PCOS Interview With Dr. Ana Kausel

We have been lucky enough to interview Dr. Ana Maria Kausel, who is an endocrinologist with a particular interest in metabolic disorders, along with diabetes and obesity. She is board-certified in endocrinology, diabetes, and metabolism by the American Board of Internal Medicine. She’s also a member of the American Association of Clinical Endocrinologists and the Endocrine Society. 

We wanted to interview Dr. Kausel on a specific condition that can affect  women we see day to day. Polycystic Ovary Syndrome (PCOS) affects 1 in 10 women of childbearing age. Women with PCOS have a hormonal imbalance and issues with their metabolism that may affect their overall health and appearance. This can be very frustrating, especially if women feel they aren’t receiving the proper guidance from their doctor.

The Interview:

Here are the questions we specifically had for Dr. Kausel:

What is the common presentation of a woman that walks in your door that hasn’t yet been diagnosed with PCOS?

Answer: The common presentation that I see experiences:

• Abnormal menstrual cycles

• Acne

• Unwanted facial hair

• Hair loss  

• Weight gain

Which hormone levels are specific to help with a diagnosis?

Answer: I check a full hormonal panel but essentially, the most important one is testosterone which is normally produced in small quantities in women. A complete workup includes: thyroid function, estradiol levels, A1c, DHEA-S levels. Sometimes we can also check LH and FSH levels and prolactin for women who come for absent menses. 

What is the typical treatment protocol for most of the patients you see with PCOS? 

Answer: Depends on whether the patient is seeking fertility. If a patient is seeking fertility, I usually refer to a reproductive endocrinologist who will likely do fertility treatments including medications like clomiphene and letrozole.

For women not seeking fertility we use: birth control, metformin and spironolactone based on the presentations and symptoms. Sometimes all of them. 

I always assist my patients in making lifestyle changes first. If the patient has prediabetes or severe insulin resistance, we prescribe medications we normally use in diabetics but that’s on an individual basis. 

Do you specifically help your patients with their nutrition or do you refer out to a Registered Dietician (RD) or health coach? 

Answer: I refer to both RD’s and health coaches. Patients with PCOS have problems handing insulin, so the best diet is a low sugar diet, including limited fruits. I must emphasize that a diet is LOW SUGAR is not the same as a LOW CARBOHYDRATE diet. There are plenty of healthy carbohydrates that you could eat that are low in sugar. 

What types of exercise do you recommend to your patients once they have been diagnosed? 

Answer: There is no science behind this but I personally see that patients respond better in terms of weight loss to HIIT, Pilates, Yoga, Kickboxing and less to spinning and running. The key is not to get the heart rate too high and to work the core. 

How do you think the medical system can better improve awareness and management of PCOS?

Answer: Awareness. Sometimes it is engraved in us that having abnormal cycles is normal and it’s not. Gaining weight without changes is also not normal. Having facial hair is not normal. When something doesn’t feel right it’s better to see a doctor.

To connect with Dr. Kausel you can visit her website or follow her on social media.

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