Why PCOS Matters at OUR MedSpa
When caring for a patient, one of the greatest tools a clinician has is-asking the right questions! To truly help our patients achieve their desired goal(s), may it be weight loss, hormonal or thyroid health and optimization, vitamin optimization, gut health, skin treatments, and overall long-term health, wellness, and quality of life, it is imperative that we assess a patient holistically.
This necessitates a baseline thorough medical history with a Nurse Practitioner, including not only the patient’s current symptoms of bother, but additionally digging into their personal menstrual, gynecologic, and fertility history, their sleep patterns, psychological, dermatologic, metabolic, cardiovascular, and thyroid histories. Obtaining current and fully comprehensive labs are also an important piece to this puzzle. While recent labs performed during an annual PCP visit are helpful, they unfortunately too often do NOT contain all of the things that we prefer to capture on a baseline set of labs, to better equate how you’re feeling now with what is occurring on labs now. While this degree of investigation may feel initially daunting for a patient, this is what truly leads us to an optimal individualized plan of care which ultimately leads to improved patient outcomes.
At Horizon MedSpa and Wellness, we aim to not only make you look and feel better now, but to also improve your long term health and wellness to keep you looking and feeling your best from the inside out.
This leads to the topic of PCOS aka Polycystic Ovarian Syndrome, that I see more and more of as a Women’s Health Nurse Practitioner here at Horizon MedSpa & Wellness, and one in which I’ve taken great interest. The reasons that PCOS matters are many, but primarily it is one of those diagnoses that impacts nearly every body system! There is no curative treatment, but there are ways to manage it alongside a skilled clinician.
Case Study: Meet Polly
Polly is a 40‑year‑old woman who presented with a long history of polycystic ovary syndrome (PCOS) that had progressively worsened over the past several years. Her primary concerns were irregular and unpredictable menstrual cycles, stubborn weight gain, increasing facial hair growth, fatigue, and lab evidence of insulin resistance with elevated fasting glucose levels. Despite prior attempts at lifestyle modification, she felt frustrated and discouraged by minimal results.
Initial Presentation
At her initial visit, Polly reported cycles occurring every 2–4 months, worsening facial hair growth along her chin and jawline, and difficulty losing weight despite calorie reduction and increased exercise. Laboratory evaluation was consistent with PCOS, including insulin resistance and impaired glucose regulation.
Treatment Approach
Polly initiated an individualized PCOS management program focused on metabolic health and hormonal balance. Her care plan included addition of a GLP-1 medication with medically supervised weight loss support, and optimization of her vitamin deficiencies, Thyroid, and hormones tailored to her specific lab findings and symptoms. Emphasis was placed on sustainable lifestyle changes rather than restrictive dieting.
Results and Progress
Over the course of several months, Polly experienced significant and measurable improvements:
Her menstrual cycles became regular and predictable
Insulin resistance improved, with fasting glucose returning to a healthier range
She achieved a 20‑pound weight loss without extreme calorie restriction
Noticeable reduction in facial hair growth
Improved energy levels and overall sense of well‑being
Outcome
By addressing the root metabolic and hormonal drivers of her PCOS, Polly was able to regain control of her health. She reports feeling more confident, energized, and empowered, with a renewed trust in her body’s ability to function optimally.
Takeaway
Polly’s case highlights how a personalized, root‑cause approach to PCOS can lead to meaningful improvements in menstrual regularity, metabolic health, weight management, and quality of life—especially for women who have struggled for years without answers.
(Names and identifying details have been changed to protect privacy. This case is fictional and intended for educational purposes only).
WHAT IS PCOS:
Polycystic Ovarian Syndrome aka PCOS is an underdiscussed constellation of chronic symptoms that are becoming increasingly more prevalent. Currently 500,000 women of reproductive age in the US are diagnosed annually with PCOS. This is likely an underestimate, given the complexities that surround both the diagnosis as well as the treatment, and also does not account for those who may remain undiagnosed or who may not have the adequate access to healthcare for diagnosis to occur.
The term PCOS is a bit of a misnomer, as the diagnostic criterion may include, but does NOT require, a patient to actually have multiple ‘cysts’ present on their ovaries; which makes this condition sound like simply a gynecologic or fertility issue. In actuality, PCOS is a multifactorial endocrine disorder that is truly more metabolic in nature and impacts the entire body. Its causes are thought to be some combination of inheritance (genetic), environmental, and epigenetic (meaning the impact that our environment has on the genes themselves).
HOW IS PCOS DIAGNOSED:
PCOS is medically diagnosed using ‘The Rotterdam Criterion,’ which requires that a patient possess at least 2 of the following:
Hyperandrogenism: High levels of free androgens (testosterone) on a blood draw but may also lead to outward symptoms of increased facial hair growth, male pattern hair thinning or baldness, acne, or a skin condition called acanthosis nigricans (a velvety thickened darkening of the skin-typically in areas of friction).
Ovulatory Dysfunction: Variability of menstrual cycles from absent to being irregularly long spaced, or infrequent in occurrence. Due to this reduced or absent ovulation, some may find themselves with difficulty getting pregnant. On ultrasound of the ovary, the coined term ‘string of pearls’ observation may or may not be captured. A ‘string of pearls’ image is typically denoting an excess of immature follicles (eggs-not cysts-as the name PCOS confusedly insinuates) that are growing simultaneously and resemble a string of pearls. In a normal ovulatory menstrual cycle there are typically 1-2 follicles that grow appropriately to maturation then erupt during ovulation midway each month, in a typical 28-35 day menstrual cycle.
Metabolic Dysfunction: Often seen in the form of resistant obesity or weight gain, insulin resistance and/or increasing blood glucose levels to pre or diabetic ranges, abnormal lipids, and the potential for cardiovascular disease.
To be clear, a patient can have metabolic dysfunction without having a diagnosis of PCOS, however every patient with a diagnosis of PCOS, even without current overt metabolic symptoms, will have a higher lifetime risk of metabolic vulnerability, and should warrant closer observation and preventative measures.
PCOS can be particularly tricky, because its own manifestations can in turn exacerbate other risk factors compounding the challenge of managing and controlling not only the current, but also the long term risk factor potentials.
WHAT ARE THE SYMPTOMS AND RISKS OF PCOS:
As noted above, there are few parts of the body that PCOS doesn’t negatively impact both directly and/or from a downstream exacerbation or causation. From increased risk of Type 2 Diabetes, High Blood Pressure, Cardiovascular Disease, Thyroid dysfunction, Infertility, Pregnancy Complications, Mood Imbalances, and even increased Endometrial Cancer risk, PCOS has the potential to wreak horrible havoc for those affected.
Additionally, because of the multi-factorial presentation of PCOS, a patient may be seeing more than 4 providers who are all treating their focalized specialty’s symptoms without scaling back and seeing how these may all piece together as one diagnosis.
This unfortunately can often lead to patients being on handfuls of pills to try and correct each individual symptom which in turn have their own added side effects and long term detriments to health, as well as the pocket book; rather than treating this syndrome as the collection of symptoms that it is.
THE GOOD NEWS: MANAGEMENT IS POSSIBLE:
At Horizon MedSpa & Wellness, we address every patient with a highly individualized and tailored treatment plan based on their age, goals, and other co-morbidities.
Lifestyle change will always be first-line for PCOS, however, its flippant and dismissive of providers to presume that all patients with PCOS will be able to fully mitigate PCOS symptoms and prevent chronic disease with diet and exercise alone. While diet and exercise are certainly part of every patient’s care plan, we also offer some very effective treatment options to help manage weight, thyroid, hormones, and vitamin deficiencies as well as the appropriate lab monitoring to ensure that improvements in long term health are being preserved, as best as currently possible.
“Success,” with PCOS often looks like:
Weight Loss-even 5-10% shows great improvement for reproductive and metabolic outcomes.
Improved Body Composition (less fat, more muscle)
Menstrual Regulation
Ovulation-improved Fertility (if desired)
Improved Mood
Improved Energy
Improved Quality of Life
Balanced Hormones
Improved Sleep
Reduced Hair and Skin Bothers
Reduced Inflammation
Improved Cholesterol (Reducing triglycerides and LDL Cholesterol)
Improved Metabolic parameters (reduced fasting insulin, improved insulin sensitivity)
Improved Thyroid Function
SCHEDULE A CONSULTATION:
If you have PCOS and are tired of not feeling like yourself, are struggling with wonky periods, and/or cannot hear another provider tell you that diet and exercise alone is all that you need, please arrange a visit with me to better discuss these concerns!