PCOS: A Conversation with Dr. Jennifer Schell

If you've followed the blog for a while, you know that I have been very open about our struggles with getting pregnant with Caleb, our first. One of the reasons why we had this struggle is because I was diagnosed with PCOS. Truth be told, I was diagnosed at 18 and I never really thought much about it. I was prescribed a birth control pill to take care of the symptoms and that was that. 

Once I had Caleb and stopped breastfeeding, my cycle became pretty regular again, and I always noticed that with a good diet and exercise, my symptoms eased up. When we thought we were ready to start trying to get pregnant with our second, we went to see our reproductive endocrinologist, and I was told that I didn't have any cysts at the time and I was good to go.  

But I feel like there is always a huge question mark when it comes to PCOS. I recently had the opportunity to chat with Dr. Jennifer Schell, MD and ask her some of my (and your) most pressing questions about PCOS. I also included some questions that my followers sent me via Instagram. Keep reading for her responses. 

First of all, what does PCOS stand for? Polycystic Ovarian Syndrome

What is it?  Polycystic ovary syndrome (PCOS) is a disorder characterized by an excess of male hormones (testosterone) or symptoms like acne and excess hair around lips, nipples etc, ovulatory dysfunction, and polycystic ovaries. The cause remains unknown, and treatment is largely symptom based and on a case by case basis. PCOS patients can be at increased risk of diabetes and cardiovascular disease.

How common is PCOS? It’s debatable but some criteria say between 55-91% of women.

What are the most common symptoms of PCOS?  Irregular cycles, hirsutism (excess hair like a mustache, around nipples or belly button), and acne. Many are overweight and it’s difficult for them to lose the weight despite healthy habits.

When I was younger, my PCOS was managed by taking birth control pills.  What are some other ways that I can manage the symptoms of my PCOS? Birth control pills are probably the best way. I usually prescribe a diuretic called Spironolactone along with my go to pill Ortho Tricyclen to improve my patient’s acne and hirsutism. This combination lowers the amount of circulating testosterone. One of the most serious problems that can occur when a patient with PCOS (not on hormones) doesn’t menstruate is endometrial hyperplasia which can lead to endometrial cancer. Birth control pills and IUDs like Mirena and Kyleena help keep the endometrial lining thin and prevent this. Some people may need to take a pill (usually Provera) to induce menses before starting the above hormonal treatments.
Another medication often added to the regimen is Metformin. It’s excellent for weight loss and to decrease the risk of diabetes. PCOS patients are usually prediabetic.

I recently heard that the Keto diet can help you manage PCOS symptoms. Is this true? I think any diet can help in just helping patients lose the weight. I don’t think the Keto diet is special for this.

Is it true that PCOS can make it difficult for me to get pregnant? Unfortunately, it is true. The reason people with PCOS have irregular cycles is usually anovulation (lack of ovulation).  The good news is that it’s easily treatable with an oral medication.

Can PCOS go away on its own? Unlikely. 

Can PCOS cause miscarriages? What are safeguards that can be taken to prevent a miscarriage, if any? Not really. It’s more a problem to conceive. 

I’ve blogged before about our struggle to get pregnant the first time. Why was it so difficult for me to get pregnant the first time, and then have a happy surprise when I got pregnant again? That is a question that is not easy to answer. I’d love to know more about your circumstances back then: weight, stress level, how often you had intercourse, use of ovulation kits, etc. The majority of infertility cases are diagnosed as “unexplained infertility” and it is very frustrating to both the patient and the doctor. One of the theories is stress levels. Once you get pregnant with your first and then “relax”, boom! 😃 Another theory is that this “unexplained” infertility somehow fixes itself or “resets” after a pregnancy. The truth is: nobody really knows the answer to this common and important question. So glad your second time was easier! I have a friend who had multiple miscarriages, did ovulation induction meds (Clomid and Femara) decided to go through IVF, failed THREE cycles and then I gave her Femara (one of the ovulation induction agents) and she has TWINS now :) ​

Thanks Dr. Schell for all the information! 

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Jennifer Schell, MD is an OBGYN and a mother of two young children. She was born in Miami and raised in Puerto Rico. Dr. Schell completed her training in PR and Dallas, Texas. She is well versed in anything from birth control, vaginal infections, some infertility, high risk pregnancies to menopause. What sets her aside from others is that she truly cares about helping women understand and take care of their bodies. After all, you don’t get another one. She also tries to help mothers with advice on feeding their children (whichever method they choose), decreasing mom guilt, and navigating the post partum period. She’s currently interested and learning about conscious discipline methods in order to help her children grow up assertive and to help women who ask questions about trouble with toddlers and beyond!

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