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Welcome to the Healing on Purpose podcast. I’m your host, doctor Miriam Rahav. The content of the show is meant for informational purposes only and is not intended to diagnose, treat, or cure any illness or health condition. Please discuss all information shared herein with your own personal health authority. I hope you find value in this episode.
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This podcast is also available on YouTube on the Healing on Purpose channel should you want to look up any of the graphics, diagrams, or other visuals mentioned in the show. Links to the podcast and its YouTube channel will also be available on my practice website, rahavwellness.com. Please join me on my Facebook group, Healing on Purpose podcast with doctor Miriam Rahav, to continue this conversation. Enjoy the show.
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Namaste. I salute the divine within you because you see the divine is within you. Thank you for joining me right now, because right now is the perfect time. The time you choose is always the perfect time to step onto and walk further along the divine path to healing on purpose. On purpose means with intention and with an awareness of what 1 is doing.
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In other words, with consciousness, you were made on purpose. You are here with me, and that is no accident. By healing on purpose, you heal so much more than your physical body. You connect to your divine purpose. Healing on purpose is right for you, right for me, and right for all life.
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Thank you for consciously choosing healing. Thank you for taking this time for yourself. You deserve it. The world is better when you are healing on purpose. The subject for today’s conversation is polycystic ovarian syndrome, also known for short as PCOS or PCOS.
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Polycystic ovarian syndrome is not uncommon. As I have developed the habit in preparing for conversations with you, I start looking back at some of the literature and making sure that my understanding is current with what’s available out there. And it turns out that there is a very wide estimate of between 5 20% of women affected by this syndrome. What is this syndrome? So this syndrome has been agreed upon, or at least the the most recent group agreement happened in 2,003, I believe, when a bunch of scientists, clinicians got together in Rotterdam and came up with the Rotterdam criteria.
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And the Rotterdam criteria say that polycystic ovarian syndrome is characterized by 3 main features and that to qualify quote unquote as having polycystic ovarian syndrome or PCOS or PCOS for short, you need to exhibit 2 of the 3. So what are those criteria? The criteria are that you have high levels of androgens. Androgens are hormones classically associated with men, meaning, of course, women have them. It’s just the balance is different different.
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So the balance is tipped, meaning testosterone and meaning the precursor to testosterone, dihydroandosteradione. We’re don’t even know if I said that correctly because I always just say it as DHEA. And we commonly test for these things in our initial blood work. There are also clinical symptoms that might go along with hyperandranism, which is those high levels of male associated hormones, classically acne, and also increased facial hair, also known as hirsutism. What else?
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Irregular menstrual cycles, longer menstrual cycles, and ovulatory menstrual cycles. That is the second criteria. And the last official criteria is polycystic ovaries. Interestingly, and this is where I might segue for those of you who feel like learning visually with me, I am going to attempt to the best of my ability to share my screen. It’s not necessary, but if you want to, I have some images potentially queued up to share with you to explain actually why polycystic ovaries may be a misnomer.
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So classically a cyst, a simple cyst is a fluid filled sac. And these naturally physiologically occur in the ovaries, especially in young women and self resolve. What we’re looking at in here and by the way, I wanna give credit to this image. Let me see. I’m gonna remember what page I’m on, and then I’m going to go to the cover of this wonderful book that I love and give credit to this wonderful author who has done just such a phenomenal job.
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Let me see if I can do this. What is, what’s the first page? Maybe here. Let me try again. This book is by naturopathic doctor Fiona McCullough.
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I hope I’m saying that name right. McCullough, maybe McCullough? Forgive me. You are brilliant. And this book is a gift.
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8 steps to reverse your polycystic ovarian syndrome or PCOS. Now I’m going to, after giving credit to this wonderful author and clinician, I’m going to, oh, here’s that Rotterdam criteria. And I wonder if I yep. It was 2,003. Thank you, brain.
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Okay. So we have those and ovulatory cycles that I mentioned, cycles that are longer than 35 days, even they, even if they come on the regular are not normal. We have here a list of some of the symptoms of hype hyperandrogenism. So that’s hirsutism, acne. Oh, also hair loss.
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Yes. And the elevated testosterone, DHEA or androstenedione that we mentioned. And then, the cysts, which we were about to clarify. So this is straight from Fiona McCullough’s book, naturopathic doctor, with an image of a normal ovary. And what we notice here is a cyclical process in the life of the, of our eggs.
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You have these tiny little eggs that grow through a process called folliculogenesis, which just is a fancy schmancy way of seeing the eggs are developing. And then you have here what looks like a mature egg. And then you have an ovulation, so almost like that egg coming out of its shell. And then once that comes out, you have a change in that shell that eventually gets involuted, kind of resorbed. And and, eventually, I guess, it’s an it’s an atrophy.
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It’s actually a magical thing, all of these signals and how the different parts of the body speak to each other in this fine tuned way that that little eggshell, once the egg ovulates, starts taking on a different function. Actually, it gets magically renamed the budial body and starts making progesterone to support potentially a pregnancy and gets a message that if the egg is not fertilized and implanted, it is no longer required to make progesterone. And since progesterone stabilizes the uterine lining, but then is no longer required. The uterine lining is destabilized. And around day 28 of our cycle had we had, this is a key, little caveat, an ovulatory cycle that uterine lining will shed.
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And that is the menstrual period. That is the actual bleed. In contrast, we have here in this very clear schema a, a picture of a polycystic ovary where the it’s not a cyst in the classic sense of the word, but it seems that the effect of that hyperandranism, to remind you, that means those high levels of testosterone, DHEA or androstenedione stimulate multiple eggs such that there is this slow and look here, you have 1 egg cycle, but you’re here, you have multiple eggs developing at the same time. There’s a classic ultrasonographic sign when people do ultrasounds to see this called pearls on a string where you see multiple, follicles. However, none of them are ovulating.
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I think that Doctor. McCullough does yes. Ovarian follicles in a state of partial development, she says. Over time, partially developed follicles pile up in the ovary, creating a look of multiple tiny cysts or what is often referred to in textbooks as a bunch of grapes or strings of pearls. So that’s just a clarification of the Rotterdam criteria.
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However, the plot thickens. And let me see if I can toggle over for our reference to some articles that I kind of built up here. And right. We said 5 to 20 percent of women of reproductive age worldwide, worldwide, and that there is still much that we don’t know and we don’t understand. And yet it is so common.
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It is thought, that there is a and this is an important piece here, that there might be an in utero exposure from mom while mom is pregnant, in other words, to the female fetus that starts causing the expression of polycystic ovarian syndrome as early as in utero. And that those exposures may include androgens. In other words, there can be endocrine disruptors, which in previous conversations we’ve had about female infertility and endometriosis and started speaking about how endocrine disruptors in in so many substances around us are actually contribute contributory to hormone dysfunction. There is also emerging information, and I was just hanging out in PubMed for a bit. And if, if you can see as I’m sharing a screen, it’s really interesting.
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Just some of the titles of, of the articles you can find in PubMed that are basically tying PCOS to, autoimmunity, as 1 possible mechanistic understanding. And, just to see some of the articles in PubMed, just the titles of the articles, you know, for our perusal and, and just to see the emerging literature. So here we have, an article published in 2021 saying genetic susceptibility, the title of the article from Frontiers in Immunology to joint occurrence of polycystic ovarian syndrome and Hashimoto’s thyroiditis. How far is our understanding? And what they say is that they are common endocrine disorders.
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That means hormones, right? Which is what really? Those are communication systems, very fine tuned, fine balanced, complex with many, many feedback mechanisms within our body, right, that are sadly commonly disordered. And that there is a higher prevalence of Hashimoto’s thyroiditis in women with polycystic ovarian syndrome. In fact, we think that there could be cross reactivity between antibodies on the thyroid, which by the way, are also driven by what?
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By endocrine disruptors and with the ovaries relative to healthy individuals. And then I saw, oh, well, let, let me just go through a few more titles here. So high prevalence of Hashimoto’s thyroiditis in patients with PCOS, does the imbalance between estradiol and progesterone play a role? A correlation between Hashimoto’s thyroiditis and polycystic ovarian syndrome, a systematic review and meta analysis, thyroid disorders and polycystic ovary syndrome. And interestingly, I found another article, which I believe I have queued up to look at together.
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Oh, this is just a review of polycystic ovary syndrome and acne. That’s fine. Current concepts. That’s a much older article. Clearly, this has been subject to much conversation, but there was 1 cool image.
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I might not find it right now, but it was actually showing how 1 of the common, clinical manifestations in polycystic ovarian syndrome is actually and this is not in all types, by the way, in some and there’s further discussion. And I think it’s a little bit technical and beyond the scope of what this conversation is meant to be. You know, the different they’re not it’s a, it’s a heterogeneous manifestation. But 1 of the characterizations is a kind of, insulin resistant metabolic syndrome, and that is, you know, folks who have, a hard time losing weight and seem to gain weight, which is also, by the way, something with a hypofunctioning thyroid that, those 2 syndromes might have in common, and insulin resistance. And that downregulation of the regulatory part of our immune system, the otherwise known as the T regulatory part of our immune system, can also increase insulin resistance.
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That insulin resistance and metabolic disruptions are not unique to PCOS, but can be overlapping and create a feed forward cycle between autoimmune processes and PCOS such that PCOS in some circles, in addition to endocrine disruption, is also thought to be a manifestation of autoimmunity. And this is interesting in the functional medicine space because so much of what I found out there in terms of PCOS and how to manage it in the clinical space actually has to do with addressing insulin resistance. I’m gonna maybe toggle us back to doctor McCullough’s excellent, excellent, book because she has here a wonderful summary. And and if you are in fact working on, on managing your polycystic ovarian syndrome, and I believe somewhere in this book, I have to remind myself. But I believe somewhere in this book, she also says something interesting, which is, once PICOS always PICOS because it’s a syndrome.
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It’s not strep throat. It’s, it’s an immune dysregulation. It’s an endocrine dysregulation and it’s something that needs to be managed throughout our lifetime and what we can do. And she also, by the way, takes clinical scenarios and and makes it a lot more understandable. But I’m looking for this really groovy image that I now realize I should have bookmarked because she outlines the 8 steps, the 8 steps that are the integrative naturopathic, way of approaching.
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While I do this and while I scroll, I will mention Oh, here it is. Here it is. This is the beginning of every chapter where she has this beautiful flower image with each petal representing a step. Or as my dear mentor, doctor Nisha Winters likes to say in her metabolic approaches to cancer, that we need another drop in the bucket, a drop in the bucket. How did we get here?
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And then we address we address each drop in the bucket to create a pathway, a conscious pathway to healing on purpose. And doctor McCullough, I really hope I’m saying her name right. Please forgive me if I have not. But, but, each step is a key piece of the puzzle. So we have inflammation.
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Now, 1 of the really powerful ways of addressing inflammation can be with diet. So addressing inflammation per se can also overlap with treating insulin resistance, which also can be dietary. But just doing a fast, for example, and this is another big talking point from my dear mentor and brilliant mentor, Doctor. Nisha Winters, a 3 day fast can completely change around your microbiome, lower inflammation and treat insulin resistance. And so, then we want to balance our adrenals.
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So the role of stress here is incredibly important and might reflect transgenerational stress. 1 of the things that I’ve noticed just looking very closely in a very detailed way at blood work and in folks who come in on their path to healing on purpose, and we do the detailed investigation. Is that 1 of the possible responses to stress, especially when our adrenals can still mount a robust response is actually to increase androgen production. And so let’s say someone is in a stressful pregnancy, a stressful time in their life where they have just inherited stress in their life where transgenerationally themselves, and then they’re pregnant or they have Hashimoto’s thyroiditis and they’re pregnant, or they have stressful circumstances in and above themselves transgenerationally and thyroid disruption and endocrine disruption. And who knows what’s happening with diet, environmental exposures.
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That’s the endocrine disruption, a bit redundant, but anyway, this is the multifactorial and we don’t know about genetics, of course, but we’re learning more and more. These are the multifactorial parameters that lead possibly to the development of PCOS. Remember 5 to 20 percent of women in reproductive age world wide. That’s absolutely staggering leading cause for infertility in the United States. Anyway, I digress.
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We said balance your adrenals and we started speaking about stress. Treat excess androgens. In previous conversations, we have had, discussions of how, the liver is very much responsible for breaking down and biotransforming and metabolizing. These are interchangeable terms, are exogenous outside of our body environmental exposures. This is, you know, the under the header that I, that we’re so worried about in our community of endocrine disruptors.
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That means toxins, metals, phthalates, things that we’re exposed to from our cosmetics, from our plastics, from from our water, from our air. This is, an incredibly, overwhelming and disheartening subject. And yet, as I’ve said in past talks, becoming aware of what these things are is necessary. If we don’t know, we cannot get conscious. If we cannot get conscious, then we don’t have a choice point.
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Becoming conscious gives us choice points, allows us to exert our agency and our free will in making changes for us. And why shouldn’t we make those changes? Do we not want to be able to have children? Do we not want our hormones to work for us? I mean, see, see how our body loves us and is speaking to us all the time and telling us that whatever the state is within our body or around our body, that is truly a reflection of the world around us.
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As I like to say, we are all fishes swimming in the same pond and each 1 of us fishes, we might have inter individual variation. However, all of us are touched by the pond and the health of the pond is our own health. These are 1 and the same. And the more we realize that all of us fishies are affected in varying ways to varying degrees, the more we can be motivated together and realize that the change is incumbent upon all of us. And where do we start?
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Here on the pathway to healing on purpose and this wonderful naturopath, Fiona McCulloch has outlined these steps that are separate and yet overlapping just like the petals on this flower. It’s really a perfect, ingenious graphic. Hormonal imbalances, balancing your thyroid, creating a healthy environment, and eating a balanced diet. How beautiful. How beautiful.
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And, I have really, really worked with this and practice. It’s been really fascinating. It’s been really fascinating to balance the thyroid. It’s, been fascinating to, heal the gut, which has so much to do with autoimmunity and with Hashimoto’s thyroiditis. And it’s been so interesting to use really straight out of this book.
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Some of the supplement suggestions that have really made a big difference. Let me see. Likely in chapter 5, let me see if I can hop right there. I’m gonna maybe get better about navigating this. Maybe, maybe this page.
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So I wanna go to the 5th chapter on oh, no. It’s actually chapter 6. And and speak to some of the things that we see in labs. So if you’re somewhere out there in space and you want to see if you are having an irregular menstrual cycle and acne and weight loss resistance or weight gain, or you feel like your blood sugar may be imbalanced or your thyroid is off or you have a family history, whatever your score, you’re trying to get pregnant and you’re having trouble. And then you start saying, okay, what’s going on?
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Whatever is the impetus for you stepping on to the conscious pathway of healing on purpose. Here we are. And, you know, really excellent clinical, technical, explanation of how these hormones, should be and where they might be instead and what things you can actually measure so that you can partner with someone who will measure this for you and be willing to look at things like thyroid antibodies. And look of course at these hormones, follicle stimulating hormone and luteinizing hormone. Classically, the luteinizing hormone will be higher about twice as high as the follicle stimulating hormone, giving you times, the ideal times to be checking in on these.
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And here is a review of conventional therapies. Commonly just to get a regular menstrual cycle, we are giving oral contraceptives, trying to figure out if we can get someone to bleed if they’re not menstruating regularly. But here are some things that peony and licorice, black cohosh. Vitex is a fascinating 1 and 1 that I really, really love. Again, this talk is for educational purposes and not for diagnosis and treatment.
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However, sending you the resources, creating a shared language and vocabulary, showing you that there’s a plurality of understanding of this as a syndrome. And that since this is something that needs to be tended to thought of and addressed throughout our lifetime, changes the thought process as to, whether just being on an oral contraceptive is going to cut it. Because when we have this is this is my own personal humble opinion. When we have a hormonal dysregulation, that is feedback for us because hormone regulation is feedback and hormone dysregulation is feedback that the feedback isn’t working. That’s very meta, but the feedback about the feedback, the feedback about the fine tuned delicate dance of all the hormones is off.
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This has profound health implications and overriding that fine tune dance is cosmetic, unfortunately. And sometimes I meet women and they say, well, I just had so much pain and I was so uncomfortable or I had acne, whatever was the case that that was what they needed to lean into. And that’s absolutely fine. But whenever it is that that spark is lit and you decide to step onto the path, the healing path on purpose, you start realizing that the plot thickens, that the story is deeper and that out of self love to really get better and be more vibrant and protect fertility and protect life and to protect the future. You might want to know, well, what are the endocrine disruptors that might be in my system?
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And what does that mean about my environment and my exposures? What does this mean about my mom’s environment and exposures way back? What does that mean about my grandmas? It might lead to discovery and self knowledge, not just in your own time, but transgenerationally. It might mean that you heal yourself from insulin resistance or autoimmunity, or even look for autoimmunity in the 1st place because it’s not standard of practice to screen for thyroid antibodies unless the thyroid numbers are out of the reference range.
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So this is really an invitation to look. Anyway, back to Vitex. What I thought was so interesting about Vitex is in the research, the newer research, this book by the way was published in 2016 and at that time was very up to date, determined that much of the way vitex works lies within its action on the brain. I found this so fascinating. Its ability to regulate the cycle involves and I’m just reading right out of chapter 6 in Fiona McCullough’s book.
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Its ability to regulate cycles involves its action on the brain’s dopaminergic and opioid systems. Meaning this has to do so much with our sense of well-being, with our endorphins, with our feel good hormones, with our neuro balance. I mean, holy mind body connection. And, this was 1, I think it was further down here that it appears to act on the brain, regulating hormones from a higher level that it seems to let me go down and try to say this to you clearly beyond estrogen and progesterone and testosterone. It was somewhere further down and it’s explained in beautiful detail, but I’m gonna get to a bottom line here if I find it or not, because I remember.
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So I’ll just say it to you is that it seems to uncouple stress manifesting in the brain from the hypothalamic ovarian communication system, hypothalamus, pituitary in the brain, and the ovaries. Yep. Here, the typical dosing that doctor Fiona recommends, 1500 milligrams in the morning. She typically use, tinctures and extracts, or, I use a standardized, encapsulated form from I don’t know if I’m a from, an encapsulated form. And this in combination with balancing the thyroid, in combination with detox, in combination with intermittent fasting, in combination in combination in combination with with other herbs, and just figuring out what works has worked marvels.
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And what’s interesting also is that sometimes, the excitement of figuring things out over time, I’m saying over years, wears a little thin. And then, in some folks, I’ve tried to see if we can kind of pare back on some of this work, And it’s been tricky. My experience has also been that this is a lifelong journey. And so if you have irregular menses, abnormal hair growth, acne, fertility difficulties, known hypothyroidism, or suspect hypothyroidism, or RN ambulatory and want to someone to look at your thyroid, including antibodies. You might wanna seek out, a naturopath trained in this area, a functional medicine physician trained in this area, or look into direct to consumer labs.
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This is an area that I really need to research more on behalf of the community since I offer labs directly in my office. How can we avail ourselves when there, is not consistent access to integrative medicine to start doing some more of this detective work that is affecting 1 in 5 women, potentially of reproductive age around the world. It’s time. It’s time for all of us to learn this and learn that the pill might be a temporizing measure, but it’s not enough taking spironolactone to block the effects of that hyperandranism on our on our on a cellular level in the form of spironolactone is not enough. Taking metformin, but not looking at our diet, it’s not enough.
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Going into in vitro fertilization because we’re infertile is not enough. Maybe you’ll manage your immediate concern vis a vis being able to conceive or hold a pregnancy. Maybe you’ll handle your regular menstrual cycle because it’s handled cosmetically by oral contraceptives. Maybe you’ll handle your acne with spironolactone. But what about the other health risks that are carried with a story of endocrine disruption, autoimmunity, inflammation, insulin resistance?
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What about downstream risk factors for diabetes? What about downstream risk factors for cancer? We need to do better and you can do better. And that is in fact why you joined me today on purpose to listen to this conversation, to be galvanized, to be inspired, to maybe be pointed to just doing a little bit of research on PubMed and pulling up some of these articles, and maybe bringing it up with your own personal health authority, finding this book, 8 Steps to Reversing PCOS, and, and maybe looking for some direct to consumer laboratory work around the thyroid, around the female hormones. I hope you do pick up the gauntlet, so to speak, and take charge and step into your own power on your conscious pathway.
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I’m so glad you’re here. Let me know what you think about this conversation. And if you want to take a deeper dive into specific subjects, such as insulin resistance, such as, nutritional approaches, such as more information on some of the natural, herbals, and nutraceuticals that we might use, whatever it is, I’m honored, excited, and looking forward to our next conversation on Healing on Purpose.
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Thanks for listening to the Healing on Purpose podcast today. I hope you found this information helpful, and I encourage you to share this episode with others who may also benefit from the information shared. Please consider rating and reviewing my podcast on Apple Podcasts so more people can find this information. I also invite you to join the Healing on Purpose podcast Facebook group to continue this conversation. I’ll see you there.