POLYCYSTIC OVARIAN SYNDROME (PCOS) IS A HORMONAL DISORDER THAT AFFECTS 5-15% OF WOMEN IN REPRODUCTIVE AGE and is one of the most common causes of infertility in women. Although it is the most common hormonal disorder in women, it is often under-diagnosed (1).

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TO BE PROPERLY DIAGNOSED WITH PCOS, YOU MUST HAVE TWO OUT OF THE THREE FOLLOWING CRITERIA:

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1. Irregular menstrual periods due to chronically not ovulating

(cycles longer than 35 days or fewer than 9 periods a year)

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2. Hyperandrogenism

(excessive testosterone levels)

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3. Polycystic ovaries

(12 or more follicles on each ovary)

 

Common consequences and complications that may result from PCOS can include infertility, metabolic syndrome, obesity, impaired glucose tolerance, type 2 diabetes, cardiovascular risk, depression, obstructive sleep apnea, endometrial cancer, non-alcoholic fatty liver disease, and endometriosis (1,2).

 

Note: PCOS is a syndrome that presents differently in different women, and there’s no one criteria that all women have (2).

 

THERE ARE FOUR DIFFERENT CLASSIFICATIONS OF PCOS YOU MAY FALL UNDER (3,4):

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1. Full blown or Classic PCOS which includes hyperandrogenism, ovulatory dysfunction, and polycystic ovaries.

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2. Non-polycystic ovary PCOS which includes normal ovaries, but hyperandrogenism and ovulatory dysfunction.

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3. Ovulatory PCOS which includes regular menstrual cycles, but hyperandrogenism and polycystic ovaries.

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4. Non-hyperandrogenic PCOS which includes normal levels of androgens, but ovary dysfunction and polycystic ovaries.

 

There are many different SYMPTOMS that may arise due to PCOS, including (2):

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·      Difficulty losing weight
·      Abnormal/unwanted facial/body hair
·      Hirsutism (male-pattern hair growth, which is coarse hair on the face, chest, stomach, etc.)
·      Thinning hair on the head
·      Acne
·      Heavy bleeding/long periods
·      Painful periods
·      Chronic inflammation
·      High triglyceride levels
·      Abnormal HDL/LDL levels
·      Headaches
·      Fatigue/low energy
·      Poor body image
·      Mood changes
·      High prolactin levels
·      Low sex hormone-binding globulin
·      Elevated luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio

 

TO BETTER UNDERSTAND PCOS, WE NEED TO DISCUSS THE ROLE OF INSULIN. Insulin resistance and excessive amounts of insulin (hyperinsulinemia) are commonly detected in women with PCOS (It's a common myth that you have to be overweight or obese to have insulin resistance--this isn't true. There are also many lean women with insulin resistance) (5).
 
Insulin is a hormone used in the body to regulate blood sugar. When we eat food, our body breaks down the carbohydrates we eat into glucose, a type of sugar. Insulin’s job is to grab the sugar and put it into our cells so that it can be used as energy or stored as fat. Depending on the type and amount of carbohydrates we eat in a meal, it will determine how much sugar is released into the blood (6).
 
When we eat a high carbohydrate meal without much fiber, protein, or fat, (think white bread, white rice, cakes, cookies, etc.) it will be broken down into sugar much faster in the body, causing a higher amount of sugar to be dumped in the blood at once. This will cause insulin to spike dramatically as it tries to remove the sugar out of the blood as fast as possible (6).

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When elevated insulin levels remove sugar this fast, it results in a drop in blood sugar levels. This drop will then cause you to crave more sugar for quick energy, which will start this whole cycle again (5). Take a look at the diagram below to see what a normal blood sugar cycle looks like versus a blood sugar roller coaster like the one we just described (6).

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If this constant rollercoaster keeps happening, over time it will cause a resistance to insulin and insulin won’t be able to do its job of taking sugar into the cells. What results is a lot of sugar and a lot of insulin at once in the blood, but the insulin and sugar levels aren’t going down at all (6).

 

 
 

 

 

 

 

 

Most women who have insulin resistance also have high testosterone levels because the high insulin levels causes the ovaries to make excess testosterone. Additionally, high levels of insulin will stop the liver from making enough sex hormone-binding globulin (SHBG). SHBG helps to keep testosterone levels at bay, but when there isn’t enough SHBG then there's more testosterone able to roam free--all of this can contribute to the to PCOS symptoms listed above (6).
 
BUT WAIT, THERE'S MORE. There is an important enzyme in the body called aromatase that makes estrogen, and when someone has insulin resistance it causes aromatase to make even more estrogen than it usually does. This contributes to the overall hormonal imbalance and can reduce regular ovulation (6).

 

TAKE AWAY: If you've been properly diagnosed with PCOS, eating a blood sugar friendly diet to keep insulin in check is really important.
 
CONVENTIONAL TREATMENTS for PCOS often include hormonal birth control to help “regulate the menstrual cycle”, improve, acne, and help with excess hair growth. Other treatments include insulin-sensitizing medicine like metformin and medications to block androgens (7). Unfortunately, these medications do not address the root cause. When you take hormonal birth control, for example, it is not regulating your menstrual cycle but rather it is further shutting down ovulation and suppressing your body's already deficient reproductive function (8).

NATUROPATHIC APPROACHES TO SUPPORTING PCOS:

Always consult with your healthcare practitioner before beginning a new treatment protocol.
 
EATING A LOW-GLYCEMIC DIET - Low-glycemic foods are foods that don’t cause a large increase your blood sugar (6). Since insulin is a big culprit in throwing hormones out of whack and women who have PCOS tend to have insulin resistance, it’s one of the biggest things you need to focus on. This also means limiting your sugar intake and finding a balance between skillfully enjoying the foods you love while making sure you’re being mindful of avoiding big blood sugar spikes (6).

 

↠ DOWNLOAD + SAVE A LOW-GLYCEMIC FOOD CHART HERE
 
SMART SUPPLEMENTATION - We encourage that you discuss getting screened for the following nutrients and getting started on a therapeutic regimen with the following: 

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·      Omega-3

·      Vitamin D

·      Chromium

·      Magnesium

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These will help support your hormones and be an advocate for controlling blood sugar; they are also biomarkers those those with PCOS are infamously found to be deficient in (6).

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ABOVE ALL

While there are commonalities amongst many PCOS cases, you deserve a deeply individualized approach to meet your unique needs dependent on your labs, associated symptoms, lifestyle, accessibility, and capacity. If you're seeking a tailored healthcare plan you can schedule A FREE CLARITY CALL WITH THIS LINK to discuss an approach best suited for you.

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FURTHER RESOURCES:

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↠ 8 STEPS TO REVERSE YOUR PCOS : A PROVEN PROGRAM TO RESET YOUR HORMONES, REPAIR YOUR METABOLISM, AND RESTORE YOUR FERTILITY BY DR. FIONA MCCULLOCH, ND 

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↠ THE FIFTH VITAL SIGN: MASTER YOUR CYCLES & OPTIMIZE YOUR FERTILITY BY LISA HENDRICKSON-JACK

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Updated June 2022

Written by: Jessica Guerra, Intern for Innate Rhythm. 

Reviewed by: Haley Smith, MSN, FAMM Owner of Innate Rhythm 

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References:

1. Rasquin Leon LI, Anastasopoulou C, Mayrin JV. Polycystic Ovarian Disease. [Updated 2021 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459251/
 
2. Hendrickson-Jack L. Polycystic ovarian syndrome (PCOS) Handout. 2022.
 
3. Sachdeva G, Gainder S, Suri V, Sachdeva N, Chopra S. Comparison of the Different PCOS Phenotypes Based on Clinical Metabolic, and Hormonal Profile, and their Response to Clomiphene. Indian J Endocrinol Metab. 2019;23(3):326-331. doi:10.4103/ijem.IJEM_30_19
 
4. El Hayek S, Bitar L, Hamdar LH, Mirza FG, Daoud G. Poly Cystic Ovarian Syndrome: An Updated Overview. Front Physiol. 2016;7:124. Published 2016 Apr 5. doi:10.3389/fphys.2016.00124
 
5. Witchel SF, Oberfield SE, Peña AS. Polycystic Ovary Syndrome: Pathophysiology, Presentation, and Treatment With Emphasis on Adolescent Girls. J Endocr Soc. 2019;3(8):1545-1573. Published 2019 Jun 14. doi:10.1210/js.2019-00078
 
6. Jardim N. The PCOS protocol: The main cause of PCOS and tips to treat it naturally. Nicole Jardim. Published June 27, 2013. Accessed May 19, 2022. https://nicolejardim.com/the-pcos-protocol/
 
7. Polycystic ovarian syndrome (PCOS): What is it, causes, symptoms & treatment. Cleveland Clinic. Accessed May 19, 2022. https://my.clevelandclinic.org/health/diseases/8316-polycystic-ovary-syndrome-pcos
 
8. Hendrickson-Jack L. The Fifth Vital Sign: Master Your Cycles & Optimize Your Fertility. Fertility Friday Publishing; 2019.