Let’s talk about Polycystic Ovarian Syndrome (PCOS) with Obstetrician Gynecologist Dr Nicole Parson

Let’s talk about Polycystic Ovarian Syndrome (PCOS) with Obstetrician Gynecologist Dr Nicole Parson


all right so the first time that I went
live I did a brief introduction but Dr Parson was not here so I do
want to introduce start Nicole Parson and she’s an obstetrician gynecologist she
works with Bradford Clinic located in Charlotte North Carolina and I was
mentioning too that you guys are in a couple different locations I know for
sure Matthews and I think Ballantyne but I also want to give you an opportunity
to introduce yourself and tell everyone about you and what you do. Okay, so I am Dr Parson as Dr Covington has already said I am a part of the Bradford Clinic here in Charlotte We have 3 office locations one down at Presbyterian Main right across the Street from the main hospital And then we have a location in Ballantyne and a location in Matthews and I see people in South Charlotte, Ballantyne, and in Matthews. So a lot of locations, that’s awesome. So for people in Charlotte you have a lot of
opportunities to see Dr Parson throughout the city so just to kind of
start from the foundation our topic is PCOS but I want to talk a little bit
about what is an OB Gyn doctor and what type of things do you ? So can you explain
that ? I sure can. So, I am a specialist
in women’s health. Specialize in taking care of
the woman from the onset of puberty in most places and for the remainder of her life and that can be anything from her menstrual irregularities to child birth and pregnancy, attempted pregnancies and then into those years they’re going through menopause and they have symptoms that we can manage we also do quite a bit of primary care and some preventative Annual exams. okay well that’s awesome
so let’s just jump right in so polycystic ovarian disease it’s a term
that a lot of women have heard and a lot of men as well but we’re just going to
start with the basic definition so What is PCOS? So PCOS is a condition that is referring to the abnormal hormonal
output of ovaries The way in which I describe is when I talk to patients is that the ovaries are an organ in your body that release hormones and they do that in in a cyclic fashion Very much I think of it like an orchestra It’s a place to play loud and then there are times when they play low and its that varying up and down that sends other signals throughout the body for ovulation, for your period to come, your body temperature, etc In PCOS, what happens is, the ovaries are not getting the memo and they are playing loud everyday all day and they never get that fluctuation in hormonal release and when that happens you
get a lot of abnormalities that bring disease and it’s those abnormalities that bring women in to see us. Okay I like the analogy of the orchestra
because that makes sense to me so there’s times when your body’s supposed
to be doing stuff and secreting things and then there’s a time where it’s
supposed to be calm but it sounds like for PCOS it’s it’s “playing loud all of
the time” so what are some of the abnormalities that a patient with PCOS
will experience So the top things that women will come in for… Number one would be period irregularity And there’s 2 main complaints, either I’ve not seen my period for several months and in some places years and then the very opposite which is that I bleed all the time so menstrual abnormalities would be number one Hirsutism, that’s when women notice
that they have increased acne or Hair growth. And that hair is often in a male distribution pattern that might be increased hair on the chin the upper lip, the chest, and then your normal areas arms, legs, etc And then a couple of other symptoms their symptoms would be infertility. Inability to get pregnant and then last, pelvic pain. Okay. Alright. That’s actually one that I wasn’t aware of so they can have some discomfort in the pelvic area as well okay So how would you diagnose this ? The diagnosis for PCOS is what we in the medical community call, a clinical diagnosis meaning when we see you, based on symptoms I can diagnose you just based on symptoms there’s a common misconception that you need labs to diagnose but you don’t if you have
a woman who has what they call hyperandrogenism which is increased male hair distribution of acne coupled with menstrual irregularities, abnormal periods, that is enough to diagnose a woman with PCOS Okay. You will also see in the work up it varies from physician to physician ultrasound to look at the ovaries, so if you should see many cysts on the ovaries Sometimes people will do labs looking at testosterone and other hormone markers Okay. So what is the typical age that a woman will experience this is this a young
adult issue ? Is this a right after puberty type of thing ? What’s your opinion on that ? So interesting enough I think that the age is actually decreasing and that’s just my clinical opinion based on my patient population One thing, one association with PCOS, is obesity. And I’m sure you will be getting into that so because obesity in the US is rising And PCOS and the incidence of it is rising and because we are seeing obesity at earlier ages then I am seeing patients for these symptoms at earlier ages as well So you can see a young girl, 15, 16 years old. and then definitely up until late 30s. I would say probably that age span that most patients that I am dealing with PCOS are Wow great segway. You bring up a great topic so I do
see quite a bit of PCOS in my clinic because of the obesity and then
sometimes I see them for infertility of course I don’t directly treat
infertility but infertility doctors will send their PCOS patients to me
because the first-line treatment and we’ll talk about treatment more is
actually weight loss so 50 to 60 percent of patients with polycystic
ovarian disease actually are overweight or even obese and that brings up a great
question and I’ll just go ahead and say that I don’t think anyone has the answer
to this question but it’s a question I get very often patients will say did I
develop PCOS because I’m obese? Or did the obesity cause PCOS was at which one
came first the chicken or the egg ? So I do want to get an expert’s opinion
you know my answer is typically who knows ? They both can drive each other and we don’t typically know which one however you know what does Dr. Parson
think about that ? Same thing, number one question that I get as well and my answer is that we don’t know probably there are clinical scenarios in which both are true. What we do know is
they travel together and so I have seen patients who had a normal BMI who have come to me for infertility and I’ve diagnosed them with PCOS and at that time I counsel them then on their increased risks of developing obesity developing cardiovascular disease, diabetes, etc and then the opposite is true as well
for patients who are overweight and my number one differential my number one
suspicion is that they have PCOS and so I think probably they run
together and both are probably true Yeah and I would agree with that too So let’s talk a little bit about treatment so for a patient who comes in and you diagnose them with PCOS what would be the first thing that you would start with for treatment? Number one thing, weight loss I would tell them that and it’s the hardest thing because it’s the one thing that we all wish we got right. I think every woman in America would love to be more healthy and lose and so you know that conversation is always difficult because it’s somewhat discouraging but it’s the truth and so I tell patients that if you are to really improve your symptoms it’s through weight loss and that you won’t ultimately improve if you lose weight So diet and exercise is the number one way for the very first visit all of my counseling and specifically do that and set goals for that The second thing for treatment. You know my treatment is always dependent on their symptoms So if I have a woman who is coming to me and her symptom was hirsutism then there are medications that can help with that There are certain birth controls that help treat the hair growth Spironolactone is a medication that is often used as a diuretic in the general medicine population but it also has some different properties which can help improve a lot of symptoms and then you know laser hair removal, etc If someone’s coming to me in their primary complaint is infertility then you have to normalize their cycles. So for them birth control might be a temporary solution will help regulate but then ultimately if we want to help with their ovulation then we may use Clomid For increasing that ovulation rate and then for irregular menses then birth control is our staple for regulating your cycles well awesome well I can tell you for the
weight loss piece there’s actually been a lot of studies in PCOS and weight
management which is surprising because there’s not always the traditional
medicine studies with weight management so one of the things that has been been
found is that typically at anytime 85% of our PCOS patients are actively trying
to lose weight and what’s unfortunate with PCOS is that it’s extraordinarily
difficult one because of the hyperinsulinemia and we know that
insulin not only drives the androgens and those male hormones that may cause infertility but insulin is also a hormone that stores fat and increases
cravings so you have someone who is trying to lose weight and then they’re
battling this physiology so what I find with the PCOS folks a lot of them are
also exercising and surprisingly some exercises will lead to more weight gain
especially for this population I always mention a case when I talk
about PCOS of a patient who gained 11 pounds in a week one they were using the
wrong protein but they were also doing really rigorous physical activity the
CrossFit and the things that we tend to think would really work for majority of the
population you know why does it not work so well
for PCOS ? Well the thought is they have testosterone so they have a lot of
unopposed male hormones and that is building additional weight that is you
know leading to them being more discouraged so I can tell you what has
been shown to work for PCOS of course we can use any of the
fda-approved weight loss medications bariatric surgery has been used but even
before you get to the more extreme options when we look at diets the best
diets for PCOS are the lower carb and ketogenic diets and it’s because of the
insulin the high insulin the high carbs when we take those out of the diet we
tend to see more more weight loss and that’s also the idea behind metformin
some of the idea behind metformin Metformin helps to sensitize the insulin
and it helps with some some weight management and it also helps with the anovulation and the infertility because you’re bringing that insulin down and
now the body’s starting to work properly for people who have a really difficult
time with diet meal replacement has been found and studied and proven and
documented to work really well in PCOS and I emphasize that because a lot
of times we don’t do those type of intense studies for meal replacement
that’s just the truth but it has been done in PCOS and shown to cause some
weight loss so with the meal replacement program these are pre-packaged foods
basically so it’s convenient it’s easy your protein your carbs your calories
your portions are all controlled and it’s something that somebody can just
start on day one now it’s not extraordinarily easy but after the third
or fourth day people tend to to do well and it can be pricey because you’re
replacing all of your meals but that is a way of handing somebody a ketogenic diet
basically or low carb diet so we see weight loss with that so do you
prescribe a lot of metformin for your PCOS patients ? So I do. I wouldn’t say a lot of my patients but I think that there is a subset that it is definitely appropriate for The patients who do have that obesity component to it They do have elevated lab values that may be approaching a diabetic status and then those who are having trouble with infertility Those would be the main causes to actually use metformin Okay. so the last thing thing I’ll say with weight loss what I see commonly is whenever people are doing a weight loss program
and they’re a woman of childbearing age we do a lot of pregnancy tests because they
end up pregnant All the hormones are working better so that is a really good well-rounded discussion on PCOS. Kind of hitting some of the
highlights. We kind of started talking about signs and symptoms, diagnoses,
treatments, weight management which is always a huge topic for PCOS this is
actually one of the topics that my patients requested so we did a poll a
couple months ago and asked people what do you want to talk about and this was
one of the top things that work that they wanted to discuss so it’s a huge
treat to have Dr Parson here. I will give about a minute well let’s say 20 to
30 seconds for questions if there are questions in the chat you can ask those
now if you have questions for PCOS that’s preferred, however, if you have a
general women’s health question we can take those as well or weight management
questions. Okay so is PCOS something you are born with or is it developed? I don’t
know much about it really. So what do you think about that ?
So it’s acquired and the reason for that is because when we’re born we don’t really have a lot of ovulatory function The ovaries don’t really come alive, if you will, until we’re approaching puberty and so how they ultimately will function will not be really be realized until you are going through puberty and after so no it’s not something that you’re born with Ok. And then our last comment was Thank you Dr Parson. so alright so we’re going to go ahead
and close. Dr Parson again is an Ob-Gyn doctor She is at Bradford Clinic. She’s
accepting new patients She’s located in a couple different locations so look for her in Matthews or Ballantyne or South Park or Uptown and I’m really excited to
have her here and to talk about this really important topic the last thing I
wanted to mention we’ve been talking a lot about women’s health for the last
two weeks however tomorrow starts Men’s Health Month so I will be giving a lot
of attention to Men’s conditions I don’t want men to feel left out and I will have a
special guest mid June to talk about men and actually give some weight loss tips
specific for men. So thanks everybody for joining in and that’s gonna conclude
this topic. Good night.

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