PCOS Awareness Expert Interview with Dr. Carrie Jones
Your hormones should work in harmony.
To successfully treat your PCOS symptoms you need to understand how your hormones work in order to heal your body. Hormones can be complicated to understand and decipher so I brought in one of the best to answer your burning questions about PCOS and hormonal health. Today’s expert is Dr. Carrie Jones, ND MPH a naturopathoic doctor who specializes in the areas of hormonal, adrenal, and thyroid health. As the Medical Director for Precision Analytical, Inc she is an innovator in the field of women’s hormones with the use of the DUTCH Test. I am honored that is she is going to share her wisdom with us.
Below you will see the Q&A that I had with Dr. Carrie Jones.
1. If you suspect something might be off with your hormones, which tests should be done and when should they be tested?
Women who want to evaluate their estrogen and progesterone, it’s important first that they do it in the luteal phase of the cycle which is their 2nd half. In particular, we want to test on days 19, 20 or 21 of a typical 28 day cycle. In PCOS it is common to have longer or shorter cycles therefore women should adjust up or down as needed. For example, someone whose period comes every 24 days, she would test her hormones on days 15-17 but a woman who bleeds every 40 days would collect on days 31, 32 or 33.
Blood testing is the most common way to look at estrogen (specifically estradiol) and progesterone however this only represents a piece of the puzzle. Many practitioners are now doing dried urine testing where patients urinate on pieces of filter paper throughout the day at home and let them dry before mailing them off. From this, the specific labs can get her hormones plus the pathways or metabolites they convert into which gives so much extra information to help her treatment plan. It’s really helpful to know not only her actual hormone levels, but where they go in her body. Some pathways are not that desirable and cause a lot of symptoms!
2. Women with PCOS tend to have inflammation and insulin resistance. What tests should be done to determine inflammation and insulin resistance?
Inflammation is such a general term as she can be inflamed anywhere in her body! She might have inflammation in her gut, skin, sinuses and joints plus adipose tissue itself is inflammatory! So, I must ask a lot of questions about all of her symptoms to narrow down how I would test for inflammation or infections causing her symptoms. One woman with PCOS might have an imbalance of her gut microbiome causing poor absorption of her foods and bloating while another might have had a serious mold exposure in her home causing all sorts of brain fog, skin problems, fatigue, sinus trouble and more. As for insulin, I like to do a fasting glucose and insulin test in the blood and then I like to go even further with a 2-hour insulin/glucose tolerance test. This is a more involved blood test requiring her to drink a sugary solution provided by the lab and see how her body responds over time, but it gives me so much good information. I will also look at hemoglobinA1C and I do a fasting leptin level. Women can develop leptin resistance just like insulin resistance.
3. Cystic acne plagues many women with PCOS, especially during their period. Is there anything you recommend to combat that?
Cystic acne can often be a result of too much estrogen and/or too much testosterone and DHEA going down the 5a-reductase pathway creating a very powerful androgen hormone known as DHT. DHT binds to androgen receptors much stronger than testosterone itself and in women, this can cause cystic acne especially along the jaw line. First, she needs to test her estrogen and her testosterone and here is where knowing those pathways and metabolites is helpful. Ground flax seeds can be helpful to bind up excess estrogen and testosterone. Drinking spearmint tea has been shown in research to be anti-androgenic. Saw palmetto, zinc, stinging nettle root, and reishi mushroom have a 5a-reductase blocking effect. Eating liver friendly foods such as foods high in fiber, artichoke, dandelion, onion, garlic, raw unpeeled carrots, parsnips, and beets. Lastly, digestive health has an enormous impact on the skin therefore consider fresh squeezed lemon in water, apple cider vinegar in water, and digestive enzymes to help improve digestion and absorption along with fermented foods or a probiotic.
4. PCOS and fatigue seem to go hand-in-hand, how can women improve their energy levels?
First and foremost, take care of yourself! We have so much stress in our society, so much junk in our environment affecting our food, air and water and we’re not getting enough quality sleep. We’re going to bed on our phones and this is directly impacting our melatonin which has a huge role in our menstrual cycle rhythm! In fact, fixing sleep habits and patterns is the first thing I do when women have reproductive issues because melatonin helps so much. Then, all the stress coming at us every day is affecting our cortisol, norepinephrine and epinephrine patterns so everyone is walking around feeling tired but wired or “burned out.’’ So, I do a great deal of adrenal/cortisol testing and work with women on how they handle or respond to stress while improving their self-care!
5. Why is there such a strong connection between hypothyroidism and PCOS? What are the best treatment options for women with PCOS and hypothyroidism?
The entire endocrine system is tightly regulated, and all the glands talk to one another all day. In PCOS, someone with elevated insulin means the pancreas is involved. Higher insulin causes more testosterone to be produced out of the ovaries. High stress means the adrenal glands produce cortisol, norepinephrine, epinephrine and testosterone! Yes, the adrenal glands make testosterone. All these hormones can directly impact the thyroid just like the active thyroid hormone, Free T3, can directly impact the rest of the endocrine glands if it’s too low or too high. The treatment options 100% directly depends on each woman, what her hormones look like, what her nutrient status looks like, whether her thyroid is autoimmune or not, whether her PCOS is more insulin based or adrenal based or both…etc. Unfortunately, there is no one size fits all treatment.
6. When doctors are evaluating your thyroid health what tests are recommended and what are the normal ranges for these tests?
Most doctors are just looking at TSH – thyroid stimulating hormone. This is a hormone made in the pituitary in the brain and its level is dependent on the amount of T3 in there. TSH tells the thyroid gland at the base of your neck to make T4 primarily, with a little T3. Free T3 is the active hormone and T4 must convert into T3 however this is regulated by numerous factors. To give a few examples, T4 might not convert into T3 with too much stress, too much estrogen, not enough selenium, iron or zinc, or when someone under-eats (caloric insufficiency). Especially with too much stress, the body will convert T3 into rT3 (reverse T3) which is inactive. When there is not enough free T3 to bind to the receptors in the body, people report fatigue, weight gain, hair loss, dry skin and nails, cold hands and feet, heart palpitations, digestive problems, heavier periods or skipped periods and fertility problems. When there is too much free T3 (such as in a hyperthyroid state), people report anxiety, weight loss, increased hair loss, increased heart rate, increased sweating, and weight loss. Autoimmune hypothyroid is called Hashimoto’s and autoimmune hyperthyroid is known as Grave’s disease. All of these thyroid markers can be tested in the blood.
7. I’ve seen conflicting reports are women with PCOS considered estrogen dominant or estrogen deficient?
PCOS women can be either depending on their cycle! Some PCOS women go several months without a menstrual cycle or much activity at all in their ovaries rendering their estrogen low until they are close to their next period. Low estrogen might cause her to feel more depressed, have hot flashes or night sweats, have vaginal dryness, skin dryness, brain fog and joint pain.
Other PCOS women might cycle regularly (or irregularly) but are estrogen dominant relative to their progesterone production because they do not ovulate. Cycling women only make progesterone once the body has ovulated or released the egg. It is common for PCOS women to not release that egg even though they can still have a period. This puts their estrogen much higher relative to their progesterone causing estrogen dominant symptoms such as PMS, heavy periods, clots in their periods, breast tenderness, endometriosis, fibroids and weight gain or water retention.
PCOS women can absolutely experience both ends of the spectrum especially if she goes several months without a period she may report low estrogen symptoms however as her ovaries gear up for a random menstrual cycle she may flip and feel estrogen dominant.
8. What is the most important thing that women with PCOS can do to manage their health?
First, test to understand your hormone levels, including testosterone and cortisol, and the pathways they go down. Test glucose and insulin as well as not all women with PCOS have an insulin problem. While working with a qualified practitioner who is going to look at this picture, be sure to really do self-care. Eat healthy, go to sleep on time, avoid electronics at night, drink enough water, choose organic, read labels on body, hair and home products and try to choose those that are more environmentally friendly! Limit the amount of plastic and BPA (bisphenol-A) in your life as these chemicals are known as endocrine disruptors and women with PCOS already have a disrupted endocrine system. Address and reduce stress and nurture relationships that make you happy!
9. Which doctors should be guiding your health care decisions when you have PCOS?
Unfortunately, most conventional doctors have about 8-11 minutes for an appointment which is simply not enough time to evaluate and work-up PCOS properly. Consider seeing a Naturopathic Doctor or practitioner who has done training in functional medicine who specializes in hormones. They tend to allow much more time in their visits and do more comprehensive testing. In addition, they have the training to evaluate diet, lifestyle, nutrients, supplementation and hormones all together.
10. What is the most common misconception about PCOS that you would like to put to rest?
Not all PCOS women are overweight and not all PCOS women have multiple cysts on their ovaries. I feel like there is somewhat of a spectrum when it comes to PCOS but regardless, it’s all about the endocrine system and how it interacts with the body as a whole.
I'd like to thank Dr. Carrie Jones for her expertise and detailed responses. I encourage you to follow her on Instagram where she shares a wealth of hormone knowledge. In fact she recently did a series called Hormones 101 which included 30 detailed posts and it was phenomenal! So make sure you are following her!
If you are enjoying the expert series, please share them on social media! Let's help clear the myths about PCOS and spread awareness!
Dr. Carrie Jones is an internationally recognized speaker, consultant, and educator on the topic of women’s health and hormones. She graduated from the National University of Natural Medicine (NUNM), School of Naturopathic Medicine in Portland, Oregon where she also completed her 2-year residency in women’s health, hormones and endocrinology. Later she graduated from Grand Canyon University’s Master of Public Health program with a goal of doing more international education. She was adjunct faculty for many years teaching gynecology and advanced endocrinology/fertility and has been the Medical Director for 2 large integrative clinics in Portland. She is the Medical Director for Precision Analytical, Inc, creators of the DUTCH hormone test.