Improving Quality of Life with PCOS [Podcast]

PCOS Podcast 85 -Quality of LifeWe all know that PCOS impacts the lives of the women who have it. Countless studies (and our own experience) have proven that. In this podcast, Dr. Rashmi Kudesia explains the impact of PCOS on our quality of life in five main interrelated areas: infertility, abnormal uterine bleeding or irregular periods, extra body or facial hair, weight issues, and emotional health and offers steps we can take to get on track both mentally and physically. Listen as we also discuss:

  • Critical importance of sleep quality
  • Tips on how to effectively advocate for yourself or your daughter
  • Pros and cons of diagnosing adolescents
  • What she says to adolescents who may have PCOS
  • Why related diagnoses (thyroid, sleep apnea, etc.) are often missed in women with PCOS
  • The counsel she offers her own patients to improve their quality of life

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Full transcript follows.

Dr. Kudesia is a board-certified Reproductive Endocrinology and Infertility specialist, practicing at Houston IVF in Houston, Texas. She joined Houston IVF in 2018 after practicing in New York City, where she was named a “New York Super Doctors Rising Star” in 2016 and 2017.

After completing her Baccalaureate degree in Biology & Medicine magna cum laude from Brown University, she received her M.D. with honors from the Duke University School of Medicine, where she was selected into a clinical research training program co-sponsored by the National Institutes of Health. Her residency training in Obstetrics & Gynecology at the New York Hospital-Weill Cornell Medical Center was followed by subspecialty training in Reproductive Endocrinology and Infertility (REI) at the Albert Einstein College of Medicine-Montefiore Medical Center, alongside a Masters’ of Science degree in Clinical Research Methods. She subsequently served as a Clinical Assistant Professor at the Icahn School of Medicine at Mount Sinai, as well as the Research Rotational Director for the REI fellowship, and Medical Director of the Brooklyn office of the Reproductive Medicine Associates of New York.

Dr. Kudesia is a Fellow of the American College of Obstetricians and Gynecologists, and an active member of the American Society for Reproductive Medicine (ASRM), Society for Reproductive Endocrinology and Infertility, Androgen Excess & Polycystic Ovary Syndrome Society, and American Medical Association (AMA). She has served in multiple local and national leadership roles in organized medicine, including her current positions as Secretary of the ASRM Women’s Council Executive Board and the ASRM delegate to the AMA Young Physicians’ Section.


Dr. Kudesia has also presented scientific research at national and international conferences, and has received multiple awards and grants for her work. She has published peer-reviewed articles and book chapters, including in leading journals such as Fertility & Sterility and the American Journal of Obstetrics & Gynecology, as well as editing a theme issue on reproductive medicine for the American Medical Association Journal of Ethics. Her current areas of focus include improving in vitro fertilization cycle prognosis, polycystic ovary syndrome, LGBT fertility, and fertility awareness, counseling, and access to care. She actively promotes women’s health and wellness on social media via Twitter, Facebook, and Instagram.

 

Amy:                                     Today, I’m welcoming back one of my favorite podcast guests, Dr. Rashmi Kudesia. She is a PCOS Diva contributor and she’s written lots of great articles at PCOS Diva.com. Her latest one is a really interesting article about PCOS and bone health so check that out, but today, we’re going to be talking about the impact of quality of life for women with PCOS and I want to just give you a little intro.

Amy:                                     Dr. Kudesia, you are a board certified reproductive endocrinology and infertility specialist. You practice at Houston IVF in Houston, Texas. You joined Houston IVF recently after practicing in New York City where you were named a New York Super Doctors Rising Star in 2016 and 2017. Welcome back to the PCOS Diva podcast.

Dr. Kudesia:                        Thanks, Amy. My pleasure. It’s so exciting to be back.

Amy:                                     I view you as one of my go-to experts when there’s some new research out or really needing to dig into PubMed studies and articles because you are just an expert at mining the data and helping us understand in a layman’s term what’s really happening out there in studies. I asked you if we could talk about quality of life and the research that is coming out about the impact of a PCOS diagnosis. I’m just going to let you set the stage for us.

Dr. Kudesia:                        Yeah, of course. I think one of the reasons that I also love helping to translate the scientific literature into blogs and podcasts like this one alongside you is because I think with PCOS, there is such a gap. Not only obviously are there things we don’t understand scientifically at all, but then taking the next step and explaining what that means to women that may be thinking that they have PCOS, or have a confirmed diagnosis, or even doctors that are taking care of patients with PCOS, there’s just so many gaps in there. It’s fun to try to plug in those holes and see if we can do a little bit better.

Dr. Kudesia:                        One of the reasons that this topic is super important to me is because really actually, I was going back to look at the original study, the first study that utilized a questionnaire that I’m going to talk about a little bit, which is called the PCOS Quality of Life Questionnaire or the PCOSQ, it was actually published back in 1998, but there have been about 30 some papers that have cited it since then and really, the thing that I like about it is, forgetting about the research piece, I think it also guides my clinical practice a lot because it focuses on five main areas that may affect women that have PCOS and those are infertility, abnormal uterine bleeding or irregular periods, extra body or facial hair, weight issues and then, emotional health.

Dr. Kudesia:                        For me, I think that the reason that that’s super helpful is because when I’m talking to somebody, even if they came in just telling me, “Okay, I’m here because I’m having difficulty getting pregnant,” I think it’s important to take a step back, look at the holistic picture, and think about those other four domains and think to myself, “Okay,” or to ask, “are all of the things that potentially be affecting her something we’ve discussed?” That, I think, is partly why I love that questionnaire because I think it helps to keep very concrete the five main areas, although there are a lot of other things that could be going on, but just getting a starting point to make sure that we’ve talked about everything from a comprehensive standpoint.

I think that’s partly why it’s really interesting, and the scientific literature does clearly show that there is a decreased quality of life for women that have PCOS and partly what I think is very interesting, and I hope we’ll understand it better in the future, is whether it’s just because all of these things are potentially going on and isn’t that enough to affect quality of life, and that makes sense as a possible explanation, or is there something about the differences in neurotransmitters or serotonin or other balances of other chemicals and hormones that we have in our body that’s also affected by having PCOS and so. there’s another explanation or a link that’s going on, and we don’t really know that answer yet.

Amy:                                     Yeah, I’ve often wondered that, and I’ve seen in my journeys online that some people think that women with PCOS may be low in serotonin and that could also account for the cravings, the sugar and carb cravings that we have and the low mood. Is that something that you’ve come across?

Dr. Kudesia:                        Yeah, I’ve definitely seen people talk about that. It’s not one of the things that there’s a lot of conclusive studies on one way or another, but aside from the things I already mentioned, something else that I’ve started to see a few more papers on and that I think is just absolutely central to our health as human beings is sleep and sleep quality, and that’s another thing that helps regulate all of these chemicals and hormones. We find that there are higher levels of disordered sleeping in women that have PCOS and that’s may be partially related, obviously for some individuals that may be having a little extra weight and sleep apnea issues, but even aside from that, there is a connection. Certainly, you could imagine that if you’re not sleeping well, you’re having really bad sleep quality that that’s also going to throw off your circadian rhythm and all these other chemicals and lead to mood and quality of life issues. I think that there’s a lot tied in there and I just feel like I see a scattering of things here and there, but it’s not enough to kind of make some good conclusions yet.

Amy:                                     Yeah, and I think you mentioned throwing off that circadian rhythm, I think that a lot of women with PCOS have adrenal issues and so, I’m finding that many women have that inverse cortisol curve where-

Dr. Kudesia:                        Yeah.

Amy:                                     … they’re wired, but tired because their cortisol ends up being high at night, but they’re like a zombie getting up in the morning because it’s low in the morning where it should be inverse. I don’t know if that’s something that you see in your patients as well.

Dr. Kudesia:                        Yeah. Definitely. Obviously in general, people come in and if you ask them, “Are you tired?” obviously, everybody’s tired, but yes, if you drill down into it I think just as you’re saying, I think that there are a lot of people that demonstrate that exact pattern and again, all of these things go together. If somebody is having a lot of issues that could be related to this diagnosis and it’s stressing them out, for example, obviously, I primarily take care of fertility patients and obviously, trying to get pregnant and it’s not working is one of the most stressful things that anybody can go through, and so obviously, you’re now maybe having PCOS and now stressed out more about fertility. You’re churning out cortisol like crazy. For sure, you’re going to see all of those typical things 100%.

Amy:                                     I think that this is looking at the whole quality of life and the different domains, too. It’s moving towards treating the whole person rather than just the symptoms.

Dr. Kudesia:                        Yeah.

Amy:                                     I love that you as an IVF doctor, you’re not just looking at infertility, but you’re asking patients about their sleep and looking at everything as a whole rather than just the specific symptoms.

Dr. Kudesia:                        Yeah, I think we can all do better at that, but it is really important to me I think that there’s no way to address one of these issues in isolation because they’re all tied together. Certainly, I think sometimes people come in and they want to talk about the thing that’s foremost on their mind, but if I tell somebody, “Okay, we’re going to work on your treatment for whatever issue, but here’s some things that you can try to concretely to maybe make yourself feel better or to be healthier.”

I think that sense of control and giving somebody back, “Here are the things that you can do. Here’s the ways that you can intervene,” I think is really important because you can’t just rely on your doctor to do everything for you. I think that actually mentally that doesn’t help people to just think that everything is going to be done because I’m doing IVF and so now, the doctor’s going to handle all of that. Obviously, I think it helps people to feel that they’re in charge of their own body and we can’t get that feeling unless we’ve talked about all the things that could be going on.

Amy:                                     Right. I’m just curious in that survey, does it rank the areas that are most troublesome to women?

Dr. Kudesia:                        Yeah. Basically what it is, and it’s been used and validated all over the world actually in different countries, basically, it gives you a score on each of those five issues and then also, just an overall score. For example, I have done a small research study using it back when I was still in training, and I think that one of the things I wanted to mention about that, which I’ve also seen in other studies that I’ve used it, but I think is interesting is that the scores that people are reporting and how they actually feel don’t always line up with objective measures.

Meaning, for example, in that study that I did as a fellow, we were looking at race and ethnicity in women that have PCOS and does that affect their quality of life. We found that, for example, while some ethnic groups may have on average in this study, and there were probably about 20 women in each group so it wasn’t a huge study, but we’re looking at the comparison between things. One of the things we noted was that for example, the women that had a higher body mass index, higher weight for their height, weren’t the ones that were actually reporting a higher level of distress over their own body weight. If you looked at the average BMI for, for example, Latina women who in our study showed the highest level of distress over their weight, they were actually one of the lower body mass index groups.

Again, as a doctor, that’s very helpful to me because it helps me to realize that I can’t just look at the numbers and say, “Okay, these are the issues that somebody’s having.” Obviously, they could be thinking and experiencing distress for a variety of different reasons and the numbers on the page don’t tell me all of that. You really have to talk to people and obviously as a patient, you have to advocate for yourself and say, “Look, this is something I’m struggling with,” and even if it’s just that last 5 to 10 pounds that you want to lose or you just want to feel healthier or more energetic, it’s very important to mention these things.

Basically, when we look at it comparatively we see that, for example, certain parts of the world we know that ethnically, women are going to have more issues with hirsutism so they might have more hair issues. Some people might be more prone to getting weight gain, especially the tummy weight. We see those variations when we do the study in different patient populations or across the world, but it just helps to I think remind us to think about all of the issues.

Amy:                                     When you’re saying mood disorders, were the researchers looking at anxiety as well, or just depression, or …

Dr. Kudesia:                        That, it asks both kinds of questions, but I think since that, we have seen a couple of big publications that have looked at anxiety and depressive disorders in women that have PCOS, and the findings there were shocking and that is another I think important thing that I wanted to talk about because obviously, it applies to the quality of life issue. Really, the biggest study that was done was a big systemic review and meta-analysis, meaning that looking at all of the prior studies that have been done in these areas and putting them all together and saying, “Okay, now that we’ve pooled all of these studies and subjects, what can we find?”

Really, they found a three to five-fold increase in anxiety and depressive disorders depending on exactly what you’re talking about in women that have PCOS versus those that don’t. That’s huge. That means that your odds of experiencing either symptoms or an actual diagnosis are 3 to 5 times higher, that’s very significant. Again, I think it’s something that … those papers came out within the past year or two, so I think important to help people think about and make sure that people are being taken care of especially in this country where our mental health resources are not always so great and insurance coverage is not so great. It’s very I think important to talk about.

Amy:                                     Do you think that more doctors are screening their patients with PCOS for mood disorders now because of it-

Dr. Kudesia:                        I certainly hope so. I think those papers, they were presented at our American Society for Reproductive Medicine meeting, not even this past one, but in October of 2016 I guess it was, and so I think that probably more and more people are thinking about these issues, but the problem is that, and you alluded to it earlier, is that in our subspecialty of reproductive endocrinology, there’s only a few of us that really focus on non-infertility issues. Actually as it turns out, I think that most of the doctors that are taking care of women that have PCOS are oftentimes your general ob-gyn, which is obviously a huge link and they have a million things that they need to be keeping up on. I find that in general that PCOS is a very confusing topic for the general ob-gyn because it’s a very … the topics keep changing. There’s a lot we don’t understand, and it’s one of like I said a million things you need to keep up on.

Dr. Kudesia:                        In fact, there was a study that just came out last year also that was a survey study of basically providers taking care of women with PCOS. In that study, almost a quarter couldn’t identify which diagnostic criteria they’re using for their own patients. That’s a little concerning to me that of people that say themselves that they take care of women that have PCOS, a quarter of those doctors aren’t even sure which diagnostic criteria they’re using to define PCOS. I think that people really should feel empowered to find the right doctor that really feels comfortable doing this because it’s not all ob-gyns or it’s not all endocrinologists. Not everybody in any given subspecialty feels I think super passionate or super up to date on what’s going on with PCOS.

Amy:                                     Can I ask you what diagnostic criteria you use or your office uses?

Dr. Kudesia:                        Yeah. Good question. Typically, we use the Rotterdam criteria and I’ve talked about that in a couple of my blog posts, but it’s the most umbrella of all of the terms, meaning that you have to have at least two out of three things. You have to have, out of the three things that you could have, one would be that the ovaries look “polycystic” on ultrasound, which doesn’t mean that you have a cyst. It just is a typical way that they might look. The periods would be either irregular or not coming at all. There’s some sort of signs, either from symptoms or blood work that would indicate a higher than average level of the male hormones or the androgen. Out of those three things to qualify with Rotterdam, you have to have at least two.

Dr. Kudesia:                        We know that certain phenotypes or certain ways of meeting that criteria are more likely to be associated with having other issues down the line. For example, if somebody has the very typical PCOS by what we call the NIH criteria or the National Institute of Health criteria, that means forgetting what the ultrasound piece, that’s the other two things so irregular cycles and high androgen levels. Women that meet those criteria tend to have a little bit more metabolic issues so weight gain, diabetes, things like that.

I could use the Rotterdam to catch everybody so I can make sure that we’re thinking about all of the people that may be experiencing these symptoms, but then be also more specific to say, “Depending on what exactly you’re coming in with, your risks might be higher or lower than somebody else.” It’s thinking through all of the ways that we meet the criteria.

Amy:                                     In a previous podcast that we did together, we talked about menopause and PCOS. I know it’s really hard. Women now that are in perimenopause, approaching menopause that never really got a PCOS diagnosis, and I could tell you, I hear from so many that they think, “Well, maybe I did have PCOS at one point, but now, I’m going through perimenopause/menopause, so I don’t really have regular cycles or cycles. Do I still have PCOS?” But they’re still struggling with other symptoms. Quality of life still is an issue for a lot of these women that have gone undiagnosed for years.

Dr. Kudesia:                        A hundred percent. I think that in general, there is a growing awareness of this issue of lack of diagnosis. Actually, that’s another thing I did want to talk about because the most recent study suggests that there’s at least a 2-plus-year delay, and in some of these cases, like you’re mentioning, it could be decades of delay, and potentially upwards of two to three providers before somebody that has PCOS gets the diagnosis. That’s like now. Basically, what that means is that women are reporting these symptoms to different doctors over a course of years before they actually get the diagnosis. I could totally imagine that … that’s now.

I could totally imagine that for women that are perimenopausal now if they were reporting these symptoms 20, 30 years ago, that they may not have been heard and that’s very frustrating because obviously, it’s hard to make the diagnosis either right at puberty when your periods are starting or on the other end, when things are becoming irregular as one would expect as you approach menopause. It definitely makes it trickier to get the diagnosis hammered out at that time, but again going back to what I said before, I think that a lot of quality of life and mental health is about understanding what’s going on with your body and being able to control it a little bit. I can’t even imagine how frustrating it could be to think that after 40, however many years of having had your menstrual cycle that now you find out that here’s the explanation for why it was never regular that whole time, that would be incredibly frustrating.

Amy:                                     I know. I had symptoms when I was in my teens, but never got diagnosed until I was 30 when I was finally by a reproductive endocrinologist, but I’m glad to hear that, if that study is true that that number is … we’re closing the gap I guess to two years or so, but-

Dr. Kudesia:                        I hope so.

Amy:                                     I know. I do want to ask you since I have you here, what do you think about diagnosing adolescents? I know I hear from so many moms who say, “My 14-year-old has been diagnosed with PCOS.” I tend to feel like that’s young unless maybe they’re really presenting themselves with the hirsutism and obesity, but I don’t know, I just think 14 is young. What’s your thoughts on diagnosing adolescents and PCOS? I know there’s some studies saying that there’s a lot of over-diagnosis in that age population.

Dr. Kudesia:                        For sure, there is, and I think that it’s a tight rope situation where you have to walk the line between not over-diagnosing because the symptoms overlap. Obviously, as we know, it’s pretty normal when you first get your period for it to be irregular. Teenagers are going to have acne. You’re developing body hair for the first time. So, there’s a lot of things that are going on that make it very difficult to sort out what’s just normal puberty. Is this PCOS?

At the same time, one of the things I talk about in one of the talks that I give is the failure to identify somebody that’s at risk. In that talk, one of the key studies I presented, let’s think about a mom who had PCOS herself. She used Clomid to get pregnant. I’m giving an example of a teenager that might come see you and this is her mom’s sister. Her mom had PCOS, used Clomid to get pregnant. Now had gestational diabetes during that pregnancy and now you, see this child who’s now 15 let’s say and she started her period, and they’re still irregular and she’s gaining a little bit too much weight, and she’s showing some symptoms of insulin resistance. What do you do?

I think that you can’t really necessarily give that girl a diagnosis firmly, but if you say, if you think to yourself, “Maybe she’s going to have it, but I’ll talk to her about that in five years,” you’re also doing her a disservice, right, because you’ve A, what if she moves and you never see her again and you’ve missed the opportunity to help teach her and her mother about what could be going on and two, even if you see that constellation of symptoms, there are interventions that make sense in terms of healthy lifestyle that are important regardless of whether she ends up having PCOS or not, right. It’s something to bring up.

I always think of it not as I’m going to give a teenager a diagnosis, but I’m going to say, “This could be what’s going on. Let’s talk about what it could mean. Let’s allay your concerns. This is manageable, especially if you start managing it early. We’ll revisit it in a few years if the periods are still irregular and all of these things are going on.” We do know that if somebody continues to have irregular cycles two to three years into having her period, chances are it will stay that way, more likely than not. It’s not just totally normal. If somebody got their period when they were 13 and now they’re 16, you can’t just tell them, “You’re a teenager. It’s normal to have irregular cycles.” It’s not really anymore at that point. Everybody’s a little bit different. I never tell a teenager, “You 100% have PCOS,” but I might tell them, “It looks that way and we’re going to follow along and here are the things that you can do to try to stay healthy and not gain too much weight,” or all the things that they might be concerned about.

Amy:                                     All right. I’m really curious what you say to girls in terms of their fertility because I can’t tell you how many women and I was one of them, whose doctor okay, now I … I wasn’t diagnosed. They never said the words PCOS, but they said they’d have to jump through hoops one day to get me pregnant when I was 17, 18 years old.

Dr. Kudesia:                        Yeah. You told me this story and that makes me really sad because I’ve seen many patients that told me that, too, that they were told that either they would never be able to have children or whatever and obviously, that’s not true. Actually, I say the opposite which is that, “Most likely you will be able to have children when you’re ready and the good news is that there are things you can do to keep it that way,” right. Trying to stay healthy generally, using safe sex practices, these are all things that I would tell a teenager that are things that protect your future fertility.

That’s one of the things in one of the papers that I wrote about fertility counseling for adolescents, which seems like, I don’t know, a provocative idea I suppose, but the idea was to me that learning about your fertility is part of just normal sex education that people should understand from a young age and the phrase that we use in that paper is “getting pregnant at the right weight and the right way and at the right time.” Those are all the things and thinking about how you could protect your fertility in the future.

There’s one study that looks at fertility concerns among teenagers diagnosed with PCOS and it shows that they’re actually more worried than their peers that don’t have PCOS and they don’t necessarily need to be. I think that I tell people, “You have to use contraception because even if you think you’re not ovulating, you may actually ovulate here and there, and you might get pregnant, so if you don’t want to get pregnant at that time, you have to use birth control of some kind. When you’re ready, you come in, we’ll talk about it, but chances are as long as you are otherwise healthy and you don’t wait too long, you’ll be okay.”

Amy:                                     Just that counseling, Dr. Kudesia, is going to improve the quality of life for a young girl.

Dr. Kudesia:                        Exactly, exactly. That’s what I think. That’s why this topic is just really close to my heart because I think that the quality of counseling that people or girls or women get on this particular issue of PCOS is really subpar, I think. Again, part of it is because there are things we don’t know, but I think part of it is because it takes time and it’s nuanced and it’s something that changes over time. When we think about all these different issues, one of the other things I like to teach the residents that are training with me is this changes over time. If you see somebody, they’re 22, they might be worried about their period being irregular, and if you are their gynecologist and you follow with them for 10 years, then you might be talking more about their fertility and then, another 10 years from now, you might be talking about something else. It’s like watching something change and blossom over time, and how you can help at different points along the way. It’s just not straight forward.

Amy:                                     Yeah, especially if they’re improving their lifestyle. I’m sure you really see that in the lab results.

Dr. Kudesia:                        Yeah.

Amy:                                     It’s like the proof is in the pudding, right.

Dr. Kudesia:                        Exactly. That’s the best. That’s the best. When we get the results that people are looking for and they’re actually making the effort, that’s very rewarding and it’s just very exciting.

Amy:                                     Speaking of labs, I know we talked about, you mentioned sleep apnea is something that women with PCOS deal with. I know thyroid conditions are … How are these related diagnoses like often missed in women with PCOS?

Dr. Kudesia:                        Yeah. That’s a great question and I think in April I think I’ll be sending you guys a blog post about thyroid and PCOS, so stay tuned for that one, but yeah, I think that there are a lot of things that overlap and it becomes very difficult to sort out the difference. Some of the symptoms are going to be similar between some of these. For example, hypothyroid … now thyroid should be one thing that’s ruled out before you give somebody a PCOS diagnosis in the first place, but let’s say somebody has PCOS now down the line, they develop thyroid issues, which could totally happen, it may get missed because it’s all just being attributed to the diagnosis that’s already there. I think it’s true that sometimes people have to push a little bit harder, I think, to really get a diagnosis of certain things once it’s already there.

Part of the screening guidelines for PCOS that come from the Endocrine Society are actually pretty … whenever I mention them, people are always surprised, but they focus really on … They do include quality of life, but they also really focus on metabolic diseases so looking at where somebody’s lipids are and making sure that they’re not developing diabetes or prediabetes. They’re very focused on those things, which are very important, but those really suggest that you should be screening for those kind of metabolic issues every two years or maybe even sooner if somebody suddenly gains a lot of weight or something like that.

I would posit that most women are not getting that level of screening, even though that’s the recommendation and certainly, some of these other things that are linked, but maybe aren’t part of the guidelines in any which way are probably missed I think with some regularity. I don’t really have a great answer as to how to avoid that, but I would say that if somebody’s had PCOS for a long time and we know what their symptoms and now, you’re noticing that you feel more so one way or another or a different constellation of symptoms, that I would keep track of it and come in and say, “These are the things that have changed and I really need help figuring out why this could be happening.” Because sure, there’s an overlap between a lot of different conditions, but some things if you start mentioning the right words or if you notice the right symptoms, I think it will pop out the diagnosis much quicker.

Part of that is we’re all so busy, but I think it’s just keeping track of how your body is changing and just usually things happen gradually, but once you notice hey, something is different now, tracking it and bringing that in to your doctor. I never mind. When somebody comes in and they have a whole list of things that they’ve been tracking, that’s actually helpful for me to be able to say, “This is what’s changed over time. Maybe that is this and so we need to test for it,” but there are a lot of things.

One of the things, for example, when we think about PCOS, we think about the hirsutism a lot so extra facial or body hair, but on the flip side, one of the things that I think a lot of people don’t know about is the hair loss that can happen like a male pattern hair loss. That’s another thing that can be associated with PCOS and that’s super distressing to quality of life for women to have that degree of hair loss. Again, same sort of thing, I have told a number of people “Oh, that is probably related to your PCOS,” and they were shocked, and then also a little bit relieved to at least know why it was happening to them. I think that there are just so many things that could be linked and it’s just people should feel empowered to come in and say, “This is what I’m noticing. Can you explain it in any which way?”

Amy:                                     Yeah. I think that’s why I really started PCOS Diva is to have a hub of evidence-based articles so that if you do have a symptom, search it on PCOS Diva because chances are, I’ve written or somebody else, one of my guest contributors has written about it. Anything from like gum issues, gum diseases, which there’s a link to inflammation and PCOS to hearing loss actually. There’s some studies that show that women with PCOS are susceptible to hearing loss. Just some things that you would never even connect to PCOS, there could be a connection. I want to end the podcast with ways that you counsel your patients to improve their quality of life.

Dr. Kudesia:                        Yeah. I think that again when it comes to this, I think the issue is trying to figure out or the crux of management is to figure out what’s bothering somebody and how can we try to fix it. The good news is that in the studies that have looked at quality of life for women with PCOS and treatment, they’ve almost uniformly found that treatment improves quality of life. That is I think a very positive finding to have. Depends on what the situation is.

Dr. Kudesia:                        For example, I read a study that was looking at actually even birth control. If somebody’s main issue is irregular bleeding, something as simple as fixing that issue can obviously improve their quality of life. Now we do know that for some women, maybe birth control, they don’t feel great on it. If somebody’s coming in with a history of mood and anxiety issues, then maybe that’s not the best choice, right. You have to really be specific. There’s no silver bullet that is the right answer for everybody, but each study that looked at okay, this is something that is bothering this cohort of women and we tried to treat it, and in many cases, there was one study that looked at lifestyle modification and it found that even if women weren’t necessarily losing weight, just going through the steps of trying to modify their lifestyle improved their quality of life.

Dr. Kudesia:                        I think that it goes back to what we’ve been saying throughout which is that giving somebody back control and saying, “Here are some of the things you can do and we’re going to work on it and it’s not going to be an overnight fix, but you’re taking steps in the right direction,” is powerfully a thing that can change somebody’s mental health and their feelings of how their life quality is.

To me, I think that that’s really the uplifting message in all of this is that doing your best whatever that means, trying to find the right resources, coming to search your site, Amy, all of those things are things that I think can help people feel better. Like I said before, finding the right care team of people that can help you, whether you need help with your diet or getting a trainer or whatever it is, whatever the things are that are bothering you, finding and assembling the right care team to help you feel in control and like you’re doing the right things, even if they’re not working right away, even if it’s two steps forward, one step back. I think those are the things that make a difference.

Amy:                                     Yeah, and speaking of finding the right healthcare team, if you live in Houston, you would be so fortunate because Dr. Kudesia is now practicing in Houston. Maybe you could just let people know, again, where you’re at and how they could work with you.

Dr. Kudesia:                        Yeah, for sure. I’m joining a practice in Houston called Houston IVF. We do full service reproductive endocrinology care. I’ll be doing a lot of help for women that are trying to start their families or grow their families, but also anybody that needs help managing their PCOS, and I will be starting there in March. If you just Google Houston IVF, you’ll find our practice website, and I would be more than happy to meet any of you in person.

Amy:                                     It’s just been great having you back on the PCOS Diva podcast and talking about PCOS and quality of life issues, and I’m really looking forward to your upcoming guest post.

Dr. Kudesia:                        All right. Thanks, Amy. I look forward to sending it to you soon, okay?

Amy:                                     Great. Thank you everyone for listening.

PCOS Podcast 84 Ketogenic Diets

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