I had the blessed opportunity to speak at the annual QEST4 Think Tank a couple weeks ago on the topic of PCOS. Now, as a woman of child-bearing age who loves all things women’s health, and spending time with all sorts of women who are also of child-bearing age, I know I’m a little biased in thinking that this topic is super important and relevant.
I have many friends, friends of friends, family members, and acquaintances who have issues with PCOS or anovulation in some form, and it is not uncommon for this type of stuff to come up in conversation with me!
However, I knew I was onto something when our head of sales (a twenty-something male) came up to me afterward and said he wanted to take notes of everything I was saying because he’s always getting people asking him about this stuff. He’s not even a practitioner – he’s a sales guy!
I figured if he could benefit, everyone can. So let’s dig in.
What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome. It is the most common hormonal disorder in women of reproductive age. It’s best defined as a group of symptoms related to anovulation (not ovulating) and high androgens.
The main symptom is irregular periods, but other symptoms include excessive facial hair and body hair, weight gain, acne, hair loss, and infertility.
PCOS is associated with long-term risk of diabetes and heart disease.
How is it diagnosed?
Since there is not a specific medical test for PCOS, it is a diagnosis of exclusion – meaning other reasons for symptoms must be ruled out.
According to the Androgen Excess and PCOS Society (AE-PCOS), the following three criteria must be met for a diagnosis:
- Irregular periods or polycystic ovaries. Irregular periods are defined as a period that comes less often than every 35 days. If your cycle is longer than 35 days typically, you have “irregular periods.” A polycystic ovary is one that has 12 or more follicles ranging in size from 2 to 9 mm.
- High androgens on a blood test or symptoms of high androgens. Androgens are “male” hormones like testosterone, androstenedione, and DHEAS. Symptoms of high androgens are excess facial or body hair, acne, hair loss, and weight gain.
- Rule out other reasons for androgen excess. These reasons could include: hormonal birth control with a high androgen index, high prolactin, hypothyroidism, some medications, and some pituitary or adrenal diseases.
Oddly enough, PCOS is a bit of a misnomer because not everyone with PCOS has polycystic ovaries. Additionally, healthy women may have polycystic ovaries up to 25 percent of the time. Plus, these “cysts” are not actual cysts. They are follicles that never reached ovulation due to androgen excess. For these reasons, you cannot diagnose PCOS by an ultrasound showing polycystic ovaries alone.
Conventional Treatments
Conventional medical doctors will usually treat PCOS with birth control, or similar medications, for the purpose of reducing excess androgens. This only works insofar as your androgens are no longer elevated. However, you still are not ovulating, and you now have to deal with the side effects these medications produce. Additionally, when you stop taking them, you will still have the problem.
Another conventional treatment uses Metformin to treat PCOS because it corrects insulin resistance, which is the most common driving force behind PCOS. Since it does address a root cause for anovulation, this is perhaps the most effective conventional treatment, however it is better when paired with more natural approaches that address the root cause of the insulin resistance as well.
What is the root cause of PCOS?
I’m glad you asked. PCOS is typically caused by one of four things:
- Insulin resistance
- Post-pill surge in androgens (meaning you come off a hormonal contraceptive and you have temporarily elevated androgens)
- Inflammation
- Adrenal androgens
Wondering what your root cause is? Ask yourself the following questions:
- Do you have irregular periods and androgen excess? If not, you don’t have PCOS. If yes…
- Do you have insulin resistance? If yes, this is your driving factor. If not…
- Were your periods regular before you started taking hormonal contraceptives? If yes, you probably have post-pill PCOS. If not…
- Do you have signs of chronic inflammation? If yes, inflammation is your main driver! If no…
- Is DHEAS your only high androgen? If yes, you probably have adrenal PCOS. If no…
- Do you really have PCOS? If yes, you may have a hidden cause.
Insulin-Resistant PCOS
Insulin resistance is the most common driver of PCOS. When someone is insulin resistant, their blood has too much insulin floating around, and the receptors for it are flooded, or resisting it.
How does insulin resistance contribute to PCOS?
Excess insulin impairs ovulation and causes ovaries to make testosterone instead of estrogen. It also stimulates the pituitary to make more luteinizing hormone, which stimulates androgens. And finally, excess insulin lowers SHBG (Sex Hormone Binding Globulin) which results in more free testosterone floating around.
So what causes insulin resistance?
Primarily diet. Eating a lot of sugar and processed foods continually spikes the blood sugar, leading to more and more insulin being released. Other things that can cause insulin resistance include smoking, stress, hormonal contraceptives, sleep deprivation, alcohol, trans fats, unhealthy gut microbiome, magnesium deficiency, and environmental toxins.
Looking for natural support options for insulin resistance?
Here are some things you can try:
- Quit eating sugar – specifically refined sugars. Carbohydrates like potatoes, rice, and fruit are still good to eat.
- Try intermittent fasting! This is when you eat all your food for the day within one 8-10 hour eating window and refrain from eating outside that time frame.
- Exercise.
- Avoid hormonal birth control.
- Supplements that improve insulin sensitivity are magnesium, alpha-lipoic acid, myo-inositol, vitamin D, and berberine. Zinc and a combo of peony and licorice are also great for promoting a healthy menstrual cycle.
Post-Pill PCOS
This is the second most common type of PCOS and it’s different from the rest in that it is temporary and completely caused by an outside source.
How do hormonal contraceptives contribute to PCOS?
Hormonal birth control can actually cause or worsen insulin resistance. It also suppresses ovulation and leads to a temporary surge in androgens when you stop taking it.
How can you naturally support yourself with Post-Pill PCOS?
Stay calm and wait it out. If your cycle truly was healthy and regular before you started taking the pill, it will find its rhythm again soon. For some women this happens quickly, and others can take up to a year. Make sure you eat well and eat enough so your hormones get all the support they need in regulating themselves.
Again, zinc and a combination of peony and licorice may be good supplementation options since they support healthy ovulation.
Inflammatory PCOS
Like I said in last week’s post, inflammation is at the root of pretty much every health condition and PCOS is no different. Though it plays a role in every type of PCOS, inflammation is the main driver for this type.
How does inflammation contribute to PCOS?
Inflammation disrupts hormone receptors, suppresses ovulation, and stimulates adrenal glands and ovaries to make more androgens.
What causes inflammation?
There are many contributing factors for inflammation. These can include insulin resistance, smoking, inflammatory foods (such as sugar, dairy, etc.), environmental toxins, and digestive problems. Some signs that you may be dealing with inflammation are digestive problems (like IBS), unexplained fatigue, headaches, joint pain, and skin conditions (such as eczema).
So how do I reduce inflammation?
First, check out last week’s post where we go over 5 things you can start doing today to reduce inflammation! Other ideas include following an anti-inflammatory diet, identifying and supporting any underlying digestive problems, and reducing exposure to environmental toxins including pesticides, plastics, fire retardants, PFCs, mercury, etc.
Some supplements you may want to consider for reducing inflammation include zinc, magnesium, probiotics, N-acetyl cysteine, and melatonin.
Adrenal PCOS
This is the least common type of PCOS and it’s an interesting one! With adrenal PCOS, the person has normal levels of ovarian androgens (testosterone and androstenedione), but elevated adrenal androgens (DHEAS). Elevated DHEAS can suppress ovulation, but doesn’t always! So someone with this type may actually be menstruating regularly, but still have other symptoms of PCOS such as facial hair, etc.
What causes elevated DHEAS in adrenal PCOS?
It’s caused by an abnormal stress response system – an imbalance in the HPA axis. It may be the result of stress around the time of puberty. However, before classifying yourself as PCOS when DHEAS is your only high androgen, be sure to rule out elevated prolactin and non classic congenital adrenal hyperplasia, as these can cause high DHEAS as well.
What are the natural support options for adrenal PCOS?
With this type, it is important to reduce stress! Make time for rest, joy, relaxation, mediation, massage, etc. Also make sure you are maintaining a stable blood sugar level.
Some supplements to consider are zinc, magnesium, B vitamins, licorice, and rhodiola.
There is hope!
PCOS is a struggle, but there are many support options out there to help you ovulate and reduce symptoms. If you want more information on this topic, I got most of this from Lara Briden’s amazing book, “The Period Repair Manual.” Any of her resources would be a great place to start. Additionally, there’s a great book by Fiona McCulloch called “8 Steps to Reverse Your PCOS” where she gives a lot of great information about how to reverse PCOS naturally and at the root cause. You got this!
