All About PCOS: What it is and What we can do

ALL ABOUT PCOS

I remember growing up as a teenager and hearing about a relative who was having trouble getting pregnant. She had gotten married in her mid twenties with dreams of being an entrepreneur and a mom to at least three kids. She had seen infertility experts and various obstetric and gynecology physicians after which she managed to get pregnant once successfully but miscarried a second pregnancy. I did not realize it then, but with what I know now, I see that she had all the clear signs of PCOS. If you are trying to get pregnant you might be familiar with this story.

She, like so many, had gone undiagnosed for years. She had hair growing in places that it shouldn’t have, including her jaw line, neck, chin, upper lip, and on the top of her toes and feet. Her periods were often irregular and only lasted three days when she would get one. She had thinning scalp hair and was irritable and moody just before her period. Though only fifteen pounds overweight, much of her fat centered around her abdomen. Several years later, now in her early fifties, she found out she was diabetic.

This story is not an uncommon one given the number of insulin resistance cases of PCOS I see yearly. In fact, in 1921, PCOS used to be known as the diabetes mellitus of the bearded woman.

It breaks my heart now knowing that simple diet, exercise, and nutritional interventions could have potentially helped with the infertility challenges she faced. This is a big deal. Let me say it again: what you eat, your lifestyle choices, your sleeping habits, and decompression measures (i.e. meditation, prayer, reading, etc.), and being just fifteen pounds overweight can be the difference between having or not having insulin resistance. This may lead to PCOS. PCOS can lead to infertility. Infertility is a really big deal for many of my patients as it stands in the way of their dreams and hopes of the future they want to have.

The good news is, you can do something about it because PCOS can be potentially reversed with the right diet, nutrition, and lifestyle changes.

WHAT IS PCOS AND HOW DO I KNOW IF I HAVE IT:

PCOS is mostly diagnosed by clinical presentation. This means the review of symptoms that you fill out prior to your doctors visit will be critical in sharing your symptoms with your doctor.

Typically, a patient comes in because she has acne and oily skin, scalp hair loss or unwanted facial hair. Often, these complaints are preceded years earlier with irregular periods (heavy periods, no periods, short intervals between periods, etc.). The irregular periods are being treated with “the pill” which masks PCOS for years. It is not until a woman is trying to get pregnant that PCOS is finally diagnosed. Even then, it can generally take up to two years and the right doctor putting all the pieces together before the diagnosis is made. So, if you are reading this and are interested in the complexity of PCOS, I wrote this for you. To empower you. To know there is hope.

COMMON SYMPTOMS OF PCOS:

To make the diagnosis, you have to have one item from two or three of the following categories:

CATEGORY ONE: Ovulation and Period Complaints:

• Infertility
• Irregular or missed periods

CATEGORY TWO: High Androgen Levels:

• Acne
• Oily skin
• Dark skin patches (usually a marker for IR or DM)
• Skin tags
• Mood swings, anxiety, and depression
• Scalp hair loss
• Excessive unwanted facial or body hair (i.e. on the on chin, neck, upper lip, nipples, or toes)
• Weight gain, especially around the abdomen
• Elevated testosterone, insulin resistance, and high blood sugar levels

CATEGORY THREE: Polycystic ovaries (on ultrasound)

• Once PCOS is suspected, we focus on what type of PCOS you have.

THERE ARE FOUR BASIC TYPES OF PCOS:

1. INSULIN RESISTANT PCOS

• The most common form of PCOS
• Laboratory findings include high blood sugars and insulin levels, resulting in insulin resistance, metabolic syndrome, or diabetes
• Excessive androgen hormone production
• Insulin resistance can occur as a result of excessive calorie intake, excess body fat, and chronic inflammation

2. POST-PILL PCOS

• Periods become irregular after a patient ceases to take birth control pills
• Hormonal birth control works by suppressing your body’s own natural hormones. When you stop taking the pill, your body needs some time to get back into its own natural rhythm.
• When you stop birth control pills, your body responds by producing a lot of androgen hormones. This surge in androgens is usually short lived as long as you remain off the pill

3. INFLAMMATORY PCOS

Chronic inflammation can stimulate an excess of testosterone, resulting in PCOS symptoms including:

• Unexplained fatigue
• Digestive issues
• Brain fog
• Headaches
• Chronic skin conditions (eczema, dermatitis, hives)
• Joint or muscle pain or stiffness
• Once you identify and correct the source of chronic inflammation, a full functional approach should take care of your PCOS symptoms. This can mean treating hidden gut infections, cutting back on processed foods and toxins, and improving detox pathways

4. ADRENAL PCOS

• This form of PCOS manifests itself in a symptom flare during an increase in stress
• When your adrenal glands respond to stress, they making their own androgens. This often leads to an increase in PCOS symptoms

TREATING THE ROOT CAUSES:

1. REDUCE INSULIN RESISTANCE

• Focus on diet. This is variable and personalized but there should be a focus on fresh, whole foods and sustainable diet plans that reduce elevated glucose and insulin
• Supplements: such as Inositol (D-Pinitol), berberine, Chromium, and ALA
• Prescription medications like Metformin and Omega-3 supplements
• Lifestyle changes like an increase in exercise, cardio, and resistance training

2. ADDRESS STRESS AND CORTISOL

• Address Sleep Hygiene which contributes to stress and loss of resilience
• No electronics one hour before bedtime
• Have regular sleep wake cycles
• Invest in supplements like Magnesium Glycinate and Phosphatidyl Serine
• Drink one table of tart cherry juice in water at night. This helps your body make natural melatonin
• Practice calm breathing and guided meditation
• Institute a calm night routine with things like epsom salt water baths and herbal teas
• See an acupuncturist who is skilled and understands your goals and mindset
• Journal daily
• Work with a health coach to set up SMART (Specific, Measurable, Achievable, Realistic, and Timely) goals
• Go to counseling
• Take herbs and supplements like Ashwagandha, Magnolia Bark, and L-theanine to work on calming support

3. IMPROVE OVULATION

• Take supplements like Chaste Tree Berry and B6 (P5P)
• Balance estrogen levels with seed cycling
• Use prescription Rx for bio-identical Progesterone

4. REDUCE ANDROGREN AND 5-ALPHA REDUCTASE

• Address insulin and cortisol levels
• Find supplement(s) that addresses root cause detected with specialized labs
• Spironolactone prescription

If you want help diagnosing and treating your PCOS please make a free 15 minute appointment here.