of the symptoms like acne, hirsutism, and the hair loss. And I was on that for a time as well. But I just think that all of these prescriptions are sort of just slapping a band-aid on the problem and not really getting to the root causes and healing those.
Dr. Hedberg: Right, yeah. I was really excited in your book, “Healing PCOS” to read and you’re really one of the few people out there that actually recognizes the issue of post-birth control pill syndrome and also all the nutrient deficiencies that are caused by birth control pills. So, I was really glad to see you mentioned that. And what I want to do now is I’m going to go through how I work up a patient with PCOS and with some of the labs that I use, and things like that, expand on it. So, first of all, of course, in the blood we’ll do fasting glucose hemoglobin A1c fructosamine to get a decent idea of blood sugar and insulin resistance. Then of course, a thyroid panel, detailed thyroid panel, comprehensive metabolic panel, vitamin D, CBC, and then ferritin is also really important, which is how much iron is stored in the body and that can be an issue if there’s a major metabolic issue like PCOS.
So, those are some of the initial things in the blood. And then with PCOS you definitely want to do a stool analysis because the microbiota is key when you’re dealing with insulin resistance and blood sugar, so I’m looking at things there. And then as far as hormones go, testosterone is really best tested in the blood, a free and total, but I’ll do urinary hormones so I can see how they’re being metabolized as well, all the sex hormones and the adrenal hormones. And then in certain cases I’ll do inorganic acids to look a little bit deeper at metabolism and things like that. And going back to the hormones and the great thing about urinary hormones is you can see all the androgens broken down whether someone’s an alpha or a beta dihydrotestosterone converter, and all the other androgens as well. So, regarding that list, is there anything you want to expand on there or any other recommendations out there that women should have as far as testing?
Amy: Did you mention inflammation markers, like C-reactive protein?
Dr. Hedberg: Oh yeah, I didn’the, but we do do… Yeah, we do a highly sensitive C-reactive protein in the blood for sure. Yeah.
Amy: Yeah. Women with PCOS tend to be elevated in that. And then the other thing was liver functioning tests because many women with PCOS have non-fatty alcoholic…or non-alcoholic liver disorder, and so I think it’s good to get like a liver function assessment as well.
Dr. Hedberg: Yeah, that’s in the comprehensive metabolic panel.
Amy: Yeah. Okay. No. I think it’s to really get a handle on your hormones. I think the other thing to kind of make a note of is that many women with PCOS are low in progesterone in relation to estrogen and that is something that I think when you can kind of get that under control it really helps with many of the symptoms and with your cycle as well.
Dr. Hedberg: Yes. Yeah, definitely. So, why don’t we shift into things that women can do to get well? You talk a lot about in your book about diet and self-care, and things like that. So, you talk about adopting these six recommendations for self-care, so could you expand on that?
Amy: Yeah. Could you mind if I just touch on the mindset piece first because I…
Dr. Hedberg: Oh yeah, sure.
Amy: So, I start the book off with a chapter called, “Think like a PCOS Diva.” And I really think that…we were just talking about the pharmaceutical pills and I think so many women are just looking for a pill to fix their problem. Boy, would that be easy if we can just pop a pill and all our symptoms would go away? In my book, I really want women to realize that they are the magic pill and it really begins with the way that they view themselves and their PCOS. I think so many of us feel like our body is betraying us. PCOS can really rob us of our sense of femininity, we’re losing hair, we’re growing it where we don’t want it, we’re having a hard time getting pregnant. And so we tend to have…feeling negative feelings towards our body.
And so I think that the first thing to do is to realize that your body’s not betraying you. It’s really calling for your help and you need to learn how to stop fighting and instead working in partnership, and realizing that these symptoms and signs are just signals that you need to bring things back into balance. And, yeah, I believe it’s mind, body, and spirit. So, partnering with your body, realizing that you don’t have to be a victim and you have a lot of control over the lifestyle choices that you make that will really help you to heal.
And then I find that a lot of women need to work on this lifestyle change from an aspect of progress rather than perfection and just setting small reasonable goals and celebrating the small wins as you go along. So, just really focusing on entering this lifestyle change with a very positive, optimistic mindset.
Dr. Hedberg: Mm-hmm. Excellent. Yeah. I’m really glad you brought that up. And there are a lot of people out there just looking for a magic pill and that just isn’t going to work especially for something like PCOS. So, now a lot of what I see in my practice is Hashimoto’s disease, and there’s definitely connections in the literature there with PCOS and Hashimoto’s. But let’s talk a little bit more about food. Let’s get into that. What kind of foods do you think women should avoid if they have PCOS?
Amy: So, I think it’s really about being on an anti-inflammatory diet, and that really is unique to everyone because we all have our own unique sort of food sensitivities. I know I recently found out that I was sensitive to eggs, and once I removed them from my diet, I regained a lot of energy. But for some people, eggs, it’s a great source of protein. But in general, the anti-inflammatory, and I think for most women with PCOS that means eliminating or reducing gluten and dairy. I think especially milk and cheese can be very inflammatory. And then, adding lots of anti-inflammatory vegetables and low glycemic fruit, and clean animal protein. I do think that certainly, non-soy like vegetarian type protein sources are good too, but I do think that it’s really hard to successfully manage your PCOS and be a vegan or even a vegetarian. So, I do advocate some animal sources of protein, but just lots of in-season produce is just so important.
Dr. Hedberg: Right. One of the things I haven’t seen talked about much…it’s talked about a little bit, is the ketogenic diet and PCOS. And I’ve been working with women with PCOS for 15 years now and in some cases, my best results have come following a ketogenic diet. And the literature…there is some good literature on the ketogenic diet and PCOS. And so the ketogenic diet is going to target a number of things related to PCOS. It’s going to lower baseline insulin levels and insulin surges are minimized on the ketogenic diet. And it also has inherent anti-inflammatory properties, the ketogenic diet. And then, of course, it’s great for blood sugar and inflammation. And in certain cases, the gut micro-flora, and it helps to really reduce inflammation of the GI tract. So, have you ever experimented with that yourself or seen any women do well on the ketogenic diet?
Amy: Yes. I mean, I have seen many women do well on the ketogenic diet. I have tried it. It’s difficult for me to sustain and I think that’s the one thing that I question is this sustainability over the long-term with the ketogenic diet, because as a woman with PCOS it’s something that…there’s a continuum of healing. That’s the reason I call my book, “Healing PCOS” but it’s never really cured. But I do think the ketogenic diet can be really helpful if a woman needs to lose some weight in a quicker fashion, and that’s where I see a lot of women using the ketogenic diet in order to try to get pregnant and they have to lose 10% of their body weight in order to improve their outcome if they’re doing fertility treatments and that kind of thing. So, that’s I think in the short term it’s going to be very helpful. I do a question on like the type of ketogenic diet that you follow. I worry that some women aren’t getting enough plant-based food, and that would just be my caution. But I do think that it can be very helpful for a lot of women with PCOS.
Dr. Hedberg: Yeah, I’m glad you mentioned the type of ketogenic diet because some people genetically, and this can be tested, have actually a strong insulin response and inflammatory response to saturated fat, and then some people genetically it’s actually anti-inflammatory and that’s going to be based on their genes. And so part of it is figuring that out and that’s why some people do really well on it and some people don’t because of their genetics. And the other thing is that I tend to use more of the Spanish Mediterranean ketogenic diet where the fat emphasis is more on omega 3s and monounsaturated fats, and it’s actually very low in saturated fat, and you seem to get a little bit better anti-inflammatory response and just better results with blood sugar as well. So, there’s definitely different ways to do it and it needs to be tailored for each individual. But I agree with you, it’s very hard to stick to in the long run because there are so many limitations for what people can eat.
Dr. Hedberg: I agree with you that the ketogenic diet is difficult to stick with. And then, why don’t you go ahead and share with us your story? You had a personal experience with infertility. So, could you share your story with us about that?
Amy: Yeah, sure. So, when I was 17, I had gone to the college clinic, of the college that I was going to and I had missed my periods for several months and was trying to figure out what was going on. And I just wrote a very clear recollection of laying on this cold exam table and this doctor telling me, “You know what? You just need a prescription for the pill, but I can tell you when you want to have kids one day we’re going to have to jump through hoops to get you pregnant.” And I hadn’t…I actually never got a PCOS diagnosis till I was 31, so I really didn’t know what was going on but it was very scary to think that, “Gee, I might not be able to have kids,” or, “It’s gonna be very difficult for me to have kids one day.” And when I met my husband and we were getting ready to start a family and I was about 28 years old and went to the doctor, and he gave me a prescription for Clomid which is an ovulation induce siren. One try with Clomid and I was pregnant with my first child. And then we wanted to try for another and it was very difficult for me to get pregnant even with Clomid. And I really suffered from some secondary infertility and ended up having to do injectables and finally got pregnant right before I was going to have to consider IVF for this second baby. And it’s actually his 15th birthday today.
So, I’m so glad that that worked out. But after I had that child my doctors told me I would never get pregnant again without fertility treatments, which is really not the right thing to say because most women with PCOS can get pregnant. And I was able to get pregnant with my third child after I had adopted this PCOS Diva lifestyle, and I was 37 and had her. And really, having a daughter and knowing that she may be genetically disposed to having PCOS, my mother has PCOS, and my sister does. I venture to say that both my maternal and paternal grandmothers did based on their symptoms that they had in their fertility history as well. My daughter may have it and I really want her to know that it’s not this negative thing that I once thought it was. It’s an opportunity to live life like a PCOS Diva but really live a very healthy life and learn how to manage her PCOS symptoms through lifestyle like I have.
Dr. Hedberg: Hmm, interesting. And so now why don’t we shift into stress a little bit? What are some of your main recommendations for women just to deal with stress and how do you think it affects PCOS?
Amy: Well, we know that cortisol can really shift the hormonal cascade and can contribute down the road to low progesterone, which is kind of a hallmark symptom of PCOS and low thyroid. A lot of women with PCOS have hypothyroidism as well, you had mentioned, Hashimoto’s as well as Hashimoto’s. It can increase insulin resistance. And women with PCOS already have elevated levels of cortisol over their non-PCOS sisters. So, we’re already I think more wired for stress and so it’s… And we’re not gonna be able to eliminate stress from our lives and in a lot of ways but we can learn how to manage it. And I found that self-care is really so critical to managing PCOS. And I actually sent out my newsletter yesterday and I haven’t done a great job with self-care lately, and I can see it coming out and my moods are much more irritable. And I know that it’s time to shift to make sure that I’m taking care of myself. And for me, that’s just making sure I have some quiet time.
I know before we got on air you were talking about kind of getting off the social media. I think like scrolling through Facebook and Instagram can be highly stressful, and it’s not a great way to relax even though I think a lot of us that’s what we do to relax after a long day, scroll through social media. So, really getting off social media, finding a quiet moment for meditation, and that can be just as simple as just taking 10 deep breaths and focusing on the moment, making sure that you’re getting adequate sleep. That is so important for managing stress.
And something that I think is so important is finding a creative outlet in the work that I’ve done with coaching women with PCOS. And in my online programs, I’ve found that women who are suffering the most from their PCOS symptoms have lost touch with their creativity and they don’t have a creative outlet. And I think that that’s a wonderful way to release stress. And you know, when you’re caught up in that flow state, whether you’re dancing or painting or playing an instrument or writing, even coloring. I love those adult coloring books. It’s a great kind of form of meditation and a really good way to reduce stress.
Dr. Hedberg: So, you started PCOS Diva, and this is an online community for women with PCOS. Can you tell us a little bit more about that and what you’re trying to accomplish?
Amy: Yeah. So, for me, it really started out very organically back in 2008. I just was sharing kind of like a… It was a blog. It was kind of like an online journal, I guess what was working for me in terms of the food that I was eating and the way that I was moving my body, and the way that I was reframing the way I thought about PCOS, and never really expecting anybody to listen. It was my creative outlet. And lo and behold, women were reaching out to me and saying that they had tried some of the protocols that I was mentioning and their PCOS symptoms improved. And so my site has grown out of that very small little organic blog and now I have, gosh, probably 400 different articles all research based on PCOS. I host a podcast. I’m almost at my 100th episode on interviewing different experts and people in the PCOS community. And I also have online programs about how to manage your PCOS. And I have programs on detoxification, which is really important aspect of managing your PCOS. And of course, now I have a book. So, yeah, there are a lot of resources at pcosdiva.com.
Dr. Hedberg: Right. So, yeah. Is there anywhere else you’d like people to find you online? So, you have pcosdiva.com. And where else would you like people to find you?
Amy: Sure. Well, my podcast is on iTunes. It’s PCOS Diva Podcast. And I’m really pretty much on all social media with the #PCOSDiva.
Dr. Hedberg: Hmm. So, this has been great, Amy, I appreciate you coming on. Is there anything else you’d like anyone to know listening about PCOS that we haven’t covered yet?
Amy: Well, I just wanted to say that if any of these symptoms that we talked about are kind of resonating with you, actually, between 50% to 70% of women that have PCOS, are undiagnosed, so please go talk to your doctor about PCOS. And I also just want you to know that there’s so much hope that you can live a very full happy life, healthy life with PCOS and you just have to sort of take the first step and realize that you have a lot of control over your lifestyle factors.
Dr. Hedberg: Excellent. Well, thank you for coming on, Amy, everyone listening. I will have links and show notes on drhedberg.com about this interview. And I’ve read Amy’s book, “Healing PCOS.” So I highly recommend it to everyone, so check that out.
So, take care, everyone. This is Dr. Hedberg, and I’ll talk to you next time.