POLYCYSTIC METABOLIC OVARIAN SYNDROME 2026

POLYCYSTIC METABOLIC OVARIAN SYNDROME 2026

 In light of the principles of

The Revolution of Medical and Surgical Naprotechnology

Welcome to our Practice for Restorative Reproductive & Robotic-Assisted Gyn Surgery. 

RELAX—if you have come with some diagnosis of polycystic ovaries, whether you are planning to achieve pregnancy or are just trying to normalize your cycles, we can investigate the issues leading to this syndrome and help you achieve your goals. PMOS is not truly a primary ovarian disease. It is secondary to the inappropriate secretion of gonadotropins. Once we stabilize and correct this, your cycles can return to normal. 

1. Charting: You’ll chart your cycles using the Creighton Model FertilityCare System (CrMS) for 2 months with a FertilityCare Practitioner (this will often be three months BEFORE you are seen in our office).

2. Inito Urinary Lab testing: start the third month (often the month before your first office visit)

3. History: At the first visit, we will listen to your story/ review your records with you-bring them with you printed. Update your US and labs with your PCP if over 3 months old.

4. DYNAMIC Transvaginal ultrasound- per Dr. Kotob with physical exam and cultures.

5. Referral to Endocrinologist: Dr. Madu, Dr Teresi, Dr Rubal or your choice.

IMPRESSION and PLAN:

Labs/diagnostics

Comprehensive ultrasound at Hoag. An MRI in Month 4 evaluates for endometriosis, which is present in about 50% of cases.

Meds: Myo Inositol, Berberine, N-acetylcysteine 600mg (OTC), Metformin

Diet: Whole 30 and/or intermittent fasting TBD (Dr. Anna Cabeca or Dr Kelly Anne).

Irregular cycles and PMS: Cooperative progesterone replacement therapy (CPRT), with Progesterone 200-400 mg on Days 16-25

Follow up: Return in 1 month, then every three months

If you’re hoping to conceive:

Ovulation induction: Clomid 25mg on cycle days 3-5

Comprehensive Management Review (CMR) monthly on cycle day 2

Ultrasound series on cycle day 14

Surgical Approach: Robotic-assisted excision of endometriosis (REE)

Your charting and test results help show whether surgery may be beneficial. Signs include limited cervical mucus on your Creighton chart, small follicle size on ultrasound, persistently low progesterone, and a poor “sliding sign” on ultrasound, which suggests adhesions.