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PCOS (Polycystic Ovary Syndrome, also referred to as Polycystic Ovarian Syndrome) is one of the most common hormonal conditions, affecting around 5 million women in the United States, and is one of the leading causes of infertility in women of childbearing age.
Although cysts on the ovaries was once thought to be the main symptom/characteristic of PCOS (hence the name), this is no longer considered a valid criteria for diagnosis, since cysts are now so common among women (around 25% of healthy women may have cysts on their ovaries) and because some women with PCOS have no cysts!
Instead, the main criteria for diagnosis are (with or without the presence of cysts):
High androgen (also known as 'male hormones') levels
Insulin resistance or dysregulated blood sugar levels
Let's break those down further.
Women with PCOS tend to have high levels of 'male hormones' (such as testosterone) known as androgens. To be clear, women naturally have some 'male hormones' in the body, just as men have some 'female hormones' (such as estrogen) naturally present in the body. In women with PCOS, however, these androgen levels can be higher than normal, leading to symptoms such as:
acne
excess facial hair and excess bodily hair (such as around the nipples) - a condition known as hirsutism
male pattern baldness or hair loss
More recently, researchers have observed a link between PCOS and insulin resistance (or unstable blood sugar levels) - insulin resistance is thought to affect up to 70% of women with PCOS. With insulin resistance, the cells become resistant to insulin, so glucose can't enter the cell, the sugar remains in the blood, causing unstable blood sugar levels. This in itself affects ovulation, but, additionally, higher levels of insulin (caused by insulin resistance) are thought to trigger the ovaries to produce more androgens, which disrupt the menstrual cycle (hence insulin resistance is doubly bad for hormones). There is also often a link to overweight and obesity - up to 80% of women with PCOS are overweight or have difficulty losing weight. Obesity itself can cause insulin resistance, but it might be that there's a separate link between insulin resistance and PCOS. In either case, both factors (obesity/being overweight and insulin resistance) put women with PCOS at risk for developing diabetes if their PCOS is not addressed.
Signs of insulin resistance can include:
being overweight or obese
difficulty losing weight
high blood sugar levels (as determined by a blood test)
sugar cravings
missing or irregular periods
heavy bleeding (because ovulation is disrupted, the uterine lining has more time to build up, so when the period does come it may be much heavier)
Besides these criteria, there may be other factors associated with PCOS, such as:
genes - you're more likely to have PCOS if someone in your family has/had it
inflammation - women with PCOS tend to have higher levels of inflammation in the body (this may be particularly the case for women who have PCOS but are not overweight/don't have the usual symptoms)
excess estrogen and low progesterone - while PCOS means our hormones are out of whack in general, it is usually seen as a condition of estrogen dominance and is characterised by low progesterone (these two conditions often go hand-in-hand, as progesterone balances estrogen)
So, what if you have some of these signs/symptoms - how can you tell for sure that you have PCOS?
In order to be certain, or to have a confirmed diagnosis of PCOS, your GP/doctor may test your androgen levels with a blood test (although they may decide this is not necessary if you have very obvious signs of high androgens such as acne or facial hair). They can also test for insulin resistance by testing HbA1c or blood glucose levels, and they may check your weight, blood pressure, and general health.
Why is it important to address PCOS?
As mentioned, PCOS is one of the leading causes of infertility among women of childbearing age (although it is possible to get pregnant while you have PCOS). Because of the connection with insulin resistance and weight, women with PCOS are also at risk of developing diabetes, metabolic syndrome, heart disease, and stroke. There is also a greater risk of developing sleep apnea, depression, and anxiety.
It's not all doom and gloom!
PCOS can definitely be addressed naturally through diet and lifestyle, to the point where the symptoms no longer present and the hormones are balanced. This involves (for starters) addressing insulin resistance, inflammation, excess estrogen (and low progesterone), and any weight issues.
1. Insulin resistance
Since this is the most common type of PCOS and can lead to diabetes if unchecked, it's super important to address your blood sugar levels. If you eat a diet of junk food and sweets, or you often have sugar cravings, then this is definitely an area to focus on. The main ways we can address insulin resistance are by:
reducing or elimination refined sugar and refined carbs (such as white pasta, white bread, white rice, donuts, etc.)
focussing on complex carbs such as brown rice and starchy veg such as sweet potato
making sure to eat some good quality fat (such as nuts, avocado, olives and olive oil) and protein (such as quinoa, nuts and seeds, tofu and other pulses) with every meal
not skipping breakfast (breakfast is super important to set us up for the day and stabilise our blood sugar levels in the morning)
Herbs and supplements* that can help with blood sugar regulation are:
cinnamon
cordyceps
inositol
chromium
berberine
*Always check with your healthcare provider before starting any new supplements or herbs.
2. Inflammation
We can reduce inflammation by reducing or eliminating the most inflammatory foods from the diet, such as:
animal protein - all animal protein is inflammatory but the two most inflammatory sources in the Western diet are eggs and chicken
refined sugar
vegetable oils
You might even want to try an elimination diet to see if there are additional foods that your body finds inflammatory.
We can then add in anti-inflammatory foods and supplements such as:
berries
colourful fruits and vegetables
'superfoods' such as goji berries
omega 3 fatty acids, found in chia seeds, flaxseed, walnuts (and adding an algae-based EPA and DHA supplement)
turmeric
herbs and spices
Besides food, inflammation also comes from our environment and stress. Rates of PCOS have sky-rocketed over the past 80 years - coinciding with the increase in pesticides and chemicals in our environment. We can try to reduce our exposure to these inflammatory agents by:
buying organic where possible
avoiding toiletries and cosmetics that contain chemicals
not wearing fragrance/perfume
not wearing anti-perspirant
not using plastic water bottles
taking our shoes off at the door
not using artificial scents or sprays at home
not using cleaning products with chemicals
not heating our food in plastic containers
And we can address inflammation that comes from stress by:
finding ways to manage stress
working on our sleep
3. Excess estrogen/Low progesterone
Like inflammation, much of the excess estrogen we see in so many hormone conditions (including endometriosis and fibroids) is connected to the rise of xenoestrogens in our environment. Xenoestrogens are present in our food, and in our environment. In food, the main sources are in animal products (not only are the animals often pumped with hormones, chemicals, and antibiotics, but they also have their own naturally occurring hormones present, which we then eat through their products). So avoiding animal products, especially dairy (as cows are often milked when pregnant, when they have even more estrogen in their bodies), is key. In our environment the major xenoestrogens are chemicals such as parabens, dioxins, and phthalates (the 'sticky' chemicals present in parfum/fragrance). Therefore, all the advice above for avoiding plastics and products with chemicals in them will not only help reduce inflammation, but also reduces our exposure to xenoestrogens.
In addition to avoiding xenoestrogens, we also need to help the body flush out excess estrogen by supporting the liver (which has the job of transforming estrogen for elimination). We can do this by avoiding things that burden the liver, such as:
caffeine
alcohol
refined sugar
trans fat
And adding in foods and supplements that support the liver, such as:
cruciferous veggies
wholegrains
plant-based protein
glutathione
DIM
milk thistle
dandelion
Tulsi (Holy Basil)
We can also support the final elimination pathway (faeces!) by eating more fibre (such as beans and pulses, vegetables, wholegrains, and nuts and seeds). The fibre binds the excess estrogen helping us poop it out!
Often, addressing excess estrogen may be enough to balance out the progesterone, but we can also boost progesterone by supplementing with B6 and selenium.
4. Weight issues
Not all women with PCOS are overweight or obese, but if you are experiencing difficulty losing weight, or excess weight around the mid-region, I highly recommend working with a holistic practitioner to help you lose weight sustainably and healthily (i.e. not by dieting or restricting calories).
Some other tips for healthy weight loss:
work on your stress, as cortisol can prevent us losing weight
make sure you're sleeping well
do more weight-bearing exercise
Bonus tip! Add in vitamin D3
Low levels of D3 are associated with PCOS, and we know D3 is so important for hormone health in general. Supplement with around 1000iu (up to 2500iu in winter, in the Northern hemisphere). Always get your levels checked regularly, as it's possible to have too much D3.
While these 5 tips provide a great starting point for addressing PCOS naturally, there are many more things we can do, including looking at the emotional component of PCOS. If you're interested in learning more, I will be releasing a webinar specifically on PCOS this year - sign up to the newsletter to stay in the loop! In the meantime, check out my webinar on women's hormones for an overview of what the hormones are, and how we can address hormone imbalances naturally.
If you'd like personalised support and advice on dealing with your PCOS, book in for a free consultation with me today: