What is PCOS?
Polycystic Ovary Syndrome, often referred to as PCOS, is a common endocrine and metabolic disorder that affects as many as five million women in the United States. It is one of the most common causes of infertility in women of childbearing age and can be accompanied by uncomfortable symptoms and long-term consequences.
PCOS is a complex hormonal disorder in which the ovaries produce too many androgens, the male sex hormones that should be present in small amounts. There are many symptoms associated with high androgens in women, but one of the most common is the presence of small, fluid filled sacs on the ovaries. This is how PCOS got its name!
However, not all women with PCOS have cysts on their ovaries, and cysts don’t automatically indicate PCOS. Confusing, I know. To clarify, PCOS is characterized by excess androgens in the female body and in some cases, high levels of androgens lead to the development of ovarian cysts. Those cysts then produce more androgens that further contribute to PCOS. But some women with PCOS have high androgens without ovarian cysts.
How is PCOS diagnosed?
PCOS can be challenging to diagnose because there isn’t one definitive test.
Diagnosing PCOS typically involves a combination of physical exams, medical history, and blood tests to determine hormone levels. There is a strong association between PCOS and blood sugar disturbances so many doctors will also test blood glucose, hemoglobin A1C and insulin when diagnosing PCOS.
Some doctors use ultrasounds to examine the ovaries for cysts. Unfortunately, ultrasounds can’t be used to make a definitive diagnosis since many healthy women also have ovarian cysts, but they can provide additional clues.
Diagnosing PCOS requires using all this information to put together the puzzle pieces!
Common Signs and Symptoms of PCOS:
Missing periods or missing ovulation
Hirsutism (facial hair)
Loss of hair on the head, hair thinning
Inability to lose weight
Acne, especially along the jaw, chest and back
Weight gain, belly fat
Dysregulated blood sugar
Root Causes of PCOS
The exact cause (or causes) of PCOS are not fully understood. Most clinicians and researchers believe it’s a combination of factors, including hormonal imbalances, dysregulated insulin, dietary choices, environmental factors and genetics.
About two-thirds of women with PCOS have insulin resistance and metabolic dysfunction. Elevated insulin levels in the body trigger the production of androgens, which speeds up the progression of PCOS. Insulin resistance also contributes to weight gain and inflammation, two additional drivers of high androgens and PCOS development.
Dietary choices, especially high intake of sugar and processed foods can exacerbate PCOS, insulin resistance and inflammation. Poor gut health also influences hormonal balance and may worsen the symptoms of PCOS.
Chronic, low-grade inflammation is associated with PCOS and factors like excess stress, poor sleep, and a low-quality diet are known to increase inflammation. Inflammation is also linked to poor blood sugar control and increased insulin resistance which can make PCOS worse.
Exposure to environmental toxins from air, water, and even body products, cleaning supplies, and household items can contribute to PCOS development. Some of these products contain compounds called “endocrine disruptors” that can interfere with normal hormone function. Consider using the Environmental Working Group's consumer guides to pick products that are better for you and your hormones.
Although genetics can play a major role in PCOS, we have the power to turn genes on and off with diet, lifestyle, and exercise. Read on to learn how!
Conventional Methods for Managing PCOS
The most common conventional method for managing PCOS is medication, primarily using Metformin and hormonal birth control. These medications can be helpful for managing the symptoms of PCOS, but they fail to address the root cause. A functional approach to managing PCOS explores the root cause and manages the associated symptoms.
How to Heal PCOS Naturally
Leveraging nutrition to heal from and manage PCOS symptoms is highly effective and has the added benefit of improving other aspects of your health!
Since insulin resistance is a hallmark of PCOS, adopting a blood sugar friendly diet is often step one. Aim to include protein, healthy fats, and fiber at every meal to stabilize your blood sugar and keep you feeling full longer. Swap simple carbs like white flours, bread, pasta and white rice with whole, complex carbs such as whole grains, winter squash, fruit and beans.
Start reducing your added sugar and processed food intake and exploring healthier, more nutrient dense options. Some of my favorite, better for your brands are:
Siete Foods-- chips, tortillas, cookies
Simple Mills-- crackers, cookies, baking mixes
Too much caffeine and alcohol can severely impact gut and hormone health, contributing to inflammation, insulin resistance and PCOS. Audit your caffeine and alcohol intake to see how much you’re really consuming. Begin slowly cutting back and replacing with water, electrolyte drinks like coconut water and herbal teas. It can be difficult to change these behaviors, but you’ll likely have more energy after implementing these other tips, making it easier to skip the third (or fourth) cup of coffee!
There are many supplements that can help address the root cause of PCOS, patch up nutrient deficiencies, and support hormone and liver health. Here are a few I often recommend:
Vitamin D and omega-3s-- for inflammation and immune health
Inositol, berberine, chromium-- for blood sugar control
Zinc-- for insulin sensitivity and lipid profiles
Magnesium-- to reduce inflammation, support adrenal function, and improve insulin resistance. Plus, many women are deficient in magnesium.
B complex-- to support progesterone production to balance estrogen levels and improve reproductive health outcomes.
Iodine-- deficiency is also linked to ovarian cysts. Ask for a full thyroid panel as well.
Herbs, both as supplements and tea, can be beneficial for women struggling with PCOS. In fact, studies show that cinnamon supplementation causes similar reductions in insulin resistance and testosterone levels to that of metformin, while ginger supplementation showed improved hormonal effects not seen with metformin.
Aloe vera, green tea, fenugreek, and milk thistle are other well-researched herbs that reduce insulin resistance, lipid profiles, blood glucose, and support hormone health.
Lifestyle Changes for PCOS
In addition to dietary changes, lifestyle modifications can have a major impact on PCOS.
Building muscle is one of the best things you can do for PCOS since muscle tissue supports blood sugar stability. Physical activity, especially strength training, can improve insulin sensitivity and support a healthy weight. The best exercise is the one you’ll do, so consider what types of movement you enjoy. If you’re not sure where to start, add a 20 minute walk to your day and notice how you feel.
Sleep is an often overlooked component of hormone health but is essential for blood sugar control and insulin sensitivity. Get serious about your sleep by cutting back on afternoon caffeine, implementing a calming evening routine, and prioritizing 8 hours of high-quality sleep a night.
Stress plays a role in obesity, metabolic dysfunction, and hormone dysregulation. Managing stress is a non-negotiable for hormone balance and PCOS. But don’t stress about your stress! Instead, think about what brings you joy. Maybe it's mindfulness practice, knitting, journaling, spending time with a friend, or reading a book. Do something that brings you joy every single day.
We’re learning that social connections are more important for our physical health than we once thought. Focus on strengthening your connections for the sake of your physical, mental and emotional well-being. When we feel loved and supported, we’re far more likely to make meaningful changes in our life!
Castor oil packs have also been shown to decrease cysts (breast and ovarian), so if you haven't already, try to do them a few times a week along with lifestyle and diet change.
What's Next for Managing PCOS?
If you’re struggling with PCOS and aren’t sure where to go from here, consider working with one of our Functional Nutritionists.
We offer comprehensive testing and symptom analysis to get to the root cause of your PCOS and will create a personalized plan to help you heal from the inside out. We know how difficult food and lifestyle changes can be and we’ll be there to support you every step of the way!
Consider our Healthy Hormones Package for ultimate support, testing and personalized plans.