Dr. Heather Huddleston
Appearances
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Well, I mean, I think it's a little bit of a million dollar question. There's a lot of research trying to answer that question. It's also a very heterogeneous disorder. So I don't know if there's one thing that causes it for everybody. But I think we do know that a major underlying factor is the hyperandrogenism that is, you know, that there's elevated androgens starting at puberty.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And that that may then sort of underlie a lot of the phenomena that comes across with women. So one of the things we know is that there's an increase in visceral adiposity or sort of belly fat that happens that we know is more common in general with men. But this is what happened when you have elevated androgens in a woman, especially starting at puberty, they lay down fat in that area.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And that in women causes a lot of inflammation that then can really be a setup for insulin resistance. So there may be sort of a pathway where you see hyperandrogenism then in many people also leading to the insulin resistance.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Then you start to get into a little bit of a vicious cycle because the insulin resistance in and of itself causes some weight gain, but it also can drive androgen production from the ovaries. So starting at puberty, a lot of these people get into a little bit of a vicious cycle. It's very hard if not impossible to get out of.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So it's a debated issue. I think that there's one component maybe that there's just, if you look at some of the enzymes in the ovary and in the adrenal gland, there's just sort of an overactivity of those enzymes in the ovary and in the adrenal glands. So there's some thought that it's just an intrinsic overproduction of androgens.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
There's also, at least in some patients, we think just from the get-go, they have an increased LH secretion from their pituitary. This is a hormone that drives androgen production from the ovary. And so they may be set up by that even sort of in utero to have increased LH secretion.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So we don't really know, but we know that at puberty immediately, these girls will often start to have much higher indrogen levels than their peers. And then that sort of lays the groundwork for a sequence of events to happen.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I think it's hard to know how much they are causative in terms of PCOS. I think it's possible. I certainly think it's definitely possible that they may exacerbate certain elements of it by interfering with hormonal function. But PCOS has been around for a long time, as far as we can tell.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
It seems to be present at a pretty standard or set prevalence across many different countries and parts of the world, which somewhat argues against it being truly environmental. Now, I do think that certain environmental endocrine disruptors or Just societal patterns, especially diet, can definitely exacerbate the way PCOS gets manifest.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So if you look at PCOS patients in Europe, especially 10 or 20 years ago, or in China, they tended to be much more lean than patients in the United States and have much less sort of inflammation and insulin resistance.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And so there's certainly, if you have a PCOS phenotype and you put it in an environment where there is calorie excess or limited physical activity, you are going to see potentially, at least in some patients, an exacerbation of the symptoms. But I don't know that you, I don't know that in my view and from what I understand about this
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
this syndrome, I don't think it's necessarily caused by our lifestyle.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Yeah, I mean, I think for sure there's evidence that in some people with PCOS, especially if there's evidence of insulin resistance or if there's evidence of glucose intolerance, that they clearly have entered a phase where they're not processing glucose well, that if you act to correct that through diet and through exercise and you reduce the degree of insulin resistance, you reduce
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
the degree of adiposity, that in some of those patients, they will ovulate more regularly. They will have more successful, more healthy pregnancies. So that is certainly something that I think I always talk to my patients about when I see them, if I think that there's a window for that.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
There are patients, however, especially when you look at some of the lean PCOS patients or patients from the point of adolescence have never had regular cycles. I think it's a lot to say, oh, just change your diet and you're going to start ovulating. I don't think that's always the case. So I think every patient's a little different and you need to really look at it.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
What I usually look at, though, is I want to say, how are we going to get you as healthy as possible for pregnancy? And maybe that will help you get pregnant. Maybe it won't. But I want to get you as healthy as you can for pregnancy and get your insulin resistance as much as possible under control.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Well, I think that there's definitely some really interesting research going on around microbiome in PCOS. And there's this idea that there may be a more sort of inflammatory microbiome that leads to more inflammation in the body. And we know that many patients with PCOS just have high rates of inflammation that is detectable.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And if you look at sort of blood markers or just even at the insulin resistance. So This is in many ways an inflammatory disorder. And so there is research going into like how much of that might be driven by the microbiome. And that's a little outside my scope and maybe more your scope, exactly how that may be the case.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
But I think it's definitely a really interesting area for us to try to understand more, how much that may be sort of setting people up to have PCOS sort of evolve at adolescence and really to exacerbate the metabolic phenotype.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Well, I think for sure we know that inflammation may have some direct effect on ovarian dysfunction. So there are some studies showing that if you treat inflammation, you can improve sort of ovulation to some degree in the ovary. So there may be a direct effect of inflammation on the ovary. There's also a path where inflammation does drive up insulin resistance, and that's
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
through sort of TNF alpha and other cytokines that are thought to interfere with insulin action. And we know that insulin resistance really drives androgen production from the ovary, at least in patients with PCOS. So there's definitely a metabolic sort of driver of the hyperandrogenism and hormonal dysfunction and anovulatory sort of status that we do see.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And then we also know that that inflammation in and of itself has really important downstream consequences, not only in terms of cardiovascular disease, but there's more and more of a thought around depression and cognition that may be impacted by inflammation. So I do think it's really an important piece of this disorder that we want to try to get a handle on and try to treat.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I mean, I think that they're probably subtypes. PCOS is, I think, a very heterogeneous disorder. It's really just a syndrome, right? It's a collection of things that kind of go together and sort of have somewhat of a shared pathophysiology. But it's not like, you know, if you think about something like hypothyroidism, which is very much, you know, it's like your thyroid gland isn't functioning.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
You're going to have this. You fix this. It translates. PCOS is messier. And so, yeah, so the patient, there is a lean phenotype, we call it lean PCOS, and it's often quite different than the obese PCOS. Some of the things that may be similar is the lack of ovulation, the need for help with fertility care. So that may be a constant.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
The other thing that may be a constant is trouble with elevated androgen. So hair growth on the face, acne, that can still manifest in lean PCOS. But, you know, lean PCOS patients are lucky in that they're often not quite as much struggling with some of the metabolic features.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Although in studies where they measure insulin resistance very closely and very carefully in research settings in even lean PCOS, they are more insulin resistant than lean non-PCOS. So there is still an insulin resistance piece there, but it's sort of
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
either genetically not as sort of exacerbated, or maybe that that person has just a very healthy lifestyle and they're able to keep a lot of it at bay.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I mean, it's, I think, a very multifaceted disorder. There's generally sort of five or six things that I go through with patients with PCOS. So the first is menstrual cycle control. So it's important for people to have somewhat regular menstrual cycles or to have at least some sort of progesterone in their system to prevent overgrowth of the lining.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
There's the management of their skin or cutaneous findings with PCOS. So how can they manage their hair growth? There's fertility concerns. There's metabolic concerns, especially things like future diabetes, future cardiovascular disease. And then there's a lot of mental health disorders that we see in PCOS. So there's a high rate of depression.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I mean, it's something I've been really interested in researching. One of the things we've shown in some of our work has been a very strong correlation between insulin resistance, actually, and depression. And even when you control for body weight, and even when you control for androgens, even when you control for hirsutism.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So, you know, I do think at least in some of these patients that insulin resistance in and of itself maybe contributing to depression. That's something we see in the diabetes literature as well.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Yeah, I think it's, to me, one of the more profound connections and profound concerns. And I think it's unfortunate because in some ways that depression can often make it harder to address the diet and the exercise. You know, if you're feeling depressed, you're not in the most ideal state to sort of make those important lifestyle changes.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So I think it's important that we take into consideration what's happening in terms of a mental health milieu for patients with PCOS and take that into account when we kind of talk to them about treatment because that's an important component, I think, that needs to be addressed if we want them to make those important lifestyle changes.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I mean, so I think in terms of therapeutic approaches with PCOS, it's always hard because I think it to some degree depends on what is their goal. Like, what are they trying to achieve? You know, are they trying to get pregnant at this moment or not? But in terms of the menstrual, let's say it's someone who's like 22 and she's coming in because she's only having three periods a year.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And when she does, it's very heavy bleeding. I want to address that because we know that when people go many, many, many cycles without ovulating, it means they don't get progesterone. And that means that estrogen is going to cause over time buildup of the uterine lining, which can lead to very heavy menstrual cycles, but it also is a risk factor for endometrial cancer over time.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So it is important that patients with PCOS get some sort of progesterone exposure. And that can be in the form of oral contraceptives, it can be in the form of bioidentical progesterone being taken cyclically, It can be in the form of an IUD that releases progesterone. I mean, so there's a lot of ways to do it.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
But if I have a patient who's having three cycles a year or something like that, that's an important conversation that I'm going to have is like, look, we need to figure out some way for you to have progesterone because it's not healthy for your uterus to not have that progesterone over time.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
In terms of their other symptoms?
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Yeah, so I think the irregular cycles would be addressed through some form of progesterone. But the hair loss or hair growth or acne, those skin findings, are best addressed, quite honestly, by being on something like a birth control pill. And you're going to suppress the sort of stimulation of the ovary that's driving up the androgens.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And you're also going to increase sex hormone binding globulin, which is a protein from the liver that really soaks up that extra androgen. So that's honestly the best way to get benefit in terms of this, especially hirsutism and acne. And then sometimes we'll even use medications that will block estrogen, block androgen action like spironolactone.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Now, I do have patients who don't want to go on those medications and feel like that's not fixing the underlying problem and it's just patching it or they don't want to be on the pill for any reason. So that tool is not always the ideal tool for our patients, but it is certainly one that I would discuss.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I think in some, for sure. And I think there haven't been great studies on this. There's been a few. I do think that if patients are able to maintain a very low carb diet, sort of a ketogenic diet, they will be able to really manage their insulin resistance.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
And that really takes away one of the sort of drivers or triggers or things that's really exacerbating their sort of phenotype or their symptoms. So if you are able to get the patient to sort of embrace that approach, I do think that you will see that often patients will see benefits. I think it's something that has to be monitored.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
I don't think all patients will suddenly start having regular cycles and their hair growth isn't gonna suddenly go away. But some patients may have more cycles. Some patients may be able to conceive that way on their own without fertility treatment, but others will not.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
So I think it's something that I try to discuss as an option, but I think I shy away from saying like, here's a way to fix this because I think in all honesty, it doesn't fix it for some patients. And that's really frustrating if they feel like they're sort of somehow failing.
The Dr. Hyman Show
Reclaim Your Hormones: How to Treat PMS and PCOS Naturally
Yeah. I think it's a challenge, and I do think it's one. I mean, PCOS is definitely a disorder that just takes a lot of personalization because it's such a diverse heterogeneous disorder. The concerns and the goals are often very diverse. So I think no patient and no treatment plan, quite honestly, is exactly the same.