-
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!
-
13 Replies
-
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.
-
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.
-
@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.
-
Of course, here is the report:
-
-
-
and the Free T3
-
@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.
-
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.
-
-
Hello,
Here are the latest tests, pls let me know your thoughts :
-
@Hasnaa Thanks for sharing the updated tests. Here are my observations, and I have a few questions:
-Vitamin B12 is suboptimal low. Does she consume enough animal protein? If not, please encourage her to start adding more animal sources with each meal following my VPF principal.
-Fasting glucose and fasting insulin seem optimal, but we don’t have HbA1C as part of the full picture.
-Serum Zinc is clinically high. This usually happens if someone is supplementing with zinc before taking the test (think multi-vitamins, protein powders, immune supportive formulas, etc) or if they consumed a zinc-rich meal the day before testing. Was that the case in this situation? And as I shared with you before, serum zinc is highly influenced by what a person consumes the day or so before, whereas RBC zinc shows what’s happening inside the cell over 2-3 months.
-Serum Copper is clinically low. This can drive down white blood cells and therefore weaken immunity, and also drive anemia because we need copper to absorb iron! And zinc and copper are antagonists. Too much zinc can deplete copper and vice versa. Since Covid, I have actually seen this dynamic because everyone was supplementing with high dose zinc blindly for months on end, and unknowingly depleting their copper levels. Can you shed light on what you think is leading to high zinc and low copper? Was she supplementing with zinc?
-Ferritin is suboptimal low! Again, likely due to low copper leading to poor iron absorption and storage. This will absolutely affect thyroid conversion, and should be addressed. Figuring out why her copper is low and zinc high will offer clues so please let me know what your thoughts are about these dynamics.
Vitamin A and selenium were not measured, but should also be considered.
-
Not at all, she hasn’t been supplementing in zinc or anything of that kind for years. So it is shocking to see the very high amount of zinc. so the three minerals and nutrients are connected in the abnormal levels. What is the reason, I don’t know, and we are investigating now
-
@Hasnaa please keep in mind that these are serum values. This means it’s highly influenced by what she consumed the day or so before testing. If she had a steak dinner for example or a lot of pumpkin seeds for example, her zinc might show up as clinically high. That’s why I prefer RBC zinc and copper testing as it shows cellular status over 2-3 months rather than what’s in the blood at the time of testing.
So if it doesn’t make sense, it might be worth retesting with RBC values. If the doctor won’t order it, it’s possible to order through Valeo Health and self-pay for the tests you need. Our members get a discount to their services. You can find more info here.
-
Hello. We have been to an endocrinologist and Aylin did more blood tests. Here are the results. We have an appointment with a gynecologist that has been referred by the previous doctor next week for more follow ups. Furthermore, my daughter has done more blood tests with another gastro doctor and the breathing tests. We have yet to receive the results. For now these are the hormone and cortisol blood results:
-
Hi @Hasnaa – the picture is beginning to get a bit clearer. Her cortisol (stress hormone) is clinically high. Cortisol is the master hormone over thyroid. High cortisol can contribute to hypothyroid function, and as I explained in a previous reply, that can lead to irregular periods and amenorrhea. I explain the different ways high cortisol affects thyroid function in this video from our Adrenal Balance course.
Also, chronic stress/high cortisol is also a contributing factor for PCOS as you can see from the Symptom Dictionary handout I shared with you initially here. Therefore addressing the “stress” is key. This can be mental/emotional stress, physical stress (lack of sleep, low calorie diet, over-exercising, etc), or physiological stress (parasites, toxins, high blood sugar (which we ruled out), chronic simmering infections like viruses or bacteria). From the previous results you shared, I do suspect parasites might be at play. A parasite cleanse might be warranted.
From your assessment, do you suspect her stress is physical or mental/emotional and may warrant outside professional support? Or do you suspect it could be physiologically (internal) induced stress?
We also know from previous labs you uploaded that she’s lacking key nutrients to make thyroid hormones and convert them into the active form. We know she’s suboptimal in B12 and iron, and clinically low in copper. These are all critical for thyroid conversion.
Since we also need vitamin A and selenium for thyroid conversion and we haven’t measured these, increasing foods rich in these nutrients is a good proactive approach. Another option is supplementation such as a thyroid combo formula that combines all of the nutrients needed such as Pure Encapsulations Thyroid Support Complex (many other brands available). This one doesn’t contain iron and copper however so that would be needed separately through food and/or supplementation.
And going back to basics, is she consuming enough protein and iodine to make thyroid hormones in the first place?
Given the low RBC, suboptimal B12, and lower ALT liver enzyme, a methylated B Complex such as Thorne’s Basic B Complex may help the possible anemia and liver detox support. To ensure there is good bile flow, taking D-Limonene for 30-60 days (1000mg, taken 1-2 x per day, 3/4 way through a meal), can help improve detoxification.
-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.
In Summary, Here’s the Order of Action Steps:
-Increase hydration (previous tests showed pattern of dehydration)
-Increase animal proteins with each meal (follow my VPF principle). This will help thyroid, iron & B vitamins.
-Increase thyroid nutrients through food or supplements (see previous reply with links to both)
-Prioritize reducing mental/emotional and physical stress (if any). Read this handout.
-Boost copper through supplementation for 60 days, then retest copper and iron panel to see if there’s improvement
-Consider D-limonene to clear up possible biliary tract congestion for 30-60 days to improve bile flow, then after 30 days, consider adding a B Complex supplement for 3 months.
-Once bile flow and liver detox are well supported, consider doing a parasite cleanse (a likely physiological stress)
Hope the above gives you a clearer direction on where to begin taking action.
-
-
-
-
-
Log in to reply.
