As September comes to an end and most of the world has had their first pumpkin spiced latte (im guilty as well!), I want to talk about a complex and very important diagnosis facing about 10% of women today, Polycystic Ovarian Syndrome. PCOS is now finally a commonly recognizable and diagnosable disease that is screened for in women with a certain set of signs and symptoms. It involves many of our body systems and can involve many of the more well known issues like diabetes and metabolic syndrome. So you can see why it is so important and why September is officially PCOS awareness month. Let dive in, shall we?
The main symptoms to look for are irregular periods, weight gain, hair growth in unwanted places (like the face) or hair loss, acne, blood sugar issues, and trouble getting pregnant. Lab tests may show hormone disruption, mainly a high testosterone, high blood sugar, and possible high lipids. Imaging can show multiple cysts on the ovaries, like a “string of pearls”. The interesting thing about PCOS is that you don’t have to have cysts on your ovaries to be diagnosed, you just need to meet 2 of the 3 following criteria:
Signs of hyperandrogenism: Elevated androgens (testosterone), Male pattern hair growth or hair loss (Hirsutism)
Menstrual irregularity-skipping periods, long or short periods, no period.
Ovarian cysts seen on US
OK, so that’s the medical side of it, but what does that mean for the future and for the women struggling with all these issues? Unfortunately there is currently no cure, and no one is exactly sure WHY women get PCOS (currently thought to be a combination of genetic and environmental). A recent finding suggests that the environment of the womb of a mother carrying a future PCOS-prone women could have something to do with it. But what we do know is relief CAN be found if you take a holistic and foundational approach to treatment. This means that when I treat, I look at the women’s entire picture, her lifestyle and her diet, stress levels, as well as her labs and physical exam. It means treating the underlying cause with low force interventions such as herbs and nutrients, but knowing when to support and keep her safe with medications. If you or someone you know is struggling with PCOS, here is my advice to you:
Take a hard look at your diet. I’m not talking about “trying” to lose weight (not all women with PCOS are overweight), but instead making a shift in what types of foods you reach for. Research shows that a diet lower in carbs and rich in vegetables, fruits, fiber and healthy protein and fats (think nuts and seeds, lean meat, avocado, olive oil..) can make a big difference in symptoms and weight loss. And the bonus of losing only 10% of your body weight is that studies showed another drastic reduction in symptoms when this amount was met. Yippy! So if you have heard of the mediterranean diet, this is basically what is being followed, maybe with a little less bread, pasta and wine ;)
Exercise: not to harp on it too much, but yes this is important, and what TYPE of exercise is important too. When we exercise too much and at too high of an energy output for our body type we can potentially lower our immune system and increase our cortisol release. Cortisol will then increase the amount of glucose in our blood and potentially send confusing signals to our body that we are in a stressful situation. So my advice is to focus on a combination of cardio 2-3x/week, strength training the other days, and stress reducing and meditative practices like yoga, stretching, walking with friends and family, and even meditation with breath work! I count this as exercise :)
Hormone balance: this is an area that in most cases needs some work and there can be varying degrees as to severity and the need for intervention. Always talk to your healthcare provider about what your individual body needs, but I like to start with:
The basics of a healthy functioning liver, high fiber diet, and reducing our exposures to all endocrine disruptors in our products and environment. This involves many steps and precautions and I recommend checking out www.EWG.org to help you clean up the products you use both on your skin, in your house, and to hold your food. Other liver supporting methods are gentle support with herbs like milk thistle or the nutrient NAC while eating liver foods like artichoke, beets and burdock.
Seed cycling: a simple yet effective treatment, this involves eating and taking oils that support our hormones in both phases, the follicular and luteal. For the first 14 days (follicular phase) you take flax seed/pumpkin seed and fish oil, and the last 14 days (luteal phase) you take sunflower or sesame seeds and evening primrose oil.
Testing can be very important to find out what your hormones are doing, and there are some pretty great options out there that not only show us your basic levels but how you are metabolizing and moving through the hormone cycle...very helpful when making an individualized treatment plan! Ask your ND about these.
Herbs: This is very individualized and can depend on why the hormones are out of balance, but one common herb to start with is Vitex. Vitex has been shown to induce ovulation and improve fertility and works on the pituitary gland to balance downstream hormones. It can increase LH so you want to make sure you don’t already have a high LH level like some women with PCOS (more commonly the lean-type)
Nutrients: There are many promising nutrients that have been studied and shown to balance hormones, especially bring down testosterone.
Myo-inositol is a key player here and also helps with blood sugar regulation. At 4g/day it has shown to help with SHBG, testosterone, FSH/LH ratio, as well as improving blood pressure as an added bonus.
Medication: OCPs are the most commonly prescribed drug for PCOS because they regulate the hormones and cycles by controlling the amount of Estrogen in the body. This can be important in terms of long term safety to the women to lower her risk for certain cancers of the uterus since she is not shedding her uterine lining at a regular rate and is exposed to a higher circulating estrogen level. It can be a great addition if you are struggling with regulation after trying the above treatments for 3-6 months, and can always be taken off once there is more balance.
Blood sugar balance: keeping our blood sugar levels in a healthy range and consistent (not spiking up or down too much) throughout the day, can help with our mood, weight, and lower our risk for developing or worsening diabetes.
Women with PCOS often struggle with high blood sugar, so the key here is nutrition and exercise as mentioned above as the core treatments, with an emphasis on low glycemic foods and eating at regular intervals. Food combining is also important, which means if you are going to eat a higher carb item like some toast, put some avocado, a slice of meat or nut butter on it as well.
There are also many herbs that have been shown to help, so make sure to ask your ND or herbalist about these too. Berberine is a top pick here.
Inositol, as mentioned above, is pretty great at helping lower blood sugar levels if taken over a period of time.
Sometimes a pharmaceutical to lower blood sugar is needed for a while (usually Metformin) and has been shown to help women with PCOS, but talk to your healthcare provider about the risks and side effects. Keep in mind that although these drugs can allow out blood tests to look better, they are masking the symptoms of a root cause that requires lifestyle changes.
Adrenal support: your adrenals are the glands that pump out the hormones involved in the stress response like cortisol and epinephrine, and they are intricately involved in our other organ systems and functions like blood sugar balance and thyroid function. Many items already addressed above will support our adrenals:
Stress management: make sure to have a self-care practice in place and some tools to deal with daily stressors. Get enough quality sleep during hours that are functional for your body (avoid those late night screens…)
Eat, drink and take adaptogenic foods, teas and herbs. There are a handful of great tonic herbs that are safe to take everyday whose main function is to support our bodies ability to adapt to stress and life around us. Eleuthero, ashwagandha, holy basil, rhodiola, licorice are just some of my favorites. Ask your ND to find or make an individualized formula for you!
So there is a lot to start with and a lot more to consider on an individualized basis. The most important thing to me, though, is that we are recognizing this issue in women as early as possible. Many times young women just getting their cycles are put on birth control as a solution to irregular periods, only many years later to come off and try to get pregnant. They struggle because the PCOS they actually had (have) never went away and now they are struggling with fertility against a ticking clock. If we can recognize how to safely and naturally restore cycles and treat the underlying cause and whole person with PCOS, I believe these stressful and frustrating situations will lessen dramatically.
If you or someone you know is struggling with any of these symptoms, make sure they have the support of a qualified healthcare professional who specializes in women's health and who looks at the root cause of disease. Naturopathic doctors like myself will be glad to help every step of the way :)
If you have any questions or need more guidance on treatments, please reach out to me at firstname.lastname@example.org or call 303-679-3402 to set up a consult or appointment with me
Jessie Miller, ND