PCOS Testing and Diagnosis: In this episode, we talk about the testing and labs for a diagnosis for PCOS. These testing and labs are also a good way to monitor PCOS.
Ultrasound: Checking for multiple cysts on or in the ovaries. It is still very common to have PCOS but have not cysts ( string of pearls ).
LH: FSH ratio:

2:1 or more

DHEA-S:

DHEA-sulfate is the best way to test for DHEA levels in the blood.  
DHEA-sulfate is a metabolite of DHEA and is much more accurate to determine DHEA levels than a total DHEA level.  
DHEA levels are highest when we are young, around 25 years old. And will slowly decline with age. It is considered an androgen.
The reference ranges for DHEA-Sulfate are very vast and are based on age. For example, a woman that is 35 years old gets her blood drawn for DHEA-sulfate. The reference ranges for a typical lab is 23-266 mcg/dL.  
For a female that has PCOS around 35 years of age, you will see the DHEA-sulfate at 200 or above. 
Commonly PCOS, the DHEA-s will show over 200 mcg/dL.  

Testosterone:

The reference ranges for testosterone labs are huge.  
Quest has a reference range of 2-45 ng/dL.  
LabCorp has a reference range of 8-48 ng/dL.  
Testosterone levels at 35 or higher

Estrogen

Three circulating estrogens: Estrone, Estradiol, Estriol

Vast reference typical reference ranges for most labs:

Follicular Phase 19-144pg/mL
Mid-Cycle 64-357
Luteal Phase 56-214
Postmenopausal

In this episode of the Progress Your Health Podcast, we are going to talk about PCOS. I know our last podcast was, PCOS, Questions to Ask your Doctor. We are still going strong on our PCOS information. But we are going to do things a little different than we have. We are going to do a five-part podcast series about PCOS.  

What PCOS Looks Like: What is it? (this podcast)
How PCOS Can Be Detected: Testing and Diagnosis for PCOS
Which Type of PCOS Am I?: Classic
Which Type of PCOS Am I?: Common
Which Type of PCOS Am I?: Concealed

PCOS stands for Polycystic Ovarian Syndrome. It is not a disease but considered a syndrome. From the name, polycystic ovarian syndrome, it is easy to assume there are multiple cysts on the ovaries. But in fact, many women with PCOS do not have multiple cysts or any ovarian cysts. As a general statement, in PCOS, there are hormonal imbalances that can cause unwanted symptoms and conditions. That is why we consider it more of a spectrum as some women can have nearly most of the criteria of PCOS and other just a few symptoms.  
What are the Hormonal Imbalances present in PCOS?

In PCOS, one of the hallmarks are elevated levels of androgens: testosterone and DHEA. A lot of time these can range from high normal to over the reference lab values. 
DHEA: comes from the adrenal glands
Testosterone is from conversion from DHEA, ovaries and other peripheral tissues
Progesterone levels from the ovaries are low to none
Thyroid function can be low
Elevated insulin
Cortisol diurnal release is degraded. 

Common PCOS Symptoms:
Multiple Ovarian Cysts:

Just like the name states: Polycystic ovarian syndrome, there can be multiple cysts on the ovaries.  
It is normal and common to get small follicular cysts during our cycle.  
But in PCOS there can be actual cysts that stay on the ovaries almost indefinitely.
While as the name states, polycystic. Many women with PCOS do not have cysts on their ovaries.

Period issues:

Irregular or lack of a period.
In PCOS, there can be missed periods. Some women might miss a period or two in a year. And others can miss their period for up to six months or more. But of course, the goal is to balance the hormones, so the cycle is regulated and not painful or heavy.

Infertility:

Some women that have PCOS can have reduced ovula

In this episode of the Progress Your Health Podcast, we want to discuss questions you might want to ask your doctor when it comes to PCOS.
PCOS stands for Polycystic Ovarian Syndrome. The name can be misleading. Polycystic means, having multiple cysts on or in your ovaries. While this can be true, many women with PCOS do not have any ovarian cysts. PCOS is a collection of hormonal imbalances that may result in cysts and other unwanted symptoms. 
During this episode, we talk about the diagnosis, symptoms, and questions to ask your doctor regarding PCOS. We explain that PCOS is more of a spectrum of symptoms as some women can have all the symptoms and others a few.  
This is why it is important to have clear communication with your doctor on how:

PCOS is affecting your life.  
What your health goals are with PCOS.  
The proper treatment to help with PCOS. 

Before we move on, let’s understand the basics with PCOS. The common symptoms that are associated with PCOS:
Common PCOS Symptoms: 
Cysts: if you have not had an ultrasound, request that your doctor order you transvaginal ultrasound. As mentioned earlier, many women with PCOS do not have cysts on the ovaries. But if there is any thought that you might have PCOS, then you do want to have a transvaginal ultrasound. This will give us information on the size of the uterus and ovaries. If you have any growths or cysts. It will even check the thickness of the lining of your uterus. 
Missing, Irregular Periods: It is very common in PCOS to miss periods for multiple months. Some women miss one month a year, and others can miss up to six months at a time. It is also common to have cycles that range from 25 days to 45 days.  
Weight gain: Weight gain is one of the most common frustrations with PCOS. It is very easy to gain and hard to lose. Even with strict caloric restriction and a lot of exercise, women with PCOS will be frustrated because they cannot lose weight.
Hair loss: It is common in PCOS to have hair loss. Particularly on the top of the head and temples can appear to be especially thin.  
Hair growth on the face and other areas of the body (except for the head): While it might be easy to lose hair on the head. In PCOS there can be hair growth on other areas of the body. Most commonly, the upper lip, chin and jaw, chest and pubic area before the belly button. We are human, and humans grow hair on our bodies. But in PCOS it might seem a bit more extreme.  
Irritable: It is common to feel irritable not warranted for the situation in PCOS. 
Lack of Conceiving, Fertility issues: PCOS is one of the top causes of infertility. There tends to be a lack of ovulation in PCOS. But there are many women with PCOS that have children. But there is a link between fertility and PCOS.   
Elevated Blood Pressure: Some women with PCOS will have essential hypertension. Or eleva

This is one of the top concerns of women in Perimenopause. Perimenopause usually occurs in women between the ages of the late '30s to late '40s. An important note here is, Perimenopause is not Menopause. And while both Perimenopause and Menopause may have some of the same symptoms. There are also many differences between the two. It is of value to know this because treating and working with Perimenopause can be quite different from Menopause. The hormone changes in Perimenopause can cause a lot of unwanted symptoms. If you are interested in more in-depth information, and healthy options to deal with Perimenopause, check out our course, The Perimenopause Masterclass. 
But for this podcast, we focused on the unexpected, unearned weight gain that can happen in Perimenopause. In Perimenopause, it is common to hear women complain of feeling like they have gained 10-20 pounds almost overnight. They are stumped because they are unsure of where his added weight came from. We have many patients exclaim that they have not changed their diet or exercise routine, yet keep putting on weight. And this weight gain is almost always focused in the stomach and waistline. I cannot tell you how many patients I have had that say, they have never had a belly before. And now they have grown a gut for no reason. Well, there is a reason, it's your hormones. 
What do women do when they start gaining weight?  
Common response to weight gain is to eat less and exercise more. Bluntly put, this is the wrong response. There might be an initial drop in weight when you restrict your food and jump on the treadmill. But more often than not, in Perimenopause, restricting your calories and increasing your exercise will either result in no weight loss or even more weight gain.
But this is what we have always been taught. 
Less calories in + exercise(calories out) = weight loss.  
Well, maybe in your 20's this might work. This will not work in your 40's. There is nothing more frustrating than to workout like crazy, eat like a rabbit, and not lose weight. Not to mention this not a realistic way of living. When you start to eat like a normal human, you will gain the weight back plus more at a rapid pace.  
Why doesn't eating less and exercising more in Perimenopause not work?  
It is about the cortisol-glucose-insulin love triangle. Yes, it is like an awful drama that results in the fatty belly that you never had.    
When you do intense cardiovascular exercise, it will raise your cortisol. When cortisol rises, it will mobilize glucose. When glucose rises, then your pancreas will release insulin. Insulin is a fat-storing-hormone in the body.  
This is really the real deal. You are doing some crazy intense, cardio exercise. This will cause your adrenals to increase cortisol. The cortisol will then mobilize glucose from your large muscles, such as your gluteus (bum) and quadriceps (thighs). The increase in glucose will cause your pancreas to pump out insulin. The insulin opens the door cell and allows glucose to enter. Now the glucose that is mobilized from your muscles gets turned into fat. That is why in Perimen

Kavinace by Neuroscience is no longer available as a supplement.  April 10th, 2019, the FDA issued a letter to several nutraceutical companies to discontinue supplements containing 4-amino-3phenylbutyric acid.  The FDA has determined that 4-amino-3phenylbutyric acid, also commonly referred to as Phenibut is not a dietary supplement. We published a previous Kavinace article shortly after the FDA letters were sent out. 
As of the letter dated April 10th, the companies had 15 days to comply.  This left people that had taken Kavinace safely for years in a bit of a quandary.  Kavinace is, I mean, was a dietary supplement that many people took to help with staying asleep.  It contained 950mg of a combination of taurine and 4-amino-3-phenyl butyric acid HCL per capsule.  
Most people did well on one to two capsules taken at night before bed.  It wasn't a sleep medication, like Ambien or Unisom but did help to raise GABA to help with staying asleep at night.  I used this myself and with patients to stay asleep at night.  
Commonly in perimenopause and menopause, women have trouble staying asleep.  Often they fall asleep easily but will wake up in the middle of the night for hours.  And by the time they are able to fall back to sleep, it is time to wake up for the day.  Kavinace was very helpful because it contained 4-amino-3-phenyl butyric acid, which is a precursor to GABA.  Meaning it is easily digested and can cross the blood-brain barrier to help convert to GABA and stimulate GABA receptors to stay asleep. 
One of the reasons that sleep is so important is terrible sleep can make you gain weight.  People, especially women, will gain weight easily if they do not sleep well at night. Sleep is necessary for so many health reasons, it is also responsible in part for your metabolism.  It really goes back to our adrenal glands.  
The adrenals secrete cortisol in a diurnal fashion.  Meaning that cortisol is released highest in the morning and stays up through the day and drops at night so that you can sleep well.  Commonly, (especially in hormone imbalance, perimenopause, and menopause) you will see cortisol rise in the middle of the night. That causes us to wake up in the middle of the night for no reason. 
Other than it is aggravating to be awake for hours in the middle of the night and tired during the day, the elevation of cortisol at night can negatively affect metabolism. Often we tell patients, forget waking up early to go to the gym.  Just get that extra hour of sleep. One of the first things that we work on with patients is sleep. Sleeping properly is great for the waistline. 
Well you might be asking, Kavinace is no longer available, what do I do now?  There are many options available to replace Kavinace and sleep well. Back when I first found Kavinace years ago, all we had available to us was GABA.  GABA is a huge molecule that is not easily absorbed through digestion, so it was a waste to take. Now we have available, PharmaGABA, which can be absorbed through the digestive tract.  
PharmaGABA is a great alternative to Kavinace.  You can take it as capsules at night or chewable tablets.  If you are a tough sleeper, and still wake in the middle of the night, you can chew up 1-2 more t

 
It is common to mistake perimenopause for menopause and vice versa.  Labs can be misleading. Doctors can be misleading in your concerns about whether you are in perimenopause vs. menopause.  Even symptoms can be misleading. In this article, I am going to explain the differences between perimenopause and menopause.  As well as information to help you determine which hormone phase you are in at the moment.
Both perimenopause and menopause can start between 35 to 50years old.  As the word states, perimenopause starts before menopause. While that might seem obvious, sometimes it is hard to differentiate between them.  I have had many patients tell me they are in menopause but are really in perimenopause. You might be asking, ‘why is it a big deal to know the difference?’.  That can come down to the treatment. Treating a woman for menopausal symptoms when she is in perimenopause can not only be ineffective. But can make the symptoms worse as well as new symptoms.
Perimenopause usually starts in the mid-’40s, but I have seen it as early as the early ’30s.  The average age of menopause is 51 years old, but I have often seen it occur in the mid-’40s. So while it seems that perimenopause and menopause can overlap, there are distinctions in the symptoms.
Some distinctions between perimenopause and menopause: I will try to be as comprehensive as possible. Here are the most common differences in symptomatology between perimenopause and menopause.
Periods:
In perimenopause, if you still have your uterus, then you will be having a period.  The periods can change from your “normal.” But you will still be having a regular period.  What you might notice are periods might be heavier, longer, more spotting, more cramping. Often this can lead to low-iron/anemia.  
This is the time that women find out that they have fibroid(s).  Fibroids are benign growths in the uterus and during perimenopause can become “active,” causing cramping, heavier periods and more spotting.  This is usually the time women will get a hysterectomy. The periods are so “off” that most doctors only recommend a hysterectomy. Now that might correct the period “issues.”  But it does nothing for the other symptoms.    
In menopause, the periods become less frequent.  Might miss one or many months at a time. The period that you do have can come at any time. They might be light one month and then four months later a heavy, painful period.  
Hot Flashes and Night Sweats:
In menopause, you will have lots of hot flashes and night sweats.  But the distinction here is, in perimenopause you don’t have daytime hot flashes. But you will have night sweats, really bad night sweats.  The night sweats in perimenopause usually happen anywhere from 7 to 10 days before your period. But once you get your period, the night sweats go away.  
Mood: 
In perimenopause, you are much more irritable than in menopause.  That is one of the most common complaints in perimenopause. Short-fuse, low tolerance, very little patience for even minor offenses.  The impatience and overwhelmed wound up feeling is not seen as much in menopause as it is in perimenopause.  

In this podcast, we talk about the difference between PMS (premenstrual syndrome) and perimenopause.  We get this question all the time, Doc, I think I am going into menopause.' When really, they are nowhere near menopause, let alone perimenopause. What makes it so confusing is that there are so many similarities between PMS and perimenopause.
But some distinctions are important to point out, especially when it comes to testing and treatment. PMS (premenstrual syndrome) is pretty much as it sounds.  Symptoms appear prior (pre) to the period (menses). But usually, the symptoms appear in a cyclical pattern.
The symptoms will appear anywhere from 14 days to just a couple of days before the period. The distinction between PMS and perimenopause, is the symptoms are present all month in perimenopause.
Perimenopause is NOT menopause.  It is the time before a woman enters menopause.  It can be anywhere from age late 30's to late 40s.  In perimenopause, you are still getting your period (it might be irregular, but you are STILL getting your period).        
But the symptoms between PMS and perimenopause are similar.
So just to reiterate:

Symptoms in PMS occur between 14 days to 2 days before your period.
Symptoms in perimenopause occur all month long.

Symptoms that are similar in PMS and perimenopause:

Irritability: patience is short.  Becomes easily irritated, even at situations that it is not warranted.  Of course, you feel guilty after having a hormonal tantrum and cry and feel badly about the encounter.  You are not crazy, it is your hormones.
Acne
Carb cravings
Sleep issues –waking in the middle of the night and cannot go back to sleep
Fatigue: low energy–both physically and mentally tired
Anxiousness not always warranted for the situation
Bloated: even though your bowels are moving fine
Cramping before period even starts

Symptoms that are different between PMS and Perimenopause

All of a sudden your periods get weird.  Periods come early or late. Your spot for days.  One month your period is super heavy, and the next kinda light.  Every month can be different in perimenopause.
Crampy painful periods
Symptoms all month long in perimenopause–it is like #pmsallmonthlong
Symptoms 14 days to 2 days before your period
Hair loss

In this episode, we answer a reader question about her low T3. Kelli’s case is a bit complicated, but it sheds light on how important it is to address low T3 levels.  We get this question all the time about the thyroid hormone, T3. Many will say, ‘my free T3 levels are low, but my doctor will not do anything about it’. We wanted to talk about low T3 and how there are many factors that can cause a low T3.  Also on ways to increase your T3 conversion as well as some medications for low T3. We are also going to touch on autoimmune diseases such as Hashimoto’s, Type I diabetes and Celiac disease.
Question from Kelli:
My thyroid labs are all within the normal range, but I FEEL so depleted. My free t3 has never tested above 2.3. I have T1D and Celiac disease already. I know my body is prone to be difficult and function lower on some levels than most. How can I fix my free t3 if it is low and if the doctor says it’s not “treatable low.”
One of our most popular blog posts is, ‘Low T3 levels”.  This partly why we wanted to talk about Kelli’s concerns about her autoimmune diseases and her low T3.  Kelli is one of a common predicament that we see all the time. Having low levels of FreeT3 but her doctor says it’s not treatable or just ignores it.  Low T3 levels are very much treatable and should not be blown off. We really like Kelli’s questions because she also has Type One Diabetes (T1D) and Celiac disease.  
T1D is considered an autoimmune disease and shouldn’t be confused with Type Two Diabetes.  T1D is where the immune system will attack the insulin-producing cells in the pancreas. So the pancreas cannot release insulin in response to elevated levels of blood sugar.  Type One Diabetes is considered, insulin-dependent and most likely diagnosed before the age of 20.
Kelli also has Celiac disease which is an intolerance to gluten.  In the small intestines, there are little finger-like projections called microvilli which is what absorbs what we have eaten.  Think of it as a long carpet/rug. You then squish up the rug together, so there are many undulations. This increases the surface area tremendously, and then there is more area to absorb nutrients.  In celiac, because of the immune reaction to gluten will cause terrible damage to the microvilli. Causing the villi to erode consequently causing many symptoms including malabsorption and malnutrition.
If Kelli has T1D and Celiac and Low T3 levels she very well may have Hashimoto’s. Hashimoto’s is a condition where the immune system creates antibodies attacking the thyroid and eventually causing lowered thyroid function. Hashimoto’s can be similar to celiac.  There is a sensitivity to gluten in Hashimotos that patients do much better on a gluten-free diet.
Hashimoto’s is similar to celiac bc gluten needs to be eliminated to reduce the Hashimoto immune response.  
Let’s back up a bit and explain about thyroid.  The thyroid gland secretes mainly T4. T4 will travel in the bloodstream and convert to T3.  Free T3 is the active form of thyroid. Even if you have perfect levels of T4 but low T3, then you could have symptoms of low T3.  
Doctors really don’t know what to do if the T3 levels are low.  A lot

For this episode, we wanted to answer another reader question.  We love answering reader and listener questions. Also, we understand that you might not be getting answers from your docs and feel frustrated. Honestly, we really try to go into depth on answering these reader/listener questions as we want to be as thorough as possible on conditions, symptoms, dosing, and options.  

With that said, this is meant to be educational only and not meant for medical advice (there, my attorney will be very happy to have said that!).  But as mentioned above, we want to be as thorough as possible in all aspects. This question is from Nickie. We love this question and really think others can relate to Nickie's situation.  She has been told she has Polycystic Ovarian Syndrome and has been prescribed oral progesterone.

She has concerns with taking progesterone, its side effects and the topical cream versus the oral.  Nickie also has concerns with her symptoms such as trouble losing weight and thinning hair. So we are going to do our best to answer Nickie's questions as well as go into depth on forms, dosing, testing and options for PCOS.

Nickie’s Question: 
Hi, I was prescribed 200mg of Prometrium a couple of weeks ago to take on day 20-30 of my 32-day cycle. I ovulate around day 16. Day 20 was the night before our vacation, and after reading some potential side effects, I decided to wait until this next cycle to take them for the ten days.

They think I have PCOS, so I'm hoping it'll make it easier to lose weight. My main concern are the potential side effects of the pills. Do you think using the cream is significantly better/less side effects than taking the two pills at night? I'll also have a few drinks on the weekend and didn't know how that would interact with the medicine as well. I have about two weeks to decide which I want to do, so I'm looking for advice.  

Also a history I have many symptoms of low progesterone. Anxiety, thinning hair, inability to lose weight no matter what I do, and after having a miscarriage at 12 weeks last year, I had to take oral progesterone to stop the bleeding. Thank you!

Dr. Davidson’s Response: 
First, we want to explain what PCOS is.  PCOS stands for Polycystic Ovarian Syndrome.  Which is exactly as it is described, being there are multiple cysts on the ovaries.  In many cases of PCOS, the ovaries are likened to a string of pearls. Because there are so many cysts in the ovaries that it looks like pearls.  However, there is so much more to it than just multiple cysts in the ovaries.

Typically there are very high androgens, being testosterone