Pregnancy and PCOS Q&A With Dr. Aviva Romm

Welcome to Episode 2 of Season 8 of The PCOS Revolution Podcast:

Pregnancy and PCOS Q&A with Dr. Aviva Rom

Are you pregnant or thinking about becoming pregnant? If so, this episode is for you. Our guest today shares great tips, tricks and insights into navigating a healthy pregnancy while having PCOS.

This week on PCOS Revolution Podcast, I am having a conversation with Dr. Aviva Rom. Dr. Aviva is a midwife and herbalist. She is board certified in family medicine with obstetrics who’s been bridging traditional medicine with good science for three decades. Her focus is on total health ecology.

Dr. Aviva currently lives in western Massachusetts in the countryside. She had an early inspiration to become a physician. She went to college at age 15 to become an MD. She was then exposed to herbal medicine and became passionate. She actually found out her grandma was an herbalist. Additionally, she began to explore the role of diet and lifestyle as well as exposure on our health.

Since then Dr. Aviva went vegetarian and vegan. She noticed weight that she gained resolved without having to ‘diet’ or exercise more. Allergies and sickness also subsided. Then she was exposed to midwifery. Functional medicine was not a popular thing when she discovered it. She had to navigate very few resources for these in order to study these topics. 

Dr. Aviva recommends probiotics during pregnancy with PCOS. She also suggestions to take two tablespoons of flaxseed to help get rid of extra estrogen. It can also help with pregnancy constipation. During the episode we dive deeper into various things you can do while pregnant. We’ll chat about blood sugar balance in pregnancy as well.

READ the entire transcript here:

Read Full Transcript

Farrar Duro

Welcome back everyone to The PCOS Revolution Podcast. I’m excited today to have with me Dr. Aviva Romm, who’s a midwife, herbalist and Yale-trained MD, board certified in family medicine with obstetrics, who has been bridging the best of traditional medicine with good science for over three decades. Her focus is on what she calls our total health ecology using episome medicine to identify and reverse the root causes of chronic health conditions, particularly hormonal problems and women and common children’s health problems. She’s considered one of the world’s leading botanical medicine experts, and is the author of seven books on natural medicine including the textbook, botanical medicine for women’s health, and the adrenal thyroid revolution. Dr. Romm is author of the integrative medicine curriculum for the Yale internal medicine and pediatric residency, is on numerous scientific advisory and editorial boards, and is a widely sought engaging speaker. Her online programs for women are also wildly popular and successful helping women take back their health affordably and her innovative professional programs are educating and next generation of health practitioners. So welcome, Dr. Romm. So excited to have you here.

Dr. Aviva Romm

Thank you. Please call me Aviva.

Farrar Duro

Okay. Hey, and so you practice in New York City, correct?

Dr. Aviva Romm

Yeah, I’m in New York City. And then I also have a telemedicine practice, based out of where I live, which is Massachusetts, I’m in Western Mass in the countryside. I live on a little dirt road.

Farrar Duro

Awesome. Oh, great. Okay, and what really inspired you to go the natural route? Because having both the degree in midwifery right and being an OB that’s really interesting. So what what led you to that path?

Dr. Aviva Romm

Yeah, so um, I actually started out on the natural path when I was 15, I had a really early inspiration to become a physician and I went to college when I was 15, to become an MD, but then during that first semester, I got exposed to so many things that kind of just really transformed the rest of my life. I got exposed to herbal medicine who knew such a thing existed. Ironically, I in my 20s, I found out that my great grandmother was actually an herbalist. She was Hungarian, and I didn’t know that. But at the time, it was so new to me and I started to explore the role of diet and lifestyle and environmental exposures on our health. And so I started to actually change my diet. At that time I became a vegetarian and a vegan, this was back in like 1981. And started to notice that, for example, weight that I had gained during my very stressful transition from high school at 14 to college at 15. Just sort of automatically resolved without me having to quote unquote, diet or exercise, more lifelong allergies I had, which were pretty significant seasonal allergies were gone, I used to get sick and take antibiotics a lot. Now, I’m 53, I’ve taken an antibiotic one since I was 15 years old when I change my diet that way.

Dr. Aviva Romm

So I started to get really interested in natural approaches. And then I got exposed to midwifery. And the two really went so naturally hand in hand, because women who were looking for a healthier, more natural way to birth, also wanted more natural approaches for their hormone health or their fertility or once they had kids for their children. So it kind of just became a whole life style and profession for me. But ultimately, I couldn’t get any of that training in conventional medicine because back in 1981, the term integrative medicine had not been coined. Nobody was, you know, my family thought I joined a cult because I was doing all these weird things, which of course, I had not done. And so I had to really seek out this training. In the very few books, there were like three or four books on herbal medicine on the market at the time, there was one book on midwifery or natural birth at the time. So I had to find people in corners of the country that were doing these things and apprentice sort of the old-fashioned way. And then I did that for over almost 25 years, where I, not apprenticed, but worked with women and kids around natural medicine and birth. And then decided that I really needed to be part of changing the medical system and being a voice of sanity for people who also had to go into the conventional medical system.

Dr. Aviva Romm

So I went back, finished my prerequisites for medical school, because I had left school at 16 to pursue these other things. And then really went to med school and then pursued, I did my internship in internal medicine. So I’d be able to do all adult medicine and encompass things like I mean everything from psychiatry to immunology to oncology, but wanted to bring back that pediatrics and midwifery care. So I did my internship in internal medicine and my residency in family medicine. And that was where I incorporated the obstetrics piece because as a family doctor, you can do family medicine, with or without obstetrics. And I chose to do it with obstetrics. So kind of the whole the whole way it happened. And I’ve just continued to incorporate the same nutritional botanical lifestyle, ecological awareness into what I do as a physician. And I always try to go to that first. Not that I shun using conventional therapies when they’re needed, there’s a time and place for medications for surgery, etc. But usually, that’s further down the line. And there’s so many natural approaches we can take first that are safer and healthier and often as or more effective.

Farrar Duro

Very cool. And I got that, you know, today we will talk about pregnancy with PCOS, because a lot of focus is always on getting pregnant, and yet, there’s not a whole lot on pregnancy and postpartum. And even less on, you know, menopausal, perimenopausal women with PCOS. So, we do get a lot of questions regarding supplements during pregnancy and, you know, also working with around balancing blood sugar and that sort of thing. If you’re already taking something, should you still take it and all that. So I thought that we could talk today about that. And I know that our listeners have a lot of questions about this. So could you just give a little bit of advice that you have a great blog post on your website about natural strategies for PCOS? And if you do have a patient who’s pregnant or with PCOS, do you have any suggestions for that patient? That would be a little different, or what would you look at?

Dr. Aviva Romm

Yeah, so for pregnancy? You know, it’s interesting. First of all, I just want to step back and say, women with PCOS have historically and sadly continued to be fat-shamed, right? There’s this perception that women have PCOS, because they’re overweight, which also is a problem because a lot of women who are thin, who can still have PCOS also get their diagnosis completely missed. So there’s been a lot of misconception and misperception in the medical literature about weight and fertility and conception and ability to conceive. And actually, would you really dissect the medical literature. Just because you’re overweight does not mean that you’re more likely to have conception problems.

Farrar Duro

If you’re obese, if someone's BMI is you know, over 30, then there can be more medical problems in general for anyone but just being overweight does not equate to a fertility problem. Similarly, you can be really slim and have PCOS and struggle with fertility problems. So getting to the crux of the matter. What we really want to think about or what I think about with PCOS, and getting pregnant, is is a woman ovulating. One of the biggest reasons that women don’t get pregnant pregnant is an ovulatory infertility, they’re not ovulating and one of the biggest problems with PCOS that leads women to have irregular menstrual cycles. And with that, sometimes fertility problems, which may be the first hint that there is PCOS, a lot of women have not had a proper diagnosis. Sometimes a woman’s been on birth control pills, it should have been recognized as soon as did most goes off the pill and now is struggling to get pregnant. I see that a lot in my practice.

Dr. Aviva Romm

So a lot of times, women don’t even realize that they have PCOS and the first sign that they have a PCOS is that they have trouble getting pregnant. A lot of times what I see in my practice, someone’s been on the pill, for example, since they were 14 or 15. It may have even been that they had symptoms of PCOS, but nobody noticed it because they had irregular periods, which is common when you’re a teenager, or they had acne, which is common when you’re a teenager, they were a little overweight, which people say oh, you know, you’re a teenager, and your hormones kicked and you gained weight. So they go off the pill. And then they try to get pregnant. And they’re having no six months, a year, two years. And it turns out, they’re just not ovulating properly. And so this is the biggest thing that I tried to give attention to, with women who are struggling with fertility and an ovulation, is looking at is it PCOS, then let’s get a proper diagnosis going. And if it is then working with their body to either address the excess testosterone, which is often what’s preventing the preventing ovulation, and making sure that their insulin and blood sugar levels are healthy.

Dr. Aviva Romm

Not all women with PCOS have measurable insulin resistance, but it is a really common problem, about up to 70% of women with PCOS have insulin resistance. And what’s interesting is that not all women with PCOS have detectable insulin resistance, but they may be more sensitive to insulin than other women. So they may still have some of the problems that come with it like this high testosterone. And the problem with this is that once they do get pregnant, well, if they struggle with the fertility problem, of course, that in itself can be excruciating, emotionally financially costly, taxing of time, then once women with PCOS do get pregnant, they have a higher rate of miscarriage. And that’s, you know, of course, very emotionally stressful, and often have if they have an insulin resistant or blood sugar problem with their PCOS, run the risk of having problems like gestational diabetes, when they’re pregnant, premature labor when they’re pregnant, and babies with higher levels of problems. So, I don’t want anybody listening to be scared about that. It’s just important to of course, be educated and knowledgeable and most OB/GYNs and family doctors are absolutely not knowledgeable about the connection between PCOS, miscarriage and pregnancy problems.

Dr. Aviva Romm

So when I have a woman who is coming in for prenatal care for fertility care, or for PCOS, and she’s thinking that she might want to get pregnant sometime. I always want to make sure that I’m working with her to optimize her blood sugar, making sure that her blood sugar levels are ideal, and healthy before she gets pregnant, usually just working with diet, and then working to make sure that we’re addressing her testosterone levels, which you don’t necessarily always have to keep testing and testing and testing. But you can often look at is that excess hair that is growing in places she doesn’t want it not growing anymore, is she having continued acne. And as those symptoms start to clear up through work with diet, sometimes supplements, you’re kind of getting the physical signs that things are improving. During pregnancy, it gets a little bit trickier because one we can’t easily diagnose PCOS during pregnancy.

Dr. Aviva Romm

So if you didn’t already know someone has it, you know, you may be kind of walking into that not knowingly, but it’s really important during pregnancy for women to keep their blood sugar really healthy. And also, if someone goes into to pregnancy on a lot of the PCOS supplements that are recommended, and particularly the botanicals, not all of those are safer use during pregnancy. So it’s important to have a really good plan in place. If someone has had problems with their blood sugar, you know, how are you going to keep it steady? If the only way you’ve achieved keeping it steady before is with you know, certain herbs and supplements, you know, and then just being aware of blood sugar throughout pregnancy and making sure that you’re staying on top of preventing gestational diabetes, which is really quite possible with a healthy diet.

Farrar Duro

And would you recommend Myo inositol powder during pregnancy?

Dr. Aviva Romm

I recommend Myo inositol, it is actually proven safe for use during pregnancy. So it’s one of the it’s one of my definite go to supplements for women who are who are struggling with preconception problems or you know fertility problems, who have PCOS in general, particularly if they have a known blood sugar problem. And interestingly, I’m at least in one study, combining Myo inositol with folic acid, which is actually really important for preconception and baby’s health, even before you get pregnant, but certainly during that first trimester as well, has actually shown to improve conception rate of improved ovulation and conception rate in women with PCOS even better than Metformin, which is the standard medication use for blood sugar regulation. You can also use D Chiro inositol, or you can use a combination of the Myo inositol and D Chiro inostiol.

Farrar Duro

Very good. And do you have any recommendations as far as you know, probiotics or vitamin D level, what type of vitamin D or anything like that?

Dr. Aviva Romm

Yeah, so vitamin D is both essential for a healthy pregnancy. And also, we know that moms that get optimal levels, or moms who have optimal vitamin D levels during pregnancy, actually have babies with healthier dentition, their teeth are better when they when they get their teeth. So it’s really important to keep your vitamin D levels healthy during pregnancy, I like to see vitamin D levels between about 50 and 80 on bloodwork. And for most people, even if you don’t know what your vitamin D level is, taking 2000 international units of vitamin d3 during pregnancy is totally safe for pretty much everyone. There’s one rare exception, which is one particular autoimmune condition that’s so rare.

Dr. Aviva Romm

But for everyone else, it’s really, really safe. So I recommend that 2000 units for all my pregnant women. But I usually do a vitamin D level on my women with vitamin D with a PCOS. And if their vitamin D level is below 40, then I will always be supplement to try to bring them up to at least 40. Usually 2000 units a day, if someone’s in a healthy range will keep them in a healthy range. And if they’re below a healthy range, so anything under 20 is considered deficient. Anything under 30 is considered insufficient. 40 is really an optimal level to start, you know to get to. So if they’re below those optimal levels, I will supplement more sometimes 4000 or up to even 6000 units a day. I don’t recommend just doing that on your own, though, that’s when it’s really good to work with an integrative family doctor who’s trained in obstetrics or an integrative ob/gyn or in a knowledgeable midwife to help get you to that right level because you want to retest if you’re at those high levels to not keep taking those sustained high levels, once you reach a normal blood level.

Farrar Duro

That’s great advice. And I feel like they’re two I guess, roadblocks when that I’ve noticed with our patients. And also myself when I when I was pregnant. If you have irregular cycles, sometimes a typical gynecologist is going to base your due date and all everything on, you know, a normal cycle and a 28 day cycle, I guess you could say. But if you’ve had 36, or 40 or 50 day cycles, that’s your norm. You’re ovulating much later. So they could actually potentially tell you that, you know, you’re not doing well the pregnancies not going as well as it should have, you know, your numbers aren’t where they need to be, if they’re basing it off of, you know, 28 day cycles. So, so I think, you know, we tell them, you know, make sure that you tell your doctor about your long cycles. So that that doesn’t, you know, happen, even with an ultrasound a heartbeat, not there. And it’s like, wait, it’s only five weeks. So typically,

Dr. Aviva Romm

if somebody is having like a 40 or 50 day cycle, often not itself has been an anovulatory cycle. So typically like that, you wouldn’t necessarily give like an extra 30 days. But I agree with you erring on the side of two weeks plus or minus is really important because one, ultrasounds can be inaccurate by two weeks. And a lot of times we’ll see somebody who gets induced too early, because they’re, they’re told that they’re going overdue when they’re not necessarily overdue, they just conceived later. The other thing is that women who have higher body weight are often going to be flagged by the medical model as being much higher risk. And that’s not always the case with significant obesity.

Dr. Aviva Romm

It’s the case and with diabetes, it’s the case with gestational or, or non gestational diabetes, it’s the case but just being overweight, doesn’t mean you’re more likely to have really severe pregnancy outcomes. And doesn’t mean you need to be induced. So women need to advocate for themselves if they feel like they’re being treated based on their weight or fat shamed and really important, because this is actually a very big problem in conventional medicine.

Farrar Duro

That’s true. And I was thinking the other thing would be anemia. Because if you have high, I mean, if you have, you know very long cycles or heavy cycles with a lot of women do with PCOS, once they get their period, you know, then also you have a higher chance, you know, also when you’re pregnant of...