03-18-24 PCOS with Dr Scott Morehead

Episode Transcript

(00:00):
Mix one of six y five.Good morning, it's Christina Woolford. It
is time for Lady Parts with doctorRichard Villarreal of a Dina Women's Health.
Good morning, doctor villa Real,Well, good morning to you. How
are you to take I'm doing greathere a we you go awesome, awesome,
And we have a special guest todayback by Popular Day Older Man.
Everybody loved having doctor moorehead on theradio. I asked him to come back

(00:22):
and he was like, sure,I'll come back absolutely, Thanks for having
me back. So we're excited tohave him here today and we're going to
talk about something that actually we seea lot of especially in this area.
It affects a lot of women,and we're going to talk about some of
these numbers. It's quite amazing.Our topic today is going to be polycistico
arian syndrome and well we're going totalk a little bit about this. But

(00:46):
again, you know, the interestingthing while we talk about all these things
is how important it is for ourcommunity for the women to understand this and
to make sure that you get seenby physicians so that you can get yourself
taken care of. And we hopethat you know listening to programs like this
with doctor Morehead to myself. Youknow, if you hear some of the
things that sound like you know it'shitting close to home. You know,
we want you to feel free tocall us and you know, come in

(01:07):
and be seeing. We have,you know, so many good physicians I
should say excellent physicians, because they'reall wonderful that can help you and get
things going and help you have abetter life. So I just want everybody
to realize, you know, we'rehere for you. Anything that we can
do for you, I've got,you know, great partners like doctor moorehead
here and always happy to see withsmiling faces. So with that being said,

(01:29):
let's talk about polycistical here and syndrome. So what is it? Polcistic
varian syndrome. It's, like yousaid, it's very common. It's the
most common indocrine disorder of women ofreproductive age. It varies by region,
but in the United States, sixto twelve percent of people have this condition.

(01:51):
And I just read you know thatin particularly in our area, about
seventy up to seventy percent of womenhaven't really been diagnosed with this yet.
And so, I mean, it'sso common and we're going to go through
some of the symptoms and you know, causes and how do you know if
you have it and how we diagnoseit. But it is so common people
don't think they have it. Theylike you said, it is common.

(02:14):
You ask me what it is.It's people come to us usually with irregular
minstrual cycles, maybe no minstrual cyclesat all. Commonly they will be having
symptoms from it, like acne,weight gain, excessive hair growth. And
then we see a lot of peoplethat are just having a really hard time
having a baby. They want tohave a baby and they're having difficulty with

(02:37):
this, so they come to us. So we see a lot of them.
They come in and like you said, there's multiple reasons people come in.
So like you started out with,you know, people come in with
either their irregular periods or very lightperiods, or some people have very heavy
periods. You know. I sawa lady the other day that hadn't had
a period in a year, andshe came in and we're like, oh
my, so you know, thisis one of the reasons that you come

(03:00):
in. And then we sit downand we start talking about things and realize,
you know, there's more than whatyou just mentioned. You know,
it's not just your bleeding, butyou know you're you're overweight, you have
trouble losing weight. You talked aboutthe hair growth. Some people have male
pattern baldness, So I mean youcan have both extremes of it. And
when you talk about the hair growth, we're talking about facial hair, hair

(03:23):
on the body and places that youreally don't want. So it doesn't just
affect women with these symptoms, butit can also really have an emotional tool
on people too and lead to,you know, psychological problems. Sure,
you just don't feel you know,I know it's it's kind of hard to

(03:44):
explained it, but you're not.You're kind of down on yourself and you
work so hard to take care ofyourself. And you know, like for
example, they come in and say, I can't lose weight. I eat
like a bird and I still can'tlose this weight, and it's always you
know, they generally have a centraltype obusity, right, and so well,

(04:05):
let's talk about so how do wediagnose somebody with this? Okay,
so a lot of the diagnosis wouldget really just from the symptoms, you
know, and talking to people.We the like the symptoms that we talked
about. It's a lot of thediagnosis is made clinically, where you know,

(04:28):
there's a basic tree ad that ifa person has two of the three
of the symptoms, that's pretty consistentwith the diagnosis. So the irregular minstrual
cycles or no minstrual cycles signs ofexcessive androgen. Androgens typically thought it was
the male hormone, but this conditionleads to like excessive testosterone production. So

(04:50):
we can check bloodwork to check forexcessive they're called androgens or just the symptoms
excessive androgen. Then sometimes we candiagnose it. Maybe they'll come in they've
had an ultrasound or a cat scanshowing multiple small follicles or cysts on the
ovary. We always have to whenyou talk about cys on the overar and

(05:12):
multiple small follicles, we're not talkingI mean we talk about cis. We're
talking very small cysts, and youknow we're basically there's eggs inside each of
these right there, mature eggs.It happens each month, the ovary is
supposed to form a little follicle whichis supposed to go through its development and
then release an ovulation, release anegg, and then the next month a

(05:35):
new one. These people they're overasjust aren't responding to their Horman stimulations.
They get lots of little follicles ina ring around the edge of the ovary.
So it's pretty characteristic appearance on ultrasound. So that's where we get the
name apolysistical varian syndrome, you know, and we look on the ultrasound sometimes
we'll see that. We call ita ring of pearls, right, but

(05:55):
the new guidelines that just came out, we used to say what was eleven
or twelve follicles per and now it'sup to twenty, just because our ultrasounds
are so much better, so wecan see so much more than, you
know, than what we used tosee. And then we always also have
to then roll out other conditions,so we'll give by that history, but
then oftentimes we will want to dosome other blood work to make sure it's

(06:15):
not a primary thyroid condition or prematureor rain failure. There's so many things
that it can be, and soit does. So that's why you know,
it's so important to come in andbe seen, because you know,
we're talking about all these different symptomsand all these different types of body types
that happen. It's it's not alwaysnormal, and so you want to just

(06:40):
make sure you know, just becauseI look like my mom or my aunt
Milly doesn't mean that, you know, that's the way you have to look
if you don't want to look thatway. You know, if my aunt
Millie had this big mustache. Sorry, but you know, there's things that
you can do for it. Itis hereditary. It does oftentimes run in
families, and so we want tohelp them to take care of it.

(07:02):
Now. You know, a lotof times the medications we give can help
make it prevent it from getting worse, but we really can't take away the
hair growth or things like that thatare there already. So there are things
that we can do and we cantalk about that a little bit later,
that you can do to try tohelp. Some of these conditions that you
have are symptoms that you have.So let's talk about We talked about some

(07:27):
of how we diagnose it. Soit's generally, like you mentioned, how
they come in, they come inwith their symptoms. We talk about looking
on the ultrasound, We talk about, well you can do some lab work
to see, like you said,looking for androgens because remember, women produce
both male and female hormones. Right, So the female hormones are the progesterone
and estrogen, and then the maleis the testosterone. So you have all
of those as a woman. That'swhy you're the stronger sex. Right.

(07:50):
So we just have testosterone and that'sit. And so women have three hormones,
some makes them three times better.There you go. So when we're
talking about insulin resistance, it's it'san interesting topic. So why do we
say insulin resistance. I mean,you hear a lot of it from the

(08:11):
intercrenologists, but when we talk aboutit, it's a little bit different because
of the symptoms and side effects thatcan occur. And so basically your body
just doesn't recognize the insulin. Yourbody produces tons of it. Yeah,
it just keeps producing more and moreof it. That's one of the primary
things we check for. And ifwe see high levels of incident that's insulin.

(08:33):
That's very characteristic of polcistic ovaries.And so what happens is, you
know, when we see the highlevels of insulin, we know, okay,
you're insulin resistant, and so yourpancras is working like crazy. And
that's why we always tell these womenthat in the future you can become a
diabetic. So if we don't dosomething about it, so you generally see
these women in families of diabetics.That's crazy, that's all connected. Yeah,

(08:56):
it is. That's one thing youcan do. If you you know,
there's different degrees of polycystic ovaries,it's like you can kind of develop
it. So one thing if you'restarting to get symptoms of it, trying
to keep a healthy body weight,limiting carbohydrates, exercise, trying to keep
your blood sugar levels as good asyou can can certainly help with treatment of

(09:18):
the condition. But then we havethese women that come in and say,
you know what, I've been doingall this, you know, and actually
they come in because they're mad becauseI have been to the gym, I
have been doing a diet, I'vebeen eating like a rabbit, and I
can't lose weight. And I don'tblame them because if I was eating like
a rabbit, I would be mad, right, And so you want to

(09:41):
be able to enjoy life. Soyou know, like doctor Moore had said,
if you're insulin resistant, basically you'renot burning up calories. So no
matter how hard you work, youcan't burn up those calories because there's no
insulin there to burn them off.So a lot of times we give medications
that will help that. It's kindof ash cycle too, because it's tough

(10:01):
to lose weight, and then asa person gains weight, that feeds back
negatively on the body and causes thepolycistic syndrome to be worse, and so
it's a vicious cycle. We kindof have to break that cycle in one
way or another. So the treatmentwe use kind of depends a lot on
what symptoms of patient's having and whattheir goals are. You know, if

(10:22):
they want to have a baby,we see that a lot. There's some
treatments we can do for that,or a lot of people they just want
to have normal, regular cycles andnot struggle with weight and some of the
other symptoms. So so a lotof times what we'll do depending on,
you know, what they want.But you know, like you're saying,
so some people just want their cyclesregular and so okay, we can put

(10:43):
you on a birth control pill thatI mean, that's pretty simple. But
what you got to remember is it'snot taking care of the problem. You're
still insulent resistant. And then there'sa bigger field beyond insult resistance, which
is metabolic syndrome, which you knowis much it's a larger, you know
problem, but a lot of thesewomen can't have that, and that's where

(11:07):
diabetes falls in. But so youstill have the issue with polycystic ovarian syndrome.
We're just kind of masking it andmaking your cycles work, but you're
still insulin resistance. You still haveit. One medication we can use this
like mat Foreman. Mat Forman istypically medicine that is used for the treatment

(11:30):
of nons independent diabetes, but matforman works very well for our patients with
polycystic overs and helping regulate the cyclesand getting really to the base cause of
what's causing the syndrome. So that'sone helpful medication we use. We to
tell people will help your fertility.There if someone's just gone to us with

(11:52):
irregular cycles and were struggled on that, the next thing you know, they're
having a baby. Right, I'mhappy with that. So yeah, so
you have to remember if you dosomething like this, it can you'll start
to ovulating. It takes some time, but it does come back. But
you know, one of the otherthings I was reading about this is when
these women have these really high insulinlevels, what it triggers is the testosterone

(12:13):
to go up. So that's wherethe hyperenergenism comes in, meaning the hair
growth and the male pattern baldness,and you know, all these other symptoms.
They get something else called it theycan't thusis niger cans or they get
these really dark areas in their skin. They get around their neck under the
breast and they're growing it's their waistand so it all kind of goes along
with the whole package. But yeah, so like he says, or like

(12:37):
you say, when you do themet form, and basically what that's doing,
it's bypassing the problem with the insulin. You're burning up your calories and
so in doing that, your weight'sgoing to come back down, right,
and so you're taking care of yourproblem with your testosterone. So all of
a sudden, you're going to startovulating again. So you know, one

(12:58):
of the things that we know withwomen who have places converience syndrome is they
have trouble getting pregnant because they don'tovulate. And so when we do something
like this, you know, ifyou're not in a big hurry, eventually
you'll start ovulating again. You know, you've got to do other things other
than just take medications, right,So we always encourage exercise and dieting.

(13:22):
You know, one of the bigthings I tell a lot of my patients
is with them at foreman, youknow, you have to do a low
carbohydrate diet because everybody gets really badabdominal cramps and diarrhea. It's not as
well tolerated. No. In termsof birth control, we'd like to talk
about that. Let's talk there's youknow, we can use lots of different
types of birth control for birth controland to help control minstrel cycles. Like

(13:43):
if a person's having heavy irregular cycles, there's depo Privera which can stop periods.
There are Marina IED's. The problemis that those don't really help as
much with the testosterone elevation and someof the other simple So this is one
condition where if a person can takethem. Oral contraceptive pills combined to all

(14:05):
contraceptive pills with both estrogen and progesterand are particularly helpful. The birth control
helps to even out the hormones,it helps to regulate the cycles, and
it on so it increases something thebody called sex hormone binding globulin, which
is like a It's kind of likeI always described, it's like a sponge
that goes around soaks up extra testosterone. So it can help with acne,

(14:28):
it can help with the excess ofhair growth, and it helps control your
cycles. So you know, whenwe're choosing which birth control to put someone
on, I always try to keepthat one in mind and let my patients
know that the benefits they would getfrom that particular type of birth control,
And I think it's a great ass. You know, a lot of times
they wonder, say, why doyou put me on a birth control pill?

(14:50):
That's not really I really want,But it really does work because it
takes care of the problems because oneof the other issues that we have.
You know, if somebody, forexample, comes in and they are only
having a period every one or twoyears, they run other risks with their
lining right if they don't want Thoseare some of the other conditions that can
occur. Like you can it canlead to like individual hyperplasia. I just

(15:11):
tell people, I'm not trying tobe an alarmist, but it is important
to have it. I always sayit's important to have a cycle at least
every three months. If someone doesn'twant worth control all right and they're really
not having too many problems, andwith the hyperplasia is it can lead to
other indimutrial cancer. Wow. Soit's basically the lining gets really thick and

(15:33):
it's just because you haven't a periodin a long time, and so eventually
those cells just start changing. Makessense. I can see where women will
be like, well, I'm notreally complaining. I don't want that,
but yeah, I guess you do. But you've got to get everything.
You got to get everything cleaned out. It's really important to do that.
So at least, like doctor mooreheadsaid, every three months, you really

(15:54):
need to have a period. Uh, that is so important. And so
that's why you know you mentioned doingthe birth control pills. It's great along
with the birth control. One ofthe problems we talked about successive hair growth.
The birth control alone can help outby soaking up some of the free

(16:14):
testosterone. There are some medications,so so water pill I use a lot.
We use a lot called sprint lacton. It's considered a water pill.
It's a but it blocks testostern's actions. So it takes maybe up to six
months to help. But spinnd lactinis very helpful helping to control the hair
growth. It can also help toprevent the male pattern baldness that someone experienced

(16:40):
with this condition. So yeah,it's always good. And then you know,
any of the other things that weuse, there's some other things for
hair growth. The one that weused to use a lot, and I
don't know if we're still using asan equa that you can get over the
counter or not over the counter prescriptiononly, but it does. It gets
rid of the hair growth. ButI think you know, unless you're treating
your problem, the hair is gonnacome right back. So you need to
be on the met form and youneed to be doing everything else right.

(17:03):
But again, all of this evenas your weight comes down. You know,
like anything that we have basically isa scale, so it goes from
like you mentioned earlier, very mildto very severe and basically it depends on
what I tell the women as usuallyit's based on your weight. So the
heavier you are, the more symptomsyou're going to have because your testosterone level
is going to be higher. Themore weight you lose, the better everything

(17:25):
gets. But the problem is whenyou're down here with the not much weight
anymore, you still have the symptoms, you still have the syndrome. It's
there, so it's just kind ofmasked by your weight loss. But as
soon as you start gaining weight,everything is going to come back, so
you have to be very vigilant aboutcontinuing doing everything. So, but other
bad things that can happen with youknow, polytistical ary INCIDENTERVE can lead to

(17:45):
We talked about metabolic syndrome, butthere's a lot of bad things that can
happen with this and the reason behindtreating it is so that these other bad
things don't happen. How prevent heartdisease down the road, diabetes, stroke,
cholesterol problem. You know a lotof people just because of the weight
gain the end, it would sleep, apnea, then you touched on depression.

(18:06):
There's so many other bad things thathappen. You know, it lowers
your HDL, it raises your hyour LDL, so it lowers your good
cholesterol, it raises your bad cholesterol, and you get hypertension, and then
you got the issues with your yoursugar is like you mentioned, so there's
so much and it's kind of crazythat when we talk about seventy percent of
women really not even being diagnosed withthis, and they have it. They're

(18:30):
walking on the streets, you know, so almost three out of four women
that walk by you. It's alot. I have some degree resistance.
I know you talked a lot aboutthe women that are skipping periods or they
don't have it for a while,but I know there's on the other side,
there's some that have you know,very heavy periods, or have it

(18:51):
quite often, you know, twicetwice a month or something. So something
like that is very obvious, youknow, to them that that's something is
wrong, right, and again there'sthings we can do for it, right.
Yeah, it's basically it's just fromthis condition, people aren't ovulating regularly.
So we either have to help theovers to work better, to ovulate
more regularly, or to kind ofcan't sel out the whole cycle that's not

(19:18):
working very well. So I thinkthat's why it's important to come in because
everybody's a little different and there's somany different issues that can come just from
this one syndrome. And so that'swhy when you come to see us,
we sort of dive in and wehave all these questions that we ask you,
you know about what's going on,what's happening, what are your main
problems, what other issues are youhaving, because then it kind of helps
us as to what we're going todo for you, you know, and

(19:41):
then some of the other issues.One of the other things you touched on
was pregnancy, right, so youtalked about how they sometimes they have problems
getting pregnant because of not ovulating.So what can we do for that?
So the mat form can be veryhelpful. And I agree mat form and
just helps the cycles become more regular, helps to ovulate. I think it's

(20:03):
a good thing for someone who kindof wants to become pregnant. It's some
of their treatments. I'm sure we'lltalk about in a minute. So I
like maat form. And for someonewho wants to become pregnant, maybe there's
not a lot of pressure on it. It's just you take the matform and
you start psyching more regularly. Butfor someone who comes in and they're ready
to get pregnant, they want toget pregnant. Now, some of the

(20:25):
things we can use would be medicationscalled clonbufence or clomid or letrasol famara.
With these medications you take them oftentimesdays three, three seven of your cycle,
and then we monitor to make surethat you're ovolated on that dose sage.
Sometimes we do ovulation predictor kits.Oftentimes it's very helpful if we can

(20:48):
do ultrasounds to see if a follicleswe're developing, if an egg's developing.
Sometimes we have to adjust these medications, so it's pretty tricky, but when
it comes down to it, it'sreally not that that tough. We always
walk you through it and help youthrough that, and the providers are very
good about that. They always theywalk you through. This is how we

(21:10):
do it. It's this, we'llsee you back. We'll make sure you
understand everything cause if you have questions, and our nurses are very good about
it. We also need to makesure that it is oftentimes it is the
polycystic overs but we also sometimes wantedto check a Seaman analysis to make sure
you know if the woman's going tobe doing all this work to take all
these medications. We've got to makesure the sperm count's good, make sure

(21:32):
that the Filippian tubes are open,so there's evaluation we do, but definitely
getting your cycles going as a goodstart and then once we get you pregnant,
does it cause any problems with thepregnancy, Well, definitely once you're
pregnant. So one thing about thecloning and FAMAR they can lead to multiple
berths, five percent chance of twins, three percent chance of triple it some

(21:55):
more so is watch out for those. But yeah, people with polycystic overs
there increased risk. We watch veryclosely for gestational diabetes preclaimsy, which is
elevated blood pressure and pregnancy there canbe an increase you know, if they
have polycystic overies. There's some studiesshow an increased risk of preterm birth you

(22:18):
know, delivered for thirty seven weeksand also partially linked to the risk of
the gestational diabetes. These babies oftentimeswho end up being a little bit bigger,
it can lead to difficult deliveries orincrease risk at see sections. So
yeah, it is important for yourprovider to know when you can impregnant if
you have a history of polycystic overage, so we can watch for these other

(22:40):
conditions. So there's a lot thatgoes on with it. So again this
is why I bring up it's soimportant to be seen, so it doesn't
you know as far as just havinga maybe it just doesn't click like that
because there's a lot that comes intoplay, particularly for the obsttricians. We
need in the midwives. We reallyneed to know what's going on. Now.
We talk about this being part ofwhen you're younger, I mean how

(23:03):
early. What's the earliest you've seensomebody with policiscoveries it is. It's a
condition of pre menopause. Oftentimes it'llstart manifesting right shortly after a woman starts
having menstrual cycles. It's called monarchy, so it can start developing very early
on, and so they start havingissues with the regular periods. They'll have
the increased weight gain and all this. They can't lose weight, and they're

(23:25):
in their high school teams and doingeverything else and it just doesn't work.
But then all through life they haveissues. Does it go away? Does
it ever go away? I meanwith menopause any of that. Well,
with menopause you wouldn't have the polycysticoveries, but there can be a lot
of other long term conditions, likewe talked about hypertension, diabetes, so

(23:45):
you still have everything else with it. So that's why you want to get
it treated. So yeah, sothat really it never goes away. So
that's kind of why it's so importantfor you know, us talking about this
today. You know, we havethe experts that do this. We do
this every day and we talk aboutit every day, and for us it's
simple. But it's because we've doneit. Doctor Moorhead has done this for

(24:08):
over twenty five years, you know, so it's second nature. And that's
why, you know, we're tryingto get this message out so for the
women to come in, don't beembarrassed about it. Come in. That's
why you're here, right right,So that's why we're here is to help
you and to keep you so somethingbad doesn't happen to you. So before

(24:30):
we end, though, do youhave anything else that you want to say
today? You know a lot ofpeople come in. We talked last time
you know, I spoke was indometriosis. A lot of people come in with
polycystic overies thinking that maybe the causeof their pain. But polycystic over is

(24:51):
in and of themselves, they cancause heavy painful periods, but the polycystic
overies they don't. It's been myexperience, they don't typically cause a lot
of pain, right, But ifa person is having pain in placestegoies,
maybe we need to check out somethingelse, like for endometriosis or and that's
a good thing. And we didin affections or some other problem, right,
and we did that other podcast onendometriosis, which would be another good

(25:11):
one to listen to. And andhe's right because you know, you think
it's one thing, but it maybe something totally different. So it is
very important to come in and getchecked. And we will always run through
that with you and say, welllet's talk about this because it may be
something else and what you're thinking.So but I agree, So you know,

(25:32):
I welcome everybody you know, geta hold of us. You can
call us at a Dina ob gy n uh seven four zero six four
two four for zero zero or sevenfor zeros seven seven nine seven two zero
one and give us a call andwe'll get you with our providers. I
think that's the key there. Youknow, these Obgians don't know if the

(25:53):
women don't tell them, you know, if there's something that you think is
not right, or you know,if you're if your daughter or your mother,
you know, cycle maybe was differentand you're like why am I so
different? Well, maybe there's anissue there one way or the other.
You know, it's so easy tojust bring this up. They can run
the test, they can check things, and you don't have to live like
this. That's the great thing,you know. I think maybe my grandmother,

(26:15):
great grandmother, you know, theymay have you said seventy percent of
people don't even know they have it, But probably there was a lot of
this back in the day because peoplejust didn't know, you know, they
thought there were you know, otherissues or that's just the way it is.
Some women have it worse than others, you know, but but it
was just probably undiagnosed PCOS or someother issues. But thank goodness, we've

(26:37):
come a long way and the technologyis there and the medications and everything that
we don't have to live like this. So I think that's the big thing
is you just need to talk toyour provider about it and ask those questions
and get some help and take careof yourself so you can take care of
everybody else in your family. Absolutelyall right, Thank you again, doctor
Scott Moorehead. He was our guesttoday on Lady Parts with doctor Richard Villarreal.

(26:59):
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