The PCOS Struggle Is Real
The PCOS struggle is real and yet many women don’t even know they have it! Polycystic Ovarian Syndrome (PCOS) effects over 10% of women in the US (1). If you or a friend are experiencing hair loss, facial hair, infertility or weight gain around the stomach, there’s hope.
PCOS affects more than 1 in 10 women in the U.S., yet many remain undiagnosed.
PCOS Symptoms:
Symptoms include irregular or unpredictable menstrual cycles, unwanted hair growth, acne or scalp hair loss, unexplained weight gain or impaired weight loss. Infertility may also be an issue and may be associated with recurrent first trimester miscarriage. Half of PCOS sufferers complain of infertility during their first visit to a provider.
PCOS patients additionally have increased risk of cardiovascular disease, diabetes, and certain cancers.
Polycystic Ovarian Syndrome is characterized by some or all of these symptoms: hirsutism (excessive body hair), virilism (man-like features), hyperandrogenism (high levels of testosterone and other male-type hormones), menstrual irregularities, chronic anovulation, obesity, insulin resistance, acanthosis nigricans (a skin condition), high concentrations of luteinizing hormone (LH) and ovarian cysts (3, 4).
Two of these appear to be primary. First, hyperandrogenism, or excess male-type hormones including testosterone and 5-dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA) and DHEAS, and androstenedione (A4). This appears to have both ovarian and adrenal origin in PCOS. Second, insulin resistance and the resultant high levels of insulin in PCOS is at the level of the receptor and not due to excessive pancreatic function (2).
What Causes PCOS:
The most recent definition known as the Modified NIH Criteria is probably the best at this time:
- Androgen excess (clinical or biochemical assessment)
- Ovarian dysfunction (oligo-anovulation and/or ovarian morphology) and
- Exclusion of other androgen excess or ovulatory disorders (5).
It is important to note that other conditions can mimic PCOS such as long-term exposure to high levels of cortisol. Therefore, your practitioner may order a pelvic ultrasound to detect ovarian cysts.
Certain medications can also cause high male-type hormones. Antiepileptic drugs such as valproic acid or valproate may stimulate excess androgens. PCOS is more common among those women who also have epilepsy or seizure disorders, but the medications themselves may have mechanisms that stimulate reproductive abnormalities (6,7).
Diagnostic Testing
With all of these factors in mind your practitioner may order some or all of the following PCOS tests:
- History of medication use and menstrual cycle
- Pelvic ultrasound for ovarian morphology
- Oral glucose tolerance test (OGTT)
- Fasting insulin and fasting glucose and/or hemoglobin A1c
- Complete thyroid panel including TSH, Total T4, Free T4, Total T3, and Free T3
- Serum Testosterone, DHEAS, Sex-hormone binding globulin (SHBG), LH, FSH, and prolactin, and estrogens
- Bodyweight and/ or anthropomorphic measures
Conventional Treatments:
The conventional treatment for PCOS is oral contraceptives (OC) to reduce hyperandrogenism and Glucophage (Metformin) to improve insulin sensitivity, and clomiphene is often used for ovulation stimulation.
Contraceptive medication (i.e. “the pill”) may indeed shift hormone levels; however, women wishing to conceive cannot rely on contraceptives to balance their hormone levels. Additionally, these medications can create drug-induced nutrient depletions such as zinc insufficiency or various B-vitamin insufficiencies including folate, B-6, and B-12. These insufficiencies then lead to new or exacerbations of other symptoms not thought to be directly related to PCOS such as depression, anxiety, digestive distress, or fatigue due to poor red blood cell formation.
Lifestyle and Nutritional Support
Insulin resistance must be aggressively addressed. Obese patients with a body mass index greater than 30 may require a medically supervised weight loss program. High intensity, interval training may additionally help. You should expect to eat 5-6 small meals per day. Artificial sweeteners including aspartame, sucralose, saccharin, and acesulfame potassium should be eliminated. Many people look to natural sweeteners such as stevia and agave nectar but PCOS sufferers may not tolerate these well either.
“Addressing insulin resistance is one of the most important steps in supporting PCOS.”
Natural Products That May Help Support PCOS Symptoms
Some examples include:
- Decrease testosterone: Omega-3 fatty acids, licorice root (under medical supervision if high blood pressure)
- Insulin resistance: Chromium, cinnamon, myo-inositol, D-pinitol, N-acetylcysteine, vitamin C, vanadium
- Follicular arrest: Vitamin D, calcium
- Increase SHBG (sex-hormone binding globulin): Green tea, soy isoflavones, ground flax seeds
- Inhibit 5-alpha reductase (slowing conversion of testosterone to DHT): Saw palmetto
Final Thoughts
PCOS can be treated using a natural approach of diet, lifestyle, and supplementation in many cases. Pharmaceutical measures may be required in some cases depending upon the patient’s preferences, goals, and severity of the condition.
For more information on PCOS and how to support it please contact your healthcare provider.
