A Functional Approach to Treating PCOS [Podcast] - PCOS Diva

A Functional Approach to Treating PCOS [Podcast]

“Think of PCOS symptoms like the rays of the sun. They’re all peripheral to that one pivotal central situation, which is your hormone imbalance.”  -Dr. Margarita Ochoa-Maya, MD

PCOS Podcast 64 Ochoa-MayaDr. Margarita Ochoa-Maya, MD is a functional endocrinologist, author, PCOS Diva, and personal friend of mine. She joins the podcast to explain why a functional integrative approach to PCOS can be the most effective treatment. If you are looking for a way to treat PCOS which considers your type of PCOS and aims to treat the cause instead of only individual symptoms, listen in as we discuss:

  • The difference between an endocrinologist and a functional integrative approach
  • The role of biology and micro and macro nutrient levels
  • Facilitating the elimination of excess hormones which can relieve acne, hair loss, and more
  • Emotional and spiritual health as an important component of biological health
  • How to develop the best doctor patient relationship

I start with a diet plan, an exercise plan, a mood plan, a sleep plan, and then we also use supplements to further supplement our food and nutrition, and then we come to the use of prescriptions.” -Dr. Margarita Ochoa-Maya, MD

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A full transcript follows.

Originally from Medellin Colombia, Dr. Ochoa-Maya graduated from ‘Instituto de Ciencia de la Salud, CES’ and completed her Internal Medicine Residency at Boston City Hospital affiliated with Boston Medical Center in Boston, Massachusetts. She is Board Certified in Internal Medicine. She then completed a fellowship in Hypertension, Endocrinology and Metabolism at Brigham and Women’s Hospital affiliated with Harvard Medical School. She is Board Certified in endocrinology and metabolism.

Dr. Ochoa-Maya, MD, CDE, established Advanced Health and Wellbeing, PC in 2010. She has been practicing endocrinology since 1999 and has been an MD since 1994. Dr. Ochoa-Maya is well-known in southern New Hampshire, Massachusetts, Florida and Colombia, and Puerto Rico.

Full Transcript: 

Amy Medling:                    Hello, and welcome to the PCOS Diva podcast. My name is Amy Medling, I’m a certified health coach, and I’m the founder of PCOS Diva. My mission is to help women with PCOS find the tools and knowledge they need to take control of their PCOS so they can regain their fertility, femininity, health, and happiness. If you haven’t already, make sure you check out pcosdiva.com. There I offer tons of great, free information about PCOS and how to develop your PCOS diet and lifestyle plan so you can begin to survive like a Diva. Look for me on iTunes, Facebook, Instagram, Pinterest, Twitter, and Google Plus as well.

Today, I have the absolute privilege of talking with Dr. Margarita Ochoa-Maya, she is a personal friend of mine and she is a functional endocrinologist here in Nashua, New Hampshire, where it’s my hometown. And she just wrote a fabulous book called “The Hormone Link” and she’s here to join us on the PCOS Diva podcast to talk about her book and her work with women with PCOS. So, welcome, Dr. Margarita.

Dr. Margarita:                   Hi, Amy, how are you? It’s so awesome to be on your podcast today.

Amy Medling:                    Well, I just want to give our listeners a little bit of your background, you completed your internal residency at Boston City Hospital and Boston Medical Center, which is affiliated with Boston University. And then you completed a fellowship in endocrinology and metabolism at Brigham Women’s Hospital and that is the teaching hospital for Harvard Medical School. And you have a private practice here in Nashua, New Hampshire, called Advanced Health and Wellbeing. And of course you wrote this fabulous new book called “The Hormone Link”, so I’m excited to dive into our podcast, we have lots of great things in store for our listeners. But first I just wanted to just to help you sort of define for us what the difference is between kind of like an endocrinologist and this functional integrative approach to endocrinology and health and wellness, how does that look different for a patient?

Dr. Margarita:                   I think what is important is really bringing into their official reason why one becomes a doctor, so in my personal situation I found that I was having a little void in understanding my medicine as I wanted to practice it and so I took foundational education that was a little bit beyond my basic medical school and my fellowship training. I furthered my education in nutrition, and I have a physician certificate in nutrition and furthermore, I have done a lot of education on psychology and trying to understand our behavior and our mind and our mood. And I decided to kind of name it functional integrative approach to endocrinology in the sense that I start with a diet plan, an exercise plan, a mood plan, a sleep plan, and then we also use supplements to further supplement our food and nutrition and then we come to the use of prescriptions. So, in that regard we really try to have a very comprehensive approach to a medical condition and look at it from the real origin and cause and trying to fix it rather than just patch it up as a symptom.

I also feel that when we are not feeling well, so the biology of the body has really a lot of influence by how we feel and how we perceive what is going on. So, I call that more like the psychology or emotional intelligence relative to our body and how it reacts to the outside world and how we’re feeling. And that blended with our inner language and our inner understanding of us being part of a community and a whole, that requires a little bit more integration and learning. And so it’s important to learn about our body, learn about what’s going on, it doesn’t have to be that everybody has to get a medical degree but at the same time, really understand to one’s capacity what is going on. And when that happens, that doctor patient relationship or when it comes to my patients, we have a much deeper conversation that can affect change as compared to just getting a prescription or just doing something without knowing why. Did that explain that a little bit, Amy?

Amy Medling:                    Yeah, and it’s really I think for a lot of women listening, it’s such a refreshing approach because typically we’re handed a prescription first and the diet and lifestyle kind of factors are sort of, “Yeah, well, you know you need to go on a low carb diet,” sort of as you’re heading out the door. So, that’s one of the reasons I wanted you on the show ’cause I just love your whole approach to wellness and treating women with PCOS, which I know you do a lot in your practice and over the course of your career. And you’ve sort of figured out different types of PCOS, which I think is really fascinating and I’d love for you to kind of talk about those different types of PCOS that you mention in your book and maybe some women listening can kind of identify with those different types.

Dr. Margarita:                   Well, kind of foundationally started with what we talked earlier, I think endocrinology is very complex and extremely difficult, even when I was in med school trying to grasp the hormones and the world of hormones, it’s just like trying to delve into the ocean because we know a lot about endocrinology but the truth is there’s so much more to discover and to learn. And thank God, technology in terms of laboratory testing, interesting things like that. I personally have PCOS, and so I had my own personal quest to find what was going on and really tackle this and actually I’ve come across your podcast, personally, before I met you and it was such an honor when I now, indeed, found out you were in my neighborhood.

So, the different types of PCOS, the way I think of them, is that PCOS stands for polycystic ovarian syndrome, as we all know, and syndrome is a collection of symptoms. It doesn’t really have to have everybody present the same way, which makes it so much more elusive because if you are unfortunate and you don’t access somebody who would know what we’re talking about, they might say it’s in your mind or it’s in your mood. Or the way PCOS can affect the mood, it could be you have depression or whatnot. The way PCOS affects the body, some people who suffer from polycystic ovarian syndrome might present with more of a metabolic problem and their issue would be more their weight and acne and the extra hair and some of those features. In some, it might present more because they’ve been trying to get pregnant and they can’t. And in others it could be mainly because their periods are so irregular and now there are some consequences at the uterine level where it’s extremely unhealthy to have less than six periods a year.

So, it all depends on kind of what drive the individual person. But I divide it in kind of four different categories, so we have the overweight category where there has been an issue more with the metabolism. And then there’s a lean category where there would be more ruptured ovarian cysts, problems in the pelvic area, severe pelvic pain, and problems of that nature. And then we also have those that have regular cycles which seem to be daunting because one of the hallmarks of polycystic ovarian syndrome would be that you have irregular periods, so for those women that do have regular bleeding, considering a hormonal imbalance is a little kind of harder to grasp. And then those that do have, of course, the irregularity in their menstrual cycle.

So, the way we see that is more that when you are overweight, hormones tend to store in our fat tissue and our liver is having a little harder time eliminating these hormones, and so as they are stored in the fat tissue, they continue to create havoc in the cycle and the delicate harmony that needs to be in process for all our hormones to be talking and synchronizing to keep the cycle regular and ovulating and metabolism and linked a little bit with insulin resistance and prediabetes. So, we have the overweight, then we have the lean. And those that are overweight tend to have very high hormones or circulating high hormones. And those that have the irregular cycle have even more of a predominance of that irregular concept and they have more of the presentation of the typical polycystic ovarian syndrome as compared those that are lean and might have some more ability to metabolize their hormones but on the other hand other problems such as these cysts that sometimes when they rupture, they hurt so much and problems of that nature. So, each one of them, each type of PCOS might have a different approach on what it is and how to take care of it. And so it’s really individualized, truly.

Amy Medling:                    Mm-hmm (affirmative). Yeah, I always say there’s really no one size fits all approach to managing PCOS because it affects everyone so differently, and I think that’s at the problem with a lot of diet advice. For some reason, they do well on a paleo, some on a keto diet, some women really feel well on eating more of like a vegetarian kind of approach, and so I try to stress with listeners that just like there’s no one type of PCOS, there’s really no one approach to managing it except looking at broad, like you had mentioned earlier, you’re looking at your stress, your sleep, your moods, and kind of figuring out what works best for you.

Dr. Margarita:                   What we can learn from the opportunity of being able to do more sophisticated testing, we have the ability to look at micronutrient levels and one of the important things is that hormones, especially ovarian hormones, they are based on a cholesterol ring, so they’re fat soluble and I really like the fact that it’s important to realize that we are very low on Omega oils and now we’re talking a little bit more about MCT oil and the important of fish oil because what happens is that these hormones kind of get accumulated in the body and we don’t have a means by which we can eliminate them. So sometimes in PCOS it might be an irregular production and a true ovarian dysfunction and in some it could be a liver problem in which you are not able to really eliminate these hormones well, if you don’t have good levels of these fish oils or these Omega oils. And so they get kind of clogged in the liver and in the fat tissue.

So when you talk about diet, it’s really important to realize that we need to have a high fiber diet, regardless of what choice of specifics, if it’s vegetarian, if it’s paleo, if it’s macrobiotic, but really try to have a high fiber so that when those hormones are eliminated via the bile and the skin, that’s why sometimes the acne, you really want to have the fiber to then eliminate them fully rather than having them reabsorb in the small bowels. And then furthermore, having those oils to help lubricate and eliminate these hormones. So, again, it’s sometimes in the source in making them and sometimes it’s in the way we eliminate them. Meaning hormones, of course.

Amy Medling:                    For somebody listening that is not taking fish oil right now, what kind of dosage do you recommend for beginning with?

Dr. Margarita:                   So the fish oils we divide them in EPA and DHA, those are the two molecular concepts when you think of fish oil. So, fish oil can be a bit fishy, you want to have a very good source because they could have some mercury in it, and so the source of the fish oil is gonna be really important. We can go down to the smaller fish called krill but it really has to be the small little fish, so sardines. We can also do salmon and herring and mackerel, but those sometimes are a little contaminated. So if we’re gonna get it a supplement level, the dose should be at least 1,700 milligrams a day so I would recommend. And then doing them morning and night. So you get a very good, high quality fish oil and you at least take 1,000 milligram in the morning and 1,000 milligrams at night.

Amy Medling:                    So, what I really loved about your book, Dr. Margarita, is that your section on PCOS, you really take this holistic approach and I would love for you to talk to us a little bit more about how emotional and spiritual health is as important to the biological health in women with PCOS is, making sure you have the right macronutrients and the right supplements. Because working on PCOS Diva and my journey with PCOS, I found that I had to really heal both emotional and spiritual side to help heal myself and manage my PCOS, so I feel like we’re kindred spirits because I loved reading that section in your book, so I would love for you to talk more about that.

Dr. Margarita:                   I have to say that that section is probably my favorite, as well, only because as women, we are now driven into many different aspects of our life where we have to be really good at pretty much everything and so one of the things that PCOS does havoc is in our hormones and our mental emotional health. And in a subgroup of women who suffer premenstrual disorder, which means it’s a really, really bad PMS, usually they have hormonal imbalance and what those hormones do within our mind. So, unfortunately, that already sets the tone for us to be a little more sensitive, a little bit more vulnerable, and so we are exposing ourselves to be being slightly tramatized and so self-esteem is super important, self-confidence, self-acceptance. And when we start having that inner language that could be going on a negative tone, then of course we’re a little bit more stressed, we have a little bit more problems interacting with other people, and then it really then kind of affects us with our motivation so in regards to our diet and exercising, if you’re exhausted, if you’re having problems connecting with other people, going outside, and having things like that, then of course the treatment should be starting to focus on really empowering yourself to really feel that you can conquer PCOS. That’s the first thing.

Or you can conquer anything, mind you, but if you set your mind to it, you have your proper team, you learn about this situation, and you set a goal to say that PCOS is not gonna rule you, can control PCOS. And it’s challenging, mind you, but really important to keep a check on our emotional health and not let that become a problem of its own. Furthermore, when you start feeling a little bit more empowered and you really feel hope that this can be taken care of, then you will be more apt to follow a diet and not surrender to certain desires that would be at the office place, somebody brought cake or such-and-such, and trying to get out of that realm of your diet and what you need to do.

Because clearly, the PCOS diet does require attention. You can’t eat anything and everything, you want to really focus on your high fiber, your vegetables, if you are not a vegetarian, choosing your meats appropriately, trying to find things that don’t have a lot of pesticides or herbicides and how to handle the budget. So, it really is comprehensive at a financial level, at a personal, intrapersonal, language, and spiritual level, and then also healing those wounds that might have happened in our past and knowing that every day is a new day. And if maybe you weren’t that good with your diet yesterday, well, today’s a new day to start on and treat yourself with a lot of love and compassion. That’s super important.

Amy Medling:                    Another thing that has really helped me is to really work on staying in the moment. I know the worry about the future, it can be so consuming for me and sometimes it seems so silly, my husband’s really a great reality check to realize that that present moment is really all we have and to focus on the moment. I think it gets rid of a lot of that needless stress that we put on ourselves that really disrupts our hormones.

Dr. Margarita:                   I totally agree and then it’s, again, the chicken or the egg because those hormones also put our brain in a very vulnerable position so almost knowing like when you get a scrape or a burn in your skin, you’re a bit more raw, and if you can just say, “Okay, I’m a bit more raw, so I just need to make sure I protect my skin,” like you would put some aloe. In our mind, you really want to protect yourself from the negativity because it’s so easy now with the media and it’s so easy to get into a negative mindset but being mindful and also in a meditative step, we’re going step-by-step and just being patient and yet disciplined. That’s really important because you don’t want to get too lackadaisical, but on the other hand, knowing that humanity, as the humans that we are, we’re not perfect but doing it every day and being mindful, it’s true with having that reality check and then also understanding being grateful and appreciating the good things that we have is a good check and balance. I find that very, very important.

Amy Medling:                    Yeah, and I think something that causes women a lot of anxiety and negativity, especially younger women with PCOS, is the thought of infertility, and I know I’ve shared my story with you, Dr. Margarita, I was 17 and a doctor told me that they’d have to jump through hoops one day to get me pregnant. And I think a lot of women hear that, this story, but I’d love for you to give women some hope based on your experience in practice. For those who feel like having a baby might be hopeless for them because they’ve been told by a doctor that they’ll have to jump through hoops or they’re struggling with infertility right now, I’d love for you to give them some words of wisdom.

Dr. Margarita:                   Yes, well, I want to share with you the fact that I, too, was told that exact same thing and that’s what made me want to become an endocrinologist and challenge PCOS. It’s personal for me. I was given an ultrasound and it was full of cysts, but I focused on one that didn’t look like a cyst, it looked like an egg and I pretty much had to say to myself … Because the doctor gave me the Clomid prescription, and personally my aunt had quadruplets in the ’80s due to an overdose of Clomid so she was like the Octomom of the ’80s, I think. But in that regard, you don’t need to take those words so deeply because that can also empower you to say, “I’m gonna show you different.”

And what I did is I changed my diet, I started doing my cardio and my physical activity with some weights, and really it didn’t have to be like a massive change in my diet in the sense that I just focused on my fiber, I focused on my nutrition, I made healthy choices, instead of delving in the negativity of this very daunting possibility that I would never be able to have children, I actually focused on me and made myself healthy. Because in case I would get pregnant, because I knew I would, was more that I was gonna be as healthy as possible and whatever I could do to make that happen, I was going to do. And miraculously, through delving into my exercise, my mental health, my kind of spirituality and connecting with nature, and then it really might be a matter of blood testing, that’s when it comes to the bottom line where it’s like, “I’ve been doing my diet, I’ve been doing my exercise, I’ve been taking my supplements, now what?”

And so there might be the case where you might need some medication that might help but the truth is, there is hope and don’t stop at any words that are negative if you really are interested in doing a transformation. But it has to be personal, it has to be at a level of oneself. So in the sense the babies will come, once you sort out things that are blocking you and then make sure you get your proper team in place. And that might mean buying some books, getting on your beautiful podcast and your website, and trying some things that might not be as conventional but at the same time, as long as you’re healthy mentally, spiritually, financially, and biologically, then things will come into place. So I do believe that don’t stay stuck. Keep reading, keep asking questions, because you have infinite wisdom. We do have wisdom within that will help us come out of our state of being stuck.

Amy Medling:                    As I’m listening to your story, I heard you say, “I got myself healthy,” or, “I wanted to kind of get myself to a place where I was at optimal health because I knew I would have babies one day, one way or the other,” and I think that is key, too, not taking what the doctor may or may have not said as your truth. And that’s something that I think I share with you. When I was told that, in the back of my head I thought, “Yeah, well, that’s what they’re just saying, but I know one day I’ll be a mom, one way or another.” And I think that is a key to the whole journey, as well, is you define your truth not somebody else.

Dr. Margarita:                   I think that’s so positive in every way, shape, and form. Things do happen and life does get in the way but we have to keep a mentality of being survivors and being fighters and being warriors and goddesses and divas because it is true, if we start going into the negative path, then of course those words will become true. And so it’s a matter of like, “Well, you’ve been doing everything, how do we connect?” Well, we read blogs like yourself, we connect with people out there that can give you hope. So, it’s really not that easy, it’s a little easier to say than to do, but like in your story and in my story, which it does go personal, and especially with our right to have babies for those that want to, that is something that should not be denied. And we have come a far, long way with technology and medicine and so in a way, the information is out there. Now, we just have to go get it.

Amy Medling:                    Yeah, and I really like what you said about be a survivor, be a goddess, a warrior, something that I just wanted to kind of mention, and I don’t know if some listeners realize, but PCOS is really this ancient disease. And it can be traced back to ancient times of famine when our PCOS bodies were set up to be able to withstand famine and be able to carry on with childbearing when others may not. And it’s just the hard part is that in this time kind of on the human timeline and the place that we’re living with all of the abundance of food in modern society, it kind of takes a toll on our PCOS bodies but we really are innately programmed to be survivors. So, let that work for you.

Dr. Margarita:                   Absolutely. And I think the basic goals of the treatment of PCOS would be really looking at your metabolism, looking at that food because despite the fact that we are in a world of abundance, we also have abundantly low calorie, not so healthy, pretty much junk food and so even though we are feeding ourselves or we’re satisfying that chewing and eating, it’s really not nourishing you or nourishing us. And so when you’re eating some kind of image of what would be a tomato, like ketchup for example, ketchup is not a tomato, and so we have filled our food shelves with things that are like make-believe almost that they have flavor but the nutrient content is not as good. And so, really looking at what your body needs. Good protein, if you’re gonna have carbohydrates have them with good, high fiber.

And then really within the oils, it’s not really a fat free world, it’s more looking at good, important oils that are important for your brain, for your nervous system. And again, when it comes to hormones, it’s really important to know that hormones are fat soluble and only an oil can take care of an oil. And so that fish oil paradigm or MCT oil, coconut oil, which is the ALA part, and the EPA, and DHA, so those would be the good molecules. To think in reference to PCOS is trying to find ways that you can also help these hormones eliminate from your body since you’re producing them daily.

Another one that I think is really important is increasing the muscle to fat ratio. Exercise in polycystic ovarian syndrome is pivotal, we really need to circulate these hormones, help them move around the body and not get clogged in our fat tissue. Also really important is to make sure to regulate the periods and vaginal bleeding, very, very unhealthy to have less than six periods a year because that tissue within the uterus is accumulating and does really need to come out and so if it’s not under other forms of treatment but naturally, a woman should have a regular cycle to avoid cyst formation. And then when they rupture, it really hurts and whatnot. So, it’s important to have your periods regulated. That will boost your fertility, if that’s what is desired.

Also, acne. There’s so many products that we can use to cover up acne or to treat acne but acne is indeed a symptom of those hormones kind of clogged within your system and the skin, using the oil gland, is trying to eliminate them. And so acne is not just a symptom as much as it is a hormonal imbalance for some. Hair loss, for example, if you’re having hair loss it might be a hormonal imbalance as well, so promote healthy and abundant hair. Sometimes those B vitamins are crucial if we’re not getting them from our nutritional sources. And lastly, but really super important is promoting healthy self-esteem, healthy relationship with oneself and with others so that we can reduce risks of getting traumatized or having problems arise with depression and anxiety and other conditions.

Amy Medling:                    So I wanted to tell people a little bit more about your book, which is really so comprehensive, like 680 pages of everything you want to know about your thyroid, adrenal, and sex hormones, it’s so comprehensive. And one part that I especially liked for PCOS Divas is you, in the beginning of the book, you give great advice about how to develop for that doctor patient relationship and I think it’s so valuable because you want to make the most of the little time that we get with our doctors these days.

Dr. Margarita:                   Yeah, I think we have to work with what’s going on in the sense that sometimes we have all the time to discuss it, but truly that is not the natural norm. So, in preparation for the visit with your doctor, it would be great to prepare what you’re gonna ask, what your concerns are, if you have actually been to PCOS Diva or read other books or like my book “The Hormone Link”, try to grab some questions and focused points to discuss so that when you’re there and you’re in the rush of the moment, you’re able to remember those questions or those points that you wanted to address during the visit. But that doctor-patient relationship is very important because in some cases as women, now I’m talking to you now as if I was a patient because I have been, we want to not just focus on the mental and then get labeled as anxiety or depression or focus on just the acne and then get acne treatments but not really deal with the hormones and so these are all kind of, I would think of it like the rays of the sun. They’re all peripheral to that one pivotal central situation, which is your hormone imbalance and why that is. Could it be a genetic predisposition? Could it be an environmental situation with how your lifestyle is? Could it be a combination of all of those things?

So, it’s a matter of trying to go inside and try to piece out what your real questions are and what you can address and those that you might want to address later. But, I usually make three lists, all the things that I think I have a problem with, those that I have maybe some solutions for, and the third list would be those that I’m going to affectively make a change. And try not to get too overwhelmed with a list that would be too long because if you create and endless list, then of course there’s gonna be that sense of never being able to accomplish it. So, you really want to start with that list of the things you want to change or address, those that have solutions, and of those that have solutions, pick one or two or three, but no more, and then change them and really make affective interventions. And then readdress those lists as time goes by but try not to get overwhelmed.

Amy Medling:                    That’s great advice and your book is a great resource to kind of dive into and kind of develop your question list. So can you tell us where we can find it, give us just the name again, and wherever we can find the book.

Dr. Margarita:                   Yes, thank you so much, Amy. Yes, so it’s called “The Hormone Link.” I thought it was an important title because we talk a lot about hormones, we talk a lot about what they are, but sometimes trying to connect them to really how we understand them, so the book is that big, I made it in a big font so it’s big letters so it’s easy to read. It’s really not meant to be a front to back read, it’s chapters that are unique to you, so I did focus a little bit on the doctor patient relationship because I think that’s really important in endocrinology since some complaints that we have can be so vague and applied to so many things. But then we delve into, for example, the thyroid gland because as women and women who suffer from PCOS have much higher risk of having a thyroid problem, I thought it would be important to really address that and the chapter starts with a questionnaire. And so if you happen to find that through the questionnaire, you have some issues, then it might be worth reading that thyroid chapter.

We have another one on the adrenal gland, and that’s really a powerhouse where let’s say we suffer from anxiety, we release adrenaline, and that’s what makes us shake a little bit and feel the butterflies in the stomach. And so it’s really important to understand that adrenal gland. And so we start also with a stress questionnaire and then again, if that’s interesting then we can read that chapter. And then, of course, we talk about what is the period? What is a normal period? Sometimes we don’t even know what is normal or we think that’s who we are and that’s how we were made and so we might just be unusually different but if we understand what is the period, then we can say, “Hey, my period is not like that.” So, let me read on to the next chapter, which is a little bit more understanding of polycystic ovarian syndrome or infertility and the different options that we might have. And then let us not forget that when a woman who has polycystic ovarian syndrome or any women in general, when we reach the perimenopause phase, the menopause, sometimes with PCOS, menopause can be far more complicated because then again, it’s another big change in hormones and another period of hormonal imbalance that just makes things really complicated.

And so, I tried to explain that in a sense where we talk about diet, we talk about exercise, we talk about supplements that would be good, and then when to really seek a prescription or an intervention with the doctor. If it’s thyroid disease, you might want to have them tested. It’s important to have those laboratory tests because without them, it’s just an opinion. The tests really are confirmatory when it comes to some of these problems.

Amy Medling:                    Yeah, it’s really a great book to have for your resource, like on your resource shelf. And I was lucky enough to have you sign mine.

Dr. Margarita:                   Well, we’ll make some book signings or we’ll do some activities, I promise you.

Amy Medling:                    Well, thank you so much and please come back and we’ll have to talk about another PCOS topic ’cause being a woman that has had hormone issues yourself, I think it just makes it so much easier to share and we kind of all learn from each other and what works for us. So, please come back to PCOS Diva podcast.

Dr. Margarita:                   Thank you so much, Amy. Thank you.

Amy Medling:                    Well, thank you everyone for listening. That wraps up our podcast today. I hope you enjoyed it and if you liked this episode, please don’t forget to subscribe to PCOS Diva on iTunes or wherever else you might be listening to the show. And if you have a minute, please leave me a quick review on iTunes because I love to hear from you. Don’t forget to sign up for my free newsletter. I send it out once a week with new content and recipes and lots of stuff to make your life easier. And just enter your email on PCOS Diva to get instant access. This is Amy Medling wishing you good health, I look forward to being with you again soon, bye -bye.

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