Jeffrey Dach, M.D. NewsLetter

Understanding PCOS, the Hidden Epidemic



PCOS Polycystic Ovary Syndrome - Anovulatory Androgen Excess 
Seventeen year old Alice has PCOS (Polycystic Ovary Syndrome).  Alice came with her Mom into the offfice and told me her story.  Alice has been overweight, borderline diabetic, and has facial hair and acne caused by elevated testosterone.  At age 12, Alice started normal menstrual cycles, but her cycles began fluctuating and periods stopped at age 15.  Her gyne doctor diagnosed PCOS (Polycystic Ovary Syndrome), and put her on birth control pills to regulate her cycles. The birth control pills caused adverse side effects of weight gain weight and elevated blood pressure (hypertension), so she stopped them. 

Progesterone is the Most Logical Form of Treatment and Actually Works

Two months ago, Alice was switched over from the birth control pills to natural progesterone, taking a 100 mg capsule twice a day for 14 days on, 14 days off. The progesterone was successful, restoring a normal menstrual period, and a return to regular cycles.

BCP’s (birth control pills) are usually prescribed by the ob-gyne doctor to regulate cycles in the PCOS patient. This standard treatment is not the best one.  There is a better more logical alternative that actually works called natural progesterone. Both John R Lee MD, and JeriLynn Prior MD advocate the use of natural progesterone as a far better alternative to birth control pills.  After all, birth control pills (BCP's) are a chemical form of castrationm, and work by inhibiting ovulation.

This article will explain the cause of PCOS, and will describe the signs and symptoms of PCOS, including the clinical features of PCOS, and give you a simple questionnaire to determine if you have PCOS. This article will also explain why natural progesterone is the best treatment, and a much better choice compared to birth control pills.

PCOS was Rare When First Described in 1935, Now Quite Common.

When PCOS (polycyctic ovary syndrome) was first described in 1935 by Stein and Leventhal, it was fairly rare.(55) Nowadays, it is quite common, involving 6 to 10 per cent of the female population, affecting 3.5 ot 5 million women. (24) Why the increased incidence?  Some believe that endocrine disruptor chemicals in the environment are to blame.

Obese Young Lady with PCOS, anovulatory infertility, acne and facial hair

Clinical Signs and Symptoms Of PCOS

Oligomenorrhea or amenorrhea (no periods)
Anovulation (no ovulation)
Weight gain, obesity 
Hirsutism (excessive hair growth, male pattern)
Insulin resistance (pre-diabetes)
Male-pattern baldness
Multiple small ovarian cysts on sonogram
Acanthosis nigrican (darkening of the skin at the nape of the neck and under arms)-indicator of hyperinsulinemia
 Typical hirsutism, with hair growth under the chin.

A Brief Moment for Definitions:

Definition of ovulation
This is the when an egg pops out of the follicle in the ovary, and starts on the long trip down the fallopian tube to the uterine cavity where it can be fertilized to form a new baby. Ovulation causes high progesterone production by corpus luteum in the ovary. Menstrual Cycles are regular.

Definition of Anovulation:

The egg doesn’t pop out and there is no progesterone production. The cycles are irregular or absent.

The bearded fat lady at the circus. She had PCOS.

How Do You Know If You Have PCOS?

This is a simple questionnaire.
1) PCOS Questionnaire   2) PCOS questionnaire

If you answer Yes,  to 2 out of 3 of the following questions, this indicates high likelihood (80%) of PCOS.

Length of Menstrual Cycle, Variable Length
1) Between the ages of 16 and 40, was length of your menstrual cycle (on average) greater than 35 days and/or totally variable ?

Hair Growth (Male Pattern)
2) During your menstruating years (not including during pregnancy), did you have a tendency to grow dark, coarse hair on your on 3 or more of these sites? Upper lip?chin? breasts? chest between the breasts? back? belly? upper arms? upper thighs?

Were you ever obese or overweight between the ages of 16 and 40?

Hormone Levels during the Menstrual Cycle with normal ovulation.
The green dotted line is progesterone which rises days 14-22. 
The progesterone is absent in PCOS, because there is no ovulation,  
and the green line stays flat on the chart, instead of rising

What Causes PCOS ?

The world’s greatest authority, Leon Speroff MD, says: “A question which has puzzled gynecologists and endocrinologists for many years is what causes polycystic ovaries. There is an answer which is appealing in its logic and clinical applicability. The characteristic polycystic ovary emerges when a state of anovulation persists for any length of time” (1Clinical Gynecologic Endocrinology and Infertility by Leon Speroff MD p.493

PCOS is the end result of not ovulating, (no progesterone production) for a long time (a few years), resulting in a vicious cycle which self perpetuates anovulation, causing increased testosterone production by the ovary. Insulin resistant diabetes and obesity aggravate the problem.  As you might expect, PCOS is a major cause of infertility. 

Oral Contraceptives for PCOS (BCP's)

Birth control pills are a chemical form of castration, which prevent ovulation. Lack of ovulation is the primary defect in PCOS, so birth control pills merely perpetuate the primary defect. Birth control pills can restore regular bleeding periods, however, this is artificial, and aggravate the underlying PCOS problem rather than solve it. In addition, birth control pills are known to worsen insulin resistance and diabetes. (2)

"PCOS may affect between 3.5 and 5.0 million young women in the United States, it arguably may be the most important general health issue affecting young women. BCP's (OCPs) are the traditional therapy for the chronic treatment of PCOS…… limited evidence raises the issue that BCP's (OCPs) may aggravate insulin resistance and exert other untoward metabolic actions that possibly enhance the long-term risk for diabetes and heart disease."

JeriLynn Prior MD Says:

“The fundamental problem with PCOS is not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones and leads to the irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense. “

John R Lee MD says:

"I recommend supplementation of normal physiologic doses of progesterone to treat PCOS. If progesterone levels rise each month during the luteal phase of the cycle, as they are supposed to do, this maintains the normal synchronal pattern each month, and PCOS rarely, if ever, occurs. Natural progesterone should be the basis of PCOS treatment, along with attention to stress, exercise, and nutrition.

If you have PCOS, you can use 15 to 20 mg of progesterone cream daily from day 14 to day 28 of your cycle. If you have a longer or a shorter cycle, adjust accordingly. The disappearance of facial hair and acne are usually obvious signs that hormones are becoming balanced, but to see these results, you'll need to give the treatment at least six months, in conjunction with proper diet and exercise."  (10) From the The John R Lee Medical Letter 1999.

An Amazing PCOS Video - Progesterone for PCOS

Below is a video on U-Tube showing a typical young lady with PCOS who resorted to using over the counter progesterone cream from Walmart. The progesterone cream successfully restored her cycles.  I am astounded that her doctors would not prescribe her progesterone and she was forced to self medicate without physician's supervision.  If you have PCOS and need a doctor to prescribe progesterone, you can find a knowledgable physician on the ACAM or A4M doctor's directory.  Always work closely with a knowledgable physician.

Can PCOS be Treated with Natural Progesterone? 

by Dr. Jerilynn Prior (3)

"Progesterone talks back to the hypothalamic and pituitary (brain) hormones that control the ovaries and stops them from stimulating the ovaries to make too much testosterone."

Dr Prior recognizes that the (BCP) pill, with its synthetic type of progesterone, does help women with PCOS to a certain degree. 

But her goal for PCOS patients is, "to return the brain/ovary system to a normal balance. The goal of the BCP Pill is the opposite - it must suppress the brain-ovary system to prevent pregnancy."

To help her PCOS patients achieve a normal hormonal balance, she prescribes oral micronized progesterone (trade name Prometrieum) which is a bio-identical hormone. Taking this natural progesterone for two weeks every month (called cyclic progesterone therapy) may help the brain to develop the normal cyclic rhythm that is missing in PCOS.

Interestingly, Dr. Prior believes there is another benefit of cyclic progesterone therapy. She explains, "most doctors don't realize progesterone antagonizes and inhibits the enzyme (called 5-alpha reductase) that is needed to make testosterone into dihydrotestosterone. Dihydrotestosterone is the powerful male hormone that talks hair follicles into making coarse hair and too much oil that causes acne."

 polycystic ovary on ultrasound image.

WHAT MAKES YOUR OVARIES TICK Insights about Ovulation, Fertility, PCOS and more. (4)

An Interview with Jerilynn C. Prior, M.D.

Dr. Jerilynn Prior is a professor of endocrinology at the University of British Columbia. She is a pioneer in research involving women's menstrual cycles, ovulation, progesterone and bone loss.

JLML: How do you track your luteal phase with a basal temperature chart?

JCPrior: If you record your oral temperature every morning for an entire month using a digital thermometer, record the temperature in the evening before you go to bed, and record any illness or early or late rising, you can quantitatively determine which days of the cycle are high progesterone days. You can then take all of those daily temperatures from the beginning of one period until the day before the beginning of the next, and do an average of the temperatures. The point where your temperature goes above that average, and stays above it, is the beginning of the luteal phase. It will go back down when your period starts or just before. That's how easy it is to figure out your luteal phase length! That alone is valuable information for women who are having miscarriages that may be due to a short luteal phase.

JLML: I have found that women who are more aware of their cycles are often better able to self-treat for hormone imbalances.

JLML: What else can you tell us about anovulatory cycles? The other kind of ovulation disturbance I called “turned on.” The woman experiencing this kind of ovulation disturbance will complain of weight gain, acne, and hair where she doesn’t want it. The biology of this is less clear, but it relates to insulin excess and insulin resistance, which have effects both on the brain by increasing LH (luteinizing hormone) levels, and directly on the ovary. Excess insulin sits on receptors on the theca cells, the outer coat of the ovary, and makes them more responsive to the hormonal environment, and therefore they make more androgens [testosterone, male hormones].

JLML: Aha! So that's why a high sugar diet aggravates polycystic ovary syndrome. The excess sugar creates high insulin levels, which stimulate androgen production in the ovary, which suppresses ovulation.

JCPrior: The higher LH and the higher androgen levels set up a signal that inhibits the follicle from ovulating. Because each follicle grows and creates a lake of fluid around it, if it doesn’t burst and release its egg, a cyst is left. Therefore you get into a situation of high or normal estrogen levels, high androgens, and low progesterone. That condition is usually characterized by obesity, especially middle-of-the-body obesity, androgen signs such acne, oily skin, facial and breast hair, and head hair loss. Because estrogen tends to be higher with weight gain, these are the women who have a higher breast cancer and endometrial cancer risk. They may also have the worst PMS symptoms.

JLML: So this is yet another good reason to avoid sugar and refined carbohydrates such as white bread and pasta.

JCPrior: And it's another good reason to get plenty of aerobic or endurance-type exercise, which is one of the best ways of getting the insulin levels down and decreasing PMS. With turned on ovulation disturbances you need to correct three problems: The first is to bring progesterone into balance –and for this you use physiologic doses of progesterone. Next, you often you need to block the effect of the male hormone. There's a medicine called spironolactone which I use that blocks androgen action at the cell level. Finally, if a person has a family history of diabetes or is quite obese, then I may use a drug called metformin (Glucophage) that sensitizes the body to insulin and allows the insulin levels to go down.
JLML: I have found that supplemental progesterone, a good amount of exercise, and a low sugar, low simple carbohydrate and low fat diet with plenty of vegetables will often restore balance. 

Help for PCOS - Cyclic Progesterone Therapy

by Dr. Jerilynn C. Prior and Celeste Wincapaw (5


I use cyclic progesterone therapy as the heart of treatment for PCOS- anovulatory androgen excess. Progesterone is the hormone made by the ovary after an egg is released.

The fundamental problem with PCOS is not making progesterone for two weeks every cycle. This lack of progesterone leads to an imbalance in the ovary, causes the stimulation of higher male hormones and leads to the irregular periods and trouble getting pregnant. Progesterone is usually missing—replacing it therefore makes sense. Progesterone talks back to the hypothalamic and pituitary (brain) hormones that control the ovary, and stops them from stimulating the ovary to make too much testosterone.

Taking progesterone for two weeks every month (called cyclic progesterone) may help the brain to develop the normal cyclic rhythm that is missing in PCOS. Progesterone also counterbalances the steadily high estrogen levels that the PCOS ovary produces even if you have no periods. Progesterone will prevent estrogen over-stimulation of the uterine lining (endometrial hyperplasia) and heavy flow. It may also interfere with the action of high estrogen on the breasts, therefore preventing tenderness and “lumpiness” and perhaps even the risk for breast cancer.

Finally, and most doctors don’t realize this, progesterone antagonizes and inhibits the enzyme (called 5-alpha reductase) that is needed to make testosterone into dihydrotestosterone. Dihydrotestosterone is the powerful male hormone that talks hair follicles into making coarse hair and too much oil that causes acne.
Useful Tools for Patients:

Protocol for Cyclic PROGESTERONE THERAPY patient handout sheet (6)
Menstrual cycle diary log sheet patient handout (7

Guidelines for Progesterone Cream Dosage for PCOS (8)

Early PCOS - 32mg from day 12-26

Advanced PCOS - 54mg from day 12-26 of your cycle

Severe PCOS with pain, 64mg of progesterone cream from day 5-26 , to address pain from endometriosis. Then try to wean back to a lesser dose or to extend breaks to fall into line with a day 12-26 cycle. Note, if you are using a regime day 5-26 in the first 4-7 months until symptoms settle, please be aware you are using a program suggested to enhance fertility.

Dr. Lam Progesterone Guidelines for Polycystic Ovary Syndrome (9)

Dr. Lam follows Dr John R Lee pioneering use of progesterone.

Apply 20 mg of progesterone cream during day 14 to 28 of the menstrual cycle. Adjust accordingly if for longer or shorter cycle. As the hormonal balance is regained, facial hair and acne, two commonly associated symptoms, will disappear.


Other treatable causes of anovulation

1) Low thyroid function (hypothyroid) causes menstrual irregularity, anovulation and infertility.  Ovulation and fertility is restored by thyroid medication.  Ovarian cysts also resolve.

2) Vitamin D deficiency is associated with anovulation.  Resolves with Vitamin D.

3) Iodine deficiency causes ovarian cysts and anovulation, reversed by iodine supplementation.


Other Drug Treatments for PCOS:

Issue                                            Drug Treatment

Infertility, anovulation:     Clomid clomephine, induces ovulation.
Insulin Resistance:           Metformin improves insulin sensitivity.
Acne, Facial Hair:              Spironlactone, Aldactone inhibits testosterone.


Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood, Fl 33021
954 983 1443



(1) The Clinical Gynecologic Endocrinology and Infertility: Leon Speroff MD

(2) A Modern Medical Quandary: Polycystic Ovary Syndrome, Insulin Resistance, and Oral Contraceptive Pills, The Journal of Clinical Endocrinology & Metabolism Vol. 88, No. 5 1927-1932

(3) Can PCOS be Treated with Natural Progesterone? Jerilynn Prior, PCOSA Today Newsletter

Did you find this newsletter interesting? Feel free to Email it to a friend with the button on the bar below.

Jeffrey Dach MD
4700 Sheridan Suite T
Hollywood FL 33021
954 983-1443

Jeffrey Dach, M.D. BLOG TrueMedMD


All after tax profits from TrueMedMD clinic operations are donated to charity.

(c) 2007-2008 all rights reserved jeffrey dach md

Visit our new NewsGroups on Google Groups:

Just for Fun: The Day the Earth Stood Still by Jeffrey Dach

TrueMedMD NewsGroup .... Breast Cancer Prevention NewsGroup .... Vitamin C NewsGroup Vitamin B12 NewsGroup

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Jeffrey Dach, M.D. TrueMedMD

Catalog of NewsLetters

Enter your email address to subscribe to newsletter.
Your email is safe and will never be shared.
Please enter your email address:

(1) My Vitamins Are Killing Me by Jeffrey Dach MD !!!

(2) Stroke Prevention and Vitamin C by Jeffrey Dach MD

(3) Testosterone Risks and Benefits by Jeffrey Dach MD

(4) Medical School Days and SSRI Research by Jeffrey Dach MD

(5) Iodine and Breast Cancer Prevention by Jeffrey Dach MD

(6) Hypothyroidism Part One by Jeffrey Dach MD

(7) Hypothyroidism Part Two Thryroflex by Jeffrey Dach MD

(8) Guard Your Daughter from Gardisil, Virginia Tech Rampage Seung-Hui Cho by Jeffrey Dach MD

(9) Orthomolecular Medicine Meeting in Toronto 2007 by Jeffrey Dach MD

(10) B12 Deficiency by Jeffrey Dach MD

(11) Rachel Carson and Silent Spring by Jeffrey Dach MD

(12) Vitamin D Deficiency by Jeffrey Dach MD

(13) Andrew Weil AARP, and Human Growth Hormone HGH by Jeffrey Dach MD

(14) Michael Moore's SICKO by Jeffrey Dach MD

(15) Blood Pressure Pills for Hypertension, When to Treat? by Jeffrey Dach MD

(16) Low Dose Naltrexone (LDN) by Jeffrey Dach MD

(17) Protect Your Family From Bad Drugs by Jeffrey Dach MD

(18) Roger Federer, Race Horses and Pulsed ElectroMagnetic Devices by Jeffrey Dach MD

(19) Vaccination, Autism Link, Real or Imagined? by Jeffrey Dach MD

(21) The Importance of the Pelvic Sonogram by Jeffrey Dach MD

(22 Cholesterol Lowering Statin Drugs for Women, Just Say No by Jeffrey Dach MD

(23 Get Off SSRI Drugs and Overcome Depression Naturally by Jeffrey Dach MD


Catalog of Articles Published on Hank Barnes World,
You Bet Your Life, by Jeffrey Dach MD


(1) Lipitor and "The Dracula of Modern Technology" by Jeffrey Dach MD

(2) Osteoporosis, Bisphosphonate Drugs and Toulouse Lautrec by Jeffrey Dach MD

(3) Prozac, Paxil and SSRI Drugs - Part One by Jeffrey Dach MD

(4) Prozac, Paxil and SSRI Drugs - Part Two by Jeffrey Dach MD

(5) Max Essex and Virological Failure in the NEJM by Jeffrey Dach MD

(6) The Origins of HIV by Jeffrey Dach MD

A Medical Article that I Published in 1980:

(7) Dach J, Patel N, Patel S, Petasnick J. Peritoneal mesothelioma: CT, sonography, and gallium-67 scan. AJR Am J Roentgenol. 1980 Sep;135(3):614

Jeffrey Dach, M.D.
Member of the Board of the American Academy of Anti-Aging Medicine
Board Certified by the American Board of Radiology

4700 Sheridan, Suite T
Hollywood Fl 33021
office phone 954-983-1443


Don't forget to visit my web site for more information, and we you might like to attend one of our free seminars on Wednesday Nights. Please call for reservations for the seminar, though.

Do you have a testimonial, or a question for the newsletter? Send it in via email reply.

Sincerely Yours
Jeffrey Dach, M.D.
4700 Sheridan Suite T.
Hollywood, Fl 33021


Dr. Dach is Board Certified by the American Board of Radiology and a member of the Board of the American Academy of Anti-Aging Medicine. He has 25 years experience in the Memorial Hospital System as an interventional radiologist. His current practice focuses on Bio-identical hormone supplementation for men and women, menopause, andropause, HGH, testosterone, natural thyroid and the use of natural substances rather than drugs in the appropriate setting.

All after-tax profits from TrueMedMD office operations (including nutritional supplement sales) are donated to charity.

Conflict of Interest Disclaimer: We receive no money from the pharmaceutical industry or from the NIH. We do not sell any products to the public at large. We do however, make available selected nutritional supplements to our office clients at a small markup to cover our costs.

If this email is sent to you in error, please accept our apology, and simply remove your email from the list with the unsubscribe button on the bar below this text. Sorry for the inconvenience.

(c) 2007 all right reserved Jeffrey Dach MD disclaimer

• • • •

Subscribe Unsubscribe Preferences Send to a Friend
My Newsletter Builder

report spam