PCOS or polycystic ovarian syndrome is not simply a disease of the ovaries. The ovaries are one part of this complex hormonal syndrome which includes symptoms such as excess body hair, increased weight, acne and insulin resistance.
The focus becomes the ovaries, however when you are trying to get pregnant.
This is because for some women with PCOS they are anovulatory meaning they don’t ovulate BUT this doesn’t mean PCOS = infertility, it just means you may need some help putting the extra ingredient in to your baby making mix.
In this episode we cover:
What is PCOS
What are likely symptoms
Is it painful?
How it gets diagnosed
What are some of the treatments available
What healthcare professionals you may need
What happens if you are not ovulating
What is lean PCOS
Brigid [00:00:36] Well, welcome, everyone. This is Episode 24, we haven't recorded anything this year, we've been working on things that we've recorded at the end of last year because it's just been so busy patt, hasn't it?
Patrick [00:00:47] Sure has. And amongst other things, we've got a new puppy. Yes, a beagle puppy called Banjo who is here in the studio.
Brigid [00:00:58] The studio people said you have to bring the dog in and so, you know, it's good that it's bring your dog to work day.
Patrick [00:01:05] So he's not here in this soundproof booth part of it. But we can see out the window that he is causing a lot of trouble in the studio.
Brigid [00:01:15] It's like having another little newborn. Nearly no,no quite. So I would like to give a big shout out to all our January babies. All the mamas that have had their babies in January was busy and was very busy. A very special shout out. I don't know whether you'll still be listening because you don't need to. But to our personal trainer and his lovely partner, had a baby this week. Very exciting.
Patrick [00:01:38] A girl, a little girl. They got to give her a name yet. They haven't named her. That is so common is none.
Brigid [00:01:45] Yeah, I would say that most people have got a list. A short list. Yeah, but they need to see the baby in the flesh before they make their decision.
Brigid [00:01:55] Yes. Absolutely. And another person I want to give a shout out to is one of our VBAC mamas. And it made me think. Have we actually done a podcast on VBAC. I'm not sure we should check that. Yeah. I think that if we haven't we should. Yeah. So VBAC means vaginal birth after cesarean. Well, there's another term now too, isn't it? TOLAC trial of labor after cesarean? Yeah, I like feedback better. Oh okay.
Patrick [00:02:22] Great. Well it puts a vaginal birth in there as the as the does. That's the desired outcome. Yeah. So if we haven't we should because that's deep in my heart.
Brigid [00:02:31] Yeah. Great. So today we're gonna talk about PCOS and fertility. Yeah. And actually this came from a review on our iTunes account.
Brigid [00:02:42] So it's from Polly Art. Thank you Polly that she's got." Love it. Thank you to both of you for making the time and broadcasting all this information. And in English terms and with humor" I like it that she thinks we're humorous. "One topic I'd love to know more about, my daughter has just been diagnosed with PCOS. So what do we do now? So we thought, yep, this is absolutely a topic we should be covering up our. Yeah.
Patrick [00:03:10] So PCOS is polycystic ovarian syndrome. And this is a condition that affects lots of young women and is relevant to gynaecological health, to getting pregnant and to having normal healthy pregnancies.
Brigid [00:03:27] And what actually causes PCOS?
Patrick [00:03:30] Like a lot of this stuff. We don't know exactly what causes it. We know that genes are involved so that there are certain there are certainly families where PCOS will run in the genes. And we know that body weight is part of it as well, perhaps not so much in the cause, but in how severe it is. Lots of the symptoms of PCOS, such as the tendency towards acne, tendency towards excess body hair and definitely a tendency towards anovulation or not making an egg each month. And the problems involved in insulin metabolism that come with PCOS will definitely, you know, the severity will definitely go up and down with the woman's body weight.
Brigid [00:04:15] And I mean, people might hear some of the sort of medical terms around, say, hair. What what's that called?
Brigid [00:04:21] Again, hirsutism is the medical. Is the medical term for hair. And of course, even that's a little bit relative to racial background and how much body hair you find it is acceptable.
Brigid [00:04:33] Yeah. And not all women with PCOS would have excess body hair, would they?
Patrick [00:04:38] No, in fact, not that many people have got every feature of the syndrome that's in the textbook and you can have PCOS if you're thin and don't have an excess of body hair and don't have acne.
Brigid [00:04:48] Yeah, right. So somebody who has thin PCOS, then how would they be diagnosed or how oh how do they even know that they need to go to see a GP?
Patrick [00:04:57] Yeah. That would typically come to light when they're trying for a baby and they come off their contraceptive. Remember, if you're on the pill doesn't matter whether your body naturally ovulates or not. The pill works by stopping ovulation so people can't tell on the pill whether they're ovulating or not. And then, in fact, you know, the desired outcome is that you're not so that it's a good contraceptive. When you come off the pill and a nice regular monthly period doesn't return. That's often when when the PCOS is is revealed.
Brigid [00:05:26] Yeah, that's similar to other things like endometriosis'. Isn't it? You might be on the pill for such a long time and then you go off that to get pregnant or whatever and then all of a sudden you have this raging painful period.
Patrick [00:05:37] Yeah. And it's one of the reasons why sometimes the pill gets a bit of a bad rap because it can sometimes looks like look like the pill has caused the problem. Yes, but more often than not, the pill has just suppressed the obvious symptoms of a problem that's been there all along.
Brigid [00:05:50] Yeah. And you might have been on the pill for, what, five, 10 years or whatever before.
Patrick [00:05:53] It's not trying for a baby. Fifteen. Yeah. And then you take the pill away and a problem you've actually had all along, but the pill was managing quite nicely, is suddenly revealed.
Brigid [00:06:03] Well yes because that definitely was part of my terminology as I was sort of growing up. If you are on the pill then it's going to make all these conditions worse. But now I understand what you're saying. It's sort of suppressed it and it will look worse. But it was there all along. Yeah.
Patrick [00:06:15] Yes. So in in you know, for the vast majority of young women, we don't think the pill does anything bad. And, you know, sometimes you've got to shop around and find the pill that's right for you. But a lot of the time problems that are revealed when the pill is stopped are things that the woman's actually had all along.
Brigid [00:06:31] Yeah, right. So for the woman with PCOS, is it only about when they're trying for a baby that they get diagnosed with PCOS or is a you know, can you be a teenager and get diagnosed with it? Yes.
Patrick [00:06:42] So another woman might have the full hand of symptoms and go along to see a GP with an interest in women's health for problems such as difficulty managing body weight, difficulty with high insulin levels and problems with acne and excess body hair.
Brigid [00:07:01] Yeah, right. So they are the main signs that would take somebody to the GP before they started getting pregnant.
Patrick [00:07:07] Absolutely. Yeah. And typically, you know, in in the typical sort of textbook PCOS patient, those things that are gonna be obvious and and ideally dealt with first. And when you go on to see the local doc or women's health GP with women's health interest or a specialist gynecologist when you're not trying to her baby, we we tend to just we tend to concentrate the treatment advice on what the problem actually is at that time. Yeah. For that woman. So if you're 18 and you're not even remotely considering having a baby, then we just don't get into that. Now let's leave that on the backburner for when you want a baby. Yes.
Patrick [00:07:45] And right now, we concentrate on good treatments for the things that are troubling you right now, like excess body hair, acne, weight control.
Brigid [00:07:53] Yes. And typically, I know what you're going to say. It's specific to each person. But typically, do people get treated with the pill?
Patrick [00:08:02] Yes. So the most common, very effective treatment is a type of pill where, you know, every pills called an estrogen and progesterone, every combined pill, and there's a class of pills where the progesterone is a special progesterone called Cyproterone. And it acts as a very effective treatment for PCOS.
Brigid [00:08:27] So I've actually heard the term polycystic ovaries is that PCOS will polycystic ovaries refers just to the ovaries.
Patrick [00:08:35] And that's an ultrasound finding where you can see that they've got a bunch of cysts in them.
Brigid [00:08:40] And they look like little bumps on the ovary, the cysts?
Patrick [00:08:42] Typically, it's a number of very small cysts on on the ultrasound peripherally located within the oversaw around the edge. But that cysts is actually a misnomer. They're not they're not ovarian cysts per say. They're immature follicles. So they're they a little eggs, waiting to pop out. Right. Yeah. And they've. And the ovary has tried to mature one up into a nice, big, mature follicle. It would actually pop in again. But for a complex endocrine reasons behind PCOS, it hasn't been able to do that. So these are a number of follicles arrested at partial development.
Brigid [00:09:22] Yeah. Right. So you might have polycystic ovaries, but not ovulate.
Patrick [00:09:26] Yes. So you might have polycystic ovaries on an ultrasound and have none of the other features of polycystic ovarian syndrome. You might have polycystic ovaries on ultrasound and have all of the other features. Yeah. Yeah. Anovulation not ovulating. This is a typical feature.
Brigid [00:09:42] Yeah. And so just coming back to your point of view statements ago, and that is that you if you go into the GP, the GP will be trading you for that problem that you're presenting with at that time. Yeah.
Patrick [00:09:53] So the Cyproterone in contraceptive in that class of contraceptive pills works as a as a an anti testosterone and works against the excess of male hormone that can be behind a lot of these problems. So it's a good treatment obviously for excess body hair that's being caused by the excess testosterone. Acne is the same. And whilst the pill, like any other pill stopped you ovulating, it will create a normal pill cycle so that you might go from, you know, having two or three irregular periods a year to at least having a cycle, a monthly bleed. Yeah. Yeah.
Brigid [00:10:35] So for those women that have PCOS, I can't believe I haven't asked this yet. But does any of this cause pain? Yeah.
Patrick [00:10:42] There's a little bit of debate about this. Some people would say that PCOS, you know, is an adequate explanation for pain. And if someone's got PCOS, obviously to look at but a lot of pelvic pain, then they might also have endometriosis. Yeah. Right. And both conditions are common.
Brigid [00:11:00] So to have together?
Patrick [00:11:01] Well they're both common so mathematically there's no reason why you can't have both.
Patrick [00:11:10] So I I've definitely seen a number of young women who've talked to me about their PCOS and then gone on to talk about pelvic pain, dysmenorrhea, which is pain with menstruation. A lot of pain with intercourse called dyspareunia. And if this sounds an awful lot like endometriosis and laparoscope, if they've been found to have two problems. Yeah, yeah, PCOS plus endo. So I get a little bit worried about someone who's got PCOS and a lot of pain who just thinks it's the PCOS series. But you can have painful ovaries from PCOS, I'm sure, because they're big and bulky.
Brigid [00:11:46] Yeah. Yeah. OK. So would you feel sort of side pain?
Patrick [00:11:49] You know, we ovaries are all you know, but not ovulatory pain because a problem is not ovulate. So perhaps pain with they've been to cause.
Brigid [00:11:58] So how common is PCOS?
Patrick [00:12:02] Well, it varies a little bit around the world, but a figure of roughly about 10 percent of women in the reproductive age group. Yeah. Wow. So it's a lot isn't it? Yeah, that is a long now. Now lots of those people will have relatively minor symptoms and they're fertile. Yeah. So they might just not come to attention yet. But technically they meet the diagnostic criteria. Okay. And then there's tonnes women who need help. Yeah. And but you know, it's this is not a rare thing.
Brigid [00:12:30] Yeah. And are there particular tests that a GP would do?
Patrick [00:12:34] Yeah. So useful tests can be a pelvic ultrasound and you can see a fairly typical pattern of carefully located follicles within the ovaries, which is sort of typical of the PCOS type appearance. And then we tend to do blood tests and the blood tests vary a little bit on how the patient presents and in particular what the what the body weight is. All right.
Patrick [00:12:58] But typical blood tests would be testosterone levels, something called a fasting insulin, which is how how much insulin you've got circulating. And, you know, first thing in the morning when you haven't hadn't had anything to eat yet. Yeah. And, you know, the other reproductive hormones are often are often tested as well.
Brigid [00:13:14] All right. So once you've got PCOS. Have you always got it?
Patrick [00:13:18] Yeah, I think you've always got a tendency towards it. Yeah. Although you can imagine that as you get older, it kind of matters less. Yeah.
Brigid [00:13:29] And as menopause mean that it goes away. Does it go at menopause? I'm not sure many of our listeners are at menopause yet, but you know, possibly.
Patrick [00:13:37] Look, it's funny, isn't it? See, you know, if you'd 19 years old, you very much want to have and you're a woman. You're very much want to be to have the female hormones as dominant. So you want to have a female body shape and and to have a reproductive system that's functioning normally. And and if you've got some excess male hormone causing that acne and that hirsutism, that's a big, big issue for you. When you've finished your family and as you approach menopause, a lot of those issues may be less important. So, for example, sub fertility in your in your late 40s, you may not know or care?
Brigid [00:14:11] Yeah, pretty sure you still don't want to have acne or be hairy. No, but I was just guessing at that.
Patrick [00:14:18] Yeah. No, fair enough. But people might, you know, in that age group be more likely to treat, say, the hirsutism by hair removal. Yes. Rather than rather than by hormonal means. Yeah.
Brigid [00:14:31] All right. So now we're going to drill down into pregnancy. So do women have a harder time getting pregnant if they have PCOS? We've touched on a little bit, but look, if we could explain it a bit more. Yeah.
Patrick [00:14:44] So simple answer is yes. But there is a but. There is always a but. Not Always. Right. So I think it's. Yeah, in the order of 60 percent of women with diagnosed PCOS will get pregnant without reproductive assistance. Nice. That's a lot. That is a lot. Yeah. Because that's a group that thought that they were potentially infertile. Yeah. I just, you know, read what they read. Yes. On the Internet. Yeah. So our old friend, the Internet. So that's a that's quite a reassuring figure. And they're people who meet the diagnostic criteria but are ovulating and can get pregnant? Yeah.
Patrick [00:15:19] And then there's obviously a group who aren't ovulating because of the hormonal disturbance, because of PCOS. And some of those people require very complex reproductive interventions. But lots don't.
Brigid [00:15:36] Yeah, I know. In our clinic, we've got a lot of people that have ovulation induction. Yeah. PCOS and it's very successful, isn't it?
Patrick [00:15:43] And so can rapid weight reduction. Yeah. Which often what we try first. Success rates depend a little bit on dedication to it. But there's abundant evidence that relatively rapid weight loss can restore ovulation quite nicely.
Brigid [00:16:01] When you say rapid weight loss, are you talking about the sleeve or this is somebody really putting effort into weight management?
Patrick [00:16:08] Good question. It's one of the few times when a doctor will tell you to crash diet. Right. Okay. Because it does work. But you need that really fast weight loss. Yeah. So occasionally, especially if you've got a patient who says I used to have a perfectly good period. It came once a month. Cycle was 28 days long. I had mid-cycle pain on day 14 when I weighed 20 kilos less than I do now. Yeah, well I reckon we can probably get back to that back. Yeah. Right. So in conjunction with a dietitian, some pretty hard weight reduction strategies. Yeah. I've certainly had had very overweight patients who've had a gastric sleeve weight reduction surgery, lost 50 kilos because they needed to and then start to ovulate again. Yeah. Well yeah. Not an option we reach for first but for some really really significantly overweight women. That is a real thing. Having the surgery in order to have a pregnancy. Because even if we could if some weighs 150 kilograms, even if we could achieve a pregnancy by using drugs to stimulate the ovaries, then you're pregnant and you still are overweight. . So there's some hard cases where that something drastic might be appropriate.
Brigid [00:17:20] And what about the women who have thin PCOS then?
Patrick [00:17:24] Yeah. So there's a phenomenon called lean PCOS,.
Brigid [00:17:28] Sorry I said thin, it's lean!
Patrick [00:17:30] That's women with a normal body weight who have got PCOS nonetheless. Yeah. And no point telling them to lose weight. They don't have the weight to lose. Yeah. And so we use medications that work quite nicely to wake the ovaries up and get them to start making an egg each month. Yeah. And that's some that's not terribly difficult. That's called ovulation induction. And there's a couple of drugs in common use for that drug that's been around for many, many years called clomiphene and more recently another clever drug called Letrozole.
Patrick [00:18:04] And they just sort of fool the ovaries into thinking that and have PCOS anymore and work hormonally to help the ovary pick an egg and say you're the chosen one for this month. Mature it up in a nice big follicle and actually pop it out.
Brigid [00:18:20] I love visualizing that. It's a nice thought is a nice thought, isn't it? You know, so if you're thinking about your ovaries, just think about that little egg that's waiting to grow and pop out of it.
Patrick [00:18:31] And that can be that can be particularly satisfying scenario to try. Yeah. Because you might have someone who's been struggling for many, many years with the other features of PCOS. But when they are finally ready to have a baby, sometimes it works very it quite straightforward.
Brigid [00:18:45] Yeah. And I know again, from our experience in the clinic, it could be a month or two months that they're doing this ovulation induction and they're pregnant. Yeah. It is just so exciting. Because you're just putting back the one the one ingredient that was missing. Yeah. And actually, let's just talk about that for Tick. So if somebody needs well, is it only a obstetrician gynecologist that does ovulation Induction?
Patrick [00:19:06] These days, Pretty pretty much, yeah. Yeah. And the right way to do it, I think is what's called supervised ovulation induction. And that means that we should be doing some ultrasounds during the cycle to make sure it's not working too well.
Brigid [00:19:20] Yeah. This is when we get the more eggs than we need.
Patrick [00:19:23] Yeah. Yeah. So that's that's. These are the fertility drugs that can lead to to twins or triplets. And whilst twins is acceptable outcome, triplets is highly complicated. Yeah. And um. And really we don't want to do that. We'd rather have babies one at a time. Yeah. So if we give the fertility drugs and then do an ultrasound during the cycle, you can see how many follicles are coming on scan. Yeah. And if there's two really big juicy ones that's twins waiting to come. Yeah.
Brigid [00:19:53] And you say abstain.
Patrick [00:19:54] Well you might cancel the rest of that cycle. Yeah. Yeah. Abstain. Condoms what have you, let those ovulate without being fertilized. Yeah. And try again the next month on the lower dose. Yeah. And similarly if the ultrasound shows no follicles. Try again next month on a higher dose.
Brigid [00:20:10] Now before you mentioned insulin levels, what what is that in terms of PCOS?
Patrick [00:20:16] Yeah. So one of the hormonal disturbances that involved in PCOS is to do with with the production of insulin and something called insulin resistance, which is how well the insulin can work out in our tissues. So sometimes women with PCOS. Have got higher levels of insulin and sometimes would full on meet the criteria for type 2 diabetes. All right. Okay. So that you'll see some people who need that managed.
Brigid [00:20:49] Like they had diabetes?
Patrick [00:20:51] Yeah. So we, um, we use drugs like metformin. That bring down sugar levels. And again, that helps manage a number of features of it.
Brigid [00:21:00] Yeah, but they don't have the lows. This is a hyper glycemic state is it? They have too much.
Patrick [00:21:08] Yeah. So what they're experiencing is resistance to the effect of insulin out in the tissues. Yeah. So they just make more and more and more. All right. But ultimately there's not that's not effective enough. And the blood sugar is high.
Brigid [00:21:26] Yeah. Okay. I've also heard about some surgeries. There's one called Ovary Drilling. What's that about?
Patrick [00:21:32] Our ovarian drilling, that's an operation that we used to do, which was laparoscopic or keyhole surgery. Yeah. And if you drill a whole lot of holes in the ovary, it would create a inflammatory response that would help kickstart them for a while. Yeah, but that's not very commonly done now. Right.
Brigid [00:21:51] Because it's not as effective?
Patrick [00:21:52] Because the drugs are better.
Brigid [00:21:53] Yeah. It sounds dreadful. Doesn't bring holes anyway. You do what you need to do. But if that's not what the current thinking is.
Patrick [00:22:01] Yeah. So the drugs are much better. Yeah. And a combination of the drugs and weight reduction is perfect. Yeah. And the odd woman still has some ovarian drilling and that would be someone who'd had some significant side effects or problems with the drugs. Yeah.
Brigid [00:22:14] So of all the women that have PCOS and they're trying to get pregnant and 60 percent of the women have got pregnant without any sort of ovulation help. Yeah. And then you've got those on ovulation induction. What happens if the ovulation induction, weight management, all of those things don't help that woman to get pregnant?
Patrick [00:22:31] Well, I mean, ultimately, you need to take it further. So whenever we're doing reproductive interventions, we just keep doing the same thing if it's not working. Yeah. Move rapidly on to the next thing and the next thing in the next thing. And. And in someone who's having unsuccessful ovulation induction, then typically there'd be other investigations to make sure the problem wasn't elsewhere. Yeah. So a semen analysis for the partner and possible laparoscopy to make sure there wasn't co-existing endometriosis or blocked tubes. Yeah. And assuming everything else was fine and the only problem was the woman wasn't ovulating enough and ovulation induction wasn't successful enough. Then the next step is IVF.
Brigid [00:23:09] Right ok. So I would like to give a shout out to an amazing organization called the Jeanhailes.org.au. it's a really fabulous resource for women on lots of different topics, including PCOS.
Patrick [00:23:25] Yeah, they just pretty much tell people all the time to get it on to there if they say, well where else can I find information? Yeah, terrific information. Plain English.
Brigid [00:23:32] And lots of checklists as well. And so one that I found was the questions you might like to ask your doctor or health professional. Yeah. And it was you know, I think you should go to that website, download them, go through it, print it out, take it to your doctor, because it's got things that you may not think about at the time. I know going to the doctor, sometimes you've only got your 50 minutes or whatever and you think, gosh, I forgot to ask him or her about X, Y, Z. Yeah. Yeah. And so things are the questions that they've sort of listed. What do I need to do to increase my chances of getting pregnant? Will I need IVF or fertility treatment to get pregnant? What should I tell my partner about fertility and PCOS? What is the best treatment for my infertility? Like all these sort of things that you might just need to have like us logical sort of step by step process to get the best out of you GP visit.
Patrick [00:24:22] That's excellent. Golden, you know, in this podcast and there now and now pregnancy program, we're always talking to people about about the role of being personally informed. Yes. And educated so that you can get the most out of the system. And one of the problems of course, where we go for good information. You know, we've got some. But there are some great providers like jean hailes.
Brigid [00:24:51] All right. So for women who have got pregnant with PCOS, they've had their baby. Are there any particular issues for women with PCOS when they're having their baby or when the baby's born?
Patrick [00:25:02] Well, yes, during the pregnancy. Once you're over the hurdle of actually getting pregnant, presumably that's gonna be the tricky bit for a lot of people.
Patrick [00:25:12] But it doesn't end there because there are complexities in pregnancy that would arise because of the white problem that's associated with a lot of people with PCOS. So suddenly you're pregnant. Woo! But we've still got some complexity to deal with, especially if there's a significant weight problem. Yeah, right. And obviously if someone already had an issue with sugar and and insulin metabolism then, you know, do they have pregnancy diabetes? Yes.
Patrick [00:25:41] And so you manage all that. And then after the pregnancy, in a perfect world, people with babies are busy. That in a perfect world we would attempt to come into the next pregnancy.
Patrick [00:25:55] Yes. In better Nick. Yeah. And that's weight reduction. Yeah.
Brigid [00:26:02] Okay. So for someone with PCOS like there's obviously there GP and then they come and say a gynecologist. But who else do they see in a health treatment?
Patrick [00:26:13] Yeah, I think again, it depends on severity. But there's often involvement from endocrinologist. Yeah. Okay. So specialists on all things glands and that some they are often involved in the management of a more complex case where the insulin metabolism is really disordered. And also other allied health people like dietitians for weight control, exercise physiologist for weight control. And it's a real team effort.
Brigid [00:26:50] Even maybe a psychologist, if I could imagine all of this would be impacting on someone's mental health. So, yeah, psychologists to sort of talk about the different symptoms and you know.
Patrick [00:27:01] And I think at the heart of it is a family doctor with an interest. Yes. I reckon these days people are getting better at knowing that the don't don't have to have the one GP. Yes.
Brigid [00:27:11] And yeah, they go to one GP for their coughs and colds and another GP for their women's health.
Patrick [00:27:17] And because as you might have a terrific GP. He doesn't need to be fired, but he might not have the interest that the female GP down the corridor has in the management of PCOS. Yeah. So you can see her twice a year for, PCOS and the original doctor for everything else.
Brigid [00:27:31] Yeah, good. That's excellent. So the thing that I want to just sort of say to people is that a lot of people do go PCOS equals infertility. I hope this podcast has sort of shown that that doesn't necessarily mean that that's your story. Sixty percent of women are getting pregnant with PCOS without help. Then that's fantastic. And then there's help for those that need some ovulation induction IVF. I think that's a that's a good story. Yeah. Sure.
Patrick [00:28:01] So we wind up with PCOS. That's the hand we are dealt with yeah. Yeah. But tons tons we can do to help.
Brigid [00:28:08] Yeah. Excellent. All right everyone. Well I think if there's you know, this is a big topic and it impacts a woman's life. And so it's hard to sort of put it into whatever this has been 20 minutes, 30 minutes. So if there's any additional questions, just pop over to our Instagram. It's really exciting to see everybody there. And we love seeing your interactions and your DMs and so that is @grow_my_baby
Brigid [00:28:35] So come over there. And if you've got any more questions about PCOS that you want us to cover. Just, um, just popped into a day. That'd be fun, wouldn't it? I'm so good. All right. Well, good luck, everybody, and we'll have you ears for the next podcast. Talk to you then.