Polycystic ovary syndrome (PCOS) and hypothyroidism are two common conditions of the hormonal (or endocrine) system that often occur in women in their reproductive years. Because of the overlap and similarities between their symptoms, it’s easy to be misdiagnosed and as a result receive improper or incomplete treatment.
It is also very much possible for both of these conditions to coexist. A study published in the Journal of Clinical Endocrinology and Metabolism found that 34.4% of women with PCOS also had thyroid dysfunction.
However what I’ve been noticing is that often women get diagnosed with PCOS without doctors checking these patient’s thyroid function.
Hypothyroidism and PCOS share several symptoms, including menstrual irregularities, weight gain, and hyperandrogenism or elevated androgen levels (think acne, excess facial and body hair, thinning of scalp hair, infertility and more).
Your thyroid gland plays a crucial role in regulating your metabolism, reproduction, and emotional well-being. And thyroid dysfunction, in this case hypothyroidism, can disrupt these functions, leading to symptoms similar to those experienced by women with PCOS. We now understand that thyroid disorders, even if subclinical, may contribute to the development of PCOS or at the least exacerbate their symptoms.
What can be helpful in distinguishing between these two conditions?
It is not just one lab test, rather a combination of a thorough understanding of your health history and timeline of your symptoms, lab tests and imaging studies.
Just running your TSH is *not* enough to diagnose a thyroid condition or to rule out a potential thyroid dysfunction. TSH (or thyroid stimulating hormone) is a hormone produced by your brain and it’s in charge of communicating to your thyroid gland to produce thyroid hormone. So, in addition to TSH, it’s crucial to run your actual thyroid hormones T3 and T4 (in their free form) as well as a couple of the common antibodies (Thyroid peroxidase and thyroglobulin antibodies). These antibodies can help you rule out a potential autoimmune thyroid disorder such as Hashimoto’s Thyroiditis.
Something else worth keeping in mind is that although the presence of polycystic ovaries on ultrasound is a characteristic feature of PCOS, you do not have to have polycystic ovaries to have PCOS.
Lastly, there are several other conditions, besides hypothyroidism, that can mimic PCOS symptoms such as non-classical congenital adrenal hyperplasia (NCCAH), hyperprolactinemia, androgen secreting tumors, Cushing’s syndrome and more. So if you suspect that you’re dealing with PCOS-type symptoms, it’s important to work with a doctor who is going to properly investigate the root cause(s) of your symptoms and address them holistically.
Even after years of practicing medicine, I’m still amazed at the fact that most doctors (conventional and otherwise) don’t ever bother asking their patients what medications they’re on – over the counter or prescribed. What’s worse is these doctors then blindly prescribe even more medications to their patients, possibly doing more harm than good. So, today let’s focus on this topic because, for some of you, your medications may be the reason behind your mysterious or seemingly random symptoms.
I repeat…your health symptoms may be the side effect of the medication(s) you’re on!
Not all side effects show up the day after you start taking your meds. Meaning, especially for medications that you’re supposed to be on long term, the symptoms can come about insidiously. It could take weeks or months for you to start experiencing and noticing these side effects.
And sometimes it’s the increase in the dose of the medication you’ve been taking for a while that can cause problems.
Now you may be familiar with a couple of these side effects that are more common such as weight gain and gut irritation but I also want to shed light on some other less talked about symptoms.
By the way, medications that cause gut issues (mainly acid reflux) are unfortunately paired with a PPI, which is an awful medication that we can get into in another article.
Here is a non-exhaustive list of medication side effects
And why is knowing this important?
Because you may be experiencing one or more of these symptoms and not know why. And, more often than not, when you share this with your doctor instead of getting to the bottom of why you're experiencing these symptoms, they’ll just put you on more meds to treat these “new symptoms”. And these will in turn give you other side-effects and the vicious cycle continues.
And yes, your doctor is responsible for educating you about all the potential side effects of the medications that they prescribe to you (including the rare ones) but they don’t! They don’t even give you the tools to be able to educate yourself!! Meaning they do *not* practice informed consent. And, to top that off, in most cases you, the patient, are placed on these medications indefinitely, with no expiration date in sight.
So, does this mean that you’re powerless and a victim? Absolutely not!
One of the many things that you can do is to learn to advocate for yourself and ask important questions and pair that with your own research.
Some good questions to ask your doctor when they’re about to prescribe meds for you are:
All of this requires that you work with a doctor who is just as eager as you to understand and address the root cause of your health problems. And a doctor who respects and encourages your sense of agency over your health and your body!
One of the intentions behind these articles is to occasionally bust some myths and this week we’re going to do just that. With bone broth being marketed as THE magic bullet solving all of our health and beauty problems, I’m going to burst that bubble just a little and bring us back down to earth.
Don’t get me wrong, bone broth can absolutely be healing. It’s nutrient-dense and has amazing gut healing properties. But as with most things in life, context matters and balance is key…
Today, I want to focus on bone broth protein powder specifically because I see so many of my patients taking it as a supplemental form of protein. Many of these same patients also struggle with chronic gut issues such as bloating as well as other symptoms like headaches, skin issues, anxiety and/or brain fog.
Now, you may say that this sounds like me, but my GI symptoms were going on even before taking the bone broth-based protein. And that is very well possible, but something to keep in mind is that even though your gut issues may have not started because of the protein powder, they could be exacerbated by it.
So let’s discuss some of the potential reasons for this…
Histamine sensitivity or histamine intolerance
Bone broth is high in histamine (especially slow cooked bone both) and high levels of histamine can cause bloating due to increasing gut permeability (leaky gut) and triggering inflammatory responses (gut inflammation).
Please note that histamine intolerance and histamine sensitivity are not quite the same.
Histamine intolerance refers to a metabolic imbalance where the body can’t break down histamine efficiently, usually due to low levels or impaired activity of, mainly, an enzyme called DAO (diamine oxidase).
Histamine sensitivity is a reactive or heightened response to histamine, even if histamine breakdown pathways are functioning. Think of this as more of your immune or nervous system being on edge.
Impaired digestion
Bone broth contains one of the highest sources of gelatin and gelatin can be hard to digest, especially if you have low stomach acid or digestive enzymes.
This undigested protein can ferment in the gut causing or exacerbating gas and bloating.
There is also a histamine connection here. High histamine levels may further impair secretion of stomach acid and pancreatic enzymes which again can lead to or exacerbate gas and bloating.
Too much glycine
Bone broth is also a rich source of glycine which is an amazing amino acid and neurotransmitter known for its calming effects. Glycine also supports collagen production. However, what we’re understanding is that glycine can have a biphasic or paradoxical effect where too much of it in some individuals can lead to excitatory symptoms such as loose bowels, bloating and GI discomfort.
Again please note that some of these factors can become problematic when we’re consuming large amounts of these nutrients such as found in powders or concentrates, on a daily basis.
So what is a better alternative?? Of course I much rather you eat actual food! I’m talking about red meat from a clean grassfed source. But if you’re looking to supplement what you’re already eating, grassfed beef protein powder can be a great option. Please be aware of artificial flavorings and sweeteners. You can always purchase a clean unflavored product and make it delicious by adding organic berries, cacao nibs, etc.
As always, my goal here is NOT to create fear or to demonize a nutrient-rich food like bone broth. But more so to educate you and encourage you to find your balance with these foods.