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PCOS / +
I would like some insight and practical actions/ tips on my daughter’s case. We’ve been to multiple doctors, (dermatologists, then gynecologists and gastrologists) but to no avail, and with no serious consideration or measures taken. Here is her history and symptoms:
It started with her going on acutane to treat her acne in autumn of 2023. The medication lasted not even a full four months which is the minimum amount, as her acne had cleared up, and she noticed the irregularity of her menses. We spoke to the dermatologist, got off of acutane and assumed the cycle would become regular again. It didn’t.
A few months passed, with the busy-ness of school and life. Around that time, she noticed that one night after breaking her fast (she was fasting that day) she felt quite congested and particularly unwell, as if the food hadn’t been digested properly, with bouts of burping – something very unusual as she didn’t have any history with that. Her immediate thought was the fruit she has eaten was perhaps contaminated or had something, and she had eaten quite quickly as we were short on time. She thought it would pass, but this kept on going for weeks.
We went to get some testing done at a gastrologist ‘H. pylori’ the test came out negative (gray zone) with the only advice from the doctor to “breathe through her burps” and unease, as the source was just pent up air stuck in the stomach area. She felt unconvinced but we took that advice.
At the same time, she went to a gynecologist, and got diagnosed with PCOS, which was at the root of the now complete absence of menses. The only symptoms of PCOS would be irregular cycles, fatigue, acne (though that was gone after acutane).
The doctor prescribed her Duphaston twice daily for five days, and afterwards her menses came but only one cycle. It was meant to help “trigger” it in a way, but that didn’t occur. This was a bit before summer break. During the break, she got her menses one more time after taking Duphaston again, and then one last time during September. It has been since then (now in February) .She and I both think that there is another solution to her irregularity and imbalance, without taking pills.
Perhaps nutrition also plays in regular feminine cycles.Thank you!
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7 Replies
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Hi @Hasnaa – I’m glad you’re both asking questions and wanting to get to the root of the problem.
There’s no coincidence that her hormones were affected after taking Accutane. Isotretinoin (the generic name for Accutane) reduces the production of sebum or the amount of oils made in certain glands which often leads to dry skin (that’s the common side effect).
Because of this loss of lubrication and loss of barrier function, a person becomes more prone to hair loss from degradation of the hair follicle, and all kinds of skin abnormalities like fungal infections.
And since Accutane causes dryness in general, it also wreaks tremendous havoc on all mucous membranes which can affect the mouth, lips, nasal cavities, gut lining, urinary tract or bladder potentially leading to irritable bladder dynamic that can lead to urinary urgency/frequency, and increasing permeability of the skin, gut, blood brain barrier (so there can also be neurological side effects).
It can also lead to liver and kidney damage.
And it can also suppress the brain’s trigger to our glands to produce hormones (specifically in the brain), including cortisol and sex hormones. And the effect can last a long time even after a person stops the drug.
That’s why I seriously hate this drug, because these risks are rarely discussed between patients and physicians.
Nonetheless, there are always ways to offer support from the side effects of Accutane:
Since Accutane causes mucosal erosion and leads to loss of barrier function, including “leaky gut” and malabsorption, supporting mucosal membranes and providing gut healing nutrients can be helpful during and way after treatment:
- Encourage lots of phytonutrients in fruits/veggies to help restore mucous membranes
- Add in oleic acid like extra virgin olive oil
- Healthy fats like omega-3 and phosphatidyl choline for cell membrane integrity
- 1 gram of fish oil taken at the same time of the medication twice a day was shown to make a big difference in terms of dryness. It can also help with joint pain. PMID: 30002675
- Ginger & turmeric as shots, teas, supplements to help reduce oxidative stress and inflammation.
- Liver supportive foods like cruciferous vegetables for example. And in supplement form, milk thistle, artichoke and curcumin can all be beneficial.
- To support liver detox, a supplement that includes both B vitamins and amino acids to help make glutathione can be helpful. Avoid supplements containing vitamin A during treatment!
- For kidney support and detox, hydration is key! Water and herbal teas. Parsley is also helpful for kidney health.
Now with regards to PCOS, it would be a good idea to start investigating possible root causes of that dynamic. Please read the Symptom Dictionary handout on PCOS which sheds light on the most common causes so you can start to dig deeper and get proper testing for her. This handout also includes initial action steps to take with regards to dietary and lifestyle changes to make.
Here are suggested tests to consider getting done:
-Blood sugar (fasting glucose, fasting insulin, HbA1C)
-Sex hormone panel (Estradiol, progesterone, FSH, LH, Testosterone, DHEA, SHBG, prolactin)
-Cortisol (24-hour collection if possible). My preference is the DUTCH test which includes both sex hormones and cortisol in urine, but this is expensive (~$500 USD) and takes about 4-6 weeks for results.
-Full thyroid hormone (TSH, Free T3, Free T4, anti-TPO, anti-TG, Reverse T3)
-CBC with differentials & CMP (complete metabolic profile) which you can find listed out in this handout HERE on p.5.
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Hello,
Thank you for this advice, she is very careful with her nutrition, always has been.
My daughter has ended her Accutane treatment a year ago already. We want to get her menstrual cycle back on track, that is the main goal. She’s done already some fasted testing like blood cells count, thyroid and sex hormones, with mostly all indicators being normal. Here are the doctors comments on the test results:
Explanation of the reports.
The full blood count and CRP (inflammation marker) are both normal indicating no infective process.
there is a slightly low red cell count, I would recommend a dedicated iron test.
The thyroid profile is showing normal TSH and T4, slightly low T3 only.
The testosterone and progesterone levels are normal.
Liver test is showing new high bilirubin, but normal liver enzymes ALT/AST.
This could be explained by dehydration at the time of the test.
finally the urea level is low. this can be from loss of muscle mass or reduce protein in the diet..
If you wish the document of the test results I can send that too.
Our priority is getting her menses regular again, without the need for prescribed pills and medication, but how is the question, as it doesn’t seem to be adapting naturally in her body.
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@Hasnaa – If the doctor reviewing her results lacks additional training in functional medicine or naturopathy, what is deemed “normal” may not truly reflect what is optimal for her health.
If you’re open to sharing her results with us, we can offer a functional interpretation, which goes beyond the standard reference ranges to provide deeper insights into what her results could indicate.
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Of course, here is the report:
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and the Free T3
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@Hasnaa thank you for sharing. There’s a lot to unpack here but I’ll try to stay as close as possible to her main concern, which is amenorrhea (loss of periods), and how to bring that back.
Based on the results you shared, there is very clear hypothyroid function. When thyroid hormone levels are low, the hypothalamus and pituitary gland, which control ovulation, are disrupted, leading to irregular or absent menstrual cycles.
Despite a normal TSH, her “normal” Free T4 is actually suboptimal. You can see it’s very close to the lower end of the clinical reference range. Ideally, free thyroid values should be in the upper half of the reference range.
To make T4 thyroid hormone, we need iodine and tyrosine. That’s what T4 stands for… 1 tyrosine molecule (an amino acid protein) and 4 iodine molecules. Therefore, if she’s not consuming enough iodine in her diet, it’s helpful to start including food sources such as kelp granules and seaweed snacks for example. If she’s not consuming enough animal protein sources, encourage her to ensure that her meals follow my “VPF” principle, which you can share with her here. If she does consume a lot of animal proteins with every meal, then we have to consider suboptimal stomach acid and maldigestion or malabsorption.
Her Free T3 is actually flagged as clinically low. This is the active thyroid hormone that regulates metabolism and affects reproductive health. We need certain nutrients to convert Free T4 to Free T3 thyroid hormone. For that we need vitamin A, zinc, selenium, and iron. All of these can be tested. If possible, ask for RBC zinc and RBC copper instead of serum measurements.
- Here’s a video with food suggestions from the Thyroid Balance Course
- Here’s a video with supplement suggestions for healthy thyroid function
Given the clinically low RBC, there is a chance of iron deficiency anemia. Was iron ever tested? If not, probably a good idea to run a full iron panel as well, especially that we need iron for thyroid conversion. Low RBC can also be due to a need for folate (B9), B12 or copper. All of these can be tested in blood as well.
Insulin resistance often coexists with hypothyroid function, but these markers weren’t measured. I would also ask for a blood sugar assessment (fasting insulin, fasting glucose, and HbA1C) as a starting point. Insulin resistance is a major root cause in PCOS so it’s important to be checking.
Other things of note:
-There was in fact signs of dehydration (high albumin and protein), so please encourage her to drink more water if she’s not in the habit.
-There are many markers pointing to possible biliary tract congestion/liver dysfunction. The lower ALT can also be due to a need for vitamin B6 since we need B6 to make this liver enzyme. You can watch this Liver/Glallbladder support video to learn more about how to support biliary tract congestion. My favorite supplement is D-Limonene for 30-60 days (1000mg, taken 1-2 x per day, 3/4 way through a meal).
-Her WBC is at the low end of the reference range, so something is taxing her immune system or once again, there is a need for nutrients. Was she sick a week or so before testing? If not, then the pattern of suboptimal high Monocytes (8.2%), Eosinophils (3.7%) and Basophils (1.3%) can indicate parasitic infection and/or some form of allergies/sensitivities/asthma. If she doesn’t have any respiratory conditions, parasites are likely. This in itself can lead to malabsorption and nutrient depletions. If she has well formed, easy to pass, daily bowel movements, it might be worth considering a Parasite Cleanse program.
I realize I’ve shared quite a bit, but this really highlights what I mean when I say that “a lot can be missed” when results are viewed through a conventional lens. I’d appreciate it if you could take some time to watch the videos I’ve shared, and I’ll be here for any clarifying questions you might have.
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Thank you so much, this is very enlightening indeed, and quite different from modern doctor’s advice we’ve had over this last year. We will move with the tests you mentioned and start the Beginner’s Health Roadmap.
I will for sure come to you as soon as we have results, and see if maybe incorporating supplements would help, in addition to improving her diet with more protein sources.
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