The Nutritional Supplement

Woman With IBS, PCOS Seeking Pregnancy:

This 30 year old woman seeks to have a successful pregnancy. She feels that her PCOS and irritable bowel syndrome are preventing her from having a successful pregnancy. She has been trying to become pregnant for the last 3 years. She had one pregnancy 1 year ago which resulted in miscarriage at 10 weeks. 2 years ago, she was diagnosed with PCOS with her history of a menses every 3 months (on average), cystic ovaries by ultrasound, hirsutism and elevated free testosterone (= 8 pg/mL, rr 1-5 pg/mL). 18 months ago, she received 2 cycles of Clomid. She did become pregnant, but this resulted in a miscarriage at 10 weeks. She did not like Clomid and does not want to use this again. For the past year, she has remained on a prenatal multivitamin prescribed by her prior fertility specialist.

Assessment Considerations:

• Diagnosis can be made clinically but serum testosterone, LH, FSH, DHEA-sulfate lab tests will be helpful.
• Rule out other causes of hyperandrogegism, e.g. Cushing’s syndrome, adrenal tumors, etc.
• Once the PCOS diagnosis is established, evaluate lipids, HbA1c, 25-OH vitamin D, and administer Patient Health Questionnaire, the PHQ-9, and the Generalized Anxiety Disorder questionnaire, GAD-7, for mental health assessment.
• Order trans-vaginal ultrasound to ensure enlarged varies are cyclic and not malignant.

Insights, Tips and Perspectives:

• Assess patient’s readiness for change.
• Address underlying depression and/or anxiety, as well as any unresolved issues resulting from miscarriage, e.g. grief.
• Be very clear on the patient’s goals that they set for themselves.

Management Considerations:

• Weight loss is key for overweight PCOS patients - only need 5-10% of total body weight to see benefi
• Low glycemic diet or low-moderate complex carbohydrate diet with moderate calorie restriction. Eat walnuts, almonds, flxseeds, fatty fih, cinnamon, spearmint and green tea.
• Goal of 60 minutes exercise daily.
• Use a form of inositol, consider chromium and fish oil. Add vitex and/or N-acetyl cysteine if trying to get pregnant. Use alpha lipoic acid if she needs liver support.
• Consider berberine, Glycyrrhiza glabra (licorice), Cimicifuga racemosa. (Black cohosh), Tribulus terrestris (Bindii), Paeonia lactiflra (Chinese peony), and Lavendula spp. (lavender) as appropriate

For more information on the client’s health history, see here https://tapintegrative.org/Subscription/Clinical-Discussions/Woman-With-IBS-PCOS-Seeking-Pregnancy