By: Carrie Jones, ND, MPH
Sarah* was a 38-year-old married mother of 2 in a Ph.D. program in Portland, Oregon. In the past 6 months she noticed her menstrual cycles were becoming more irregular and actually skipped 2 entire periods. She had gained some weight despite no changes to her dietary or exercise plan and was experiencing more acne along the jawline with some annoying dark chin hairs.
She decided to see her primary care physician who heard her case, diagnosed her with PCOS and immediately suggested the birth control pill. Sarah was hesitant as she had never had problems with her cycle before and was not sure the diagnosis fit her. She sought out additional testing and a 2nd opinion.
It is important to understand that androgens, like testosterone, can be made in the ovaries, in the adrenal glands and in the fat tissue. This means testing is very important to have a clearer understanding of which gland (or glands) are causing symptoms and should be addressed.
In Sarah’s case, her blood sugar and insulin levels were normal. Her Dried Urine Test for Comprehensive Hormones (DUTCH) testing showed low progesterone and elevated estrogen. This means she did not ovulate and therefore did not produce any progesterone rendering her estrogens out of balance. High estrogen can cause symptoms such as weight gain, acne, mood swings, heavy periods, breast tenderness, and water retention.
In addition, her testosterone was elevated and she was going down the pathway that encourages unwanted hair growth and more acne known as the ‘alpha’ or ‘androgenic’ pathway.
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Lastly, her adrenal results showed elevated levels of both cortisol production (cortisol metabolites) and what was free floating around her body (free cortisol). This increase in adrenal output suggests that it was also a reason her testosterone was so elevated as about 25% of testosterone is made in the adrenals in women.
While she fit the Rotterdam criteria, her history and her DUTCH test suggested that the high stress in her life may be causing an increase in output from her adrenals and a decrease in ovulation resulting in symptoms. In this case, her adrenal health was primarily addressed followed secondarily by ovulation support and trying to slow testosterone from going down the ‘alpha’ pathway.
After 3 months, her menstrual cycles resumed normally, her acne and facial hair improved and she was feeling a great deal improved.
Having the most comprehensive, easy to collect testing available allows for a deeper level of understanding in a complicated case in order to determine appropriate treatment and lifestyle changes. The DUTCH test evaluates markers such as metabolized cortisol along with the free cortisol and the alpha pathway of testosterone not available in blood or salivary tests. In Sarah’s case, her symptoms were a result of an overworking hypothalamus-pituitary-adrenal (HPA) axis coupled with an upregulated ‘alpha’ pathway. By addressing the cause, she felt markedly improved and avoided the birth control pill.
>> Watch the Webinar: “Hormone Testing Strategies for Weight Loss, Acne, Facial Hair, Hair Loss, Energy, Menstrual Regularity & More” – Click Here
*names have been changed for privacy