Polycystic Ovary Syndrome, PCOS, is a complicated metabolic and reproductive disorder that causes concerns for many women.
It is estimated that 10% of women have PCOS. There are many blogs and resources that go into what exactly happens with PCOS and we now understand how complicated it can be to treat and manage.
Polycystic Ovary Syndrome stems from an underlying metabolic concern from the body not using insulin properly. This abnormal production and signaling of insulin lead to various concerns in the body. The other medical term for PCOS is hyperandrogenic anovulation. This name is rarely used, but it does a great job of describing what happens. This syndrome causes women to increase their male hormones (androgens) and lose their ability to ovulate due to hormonal imbalances. However, like many other syndromes and diseases, no two PCOS women are the same. Therefore, some have all of the signs and symptoms, and some have only the underlying concerns.
• Blood sugar concerns and insulin resistance. To truly understand the complexity of PCOS, it is important to understand the role of insulin and blood sugar regulation in the body. The main purpose of insulin in the body is to control blood sugars. Insulin is responsible for pushing sugar out of the blood and into the cell for energy production inside the cell. For this process to occur, the cell receptors on the outside of the cell must be "sensitive" to the fact that insulin is in the blood and telling the cell to utilize sugar. If there are higher levels of insulin or the cells, become less receptive to insulin than insulin resistance occurs. This then leads to more insulin being released and ultimately then higher levels of insulin and blood sugar occur. From the dysregulation of insulin and sugar in the body, many metabolic concerns can arise. This is the fundamental reason for many of these other concerns and hormone imbalances we see with PCOS.
• Weight gain- especially around the middle. Insulin resistance leads to higher levels of cortisol, the hormone released by the stress glands- the adrenal glands. High cortisol levels along with increased blood insulin and sugar levels lead the body to lay down what we call "visceral fat." This is the fat that is laid down around the middle section and leads to a known increase in health concerns. Another problem for individuals with PCOS is that this fat then disrupts hormones more. Research now shows that fat releases hormones and causes an increase in hormone disruption. Many times even a loss of 5-10 pounds in a PCOS woman changes her hormones drastically. However, losing weight is more difficult due to the underlying metabolic concerns. That is why it is important to support the body in a specific way that we will talk about in the treatment part of this blog.
• Estrogen dominance. One of the problems we see time and time again with PCOS patients is that they have estrogen dominance (an increase in both natural and foreign synthetic estrogens). This can either be due to low progesterone, high estrogen, or both of these hormone imbalances being present. As a whole, in our society, we are exposed to more estrogens in the environment. This leads to a variety of problems especially if there is not the counter effect of progesterone. PCOS patients naturally have lower progesterone levels because of the fact that they push more of their hormones to make the stress hormone of cortisol. Therefore, it is vital to decrease estrogen exposure and the breakdown of estrogen through liver detoxification. It is also important to increase progesterone levels along with supporting the adrenal glands through supplementation and lifestyle choices.
• Low progesterone. Most women with PCOS have low levels of progesterone when evaluated. I know that the hormone cascade can seem overwhelming, but if we look at the hormones, then we can understand one of the underlying mechanisms. If you look at the balance of hormones, you will see how progesterone can move down to cortisol easily if the body is stressed and the adrenal glands that make cortisol need to take the progesterone to make more cortisol. We call this the "cortisol steal" and it happens because increased cortisol production decreases circulating levels of progesterone. Therefore, it can be very beneficial to increase progesterone levels. This can be done with natural wild yam based creams. It is also vital to support the adrenals through adrenal calming supplementation. Lifestyle changes like yoga, meditation, and stress reducing techniques.
• High testosterone. Higher levels of insulin lead to an increase in testosterone levels. This leads to many of the symptoms that we see with PCOS including increased acne and body/facial hair.
• Cystic ovaries. There is a large population of women that have the metabolic component of PCOS without cystic ovaries, but many women also have the cystic ovaries. The cystic ovaries of PCOS are unique in that they are considered a pearl of cysts and cover the ovaries. This is due to the imbalance in hormones and the changes in the brain secreting hormones of LH, luteinizing hormone, and FSH, follicle stimulating hormone. As we discuss in the treatment part of this blog, decreasing the production of mucous also has a significant positive effect.
• Cholesterol problems. Abnormal lipid panel. The underlying insulin and metabolic concerns that we see with PCOS also lead to abnormal lipid numbers. This includes an increase in total cholesterol, LDL, and triglycerides. We also see a decrease in the good cholesterol levels; HDL.
• Thyroid problems. It is common also to have thyroid concerns with PCOS. It is important to look at the thyroid panel fully to assess the thyroid. Since the thyroid and reproductive hormones are all part of the endocrine system. There are many women that have both thyroid findings and hormone imbalances.
• Infertility. For the body to release an egg each month, it is vital for the reproductive hormones to be balanced. An imbalance in progesterone, estrogen, and testosterone leads to abnormal production and release of the egg. Therefore, it is vital to balance out the hormones and improve insulin levels to regulate the release of the egg each month.
Because of the complexity of PCOS, it is important to take a multifactorial approach to treating it. I have clinically seen many women with PCOS, and every woman responds differently to various treatments. However, I have listed the ones that I find to be the most effective and easiest to incorporate. It is also important to remember that you don't have to start with ALL of them. You can slowly incorporate the different recommendations as you see fit. Don't feel overwhelmed by this list. Use it for your reference and don't feel like you should tackle it all at once.
It should also be stated that there are many other things that can be done, but I have chosen to focus on the ones that I find make a difference and are beyond just the basic suggestions of PCOS. (PCOS Diva is a great blogger that discusses many of the concepts and treatments that are important for PCOS- PCOS DIVA
• Low-carb diet. Diet is so important for women with PCOS. It truly is hard to reverse the effects of blood sugar and insulin dysfunction if you are eating foods that continue to cause the problem. I recommend that women start with taking out the white stuff first (white sugar, white bread, potatoes, all the white stuff). It is my clinical experience that this is the most important aspect of treatment. Therefore, I truly recommend that PCOS women make the necessary changes in their diet. I find that most PCOS women do real keeping their daily carbohydrate intake between 50-75 grams each day. It is best to use an app to track your daily intake.
• Avoid dairy. Dairy is a mucous producing food. This is true for both individuals that are sensitive or allergic to dairy. I have had many women decrease the amount and size of their cysts due to just avoiding dairy. The number one void I have PCOS women avoid is dairy because of its effect on forming cysts.
• Good oils. Omega-3. In a nutshell, the ovaries love good oils. And remember that the ovaries are the main producers of female hormones. Your ovaries are only going to be as good as what you feed them. Therefore, it is vital to make sure to avoid all bad fats. You MUST avoid trans fats. This is easier these days since they have started to remove them from food. You also have to make sure to feed your body with good oils and fats. This can be a key part of PCOS because many of these women battle weight and are told wrongly that a low-fat diet will help with weight management. These women should be eating coconut oil, olive oil, grapeseed oil, and taking higher amounts of fish oil.
• NAC (N-acetyl cysteine). NAC is the stable supplement of the amino acid cysteine. Several research studies show that NAC helps to improve ovulation and fertility. There is also an anti-mucolytic property of NAC. Since reducing excess production leads to a decrease in the cysts, NAC has many different positive effects on PCOS. It also helps with detoxification and antioxidant support.
• Inositol. Especially D-chiro-Inositol. This is a family of molecules that are quite beneficial for PCOS and blood sugar control. It acts as the second messenger for insulin signaling. It facilitates the way the body and cells react to insulin and utilize sugar. Therefore, it has been shown to be quite effective for PCOS. It helps to decrease insulin and testosterone and to help decrease certain signs and symptoms like acne, unwanted hair growth, abnormal periods, cysts, belly fat, and infertility. The recommended dose is 600 mg once to twice a day.
• Berberine. Berberine is a herb that helps to lower insulin and glucose in a fashion that is close to the allopathic way to treat PCOS, which is the drug metformin. It has a multifactorial positive effect by regulating blood glucose and blocking testosterone production. It also has a positive effect on the gut microbiome and cholesterol levels.
• Apple cider vinegar. This is one of the easier and cost effective approaches that I have found for women with PCOS. I have found that by taking a "shot" of apple cider vinegar in the morning and at night has many benefits. The dose is two (2) tablespoons 2-3 times a day. I just recommend a "shot glass" dose for my patients. I recommend that people do this first thing in the morning followed by a large amount of water before taking any food. I also recommend that people, especially PCOS patients, take another dose right before bed. There are many benefits, but the one that I want PCOS women to capitalize on is the blood sugar regulation that comes with apple cider vinegar.
• Vitamin D. There are definite benefits to a multivitamin for everyone, especially someone that has metabolic concerns. However, there are many benefits specifically to Vitamin D that make it a necessary supplement for PCOS women. Vitamin D helps the body regulate insulin and blood sugar. It is also needed for optimal functioning.
• Detox. Focusing on estrogen detoxification. The liver is responsible for breaking down hormones. Since there are hormone imbalances and usually an excessive amount of estrogen. Avoid foreign estrogens as much as possible. Support the liver to help the liver rid the body of excessive amounts of estrogen.
• Cruciferous Vegetables. Indole-3-Carbinol. DIM. The liver utilizes both of these compounds to support the proper pathways for estrogen. These are found naturally in cruciferous vegetables (broccoli, kale, cauliflower, Brussel sprouts). It can also be found in certain supplements that focus on estrogen and hormone support.
• Castor oil compresses. I have had many clinical successes with having patients utilize castor oil compresses for various conditions. One of the patient populations that I always recommend castor oil compresses is PCOS. Castor oil compresses help to deliver healing properties, circulation, and detoxification benefits specifically to the area.
Here is a link to a site on how to do the castor oil compresses: CASTOR OIL
• Essential Oils. The ones that I find are the best for PCOS are lavender, clary sage, and geranium. I especially like clary sage for PCOS and recommend that any women with PCOS utilize clary sage. You can use this one with or without a carrier oil, such as coconut oil. I recommend that you rub clary sage directly on the lower part of your abdomen or to use the oils with the castor oil compresses.
• Relax and reconnect with your body. It is important to support the adrenal glands to promote the proper production of hormones.
• Cinnamon and chromium for blood sugar support. I find two of the best supplements for blood sugar regulation are cinnamon and chromium. This helps to regulate blood sugar, decrease cravings (especially for sugar and carbohydrates) and improve weight. This can include either adding more cinnamon to your diet or supplementing chromium.
• Interval training or HIIT (High-Intensity Interval Training). Not all exercise is created equal especially when it comes to PCOS. A matter-of-fact if PCOS women exercise in the wrong way then they can increase cortisol levels and cause further weight gain. Research has shown that interval training and heart rate variability is the best approach to decrease insulin resistance.
• Intermittent fasting. There are so many great benefits on insulin and blood sugar regulation with intermittent fasting. Due to the metabolic concerns that occur with PCOS, Intermittent fasting has a great benefit for PCOS women. There are many different ways that someone can incorporate intermittent fasting into their lifestyle. I recommend finding the way that works best for you.
• B vitamins. Either oral or injections. B vitamin supplements are beneficial for the adrenal glands and the regulation of stress hormones. This is especially important if you are taking metformin, which depletes B12 absorption. I utilize B vitamin shots in the clinic with great success. If you can't find a practitioner near you, that does the B vitamin shots than I recommend to at least supplement with a comprehensive B vitamin supplement. Make sure that you are taking the right B vitamins, though, and that you do not have problems with methylation and need a specific form of B vitamins.
There is so much more that we can do at One Agora to help you with Polycystic Ovary Syndrome and help you with your metabolic and reproductive hormone health.