Does it Make Sense for a Woman with PCOS to Use Progesterone Cream?

Many women with PCOS realize that they have significant hormonal dysfunctions, manifesting in many ways, including menstrual irregularities, thyroid problems, insulin resistance and glucose dysregulation, weight loss resistance, sleep problems, and infertility.

Among the many hormones which can be dysfunctional is progesterone.  In fact, women with PCOS do have serious progesterone “issues.” The concerns involving progesterone can result in an increased risk for miscarriages, pregnancy complications and preterm delivery, irregular cycles, PMS and mood swings, and significantly elevated risk for uterine lining (endometrial) overgrowth (hyperplasia) and uterine cancer!!

The elevated uterine (endometrial) cancer risk arises from infrequent and irregular ovulation and from progesterone receptor resistance.  The continuous estrogen production results in an imbalanced situation in which there is chronic, unopposed exposure of the uterine lining (endometrium) to estrogen, without the balancing effects of progesterone. The progesterone receptor resistance issue compounds the problem by not allowing the progesterone which is produced to have the desired effects upon the progesterone receptors throughout the body. And of course, by not properly impacting the receptors on the uterine lining, the effects of estrogen dominate; increase the cancer risk, with the result being frank endometrial cancer developing, in some cases.  Shockingly, such cancers can occur at surprisingly young ages!

Progesterone receptors reside throughout the female body. Among the other progesterone receptors which have received much attention are those in the breasts. In fact, there is now much written that in the event of radiation exposure, both large and small, progesterone can possibly affect certain breast stem cells, now known as cancer stem cells, stimulating them to develop into florid cancer cells.

Of great interest in our evolving understanding of progesterone as a critical regulator has been the research into the functioning of the progesterone receptor. As inferred above, several studies in humans have indicated that, in women with PCOS, there is receptor resistance to progesterone in the cell nucleus within those organs which possess progesterone receptors.  Progesterone resistance means there is a reduced responsiveness of target tissues to the available progesterone. Gene expression analysis of PCOS endometrium reveals progesterone resistance, but the mechanisms and sensitivity are not yet completely understood.

It is clear, though, that PCOS women with endometrial hyperplasia are more likely than non-PCOS women to proceed further into trouble and have a higher likelihood to develop endometrial carcinoma. There are two forms of the progesterone receptor, A and B, and they are not functionally equivalent. Some animal studies suggest that the A receptor may be key to normal uterine function. Most likely, however, both the A and B forms contribute to the diverse and indispensable actions of progesterone involving cellular events in humans. Progesterone in human females also acts through another set of receptors; these are different from the nuclear receptors. They are membrane-bound progesterone receptors, and these receptors appear to be regulated in normal human endometrium in a cycle-dependent manner, but the precise mechanisms of each membrane progesterone receptor also has yet to be determined.

With the widespread dissemination of information now available, affording a degree of understanding by many women with PCOS that they have significant issues with their progesterone, some have wondered if adding progesterone cream into their PCOS treatment regimen makes sense. Perhaps this could reduce their risk for endometrial (uterine) cancer? Perhaps such hormone use would aid proper sleep, and improve mood and fertility? Perhaps so!! There are progesterone products which can be readily purchased over the counter (OTC), without any medical supervision. Does it make sense for a woman with PCOS to buy and use them?

These are excellent questions, and the answer is: maybe yes to the use of progesterone as a therapeutic modality, but a resounding no to the use of any OTC versions of progesterone.

The biological effects of progesterone depend on the dose, the duration of the stimulus, and the presence, levels, and function of other hormones such as 17 Beta Estradiol, testosterone, thyroid, melatonin, DHEA-S, cortisol, and oxytocin. The woman’s age can also play a role. The application of progesterone as a therapeutic modality is complex and is absolutely not one which should be undertaken without medical supervision. The prescription should be individualized as far as its dose, and absolutely should be formulated by a quality pharmacy. Additionally, the goals involved with its use should be clearly delineated, and the woman using the progesterone must be closely followed and monitored. Depending on the specific needs and situation of the patient, other hormones may be indicated to be prescribed as well.

We live in a world filled with toxins, and some behave as endocrine mimics or so-called endocrine disruptors. Such ubiquitous chemicals play additional havoc with our endocrine systems, creating individualized needs and responses. This adds another layer of complexity which must be considered as therapies are planned. Often a several week detox program is warranted.

It should always be acknowledged that progesterone is an important and powerful hormone with many effects throughout the body. An over the counter product is not able to provide a consistent and therapeutic dose of progesterone, as the actual dosing is truly unknown when such products are utilized and reproducibility does not exist.

I would urge all of you who read this who suffer from PCOS to locate a qualified and caring doctor to work with you, one who will carefully measure your hormone levels and your inflammation markers, and truly look at your total medical picture. If I can personally help any of you on your quest for health, please let me know, as I have created special programs for women who live a distance from my practice in Southern California.

Happily, through lifestyle changes, detoxification, and nutraceutical use, one’s intrinsic hormones can often be improved and this may happily negate the need for prescription hormones. Should that goal not be attainable, it truly is essential that you use only quality, commercially prescribed or compounded progesterone, and not an OTC product, containing unknown ingredients and dosage, and without the critical supervision of a caring and knowledgeable physician.

Progesterone can be a part of the treatment plan for PCOS women, but, please, promise not to undertake this on your own with products not standardized for such a critical application. Remember… I am talking about YOUR WELFARE!!!

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

How to Treat PCOS Related Acne Effectively

Just thinking “acne” makes my stomach churn….it is one of the most hated of all the PCOS symptoms.  Acne affects a large percentage of women with PCOS and is something you simply cannot ignore. It stares at you with every glance at your reflection. I am fully aware of the pain experienced by those with acne; I suffered for the much of my adult life with it.

I want to up-front tell you that I cannot give you a magic pill to clear your acne, but I will share my most effective approaches, and let you know of some exciting up-coming research.

The sad thing is that there are many dermatologists who believe they have the magic pill… in the form of Isotretinoin (Accutane), a drug originally formulated as a chemotherapeutic agent. I must issue a serious warning concerning this medication for PCOS women. The success rate in this group is much lower than for others; only about one in three has long term benefit. Some see short-term improvement, followed by the acne’s return with a vengeance a short time later.  Isotretinoin also has many side-effects such as headaches, dry eyes, cracked lips, bleeding gums, and fatigue. Among the more serious ones are birth defects, increased suicidal feelings and suicides, liver injury, elevation of blood lipids (fats), and permanent irritable bowel syndrome.

The other topic I want to address immediately is the use of oral contraceptives for PCOS acne. Oral contraceptives do sometimes help reduce the acne in PCOS women, though often it does not. Oral contraceptives are chemical hormone mimics and are not good for the gut health. They deplete the body of B vitamins as well.  They increase blood clot formation, which can be life-threatening. Long term use can increase breast cancer risk. They also can increase headaches and depression. These effects make me hesitant to prescribe them, though I will at times.

Spironolactone is another conventional drug often prescribed acne, with mixed results. Although technically approved as a diuretic, it seems to work by blocking the action of testosterone in the skin. I have had less than stellar results, but it can be tried.

I’d like you to understand why you have such stubborn acne. Your acne is the outward manifestation of inner inflammation combined with an elevated level of androgens (male type hormones)!! Those of you who have read my previous article on PCOS and inflammation understand that a cardinal issue with PCOS is systemic (generalized) inflammation. This inflammation is also occurring in your skin, and so you must tackle this problem for what it truly is….a terrible SYMPTOM of an underlying inflammatory situation. The high levels of inflammation trigger still higher systemic levels of testosterone and DHEA (adrenal androgen), further aggravating the acne in an emotionally aggravating feed-forward scenario.

In PCOS women, the bacteria on the skin have been demonstrated to be different from that of “normal” women. Additionally, the sebum, or oily material which protects our skin, is also unique in PCOS women…its constituent fatty acid components are not the same and have reduced capability to fight off infection, hence the development of cystic, recalcitrant acne.

So what shall we do? We must douse those fires! We first must measure your inflammatory status and then must lower it. Your acne will dramatically improve once the flames are out. Start by getting your inflammatory lab tests performed. Contact me if you need help on this. Over the past few months, I’ve worked out a system to help all get these important tests performed at a network of draw sites. Next, we must get that inflammation down. As this is a short article on a very complex problem, I can only provide an overview of my program. If desired, I am happy to help you individually… simply contact me.

The treatment of PCOS related acne starts with your food choices. You must eat an anti-inflammatory diet. Avoid all dairy, in all forms!! Dairy increases levels of IGF 1, which increases testosterone, increasing acne! Also, avoid all wheat and gluten, all sugars and sweeteners, alcohol, white rice and corn, and all chemical and processed foods.

There is no diet which is perfect for all PCOS women, so please feel free to do some experimentation to discover what works best for you. We are all unique in our immune systems, our toxic load, and genetics. The unifying theme must, however, be a diet to reduce inflammation! For those who enjoy it and can handle it, I suggest trying initially, for three to six months only, an organic vegan diet consisting of 10 servings (1/2 cup each) of vegetables, including at least 4 servings of a variety of root vegetables such as beet roots, turnips, rutabagas, parsnips, and carrots. Add in 2 fruits, particularly tart apples and berries. The other vegetables should consist of many different varieties of vegetables… all the colors of the rainbow!! The phytonutrients and anti-oxidants in these foods fight inflammation and the resistant starch fibers in the vegetables, particularly in the root vegetables, provide nourishment to those critically important bacteria living in your intestinal tract. Add in organic beans, lentils, a handful of organic raw seeds and nuts, small amounts of whole grains such as millet, buckwheat, quinoa, and brown rice, along with lots of green and spearmint tea. This diet is high in nutrients, anti-oxidants, and gut nourishing fiber. A healthy gut lowers generalized inflammation, which in turn lowers circulating testosterone and DHEA levels, which then reduces inflammation in the skin and improves acne!!  But if not eating animal products is more than you can handle, go ahead and add in some organic eggs, chicken, red meat, and fish. (See archived article on the gut microbiome for more info on this topic.)

Another option exists for women without disordered eating. Published data has revealed that testosterone and inflammation can be reduced by eating most of the day’s calories at breakfast, a third at lunch and fewer than a hundred calories at dinner. In one study, testosterone and insulin levels were reduced quickly by 50%!! Although this was an incredible achievement, please recognize that this regimen was only tested in one study and this way of eating is definitely neither suitable nor feasible for everyone!

You also must control stress! High stress causes increased output of cortisol, and that causes more acne! I hope to write an article on stress and PCOS in the upcoming months, but for now I would recommend buying guided imagery CD for stress, take a course in meditation, learn progressive relaxation or tapping, get massages, or all of the above! There are studies showing that hypnosis can actually improve acne. The mind controls your stress level and your immune system’s responses and YOU can control your mind with practice!

Sleep…. a critical element related to inflammation. Just one night of sleep deprivation results in elevated markers of inflammation. Maintaining your Circadian Rhythm is a key element of health and the management of your acne. Wake and sleep consistently and get 7-8 hours of sleep nightly.

There are a few key supplements I recommend to reduce acne. They work by improving detoxification functions in the liver and by improving the metabolic functions of the body. In turn, generalized inflammation is reduced. Myo-Inositol, resveratrol, N Acetyl Cysteine, and berberine are all very helpful. Taking a high potency B complex, containing methylated B vitamins is important. There are also published studies showing benefit from taking Vitamin B5, at a dose of 2 grams, 3 times daily, along with COQ10, and L Carnitine at a dose of 1 gram twice daily. Spearmint tea has been shown to lower testosterone levels and reduce acne.

Healing acne is slow going, so expect it to take 6 months to see very significant improvement.

In terms of topicals, several are helpful. Organic essential oils can help to control the skin bacteria. Blends with Thyme and Tea Tree are great. We use an excellent blend called Clear Skin by Simplers Botanicals. I recommend an organic acne line from Sophyto. In a study pinning ProActiv against Sophyto, Sophyto won! It incorporates antioxidants from organic fruits and vegetables grown on a farm on the British Isles. There are also several prescription topicals I have made up at my local compound pharmacy which I utilize. I have also found that acne peels can be very beneficial by exfoliating the skin. I have had success with a peel called ViPeel,  designed specifically for acne skin.

I also want to emphasize that I am vehemently against the use of antibiotics for the treatment of acne. Actually, they rarely work for PCOS patients anyway and from a long-term view, they are incredibly harmful to the GUT microbiome. Remember, there are supposed to be bacteria all over our bodies and within our bodies. The “right” bacteria in our guts reduce inflammation, and hence, reduce acne. Bacteria also typically grow resistant in time to the antibiotics and cease working at all, and so the antibiotics can create more harm by killing off our GOOD bacteria, those which are actually protective!

In terms of future hope, I am currently working to begin a study of the effects of a five day diet which mimics the effects of fasting on the state of acne in PCOS women. It has been shown that this program reduces markers of inflammation, IGF 1, and insulin levels, all of which are associated with acne. The hope is that this dietary program will substantially reduce acne. If you have an interest in being a volunteer for this or future studies of this sort, please email me.

In summary, as you have seen, there clearly is no magic bullet for the treatment of PCOS acne, whether cystic or not. As my imperative is always to do no harm, I avoid Accutane and antibiotics, and prescribe oral contraceptives judiciously. My ultimate hope is to reduce the underlying generalized inflammation and lower androgen levels (testosterone and DHEA levels), while also healing the gut of PCOS women. Then the fire in the skin will be calmed… and the acne will finally fade away.

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

PCOS Update: The Latest Research on Microbiome and PCOS

The Microbiome and PCOS: An Evolving Area of Research of Huge Importance

Until fairly recently, you could look at yourself in a mirror and believe that the reflection was the real “you.” No longer is that the case! It is now recognized that more DNA exists within us that derives from our Microbiome than from our own genetic tissues. The Microbiome consists of the trillions of bacteria which live both on and in us. And what is now understood is that those little critters are not freeloaders! To the contrary, they are key players in all aspects of our health, and unfortunately for those of us suffering from PCOS, the bacteria comprising our Microbiome are unlikely to be the right ones, nor to be present in the correct amounts, for our maximal wellbeing.

The particular areas of the Microbiome I’ll touch on in this article will include the mouth, along with the rest of the gastrointestinal system, and the female reproductive system. Next month, I will deal with acne, so I’ll touch on the skin Microbiome at that time. The topic of the Microbiome is truly “hot!” New information is coming out about the enormous significance of these bacterial colonies on a weekly basis. In fact, along with a colleague of mine, I am currently designing a study of the Microbiome of PCOS women. If you’re interested in being a part of it, I may actually be soliciting your help in the near future!

Let’s start our review of the Microbiome by beginning at the top, with the mouth. I would say that virtually no one has been thinking of the mouth bacteria as important except as an annoyance, as something to wipe out as much as possible with mouthwash. Let’s all kill those germs on contact!! Well….unfortunately, it turns out that the bacteria in our mouths are actually critical to making nitric oxide, a necessary ingredient for the proper function of our cardiovascular system. It has been realized that when we eat certain vegetables which contain nitrates, the bacteria in our mouths, after being swallowed with our saliva, works in the stomach with our stomach acid, on the food, to create nitric oxide.

Without the right bacteria, nitric oxide quite simply will not be made. Nitric oxide is an essential part of our health. Unfortunately, we have done a great job of killing off the essential bacteria within our mouths through the use of mouthwash, antibiotics, toothpastes, and numerous bacteria-killing chemicals in foods. Also, drugs such as Nexium and Prilosec, which block stomach acid production, prevent proper nitric oxide production in the stomach.

Even without the things we do to kill off our bacteria, it seems from several small studies, that women with PCOS have different bacteria in their mouths than do “normal” woman.  What that means is still unclear, but most probably, PCOS women do not, as a group, produce nitric oxide properly. One thing that is clear is that women with low nitric oxide have higher pregnancy complications, which we know is true of PCOS women, and more cardiovascular conditions.

Moving down the GI tract, we come to the Microbiome of the Gut. These bacteria are critical to every function of our bodies and the wrong Microbiome results in increased risk of cardiovascular disease, autoimmune disease, depression and anxiety, cognition issues, and cancer. It is beyond the scope of this small article to go into great detail on all aspects of the Microbiome, but it is important that you at least learn that it exists and its critical import to your health.

The analogy I like to use is the following: there is a complex society-an advanced civilization of microscopic people living in our intestinal tract, and they perform many critical functions necessary for our wellbeing. By not realizing their importance, we’ve systematically gone about trying, inadvertently, to destroy them. We’ve dropped bombs on them (antibiotics), starved them (inadequate fiber in our diets), and tortured and killed them (additives and chemicals in foods). Most of us weren’t even given the best start to the formation of our Microbiomes since we weren’t breast fed for at least a year. For all of these reasons and more, our Microbiomes have reduced diversity and absolute numbers and may include many wrong players as well. When the conditions within our Gut are not right and the Microbiome is “wrong,” there is typically inflammation of a low grade in the Gut, resulting in inflammation throughout our bodies. Systemic (body-wide) inflammation leads to increased insulin levels, insulin resistance, weight loss resistance, elevated levels of IGF 1, and higher levels of testosterone. Now, with this new knowledge, evaluating my patients’ Microbiome has become commonplace for me and healing the inflamed Gut and remediating the Microbiome is an essential part of my treatment plan.

Lastly, I want to mention the Microbiome of the female genital tract. The bacteria in the vagina are essential to the health of the organs which lie above-the uterus, fallopian tubes, and ovaries. We’ve known that there are bacteria within the vagina, but the essential functions they perform for the health of the reproductive tract and their role in fertility was minimally comprehended. What is now coming to light is that the vaginal Microbiome is related to the proper function of the sperm, facilitating proper motility and ultimate fertilization of the egg. Additionally, in the past we believed that the environments within the uterus and fallopian tubes were sterile, but in fact, that is not true. The bacteria within those spaces are critical to having normal fertility. Even the ovary can contain some bacteria, and they must be of the right sort for all to work properly.

So what can you do today? Do not use mouthwash or chemical toothpaste-use a natural one. Do not take a drug to lower stomach acid production. If you are on one, work with a doctor who knows how to wean you off. I can help, if necessary. Do not take antibiotics unless it is absolutely essential…. and I mean that! Don’t put chemicals in or near your vagina. Use organic aloe vera gel or coconut oil as a lubricant. Use Vitamin E suppositories or oil for irritations. In general, use natural products for all treatments of the vulva and vagina.

Recognize that oral contraceptives are bad for nitric oxide production and the Microbiome. If you use them, there are risks and benefits which must be considered. This is, unfortunately, one of the risks. Eat lots of root vegetables (all vegetables from below the surface), as well as beans and lentils, buckwheat and millet. Those items contain resistant starch-hard for you to digest but great for the bacteria to ferment! Eat above ground vegetables too. Avoid all sweeteners, soft drinks, bread, processed foods, dry and instant cereal, alcohol, and please try to eat all organic. Eat fermented foods. Work with a doctor who can test your Microbiome and treat it. Also work with a doctor who understands nitric oxide. These are all really important items. Email me if you need help, and I will see what I can do:

Treat your Microbiome like the important complex civilization it is! You need them as much as they need you!! It is the ultimate symbiotic relationship!

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

How to Protect Yourself from BPA Exposure While Pregnant

The world in which we all live is quite different from the one inhabited by our grandmothers. Our world is filled with well over 80,000 different chemicals, most of which have no safety data whatsoever. Others are recognized as dangerous by leading scientists, yet no alterations are recommended by our government for their continued and widespread use.

One chemical found widely in our world is Bisphenol A (BPA). It is produced in huge quantities and is used in the production of plastics intended to have a direct contact with food, including plastic packaging and plastic kitchenware, and it is also present in the inside linings of cans and jar lids.

Humans get exposure through the ingestion of BPA through the mouth, by breathing it in, and through the skin by absorption. The main sources of BPA include food packaging, dust, dental materials (including dental sealants), healthcare equipment, thermal paper (receipts and boarding passes), and children’s toys and other articles.

BPA has a chemical structure with some similarities to real estrogen, and therefore, it can interact with estrogen receptors in strange and various ways, acting in some cases as if it were a powerful estrogen (agonist) and on other organs it acts as an estrogen blocker (antagonist).

BPA is what is known as an endocrine disruptor. It basically creates hormonal chaos throughout the body. Strangely, its initial existence was as a “synthetic estrogen,” proposed to be used as a drug.

BPA has been shown to play a role in the development of several endocrine disorders of women (and men). These include precocious (early onset) puberty, breast tumors, and, of course, our very own Polycystic Ovary Syndrome.

We all experience continual exposure to BPA on a daily basis and it bio-accumulates (meaning it’s amount in the body grows steadily), and during pregnancy, BPA accumulates in the fetus more so than in the mother! In rodents, levels of BPA which are comparable to the levels many women are actually exposed to, affects the brain, liver, gut, adipose tissue, insulin producing pancreas tissue, breast tissue, and the reproductive tract structurally and functionally. High levels are associated with obesity, diabetes, and cardiovascular disease, in addition to PCOS.

Exposure to BPA while in the womb can alter the very structure of the ovary, increasing the number of cysts and can actually disrupt the development of those critical eggs within the ovaries. Exposure can alter how the genes actually work. The genes can be reprogrammed, resulting in reduced fertility and alteration of the very development of the baby.

BPA has been shown to directly cause higher levels of testosterone to be produced, higher rates of implantation failure, reduced ovarian response to hormonal signals, altered development of the embryo, defective uterine response to hormones, alterations in the function and production of hormones by the pituitary gland, recurrent miscarriage, decreased estrogen response to fertility drug treatments, and premature births!

Given this knowledge of the enormous effects which BPA (and likely many other endocrine disrupting chemicals) have and their potential role in the development of PCOS, what is one to do?

  1. Avoid plastic like the plague! Don’t store food in it, use plastic utensils, or microwave in it. Remember that the chemicals are most likely to leach out and into the food when the food is warm, so if you must use plastic, only use it with cold food. Try not to touch receipts, don’t buy food from cans, and place water in glass or stainless steel containers as much as possible!
  2. Get your BPA levels checked. There are labs which do BPA testing.
  3. Eat a high fiber diet, low in protein and with moderate amounts of healthy fats. 
  4. Keep stress controlled.
  5. Use supplements advocated by myself and PCOS Diva to control inflammation and assist proper metabolic functioning.
  6. Consider supplementation with bio-identical hormones. 

Though we cannot change your in-utero and childhood exposures to BPA and other endocrine disruptors, there is so much we can do to ameliorate the damage which they did and continue to inflict.

Stay optimistic and true to your cause to stay on the path towards optimal wellness!

Feel free to contact me at my office website for further information on bio-identical hormones and how to get your BPA level tested.

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

PCOS: How to Manage Chronic Inflammation

PCOS and it’s Smoldering Driver: Chronic inflammation

PCOS is the most common endocrine dysfunction of women, now affecting, in varying degrees, up to 20% of all women across the world! There is now no area of the globe in which women are not impacted by this condition. It is widely recognized that women affected by PCOS have many medical troubles….obesity with weight loss resistance, pre-diabetes and diabetes, increased risk for strokes and heart attacks, menstrual dysfunctions, infertility, pregnancy complications, recalcitrant cystic acne and excessive facial hair, sleep problems, irritable bowel syndrome, arthritis, mood swings, and thyroid problems.

There is a powerful piece of foundational understanding of PCOS, which is often neglected, and that is the essential fact that inflammation is the driver of ALL of these problems!! Amazingly, the majority of scientific and medical researchers in this field remain unaware of this powerful connection, yet the recognition of the relationship between PCOS and inflammation is critical to the proper approach to managing and treating it! It goes beyond the scope of this article to explain the entire array of factors underlying the chronic and unremitting inflammation present in all PCOS women, including the 20% who are lean, but I want you to understand the very basics of this issue and why it is so critical that YOUR level of inflammation get measured, monitored, and as best it can be…..remediated!

So here is a brief overview of inflammation and PCOS….. Women with PCOS live in a chronic state of physical stress (and often emotional stress) with an up-regulated adrenal system, giving rise to elevated levels of the hormone cortisol. Chronic over-production of cortisol results in a lowered level of metabolic activity, with reduced thyroid functioning, elevated levels of blood glucose, and intestinal abnormalities.

This creates a state of inflammation in the intestines and insulin resistance throughout the body. This chronic, low level intestinal inflammation damages the intestinal lining, impairing the function of a critical barrier, a barrier designed to prevent transport of toxins and bacteria across the intestinal wall. When this barrier no longer functions properly, the result is “leaky gut.” Intestinal contents actually cross into the body proper, inappropriately stimulating the immune system….inciting inflammation!!

As well, women with PCOS have adipose tissues (fat) which function abnormally, with low production of a hormone made by fat tissue called Adiponectin. Adiponectin is a very anti-inflammatory hormone which promotes fat burning and the transport of glucose across cell membranes. When the levels of Adiponectin are too low, insulin resistance grows and the body cannot burn fat properly!

The combined effects of low Adiponectin and elevated cortisol levels, result in abnormal fat accumulation and distribution, and high levels of circulating glucose. This then leads to a “snow ball” effect.  High blood sugar induces more inflammation; excessive fat tissue elevates levels of inflammation; low Adiponectin further increases inflammation; leaky gut augments inflammation, and high cortisol levels perpetually fuel the fires of PCOS inflammation…..So what is the sum result of all of this? This results in the perfect storm of inflammation producing factors!

These factors create a persistent and constant up regulation of macrophages-the white blood cells of the body which produce what are called inflammatory cytokines-chemical messengers of the body designed to enable us to fight and fend off invaders, like bacteria. But in women with PCOS, this defensive mechanism is being activated inappropriately and persistently…with the potential for dire results. Inflammation is now universally recognized as a factor contributing to the development of cancers, dementia, cardiovascular disease, depression, arthritis, tendinitis, autoimmune disease, and more!!!  Unattended, PCOS women all have a lifetime elevated risk of all of those outcomes.

Now comes the good news! Although all PCOS women are impacted, we can dramatically lower this state of chronic inflammation, promote weight loss, reduce insulin resistance, improve acne and facial hair, as well as improve the large array of additional maladies suffered by PCOS women around the world! The journey to health begins by measuring your personal level of inflammation, evaluating your initial inflammatory state and monitoring its subsequent improvement following the institution of appropriate therapies.

To provide my patients with the ultimate in excellent healthcare, I utilize the premier, specialty cardiovascular laboratory in the U.S., Cleveland HeartLab. By utilizing their unique panel of inflammatory biomarkers, in addition to other cardiovascular and hormone tests, the progress towards restitution of health can be measured and monitored.

If you would like to learn more about the special inflammatory lab panel I utilize and how you can get these tests drawn on yourself, no matter where you live, please email me at My team will contact you, so you can get your needs met! To learn more, please access an excellent educational website at You can view, at no charge, a webcast I did last month. It’s entitled, “Tame the Flames of PCOS: A Unique Integrative Approach.”

As you all know from working with this wonderful resource, PCOS Diva, there is much that you can do! With lifestyle changes, adequate sleep, exercise, stress reduction, proper nutrition, reduced toxin exposures, and select nutraceuticals, although the flames of PCOS may not be completely quenched, they can be very well controlled to such a degree that you really can live the life you deserve!

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

Can a Hysterectomy Cure your PCOS?

As an integrative gynecologist, I talk to and care for women seeking a second opinion on a variety of medical issues. One of the most common questions I’m asked is “Will a Hysterectomy Cure My PCOS?”

Even the organization which “governs” my specialty, the American College of OB/GYN, has acknowledged that about 70% of hysterectomies are not indicated, and it is documented that approximately 45% of hysterectomies performed on premenopausal women do not have pathology findings which match the preoperative diagnosis. As bad as that all sounds, I’d like to share additional concerns.

Some gynecologists are recommending to women with PCOS that they have a hysterectomy to treat their condition. In some cases, the recommendation includes removing both ovaries as well. And these recommendations are to remove organs which do not contain cancerous or precancerous cells.

First and foremost, many gynecologists have little to no foundational knowledge of PCOS. If your physician is one of them, I highly and emphatically urge women to become armed with the facts to protect themselves from medically induced harm.

PCOS is fundamentally a problem of intra-body hormonal communication, not of structural or anatomic issues. The development of multiple tiny cysts on the ovaries, giving the condition its name, is a consequence of the hormonal dysfunction, not the cause. The remedies can involve major lifestyle changes, detoxification, various nutraceuticals, pharmaceuticals, and possibly hormones. Unless the unfortunate development of cancer occurs or advanced endometriosis or problematic fibroids develop, surgery is not indicated.

Removing the uterus has potential consequences in premenopausal women. Such surgery has a small association with increased incontinence and some women feel it changes their sexual responses, but the biggest issue is that it can accelerate the onset of menopause by reducing the blood supply to the ovaries. And of course, pregnancy is no longer a possibility.

Removing the ovaries is horrific for women with PCOS, from a metabolic perspective. Estrogen is essential to the proper metabolic functioning of the female body and women with PCOS have dysfunctional estrogen receptors and need the estrogen produced by their ovaries. With lower levels of estrogen, disorders such as hypertension and diabetes escalate in frequency, and obesity can worsen! For some women, there is a benefit of reduced levels of testosterone and improved acne, but for others it does nothing for their skin as their acne stems primarily from the high levels of DHEA and the pervasive systemic (body-wide) inflammation.

Many women with PCOS have menstrual dysfunctions-heavy periods, cramps, and irregularity. In virtually all women, these symptoms can be greatly reduced through the utilization of the treatment modalities mentioned above. Therefore, it would be the rare woman who should resort to surgery as a treatment for PCOS.

If surgery is suggested to you as the treatment of choice, please get another opinion. And of course, as a practicing integrative gynecologist, this is an essential part of my job. I’m here for women; to listen to them, care for them, particularly when it comes to a misunderstood, often times misdiagnosed and poorly treated PCOS.

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

PCOS: How to Reduce Your Symptoms and Inflammation

If you have polycystic ovarian syndrome (PCOS), you have chronic body-wide inflammation.

Recently, Dr. Felice Gersh, M.D., a leading expert on the subject share her views on this topic.  Dr. Gersh is one of the top integrative gynecologists in the United States and an expert in the field of PCOS.  Her philosophy involves looking at a patient’s whole being in order to help them achieve optimal health.  She believes that doctors don’t heal people; they merely help patients resource their own healing abilities and find the right balance in their bodies, ideally through the right mix of exercise, nutrition and lifestyle.  In our recent interview, she delivered cutting edge information about PCOS and its causes as well as practical advice on how to begin healing.

Listen and you will learn:

  • How gut inflammation is the root of many of your toughest PCOS symptoms
  • The 5 steps you need to take today to reduce inflammation
  • How to protect your children from PCOS starting even before birth
  • Whether a hysterectomy will cure your PCOS
  • How to monitor your inflammation levels

*This is a repost of a guest post Dr. Gersh orginally posted on PCOS Diva at:

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