Welcome everyone to another episode of a Sister and mister. Today we have Dr. Loria Soma. She’s a physician in obstetrics and gynecology at the Ohio State University, Wester Medical Center. Dr. Soma has a special interest in and specializes in polycystic ovarian syndrome and sees patients in a multidisciplinary P C O S clinic. She’s a member of the androgen excess and P C O S society.
Dr. Soma is involved in the update for the international evidence-based guidelines for the assessment and management of P C O S, which will be released in 2023. Dr. C o s now go home girl. Just lose somewhere symptoms, hands and let push them naturally now. So I became a dietician. Help my sister’s the best they’ve ever take a step my direction if wanna them in control of yourself.
Welcome Dr. L. It’s so nice to have you with us. Yes. Yeah, thanks for having me. I’m excited to talk with you guys. Thanks for coming on our podcast. We’re really excited. We wanna talk all about pregnancy and postpartum with P C O S women and we have a lot of followers and listeners who are really interested in this topic.
Yeah. For those of us who are new, what is your history with P C O S N background? Well, I’m a general obgyn, so I take care of patients for like routine gynecology checkups and then pregnancies. And just in the past few years I’ve gotten more interested in learning about P C O S and at my office, at my hospital we have a P C O S clinic,
a multidisciplinary clinic with myself and an endocrinologist and nutritionist. So I’m kind of specializing in that and seeing patients specifically with P C O S at that office. That’s great. So you work as a team to treat P C O S in like a multidisciplinary way. I love that. What are some of the things that you do at your practice when A P C O S woman comes in?
Well, when they come first for their first consult, I just like to get a, a detailed history from them and kind of figure out when were you diagnosed, how was that diagnosis actually decided? And like what kind of testing have you had done to make sure it’s a real, you know, diagnosis. And then I’m able to, if I can review previous labs that have been done and if she’s had an ultrasound.
And then usually an in-depth history of like, what’s your life like, what are you eating, what are you exercising, what’s your stress level, how are you sleeping? And other, all the other medical problems too. And then of course talk about their periods and what the pregnancy, if they want pregnancy, if they want birth control. And then of course a lot of the cosmetic complaints,
facial hair, acne kind of, Yeah. What are the symptoms that they want to work on. Do you find it difficult to like diagnose P C O S as a condition since it is a, there’s such a, you know, big difference in you know, one person’s symptoms versus another. Do you find it sometimes hard to kind of pinpoint P C O S initially?
Yeah, it is hard and I know there’s data about patients having to see multiple doctors before they get a diagnosis and patients that kind of either are told the diagnosis in a wrong way, like, oh, you’ve gained weight, you have P C O S or that haven’t ever been given the diagnosis. So yeah, I think it is important to get the detailed information and kind of sort out.
Are there other medical problems that are kind of seeming like they’re P C O S that we need to rule out? Or is it truly P C O S? Yeah. Jumping on the fertility side, when a, a woman with P C O S comes to your office and they’re looking to, you know, get hopefully pregnant, what are like some of the criteria that you’re looking for to basically help them,
you know, get pregnant as best as possible? Well, I kind of think about their whole history. So age is certainly an important thing of just knowing how old they are is important to determine like how, how fast do we need to be or how much time do we have? Because ideally if, if she has P C O S, there’s a high chance that she has some other metabolic complications.
She could have insulin resistance or pre-diabetes or undiagnosed diabetes weight can be a problem oftentimes. So figuring out like how healthy she is and what kind of things she needs to work on to improve her health before she gets pregnant and to help her fertility. So we do try if someone’s overweight, to encourage them to lose weight with improving exercise and nutrition and if they can lose even five to 10% of body weight that has been shown to improve like cycles and fertility and pregnancy outcomes.
Yeah, I think there was even a research study that showed for PCs women when there was just a small reduction in weight for, for those who are overweight, it increases their chances of pregnancy like by a lot. Yeah. There’s oftentimes a lot of stress around getting pregnant for P C O S women because of the pressure to have to lose weight. And I’ve found that like a lot of women feel like they go down this like weight loss path in order to get pregnant rather than going down the path of let me reverse my insulin resistance,
let me treat the root issues of my P C O S, you know, in order to get pregnant naturally you’ll lose weight once you do that. But the idea is that you treat these things that are driving the root issues of your P C O S because when you don’t treat them and when you just cut calories and lose weight, then your, your pregnancy outcome might not be as ideal as you want it to be because you didn’t address the blood sugar issues,
the stress hormone issues that can actually cause like preeclampsia and all these problems while you’re pregnant. Instead you focused on the scale and it was just weight loss, weight loss, weight loss. So that being said, I wouldn’t necessarily say like it’s all the woman’s fault because she’s focusing on weight loss. It’s actually like such a stigma of like if you want to get pregnant with P C O S,
you have to lose weight. And then it’s, it goes down this like awful road of like self deprecation instead of understanding like what is going on metabolically. So I’m curious to know like how you approach this kind of like problem that’s just happening everywhere, it seems like how does your practice handle this differently so that the woman has better pregnancy outcomes? Did you hear about that sister who took OVASITOL and finally got her period after a year of not having one?
Incredible, I see those kinds of messages on Instagram a lot. How does that even happen? Well, Ovasitol helps with healing insulin resistance, a common root issue that most P C O S sisters have. And by targeting insulin resistance, we’re seeing sisters kick those crazy cravings finally regulate their periods, ovulate and improve their ED quality. Each packet of ovasitol has a 40 to one ratio of my acetol and de chiro acetol.
This ratio is similar to the ratio that should be found in the body, but with women like me who have P C O S, this ratio is often imbalanced. So taking AVAs can be super effective in treating insulin resistance starting from the root of the issue. So awesome. It tastes like nothing. So just warm me when you put it in a cup so I don’t drink it.
You Got it, boo. Check out the link in the description to get 15% off your order. I think that’s a great point. And like I said, ideally if, if a woman is not in her late thirties or 40 or something, we have more time. And like I prefer not to jump in. You know, we have medications that we can give to induce ovulation,
but I prefer not to do that right off the bat. Like I wanna evaluate does she have insulin resistance, has she done a glucose tolerance test, is she glucose intolerant? And have her meet with the nutritionist and see if we can improve those parameters like her fasting insulin level and her glucose tolerance and work on the ways that she’s eating and how often she’s eating and improve those things.
You know, some patients are on like, it’s exactly like what you said. If they just do some sort of fast strict calorie restriction and they lose weight, it’s not gonna be sustainable and then they will probably gain even more weight during pregnancy. And that’s one of my concerns too. There’s these new weight loss medications and they can’t use during pregnancy. So if they go on them before they get pregnant,
then we don’t really know like what’s gonna happen once they’re pregnant. Yeah. So yeah, I, I try to give the patient time and really work on those metabolic issues before we jump into deciding if we need to induce ovulation and make sure like her micronutrient labs are okay and her insulin is improved hopefully. And like you said, as a side effect that should result in some weight loss.
Yeah. Yeah. If the patient is overweight. Yeah. What are some of the issues that you find come up with women who have P C O S while they’re pregnant? Like what do they typically face? I know gestational diabetes is one of them. Yeah, that’s probably the, the biggest one that we think about. Just because so many patients will have underlying insulin resistance and then with the pregnancy hormones,
all women without P C O S two will have worsening insulin resistance. Yeah. In pregnancy. So gestational diabetes is two to three times higher in patients with P C O S. So it can be up to like 30 to 40%. Why does that happen when like someone gets pregnant? Why does it, they become, why do they become more insulin resistant?
It’s like the body’s way of getting more nutrients to the, the pregnancy to beat it. Oh, I see. Yeah. Oh, I see. Okay. Yeah. How does that happen? Can you like paint the picture for me? I talk about insulin resistance a lot in the podcast and I explain it in a way where it’s like the cell is locked and you need the insulin.
It’s the key to open up the cell and give it the sugar from your bloodstream so your cell can burn it for energy. But when that’s not happening, insulin’s floating around in your bloodstream and then that’s triggering high testosterone in your ovaries and all these issues with P C O S weight gain in the midsection and so on. How is that exacerbated when they’re pregnant?
Well, it’s kind of like in pregnancy your, like when we think about P C O S as being a way for like women to like preserve energy and have more insulin so that they, like in the old a long time ago, they would like preserve energy and have fat storage and be able to like get through life and not reproduce too much so that they can survive.
And so your body is like holding onto this extra energy to sustain the, the life that you are growing inside. So it’s like a stress response to the pregnancy. Yeah. So your body’s like in survival mode and storing more fat and then more insulin resistance and then it’s an issue for the baby. Yeah. Very interesting. Yeah. And then the other big group of disorders are like the hypertensive disorders.
So you mentioned preeclampsia and also gestational hypertension is sort of on the spectrum of preeclampsia, but just with the high blood pressure and then also heart problems that could happen or blood plots during pregnancy. I don’t mean to scare people I know, but it’s good to, it’s good to talk about it and spread awareness so that people are aware of what can happen.
So you’re better prepared for it. I think it’s good to talk about it. All things that you can actually do something about in advance. Yeah. If you don’t waste until the last minute to get off birth control and get pregnant. I often say like, you know, birth control is the choice, but just know like it’s a bandaid approach. You’re not actually treating what’s happening and the second you get off of it and you wanna get pregnant,
that’s when you decide to go to the doctor, you’re gonna be like, it’s like a rude awakening of like all the stuff you didn’t manage for years and years, which is often, you know, it’s when you’re diagnosed with P C O S, you’re so young and you don’t know that you can manage it because we’re often explained that we can just take birth control metformin and that’s it.
And then we’re like, okay, whatever birth control sounds good and we just carry on for years and years. And so it’s this huge like issue that’s happening now with so many women having P C O S getting off birth control after being on it for like 10, 15 years because they were put on it at like 16 without question, without explanation or anything like that.
Yeah. Yeah. And then they don’t know until they stop and then who knows what’s happening with their cycles and Yeah. Yeah, Exactly. And then going into like let’s say the, once the baby is delivered postpartum, are there any like health factor or health risks associated for P C O S women? Or, I’ve heard some people actually say pregnancy cures,
P C O S, meaning like once you deliver the baby like it’s supposed to like get rid of symptoms and it’s almost like P C O S is no longer there. Like is that a, is that a myth have any, you know, way to it? Or is that just, you know, nonsense? I think like anecdotally, I have had patients where either I’ve seen them before,
they come to me and they say, Well I had P C O S and then I had my babies and then now I have normal cycles. And so I have heard that, you know, from some patients, but it’s certainly not a cure. Like, But maybe I think, you know, maybe patients are just doing different lifestyle things because the pregnancy is such a motivator that they’re improving things during the pregnancy,
but if that doesn’t happen, they are at risk for these high blood pressure disorders can happen and be diagnosed in the postpartum period. There’s also a higher chance of postpartum depression because that’s, you know, anxiety, depression disorders are more prevalent in patients with P C O S. So that’s a high risk time to, you know, we need to watch for those things.
And then breastfeeding can be a problem too. Can we dive into some of these like breastfeeding and postpartum depression? Sure. So what about, let’s say postpartum depression, How does that come to life like after you’re pregnant? You know, why is it so strong for women with P C O S? I know it’s a hormonal imbalance of course, but what’s happening that’s making it worse?
Yeah, well we just, we know that it’s a higher chance for any patients that have previously had depression or anxiety, even if it wasn’t active during pregnancy. But there’s so much going on after you’ve delivered a baby, your, your hormones are up and down, your body is like exhausted. Especially, I mean, it depends how you’ve delivered, but probably you’re gonna be exhausted no matter what.
You’re not sleeping enough. You have all this new responsibility for a baby, especially if you’ve never had one before. So there’s a lot of stress in general for all patients with the new baby. And then if you’ve had underlying depression that maybe wasn’t diagnosed or you’ve had it in the past and it got better, it can just return during that risky time.
Stressful time. Yeah. And what about breastfeeding? What makes it difficult and what are the challenges most women with P C O S face? So it’s not nec you shouldn’t, I shouldn’t say most women, but I take That you shouldn’t go in just thinking that it won’t work, but to just be aware, to watch out for it, that there could be a lower supply and it’s not known exactly why that is,
but it’s probably has to do with insulin resistance and the androgen levels and then potentially that women with P C O S when they’re going through puberty that the breast tissue may not develop in the same way to have enough like breast tissue and milk glands. So that specifically if there’s not enough milk glands in breast tissue, that’s something that can’t necessarily be reversed. But there are lots of things that you can work on with your doctor,
with the lactation consultant to try to improve breastfeeding. Yeah. Which a lot of it’s supply and demand. So you know, trying to put the latch the baby and directly breastfeed, you know, regularly and or do extra pumping or do hand expression. Yeah. And I’m sure that you and your team have like a whole protocol post, you know, delivery for someone with P C O S to make sure that,
you know, you’re meeting all these criteria to make sure you know you’re on top of it, right? Yeah, yeah. We have lactation nurses who are in the hospital right after they deliver, but they’re only there for a day, day or two if they’ve had a vaginal delivery and then two to four days if it was a C-section. So that’s just barely a start of the breastfeeding relationship.
So it is important that they, you know, they get as much education as they can before you can take a breastfeeding class bef, you know, during pregnancy. I encourage that like in the third trimester. And then you’re monitoring the babies like feeding cues and the dirty diapers and wet diapers and having checkups for, for weight checks and then potentially checks up checkups with lactation in an outpatient setting too.
Yeah, that’s great. I think something to really remind everyone too is cuz there’s a lot of fear about P C O S and pregnancy in general. Like that’s, I feel the first fear is like, oh like am I not gonna be able to get pregnant? Of course. Like un understandably it’s such a, you know, big fear to have,
like we feel from our experience that like majority of P C O S women can still get pregnant and it’s still majority do in fact get pregnant. Of course there are, there are some who have difficulties but can still, you know, go through it and actually still get pregnant. So I think that’s a, like in your experience, have you seen that as well?
Yeah, yeah. We take care of lots of patients that are able to get pregnant and there are statistics that P C O S patients are able to achieve at least one pregnancy as much as the general population. So Amazing. Yeah, That’s amazing And such good news to share. Yeah, Yeah, absolutely. Well is there any points that you feel like we should cover for like in terms of postpartum or,
or pregnancy? Like any, any topics you feel like listeners should know about as well In terms of the postpartum time Also it’s another like difficult time with the breastfeeding. I also didn’t talk about like hydration and eating enough and that’s, that’s a time when you have hardly have any time to yourself. But it’s important to be having as much support as you can and trying to get it,
like we talk about sleep when you can and get outside. I try to encourage people to go outside and just get some, you know, gentle movement. You shouldn’t be doing any vigorous exercise, but it’s important to be, again, thinking about your metabolic health and hopefully you haven’t gained too much weight during pregnancy, but returning once you’re able to, to get back to like physical activity and eating,
having nutritious nutrient dense foods rather than just like processed snack foods and stuff. Yeah. And the postpartum time. And that kind of goes along also in the first trimester. That’s another hard time for patients when they often have nausea and vomiting and they don’t feel like eating anything. And like carby snack foods are oftentimes the only thing they can eat. So that can be a challenge for patients too.
What about like, like supplementation? Cause we know like for for P C O S in OST is a really popular supplement in terms of not just like magic insulin resistance but also improving fertility. Is that something that you like recommend in your practice for pregnancy or, or even postpartum? Yeah, I am recommending it to my patients that are pregnant because they’re,
it’s not like in our guidelines yet. Cause I think there’s just not enough like bigger studies, but there are smaller studies that show that it improves, it decreases the, the rate of gestational diabetes. And then I was gonna tell you guys, there’s this new study that has come out recently. It’s not about P C O S specifically, but it’s about my ACETOL probiotics and just the typical like micronutrient multivitamin.
So when they compared giving that regimen of those three things versus like just the standard multivitamin, they found that those patients had a shorter second stage of labor, which is when the patient is pushing and lower risk of an operative vaginal delivery with like forceps or a vacuum and a lower risk of postpartum hemorrhage. So that was just an interesting study about the nutrients in general during labor and delivery.
So that’s I think another plus for my acetol. Yeah, For Sure. Probiotics too. I think we can learn a lot more about that too. Was that study done on women who took it while they were pregnant or before? Both. They started before and then they took it through the whole pregnancy. Oh, that’s awesome. Yeah, That’s really promising.
And there’s even like an existing study right now that’s ongoing at Penn State and Harvard I believe on and o taught like Myo and Chira and ota. So we’re looking forward to, and that’s on P C O S women, which is, you know, like it’s rare to see studies being done that often on P C O S. So it’s really, we’re looking forward to seeing those results and it’s a lot of great,
great supplements in natural things out there, you know, to help. Yeah. And then in terms of supplements too, I do either preconception or the first visit if I hadn’t seen them before, talk about myNO like we discussed and then I would check like a B12 level if they were on metformin because that can decrease from metformin and then a vitamin D level to see if they need extra and additional to what,
what’s in their prenatal vitamin. So those are the kind of important things in addition to whatever’s in the basic prenatal vitamin. Yeah. Is prenatal vitamin something you recommend just for anyone who is pregnant? Essentially just cause it’s like it’s, it’s important to have all those nutrients. Yeah. And they should ideally start it a few months before they start trying to get pregnant.
Yeah. Oh, I see. Okay. That’s good to know. And mainly the folic acid is the big thing for, to prevent like neural tube defects, but they’re usually a bunch of things in the prenatal vitamin too. Yeah, I believe folate active form is a TOD as better. Correct. For prenatals. Yeah. Yeah. If you can find one with folate that could,
it’s possible that your body isn’t processing the folic acid, so the folate would be a better bet. Awesome. Well if anybody wants to get in touch with you and your team for, do you do like virtual virtual practices practicing? Or is it just like a physical, like people have to come into your Location? We do virtual, I haven’t ever done like a new patient as of,
I haven’t ever seen someone like outside of Ohio. Like we do have people that get referred from like outside of Columbus, but we do have the capability to do virtual, so I could do that. I do follow ups with patients over either video or phone. Oh, nice. They have to drive, you know, a few hours. But the P C O S clinic is at the Center for Women’s Health at Ohio State,
and I also see just general obstetric patients at a different office at Ohio State. Great. Awesome. We’ll put the, we’ll put a link for it in the description for anybody who’s interested. And do you have like an Instagram or any like social media you, you want us to, to mention? I don’t do any medical stuff on social media. That’s,
That’s okay. I just wanted to ask just My little kids. Cool. Well thank you so much. We really appreciate it Dr. Lono, for coming on here and talking about P C O S fertility postpartum. And thank you for, thank you to the listeners for being part of this episode and yeah, we’ll be back next week with another one.
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