What is PCOS?
Between 5% and 10% of women of childbearing age (between 15 and 44) have PCOS. Most women are diagnosed between 20-30 years of age, when they have problems getting pregnant and present to their physicians. However, PCOS can happen at any age after puberty. Every month as part of a healthy menstrual cycle, the ovaries release an egg. In women that have PCOS, the ovaries will develop a thickened outer wall, underneath which many partially stimulated eggs form cysts, hence the name polycystic ovarian syndrome.
Normally, the ovaries release a small amount of male sex hormones, called androgens, however, in women with PCOS, the ovaries start making slightly more androgens, which is the reason for masculine symptoms like extra facial and body hair and male pattern baldness.
Traditionally, the diagnosis of PCOS was made when an imaging study revealed multiple cysts on the ovaries, however, not every woman diagnosed with polycystic ovarian syndrome has visible cysts on her ovaries. Polycystic ovarian syndrome can still be diagnosed if the majority of other common symptoms are experienced and/or they have the common endocrine abnormalities associated with PCOS.
Symptoms of PCOS include:
- Trouble getting pregnant (infertility)
- Irregular menstrual cycle
- Hirsuitism, with hair growth on the face, chin, or parts of the body where men usually have hair
- Acne on the face, chest, and upper back
- Thinning hair or hair loss on the scalp; male-pattern baldness
- Weight gain or difficulty losing weight
- Darkening of skin, particularly along neck creases, in the groin, and underneath breasts, which is commonly associated with insulin resistance
- Anxiety and depression
- Elevated waist to hip ratios, overweight and obesity
The exact cause of PCOS is unknown. Several factors, including genetics, diet, stress and environmental toxins may play a role. The common hormonal imbalances associated with PCOS include high androgens (testosterone/DHEA), overproduction of CRH (corticotropin releasing hormone) and cortisol, elevated insulin/glucose levels, elevated estrone levels and improper ratios of LH (lutenizing hormone) to FSH (follicle stimulating hormone).
Treatment options conventionally have been to put patients on the birth control pill to decrease androgen production and regulate estrogen. Progestin only pills are also used.
To help with ovulation, Clomid, Femara, Metformin and Gonadotropins have been utilized. For excessive hair growth spironolactone, birth control pills and Vaniqa (a facial cream) have been prescribed.
At CentreSpringMD, our providers offer an integrative or functional medicine approach to treatment of PCOS. Although utilizing medication is an option, treatment should also include an assessment of all of the potential factors contributing to PCOS. This includes assistance with dietary intervention, stress management, assessment of possible environmental factors, as well as non-pharmaceutical options.
- Diet and Weight Loss if Overweight
Consuming a nutrient-dense, low-glycemic diet will improve insulin sensitivity, body composition and androgen levels. In the Journal of Obesity, participants followed a low starch/low dairy food plan for 8 weeks, which resulted in a decrease in testosterone, improved insulin sensitivity and weight loss. In addition, there may be some association with improper detoxification and bodily retention of environmental toxins in patients with PCOS. I suggest most patients consume a whole foods diet, limiting exposure to pesticides, preservatives, and artificial sweeteners. Include a plethora of non-starchy vegetables, grass-fed/pasture-raised meat/poultry, wild-caught fish (salmon is my favorite), nuts/seeds and unrefined oils/fats like coconut oil, olive oil and avocado.
Increased stress will elevate your cortisol levels which in turn elevates blood glucose levels. This will lead to increased weight gain around the abdomen as well as an increase in androgen levels. Excess androgen levels can lead to aromatization and an increase in estrone levels created by the increase in adipose (fat) tissue. Elevated estrone levels disrupt the proper ratios of LH and FSH that lead to menstrual irregularities and the many other symptoms associated with PCOS. Many patients admit to experiencing stress in their lives, however, most are not aware of the real physiological changes that occur when they feel stressed.
Some suggestions for reducing stress are to spend more time in nature, try yoga a few times per week, start heart-centered meditation, engage in daily prayer, start a journal and ensure that you are getting proper sleep (at least 7-9 hours per night). Other suggestions include acupuncture, energy therapy such as marma therapy, massage and/or chiropractic.
Getting regular movement is part of any treatment plan for patients diagnosed with PCOS. It is important to engage in moderate activity to improve body composition, burn fat and lower cortisol levels. Some women make the mistake of engaging in extremely intense activity, which can actually cause more hormonal imbalances. As a general rule, I recommend listening to your body and paying attention to how you feel during and after your exercise routine.
Herbs known as adaptogens can help promote hormone balance and protect the body from the effects of cortisol caused by chronic stress. Ashwaganda, holy basil, rhodiola and maca root can are a few of the herbs that can be helpful in PCOS. Licorice can lower testosterone levels, however, care must be taken if you also have hypertension. Inositol is another commonly used supplement to improve symptoms associated with PCOS, although it seems to be more helpful in the patients that are not classified as obese. There are two types of inositol: myo-inositol and D-chiro-inositol and doses somewhere between 1,200-2,400 milligrams per day can help with follicular maturation, weight loss, reducing leptin levels , lowering triglyceride levels and improving HDL levels. Lastly, omega- 3 supplementation can affect gene expression that is involved in insulin and lipid signaling pathways.