PCOS - What It Is and What to Do about It

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What Is PCOS?

Polycystic ovary syndrome (PCOS) is a misleading term, since it doesn’t always involve cysts in your ovaries. You might now be wondering why the heck PCOS is called that, then, and what it is anyway. It’s called polycystic ovary syndrome because on imaging, many women had many (poly-) follicles (cystic—not really cysts, but that’s what was landed upon) in their ovaries (ovarian). Getting to the second part of the question above is a bit more complex, but simply put, PCOS is a condition marked by metabolic and ovarian dysfunction. Perhaps it should be called Pretty Common Ovarian and Metabolic Syndrome (PCOMS).

What Happens in PCOS?

A lot can happen in PCOS, and the answers aren’t completely clear-cut! It’s definitely multifactorial with a genetic component, and one thing can trigger a chain of events and all those events feed into each other. Sounds like a riot, right? Here’s a summary of the issues that can be seen in PCOS:

• irregular periods;
• anovulation (lack of ovulation and infertility);
• multiple follicles in your ovaries (this is where the diagnosis PCOS comes from!);
• high-androgen symptoms: oily skin, acne, hair loss on the scalp, unwanted hair growth elsewhere;
• insulin resistance;
• high ratio of luteinizing hormone (LH) to follicle-stimulating hormone (FSH);
• low-grade inflammation;
• obesity or difficulty losing weight;
• thyroid dysfunction;
• nonalcoholic fatty liver disease;
• vitamin D deficiency; and
• adrenal dysfunction.

As mentioned above, all these issues are linked and can be the trigger to the others. There’s also a genetic component that can be present; those with a family history of PCOS, type 2 diabetes, nonalcohol fatty liver, or a thyroid disorder may be at a higher risk of developing PCOS. And those with PCOS are at a higher risk of developing type 2 diabetes, metabolic syndrome, and thyroid problems.[1][2][3]

How Is PCOS diagnosed?

PCOS is actually quite common in women of reproductive age; as of 2015, 5–10% of women between the ages of 18 and 40 experience PCOS.[3] It wouldn’t be surprising if that number has increased since then, based on the higher prevalence of sedentary and stressful lifestyles and endocrine disruptors in personal-care products and our food supply. Diagnostic criteria can vary, but the symptoms paint a pretty good picture of whether someone has PCOS or not.[2][3][4] That, in combination with imaging and bloodwork, can confirm this diagnosis after other possible diagnoses are excluded. Comprehensive and functional testing is really important because it can not only help manage symptoms but actually get to the bottom of things; this way, the risk of developing future problems is decreased and even eliminated! Here are some tests that are helpful to paint a full picture:

• comprehensive lab work to check your sex hormones, blood sugar and insulin, liver function, inflammatory markers, adrenal function, vitamin D status, cholesterol levels, thyroid function (including antibodies), and other standard parameters;
• pelvic exam and ultrasounds; and
• comprehensive urine or saliva hormone testing.

What Are My Treatment Options?

PCOS treatment varies depending on symptomology, reproductive goals (e.g. are you trying to conceive?), and/or what else is going on in your health/life. With any medications, dietary plans, and supplementation, make sure to talk to your health-care provider about duration of treatment, side effects, and alternatives.

Conventional Treatment

Metformin (a diabetes medication) is commonly used in PCOS, with good success since it helps with insulin resistance, and it can help regulate menstrual cycles and increase pregnancy rates since improved blood-sugar control means ovulation can actually happen. To induce ovulation, clomifene, letrozole, and gonadotropins can be used especially if/when trying to conceive.[5] A few other meds are used in these cases. Oral contraceptives are often used for regulating your period as well as to help decrease acne and excessive hair growth. This, however, is usually a bandage approach and not a solution to the underlying hormone dysfunction that is happening in the body. Antiandrogens like spironolactone can also be used, especially in those with hirsutism, high lipid levels, and acne. Laparoscopic ovarian drilling, which is a surgical procedure to potentially get rid of tissue that produces androgen, is a newer and seemingly effective intervention; however, many other naturopathic treatments are less invasive and very effective.[5]

Naturopathic Treatment

Naturopathic treatment will consider not only your diagnostic testing and health history, but also your diet and lifestyle. As always, ask your naturopathic doctor questions regarding your treatment plan.

Diet and Lifestyle

• Avoid foods that will spike your blood-sugar and insulin levels. Stay away from refined sugar and simple carbohydrates. Opt for lots of veggies, colourful fruits, lean protein and healthy fats, and adequate fibre and resistant starch. Cushioning your whole grains with some protein and fat in order to help balance blood-sugar levels.
• Eat lots of fibre to keep you regular, to help regulate cholesterol levels, and to help get rid of excess hormone metabolites. This includes fruits, veggies, nuts and seeds, and whole grains.
• Increase intake of anti-inflammatory foods that are packed with antioxidants—i.e. eat lots of colourful plant foods including herbs and spices like turmeric, ginger, and cinnamon. Cutting out inflammatory foods like the aforementioned refined sugar as well as dairy and other foods that aggravate you are important. For autoimmune conditions, gluten might be a food that should be removed as well.
• Consider decreasing coffee intake (especially if you drink more than one cup per day!), especially if your adrenals need support and/or fatty liver is an issue for you. Replace your coffee with fruit-infused water or an herbal tea like spearmint.
• Exercising regularly as a way to improve your health should come as no surprise! Weight-bearing exercise help improve blood-sugar levels and fat distribution in the body, which in turn helps decrease inflammation. Two minutes is better than zero minutes—any kind of movement will do.
• Avoid endocrine disruptors in personal-care, household, and other products as much as possible. This includes phthalates, parabens, and triclosan found in many commercial sunscreens, cleaning products, makeup, and hand sanitizers.
• Losing weight if you are overweight or have gained some weight around the time you were diagnosed with PCOS has numerous benefits including better insulin sensitivity, decreased inflammation, and decreased fat around the liver. A diet low in carbohydrates was shown to be helpful here.
• Getting restful and adequate sleep is crucial for healthy hormones and to decrease inflammation. Plus, you have better appetite control
• and energy when you get good sleep, so this is important for making consistent and healthy choices. If sleep is an issue for you, this definitely needs to be fixed!
• Unmanaged stress wreaks havoc on your body including hormonal shifts, poor sleep, lack of motivation, spiking blood sugar, and dysregulating your appetite, so take care of yourself!

Supplement and Herb Considerations

Similar to conventional treatment, supplementation depends on your individual case and requires the strategic and knowledgeable eye of a functional health-care practitioner. Common PCOS interventions include:

• B12, iron, and vitamin D optimization;
• Thyroid support like selenomethionine, ashwagandha, zinc, and l‑tyrosine.
• Inositol to help resolve insulin resistance, anovulation, poor egg quality, and high androgen levels.
• N‑Acetylcysteine (NAC) to help with inflammation, insulin receptor protection, and ovulation and fertility outcomes, especially in combination with clomifene.[6]
• Berberine can help with blood-sugar control, cholesterol levels, and NAFLD.
• Adrenal support like B vitamins, vitamin C, magnesium, ashwagandha, cordyceps, and gotu kola;
• Spearmint tea for excessive hair growth;
• Antiandrogenic herbs like nettle root and saw palmetto;
• Compounds and herbs that help with healthy estrogen and progesterone ratios like DIM, I3C, black cohosh, and chaste tree; and
• Anti-inflammatory compounds like curcumin and resveratrol.

Conclusion

PCOS is multifactorial and complex in nature, and its treatment should address a variety of aspects of your life and health. There are numerous treatment options that can be used based on your symptomology, medical history, testing, and family history. Diet and lifestyle changes can go a long way and can decrease the risk of future disease. Discussing all these aspects with your health-care providers, so you can get comprehensive care specific to you, is important to achieve and maintain good health.