Guest: Dr. Rebecca Harwin
Guest Bio: Dr. Rebecca Harwin is an international author and PCOS expert, and an experienced clinician.
Health Professional Radio
Katherine: Thank you for listening to Health Professional Radio. Today we have international author and polycystic ovary syndrome expert Rebecca Harwin. Welcome to our show, Rebecca!
Rebecca Harwin: Thank you for having me!
Katherine: Now, today we’re talking about PCOS, which is polycystic ovary syndrome for short. Can you tell us exactly what that is?
Rebecca: Yeah. It’s a really common hormonal condition and it affects – the stats vary – but at least 11 percent of women, across the board, of reproductive age. To be diagnosed with polycystic ovary syndrome, you need to fit two or three out of the criteria. They are absent or irregular periods. So women with PCOS don’t have any periods sometimes or at other times they might have less than eight a year.
They also have high levels of testosterone, or what we think of as male hormone. They also may have polycystic ovaries on ultrasound, although, as weird as it sounds, that’s not actually a necessity for the diagnosis.
Katherine: Oh, okay. You mentioned it’s child-bearing age, potential of as early as early teens, is that correct?
Rebecca: Yeah, absolutely. I was diagnosed when I was 17, but I have heard of girls who are diagnosed younger. One of the, I guess, challenges is that when women, or when girls start to actually have a cycle, they can have symptoms pretty early on that they’re having trouble with ovulating. We often say, “Oh, it’s just beginning. That’s just the start. It’s just normal.” But they can be signs that they are likely to develop this condition.
So ages 14 and upwards are possible. Then, women sometimes only discover that they have it when they’re trying to have babies. So they might be in their 30s. It’s pretty well known that women can suffer it up to menopause and then even afterwards because of some of the underlying drivers of the condition, like insulin resistance.
Katherine: I see. Okay. You mentioned, and the statistics are, they do vary, but about 11 percent of women have PCOS?
Rebecca: Yeah. In the indigenous community it’s actually more than 20 percent.
Katherine: Okay. About 89 percent of women with PCOS need to see more than one health professional before they’re diagnosed. Why is it so hard to diagnose?
Rebecca: It’s actually really not. It’s just that the condition is not well understood in the mainstream health profession yet. There’s still so much – I don’t want the word ignorance – but just lack of general knowledge. But once you know what you’re looking for, like my husband now can walk down the street and say, “Oh, I think she’s got PCOS.” And [laughter] he’s probably right. It’s just that we’re not trained to know what to look for.
Unless you see someone who specialises in this condition, it can be really difficult because there can be other reasons for infertility or there can be other reasons for weight gain.
Katherine: Right. Like you mentioned that your husband, that [laughter] he can spot someone, there are some tell-tale signs, aren’t there, that someone has PCOS? For example, the acne and maybe excessive hair? Can you tell us a bit about some of the symptoms?
Rebecca: Yeah. In 60 to 80 percent of women with acne, they will have PCOS. The stats are about the same for excessive hair growth. So they’re two massive indicators. If a woman comes into clinic and she has acne and/or excessive hair growth, then there’s more than 50 percent chance that she will have PCOS. Those indicators alone can be enough to start clinically thinking that it might be an idea to look into this further.
Katherine: Right. So some of the listeners out there that might suspect they have this or their family and friends, what process do they go through? What are the tests that are done to confirm this condition?
Rebecca: Yeah. The first thing is to go in armed with information about what you need to ask from your health professional, because they might not know much about PCOS. So if you can help guide them or ask for what you need, that’s really important. If you have no period, then there’s tests that they can do to look at your hormonal levels. You also need to be tested for testosterone.
When you’re looking at male hormone levels, you want to look at the actual male hormone levels. So you want your testosterone levels checked, but you also need to have something called sex hormone binding globule tested, because that’s the protein in your body that grabs the free testosterone and basically give it a big hug so that it can’t actually work anymore.
So if you have what’s considered normal testosterone but you have low levels of sex hormone binding globule, then that testosterone in your body can still be active. So that’s important to have checked as well. The other test that they do is an ultrasound of your ovaries to see if you have basically what they call cysts on your ovaries. Then you need two or three out of those positive to be technically given the diagnosis of polycystic ovary syndrome.
The trouble is that there’re other tests that are critical that are often not done. When you have PCOS, you’re very, very likely to have insulin resistance, and this is the main driver for nearly all of the symptoms and signs of PCOS. So rather than just having a fasting glucose test, which shows up how much sugar is in your blood, you really need to have a two-hour glucose tolerance test with insulin levels, because sugar in your blood is really dangerous.
It’s sticky, it can cause lots of health problems. So your body produces a hormone called insulin to try and grab that sugar and take it out and put it in the cell where it’s safe. So your body will keep increasing your levels of insulin to make that happen. You can actually have a normal glucose test but trouble with your insulin. So when you go to your doctor, ask to have a two-hour glucose tolerance test with insulin levels at fasting, 30 minutes, 60 minutes, and an hour-20, and make sure it’s done in a lab that actually spins or centrifuges the blood immediately [07:08 inaudible] you get accurate results.
The other test I really believe everyone with PCOS should have is a full-panel thyroid test, because thyroid hormone helps produce something called follicle stimulating hormone, and that’s actually the thing that helps get those eggs matured and out of your ovary. So those little cysts in your ovaries are actually just immature follicles. So knowing what your thyroid is doing is really important as well.
Katherine: I see. Lots of good advice there, Rebecca. Thanks for that. I wanted to touch on something that you mentioned, that women who suspect that they might have this and need to see a doctor, you said that they might need to come armed with information themselves and maybe, like you said, the doctor does not specialise in this. So therefore, women might have to request certain tests.
I was reading that 66 percent of women are not given adequate information about their condition at the time of their diagnosis. So maybe they’re forced to turn to other avenues such as maybe searching online for answers. Yeah?
Rebecca: Yeah. The thing that worries me, I mean there’s great information on the internet and it’s such a valuable way to arm yourself. However, there’s a lot of also misinformation on the internet, so you don’t really know what you’ll find. The trouble is if you’re, first, a lone practitioner, as often is the case and it’s fine if you’re a GP – the GP has to know so much information about so many different things, and they just can’t specialise in everything. There is not enough time in one lifetime.
So by you knowing something about what you possibly suspect, you can help get that direction faster, because diagnosis of any condition can be really, really tricky. So if the doctor can work with you to get to the quickest, best conclusion, that’s the best outcome that you can have. I think we need to know that we’re part of the process. We can’t offload blame or responsibility to other people. We need to be actively involved in our health and our care.
Katherine: Yeah. Well said, well said. You mentioned a bit earlier that you have some personal experience with this and perhaps that [laughter] actually led to your now career.
Rebecca: Definitely. [laughter]
Katherine: And actually, you’ve written a book about PCOS. Can you tell us about “Conquer your PCOS Naturally?”
Rebecca: Yeah. I was diagnosed, like I said, when I was 17, and especially back then – I’m 38 now – there was just no information out there. So for 15 years I didn’t have a natural period at all. I had terrible acne, excessive and really embarrassing hair growth. I obviously didn’t ovulate. I had mood swings and cravings and I also weighed about 95 kilos, and I now weigh about 69, and losing weight was just impossible. So I came to the conclusion that it was up to me to discover how to fix me.
I’ve spent 8 years studying health at [10:43 indecipherable] postgrad, a lot of further studies, research, seminars. I started to work out what worked and what the research shows were the best steps to take. When I implemented them myself and with my patients, the changes were remarkable. To take women from being infertile for years to having happy, healthy babies is very, very powerful.
To help women that have struggled their whole life to lose weight, to lose weight and keep it off permanently makes a massive difference to their quality of life, to their lifespan, to everything. So my personal experience was what started my journey and the changes I’ve seen in myself and my patients have just continued that journey because it’s pretty amazing.
My book came from a feeling of responsibility that I had this information. I knew it wasn’t available out in the big wide world, and I knew that women needed this information. So after I got married, I’m kind of a goal-oriented kind of girl, I thought, “Okay, what comes next?” So I dedicated the next two-and-a-half years to researching and writing my book. Then I think it was last June it came out, it’s available in bookstores around Australia. To make it really affordable, we also are launching, on Saturday, the book on Kindle. So it’ll really be less than four dollars.
Katherine: Well, for listeners that would like to know more, we can go to conqueryourpcosnaturally.com.
Rebecca: Yeah. There’s a lot of information there.
Katherine: Thank you so much for the time spent, Rebecca.
Rebecca: It’s my pleasure, thank you for having me.