What is PCOS?
PCOS or Polycystic Ovarian Syndrome is a hormonal disorder that causes your ovaries to produce higher levels of androgens (male hormones) than normal which can interfere with egg production. Eggs which are normally developed and released during the cycle get turned into fluid-filled cysts which can be very painful and may cause larger health problems. Up to 1 in 10 women has PCOS, although I suspect this is under-reported and under-diagnosed.
It took me a full year to get my diagnosis, as doctors assumed my problems were mostly in my head or due to coming off the birth control pill. I trusted my intuition and finally got the confirmation I needed. Keep at it- you will get an answer!
Diagnosing PCOS is sometimes difficult, as you don’t actually have to have cysts on your ovaries to have the condition. I myself only have one very small cyst on my ovary, and haven’t had any since. To be confirmed PCOS, you must have two of the following three features:
- Chronic Anovulation (lack of ovulation + irregular periods)
- Clinical (acne, excessive hair growth, hair loss, oily skin and hair) or biochemical signs of excess androgens (elevated blood levels of androgen hormones like testosterone and DHEA)
- Polycystic ovaries on ultrasound
The causes of PCOS, like Endometriosis are somewhat unknown or unconfirmed.
High Insulin Levels or Insulin Resistance
Insulin is the hormone that helps our body usher sugar into it’s cells. When we have too much dietary sugar, our bodies have a hard time knowing what to do with it. A lot of it gets stored as fat, and the rest floats around our blood stream. Insulin will normally open the cell door to let some sugar (cell food!) inside. But with excess blood sugar (hyperglycaemia) our cells become resistant to the action of insulin and the sugar stays in the blood stream.
Research is showing a big connection between this sugar and insulin problem and how our ovaries function. High blood levels of insulin actually cause our ovaries to produce too much androgens and suppress sex-hormone binding globulin (SHBG) a lovely neighbour who usually mops up all the extra androgens and other hormones floating around. This ripples downs and prevents proper ovulation, causing late or non-existent cycles, plus all the other nasties of having too many androgens. See the full list in the Signs and Symptoms section of this post.
This potential cause of PCOS is still in infancy for research. We know now that there is a genetic connection, but it does not necessarily mean that the daughter of a mother with PCOS will get PCOS. Other lifestyle factors including a high-sugar diet (see above!) play a bigger role here.
Many women with PCOS have a constant, chronic low-grade inflammation happening in their bodies. This inflammation can be brought on by both dietary and lifestyle factors like poor diet and lots of stress. This inflammation can lead to insulin problems, cholesterol accumulation and other issues leading to PCOS.
Signs and Symptoms
- cysts on ovaries
- excess androgens (testosterone)
- weight gain or obesity
- insulin resistance
- irregular or no periods
- painful periods
- heavy menstrual bleeding
- mood swings
- hair loss (male pattern baldness)
- excess body hair growth
- infertility or inability to get pregnant
- waist bigger than 35 inches or waist bigger than your hips (apple shape)
Birth Control Pill
The birth control pill or other hormonal birth control methods are the most prescribed “solution” to PCOS according to medical doctors. The pill, while it’s taken, helps to balance hormones and therefore reduce excess androgens floating around. This method does nothing to cure PCOS or address the root cause. My own gyro recommended it to me, even stating herself that it wouldn’t cure me, only help while I took it. The birth control pill comes with it’s own risks, so I highly recommend making an informed choice before using this medication.
Because of the insulin resistance connection to PCOS, the anti-diabetic drug Metformin is often prescribed. Usually doctors give this medication to help women with PCOS lose weight. Metformin helps the cells become sensitive to insulin again, allowing insulin to open that cell door for the glucose (sugars) to come in. When this happens, less insulin needs to be secreted by the pancreas. Androgens will decline when insulin is in balance, so this drug is also helpful for ovulation.
Spironolactone is a prescription drug that inhibits the binding of testosterone to its receptors and so is helpful in decreasing abnormal body hair growth. There are tons of side effects to this medication, and a focused decision is needed before trying this medication. Some of the side effects include excess urination, breast tenderness, weight gain, fatigue and dizziness.
There are sometimes other treatments used, depending on the goals of the patient. If you are trying to conceive, then Clomid, an ovulation-inducing drug may be prescribed. For some women, none of these allopathic treatments are effective, and the doctor may recommend a partial or full hysterectomy.
Low Glycemic-Index Diet
Enjoying a low GI diet reduces the amount and type of carbohydrates we consume. The lower the food item is on the Glycemic index the less it will spike blood sugar. And we know that stable blood sugar = no insulin resistance. And without insulin resistance, our ovaries will not produce as many androgen- this is good news for us PCOS ladies!
Generally, avoiding sugar in all forms, and reducing the amount of starchy carbohydrates (sorry, potato chips) and using non-starchy veg (hey there, broccoli), clean protein and healthy fats will keep your GI low. Adding fat to any meal will help slow the speed at which our blood sugar builds, preventing big spikes and crashes. This is a great list of low GI foods.
As obesity and excessive weight gain is a common problem in PCOS, exercise is vitally important. If you are struggling with low energy as well as PCOS, don’t try to push your body too hard. Simply moving more like taking walks or bike rides and doing yoga will be enough to begin. Once you have made some changes and your energy is more consistent, consider trying High Intensity Interval Training (HIIT) which combines bodyweight resistance and cardio exercises in short but intense bursts for very effective fat burning.
Exercising several times weekly will help to reduce insulin resistance, and therefore help to reduce levels of circulating androgens. Weight loss through exercise will also do this, as excess hormones are stored in our fat cells.
There are literally hundreds (thousands?) of different supplement formulas out there to help balance hormones, including insulin. See below for a short list with brief descriptions.
This herb is sometimes known as Chastetree Berry or the “woman’s herb”. This is one of the most widely used herbs in women’s health. It is a photo-progestin, or has an ability to increase progesterone production in women. This is fantastic for PCOS, as we often don’t have enough progesterone due to too many androgens and estrogens floating around.
I’m not talking about the candy here, but the actual root of the liquorice plant. This herb is fantastic for supporting the adrenal glands (our stress centre) which are often fatigued in women with PCOS. Licorice is often used to help reduce excessive body hair growth as well. For women who don’t ovulate or are trying to get pregnant, this herb can be very helpful. If you have high blood pressure, do not use licorice.
N-Acetyl-Cysteine, or NAC, is an amino acid with a penchant for our blood sugar. This supplement helps our bodies become sensitive to insulin again through increasing anti-oxidant activity and reducing glutathione levels.
Some research indicates that part of the insulin-resistant problem with PCOS is a deficiency in d-chiro-inositol. When taking inositol, whether in the hard-to-find d-chiro form or the readily available my-inositol form will not only help repair insulin resistance, but it also helps to bring on ovulation in women with PCOS.
Gut health is extremely important when healing any chronic disease or syndrome. Our gut is our first line of defence against pathogens and other nasties that come into the body. When we eat a high-sugar, processed-food diet, the beneficial bacteria (probiotics) in our gut start to die and become overrun with things like parasites and candida. These little guys love to feast on sugars, and often make us crave more- furthering the vicious cycle of insulin resistance and weight gain. Taking a daily probiotic supplement will help to stop this cycle in its tracks.
We’ve all heard about Omega-3s, and that we should eat them for good health. Found naturally in fish, nuts, seeds and other foods, we can get concentrated doses by taking a fish oil supplement. Not only with this decrease the chronic inflammation that many PCOS ladies have, it will help to balance blood sugar, regulate moods (bye-bye crying spells and assist weight loss.
Thakker D, Raval A, Patel I, Walia R. N-acetylcysteine for polycystic ovary syndrome: a systematic review and meta-analysis of randomized controlled clinical trials. Obstet Gynecol Int. 2015;2015:817849. doi: 10.1155/2015/817849. Epub 2015 Jan 8. Review. PubMed PMID: 25653680; PubMed Central PMCID: PMC4306416.
Holford, P. (2011). Balance Your Hormones. London: Piatkus.
Schauch, M. (2012). Making Sense of Women’s Health. Hillsburgh: ActNatural Corporation.
Harris, C., & Cheung, T. (2006). The Ultimate PCOS Handbook. San Francisco: Conari Press.