What is PCOS, with Dr. Jennifer Roelands

The two big hallmarks that have to be there is that you have to have irregular cycles because you're not ovulating consistently. And you need to have evidence of higher androgen levels like acne or unwanted hair on places that you don't really want to be on your abdomen or even on your face or lab abnormalities having your androgen levels actually be high.

If you want to live like you matter, ditch the pills, look great and feel Freaking amazing. You're in the right place. I'm Dr. Wendy Trubo. And I'm Dr. Ed Levitan. Welcome to the Feel Freaking Amazing podcast where we empower you to live a vibrant and healthy life by optimizing your structural, chemical, emotional, social and spiritual lives. Hold on to your hats. Hello and welcome to this episode of the Feel Freakin Amazing Five Journeys podcast. I'm Dr. Wendy Trubo. Ed is again, not with us. He's speaking, seeing patients. So I'm on my own. But it's a great conversation because we have Dr. Jennifer Rowlands. She is an integrative medicine trained OBGYN. So after my own heart. She specializes in PCOS, hormones, gut health. She's also the Shio of well, women MD where she partners with women to discover the root cause of their symptoms so they can have energy, predictability in their periods, weight, fertility, and most importantly, feel like themselves again. So, Dr. Jen, welcome. It's great to have you here.

Thank you so much. I'm excited to chat with you today.

Me too, Sue. I mean, you and I both learned about PCOS in residency, but tell me about what is it? What are the symptoms?

Yeah, so polycystic ovarian syndrome. We typically sort of call it a gyn problem or reproductive problem because most of the time patients will come into the office and they say, well, I got off the pill and I'm trying to have a baby and I'm having difficulty getting pregnant. Or they'll come into the office and they'll say, I got off the pill and I'm gaining all this weight. My periods have become very irregular. I'm starting to notice that my face is breaking out and I just have a lot of food cravings, a lot of hair thinning or hair loss. And those are also very common symptoms of pcos. But there can be some uncommon symptoms of PCOS because it's a metabolic and a reproductive problem. There are patients who have even poor immune function, so they have difficulty healing, they have poor wound healing to begin with because of immune issues. But they can also have, I mean, even Things like funny rashes and all kinds of derm disorders. They can even have sort of what we call those syndrome, so IBS and fibromyalgia and migraines and these kind of other things that go with a collection of people who tend to sort of have these metabolic problems. And so I think in general, we sort of recognize that more or more women recognize as a reproductive problem because they tend to come in because they're having difficulty getting pregnant or their periods are regular. But there's so much more to the, to this complex disorder that I think it's important that patients who are having. They kind of feel like something's not right need to be evaluated for what's going on. The one thing I would say is a very common problem, right? 1 in 10, 1 in 5. There's a lot of different statistics, and I really want people to know, like, you're not alone. You're not alone in this. There are people who can help you if you feel like you've been dismissed or feel like you really are not getting answers or you feel like something is really, really wrong. That really to listen to yourself, because I find that the patients who are really sort of good advocates for themselves really are able to heal much better than the ones that have sort of silently suffering and not realizing there are people that you can see, there are other women just like you. And so I think it's important to sort of listen to that intuition that's like, something's wrong. I really need to, to figure this out.

So what comes first? Right? So do you gain more weight? And that is increasing aromatization in the fat cells, so that's altering your estrogen levels and that's leading to the presentation of pcos. Or do you feel more that the PCOS intrinsic imbalances lead to the weight gain? What do you think is the chicken or the egg? Do you have a sense of that?

Yeah, I think the intrinsic imbalances are causing issues because if you have insulin resistance issues, you can gain weight. If you have high inflammation, you can gain weight. If you have poor gut health, you can gain weight. Like all of those things can, can lead to a side effect of weight gain. It's just important, I think that PCOS know, like, PCOS patients know like, it's. It's much better to sort of like, look at what can we fix going on with the pcos and the side. The weight loss is going to be your side effect from this happening, right. As opposed to sort of focusing on like, I want to weigh Myself every day. Did I lose a pound today? Is this you? We focus just on, I want to lose weight. This is what I want to do. You miss a lot of the other things, which is to overall get healthy. I think that that's important for patients to realize is that when they start addressing these things, that will follow. Weight loss will follow.

Right. And we find in our practice that when we deal with the toxins, which is a massive inflammatory event for people, weight loss happens, you know, but, but you can't focus on the weight loss. You have to focus on the toxins. And the weight loss is the barometer that tells you, oh yeah, I'm removing my toxins. They're coming out of my fat storage, so I can now lose fat. So it makes sense. So you're really working on the underlying imbalances that lead to the weight gain, the inflammation, the irregular periods, the hair growth or the hair loss, depending on what part of the body we're talking about.

And even toxins is a perfect example. I mean, toxins, so many as, you know, because you do this all day is like when you start sitting and asking patients these questions about environmental exposures, what is your day to day life? Like, what are, you know, it's amazing how many things come out and then you're like, oh, like this person clearly needs heavy metal testing. Or they, you know, they may have a mold exposure. Or like, it's kind of amazing when you just sort of ask those questions that you can get so many answers. And toxins, I would say specifically because those, those are not the, the obvious, you know, like, are you pooping? Or I think these are kind of more detailed questions you have to ask as to what is someone's everyday life like and what do they do, you.

Know, and think about, think about the endocrine disrupting nature of all the things we put on our body. All these phthalates and plastics, all of them are endocrine disrupting. So almost that easy. Low hanging fruit is. Are you wearing any makeup or using any products that environmental working group has not certified as like, certified and highly rated? Because by the time you've left the house in the morning, you probably used 200 to 250 different endocrine disrupting products. And so certainly, I mean, that's a toxin right there. So it's, it's amazing. Yeah, I think there's such a great opportunity to even drill into. Did you ever live, work, go to school in or travel in something that was water damaged? Because 50% of buildings have water Damage. So when you think about those statistics, the chance of you not being exposed is practically zero as you think of going through your life.

Yeah, exactly. And I think those are definitely less talked about in medicine. So those are things that I find when I start talking to patients. They're like, oh, yeah, actually, I, you know, I don't ever look at, you know, what's. I don't ever look at the skin deep site or I never sort of look at what I use or. Or even just like, getting rid of stuff you haven't used in a long time. Right. I mean, that happens sometimes. I have conversations with patients are like, they pulled the drawer of their makeup and they've had it for, like, five years. I'm like, you probably need to relook at this and we need to kind of talk about it.

So there's.

There's a lot of the pieces of the puzzle, I think, that. That you have to start with, trying to understand with PCOS specifically, what is it that's causing them to still have these symptoms despite being given the medical treatment that they. That is standard, you know.

Mm. So can you draw the line for how PCOS affects infertility? You know, because I know it. But if you sort of go into, like, what's happening, that women are having challenges getting pregnant and I, I personally despise the word infertility because you're fertile. It's just dysfunctionally fertile.

I know, I know. I never liked when we would put those labels on the chart. Right. Infertility or even, you know, there's a lot of labels in OBGYN that we don't like, either advanced maternal age over 35. Right. All of those labels that just seem very patriarchy. But. Yeah. So essentially, you know, there are different ways to diagnose this. Is one thing that becomes a problem, too, is there's no one set way to diagnose pcos. Right. Some people use Rotterdam criteria, some people use androgen excess society criteria. I mean, there's different ways, but the two big hallmarks that have to be there is that you have to have irregular cycles because you're not ovulating consistently. And you need to have evidence of higher androgen levels. And that could be by clinical signs like acne or hair that you. Unwanted hair on places that you don't really want to be on your abdomen or even on your face or lab abnormalities, having your androgen levels actually be high. And that first criteria where I was saying the, you know, the irregular cycles. Well, if you're not ovulating consistently. Say if you have 12 possibilities in a year, if you had a normal cycle every single month and you're only getting maybe three or four chances to ovulate, then you drastically decrease your chance of becoming pregnant.

I mean it is a statistical game, right? I say to people, if you're going to have an egg, you need to flood it with sperm. It's just a statistical probability. And so you need to make sure that there's sperm waiting for the egg. But if you don't get the egg, the sperm are just hanging out, loitering, waiting.

Yeah, yeah. And even some people with PCOS may ovulate in a very outside the normal window, right? So they might have like 37 day cycle and instead of it being day 12 to 14, like the apps say, it's like 16 or 17 for them and say sometimes they just frankly miss the window. So you may even get a limited amount of time. But on top of that, not even understanding that your window is a little different timing. And so that can happen where patients will come in and say, I tried this ovulation test, they're positive all the time. Which is, you know, happens with PCOS because the higher LH that they have all the time and they really kind of can be missing that possibility of when it happens.

And you bring up a really good point. Like I'm actually on one, you know, these four kids, my kids are older, my oldest is going to college next year and my youngest is 11. So it sounds like anyway, I'm really on one of my kids schools because they're not teaching sex ed. And I'm going crazy. I'm like, I am an OB gyn. These kids need to be taught sex ed. But it's really poignant that you talk about because we're not necessarily taught what are the signs of ovulation, what happens, you know, as you ovulate, your sex drive goes up. Because we are programmed to get pregnant. You know, we have, as we ovulate, we have more sex drive, we get more mucus. I love the word spin barki. It always just was really cool and like seeing the spin barkite mucus that you can stretch, but then also the height of the cervix in the vagina comes lower and then after ovulation it goes up. And all these signs women can use, but often they're not even aware, like, oh, oh. Not only is it the PMS stuff, but it's really even understanding how do I know if I'm ovulating? So I think that's really important for women to be taught. I'm going to go back to my kids school now that they're back from break and be like, okay, what's happening with this? Because it's really important to teach people. So if you're listening, those are signs.

Yeah. And those are the bonuses and the negatives. Also the apps that are out there. A lot of younger patients come in and they're always asking me, here's what my app said. Here's what my app said. And the bonus is that I think some of these can do great job with education and teaching women. Like, hey, look for this. Hey, here's ideas, here's this. But it can also, for those that have pcos, can be very difficult because they can be very inaccurate for them who are not having regular cycles and can oftentimes sort of not be inclusion kind of with those types of patients who are like, well, what does that mean for me? Like what's going on with me? So, and I have younger patients who will rely on them and then they don't bring that information to me because they, they're using the apps, you know, and so sometimes I'm kind of like, wait, we still have to kind of go back to the basics and kind of, you know, here's what's happening to your body, here's what you're looking for. This is what you should report if it's, if you don't have this. So I think, you know, we kind of rely on technology sometimes for good, but sometimes it can be hindering for some patients.

Is there a PCOS specific tracker?

No, not that I'm aware of. I do know that there are some of those apps. You can literally say, okay, my cycle length is here and kind of adjust it a little bit or literally use it as a calendar and track what's happening for you. But there is no PCOS app, which would be a great idea.

It's my gift to you because that's not my area of expertise. But okay, let's go back to fertility. So certainly missing the window, which is a good argument for if you're trying to get pregnant, you want to have sex every two to three days throughout any possible fertile time. What other ways are there other ways that PCOS is going to impact the fertility other than decreasing the number of ovulatory cycles and maybe changing the window?

Yeah. So certainly the other component from the metabolic side is insulin regulation. Right. Insulin resistance issues. Most women with PCOS have insulin resistance. I mean, some people quote 60%, 80%. I mean, I think a lot of us in the integrative and functional medicine world say everybody has some, a little bit of insulin resistance. Even if you're a lean PCOS patient. Certainly blood sugar regulation can affect ovulation. We know that can affect fertility. We know that when women get pregnant they have a higher risk of miscarriage if they have blood sugar problems, if they're pre diabetic or diabetic, especially diabetic, that's a component of PCOS that comes in there. Then inflammation. We can look at our fellow endo buddies and know that inflammation prevents ovulation because that's the, I mean that's what endo is, is sort of an inflammatory state. So you have these pieces of PCOS that often aren't put into the puzzle, which is inflammation, insulin resistance that also need to be addressed when you're, when you're seeing someone who's like, well how do I get pregnant? Well, we need to make sure. Do you have insulin resistance? Let's test. Do you have inflammation? Let's test.

So Jen, talk to me about is it that PCOS negatively impacts menopause or the process of going through perimenopause into menopause is worse, negatively impacts PCOS and the tendencies you have. Do you have a sense of which bothers which more, I guess is the term. It feels like the process of becoming less resilient will exacerbate your PCOS into worsened metabolic dysfunction.

Yeah, I think it's being the fact that by PCOS and in your 40s, you're going to have this testosterone level that's higher. Right. Than the average sort of 40 year old walking around typically this sort of lower progesterone, higher estrogen state and you may have insulin resistance as well. And we know just frankly nothing to do with pcos. Women who go through perimenopause menopause, the insulin resistance issue goes up. So you're talking about compounding problems. Right? So that someone who's sort of already in this metabolic dysfunction and perimenopause alone sort of puts you in a metabolic dysfunction. So the two don't make each other better. Do you know, like oftentimes I hear from PCOS patients perimenopausal who were like, man, this is like I had everything under control. And now just like a, you know, slippery slope to go off and it's like you have to readdress again. The bigger issue, which happens more with the insulin resistance as you go through perimenopause for a PCOS patient. And I think that's something we don't, we kind of do talk about a lot with fertility. But, but the more you sort of like know what's going to happen to you on your PCOS journey, the better off you're going to be able to handle those things that are coming.

Yeah. And I think what's, you know, knowledge is ignorance is bliss, but knowledge is power. So the more knowledge you have when it happens to you go, oh, wait, wait, I learned about this.

Yeah. And I think on the other end of the spectrum, since we mentioned perimenopause too, you know, those patients too are so high risk for diabetes, chronic diseases like hypertension, cardiovascular issues like heart attack, stroke, obesity, all these things. And so much of those, I mean, I don't want to sound negative, but it, you are kind of a setup already from having PCOS and you hit perimenopause. So toxin exposure is incredibly important. Right. You want to hold on to that little bit of estrogen progesterone that you have before. You can't. And so being overly burdened by toxins at that time is critical as well because then you're, you know, your body's spending so much time dealing with that, it has no time to sort of store the good stuff.

So you talked about the high testosterone and the high estrogen and the low progesterone, which is an estrogen dominant state. An estrogen dominant state will put you at risk for a whole host of other issues. So can you talk a little about that? And what. Because I know that some people are giving, you know, consistent and higher dosing of progesterone to PCOS patients to help balance them out. So can we talk about the estrogen dominant.

Yeah, so the term estrogen dominance, as you know, is a pretty controversial term because the medical community, the conventional medical community says that doesn't exist. And we know that from our textbook, it says like that term estrogen dominance is not a thing.

Just like women don't need testosterone. Right?

Yeah, yeah, I know, but, but I often, whenever I hear that, I often ask that conventional doctor. Okay, then what is the term? Right. Just because it's not in the book doesn't mean that it's not a thing because we know that perimenopause, that's exactly what happens, is that people have progestero falls first. There's a distinct difference between. And their estrogen is like a roller coaster on the way down. It's not a gradual fall. It's like up and down, up and down, up and down. And you often see that in blood work, you look and go, wow, their estrogen's super high and her progesterone's low. And on this time her estrogen's like, okay, but her progesterone's low because you see that sort of transition of what happens. And so there is no better term, I think, than the word estrogen dominance. I think it is a good term because that is kind of the effects of what someone feels is the fact that their estrogen is so much higher than their testosterone and they should be really competent, complementary to each other. And so I think, you know, by nature of pcos, that kind of happens pretty often in, in a, as you sort of age and certainly I think in that perimenopause time that then that natural progression that's supposed to happen, you're already set up for like you're already sitting there doing it right from that perspective. And so I think that people do notice those symptoms that really get accentuated with it, like difficulty sleeping, like really having insomnia issues, really have noticing that hair thinning at your part, really noticing your face breaking out again when you hadn't had that happen to you in 20 years. And sort of note and even those funky hairs that pop up from that higher testosterone that can happen. So I think that that's a predominant. I like the term estrogenics because I do think it sort of describes what people go through during that time.

Yeah, I was just thinking about something else you were just talking about because it's always important to make sure that the gut is functional because think about all of whether you have PCOS or you don't have pcos. You're going to put your bound and processed hormones into your gut. So if your gut has overactive hormone levels, particularly beta glucuronidase, you're going to deconjugate that bound inert, water soluble hormone. Now you make it a free radical that's fat soluble, cannot stay in your gut, gets recycled into your bloodstream and now you have a dysfunctional pattern of hormone balance also. So I would imagine that particularly for PCOS patients, ensuring adrenal liver gut axis health is critical just to make sure they don't go down that pathway even worse.

Yeah, yeah. I talk about drivers for PCOS symptoms. So I often, and actually when I do, I do a group coaching program with PCOS patients twice a year. And part of it is really distinguishing that gut health is a serious driver, inflammation is a serious driver, and insulin resistance is a serious driver. And you have to be able to know whether or not you have a component of any of those as driving your symptoms. Because, as you know, when you work with pcos, patients, like, most of them will say they have constipation issues or they have some sort of bloating or some sort of GI component. So that's, I would say that was the one thing that changed from when I became an integrative doctor to when I was a conventional doctor is I ask, do you poop? Do you poop regular? What's going on with your bowels? Do you have bloating? Do you have, do you feel like some foods just don't work well for you? Do you feel like you have, you know, that alternating diarrhea and constipation? Like, what happens with your bowels? Because I never used to that in a, in my practice for 13 years, but now I'm like, that's one of the first questions I asked my. Tell me what's going on with your bowels. Because if you don't have good, you can produce all the hormones you want, but if they can't be metabolized appropriately, it doesn't matter. Like, it's, it's all a wash. Because when you talk about gut being almost a component in almost everybody, like, you can't not talk about mental health. Right. Because your gut health is so key and so tied to your mental health. And I would say after the 15 years of working as an OB GYN doing this, I rarely see the patient who doesn't have some sort of anxiety. With pcos, it could be anxiety that has happened because of trauma in the medical community. It could be that sort of feeling as though you've been dismissed or you took a long time for your diagnosis or you really don't have anybody in your corner. But a lot of times it can be this sort of underlying generalized anxiety. And so when their PCOS symptoms are kind of getting out of control, they also have worsening of their anxiety and feel that they're having, you know, difficulty functioning. So I see a lot of anxiety with my practice. And then, and certainly then they're put on, you know, the SSRIs. And that can sometimes sort of hurt the longer term goal because it's not addressing inflammation in their gut. It's just saying, let's, you know, produce serotonin. But it doesn't help you long term to sort of fix the issue.

Right, Right. Okay. I'm assuming that you reverse the symptoms and the, the experience of pcos. Is that accurate?

Yeah. I mean, I even use the word heal because to heal, the word, the definition of heal is to feel sound or healthy. It's not curing. So when someone has pcos, they have pcos. They're not. I know that some people online say that they're get rid of their PCOs, but you don't really. You don't do that. Right. It is what you are. You could. Those symptoms can be there, but you still have pcos. But I certainly feel like if you understand your biology and you understand what's going on and what's driving your symptoms, you can heal and you could feel good even with pcos.

Okay, so what do you do for. For women who come to you and they are experiencing this?

Yeah, so I often. I think what I do first is try to connect the dots for people, for them to understand that it's not. So they're irregular cycles. Their anxiety, their hair thinning, their constipation are all related. And there's all a connector.

We're all one, right? It's all one.

Yes. Yeah. So I think the first step for me explaining to people what integrative medicine really is is whole body medicine. Not here's a diagnosis, here's a treatment, here's a disease, here's a treatment. That's kind of the way that conventional medicine or the traditional medicine works. And for me, it's trying to get them to understand first, hey, this is all connected. If we start addressing these things, we'll actually fix some of these other things going on just by sheer nature of understanding what's going on. So I try to really figure out what is causing their symptoms. Could it, you know, again, going back to Those basics with PCOs, what's driving them? Do they have a gut health issue? Do they have anything going on with their gut? Do they have anything going on with insulin resistance? Have they been tested for these things and inflammation? Where is it that they could have inflammation building in the body because of, you know, exposures or other chronic conditions or stressed out or over exercising? I mean, you know, the typical thing we tell PCOS patients is exercise more and eat less. Well, that causes a lot of information inflammation for some patients who are overdoing it.

Right, right. I think also let's back up a step, that if you are in the typical PCOS presentation, which is difficulty losing weight, the human response is eat less and move more, but that's not addressing the underlying causes of the imbalance. Thank you for your commitment to women. I know that it started from your experience, but then you brought it into life as a way that takes care of women and helps them transform their health. So I'm really struck by your commitment to them. So a thank you. And then I think the natural question from that is where can people find out about you? Tell me about the program that you run twice a year. Tell me more.

Yeah. So I left the traditional office and now I have a telehealth company called well Woman MD and I'm licensed in nine states. And so I see women for consultations to help them figure these, these out and help them come up with a personalized plan for how to heal their pcos. And a lot of times what I do is actually give them a good way to communicate with their doctor. Right. So they continue to see their doctor, but now they're more empowered and now they're a better advocate for themselves. And to say, nope, every year I want these labs or this is what I want to look at, or I need to readdress my insulin resistance so they can really sort of know how to use the system. And then I inside of that I actually have integrative health teams. So I have a nutritionist in my practice, I have a chef in my practice, a acupuncturist. So I have kind of, I'm building more of a team aspect because I think there's different ways to heal. And then I do twice a year run a group coaching program where it's a set of like 10 to 20 women with PCOS in a six week weeks. And usually I run it September because it's PCOS awareness month. And then in the springtime and really kind of walk you through. It's like getting a one on one consultations with me. But I broke it into six weeks. So every week we do a zoom meeting on a particular subject and we really kind of dive into how to have you heal yourself with this kind of coaching program. And I love it because patients ask each other questions. They're just like, what did you think about Inositol? And what did you think about this? Or did you try this? And so it's great. Community. There's nothing better than sort of women helping women. Right? Like a community effect. And I think that that's for me it's been very rewarding to be a part of that.

No, that's fantastic, Jen. So we're going to put all the links in the show notes so anyone who wants to find out more will be able to go to the websites that are important and find you. This is great. So thank you. I mean, thank you for being here.

Thank you so much for having me.

Our pleasure. And to the listeners, thanks for listening to another episode of the Feel Freakin Amazing five Journeys podcast. Our guest today, Jennifer Rolands, who is a specialist in pcos. Look at the show notes to find out more about her. And again, Jen, thanks for being here. Inspire and empower someone else by leaving a five star review so they can transform their lives too.