Polycystic Ovarian Syndrome (PCOS) is a complex disorder of the female reproductive system that results in multiple ovarian cysts which enlarge the appearance of the ovaries and may make the ovaries feel lumpy.
PCOS can occur at any age and affects about 6% of women. Most women with this condition have elevated insulin levels, in part because the body is resistant to the effects of the hormone. Other hormones are out of balance, including the prolactin level (which is high), the testosterone and DHEA levels (which are generally high) and abnormalities in the luteinizing hormone levels. The individual often doesn’t ovulate, leading to persistently low progesterone levels and infertility. This may be accompanied by a prolonged time between periods. PCOS is often temporary. PCOS can be seen in girls who are going through puberty and in women who are transitioning into perimenopause. Clinically, PCOS responds by balancing your unique individual chemistry along with dietary changes to correct these imbalances.
What causes PCOS?
The exact cause of PCOS is not known; however, many healthcare providers feel that the consumption of sugary processed foods and foods high in trans-fats contribute to both insulin resistance and PCOS. Some consider that insulin resistance is the initial effect of eating unhealthy foods and that this abnormality triggers hormonal imbalances that ultimately support the presence of multiple ovarian cysts. The increase in intake of xenohormones, which are hormones derived from outside the body like plastics, cosmetics, environmental toxins and the consumption of hormone-laden beef, contribute to the abnormal hormonal environment that becomes PCOS
How do I know if I have PCOS?
PCOS causes women to have an increase in weight and, because of the elevated male hormones, the skin is often greasy and contains excess acne. Women often crave sweets or other carbohydrates and suffer from infertility. The excess male hormones also cause infertility and excess body hair. In some situations, a woman with PCOS will become hypothyroid or can develop diabetes, high blood pressure and/or cardiovascular disease.
What is the Treatment of PCOS?
Traditional Medical Approach:
Doctors have generally done nothing about PCOS unless there is a fertility issue or a woman has markedly irregular periods. Often the treatment was simply to use birth control pills to override the ovaries and regulate the periods. The birth control pill reduces the symptoms of PCOS by blocking ovulation and giving the ovaries arest from follicle production. This is a good choice for women looking to avoid pregnancy. Testosterone levels will go down when on the birth control pill and it is good for regulating cycles but it won’t address the basic issue of insulin resistance. Some doctors are now prescribing a diabetes drug called Metformin (Glucophage) for blood sugar control; however, the ovaries become polycystic again when the patient goes off either type of pill. This is particularly problematic for women trying to get pregnant. Women who wish to get pregnant often have to resort to fertility treatment like in vitro fertilization in order to conceive a child.
Functional Medicine Approach
The first thing that needs to be evaluated in a PCOS patient is her blood sugar levels to see if she is in insulin resistance. This is another prime example of how we have to look at the whole body and endocrine systems that intercommunicate with one another. By addressing the blood sugar problems and hormonal imbalance, the body will work the way it was designed by our Creator. If you do not correct the underlying sugar cravings and make them go away by balancing your chemistry, then it is very difficult to break the vicious cycle. As you balance out the chemistry, the cravings will go away. Proper supplementation based upon your individual chemistry is a must. Dietary and healthy lifestyle changes play a significant role. These programs are individually customized based upon your unique chemistry.
Types of PCOS
1) Insulin-Resistant PCOS
This is the classic type of PCOS, and by far the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, obesity, smoking, trans fat, and environmental toxins.
Is this you? You have been told that you are borderline diabetic, or you had an abnormal glucose tolerance test. You probably have elevated insulin, and you may also have elevated LH (luteinizing hormone). You are probably overweight, although you may be normal weight. Normal-weight insulin-resistance can occur in the years following dieting or eating disorder.
Treatment ideas: Reduce sugar and/or lose weight. Use supplements for insulin resistance. The Pill is not a treatment for this type (or any type) of PCOS because it impairs insulin sensitivity. Improvement for Type 1 PCOS is slow and gradual over 6-9 months.
2) Pill-Induced PCOS or Post-Pill PCOS
The birth control Pill suppresses ovulation. For most women that is a temporary effect, and ovulation will usually resume fairly soon after the Pill is stopped. But for some women, ovulation-suppression can persist for months or even years. During that time, it is not unusual to be given the diagnosis of PCOS. Some experts deny the existence of Pill-induced PCOS, but it is very real. It is the second most common type of PCOS that I see in clinic. I have spoken to many other clinicians who are seeing the same thing. We desperately need more research into it.
Is this you? You had regular periods before starting the Pill, although you may have had acne. You probably now have elevated LH on blood test, although you may have normal LH, and high-normal prolactin.
Treatment ideas: If your prolactin is high-normal, then the best herbal treatment is Vitex (also called chaste tree or chaste berry).
3) Inflammatory PCOS
Inflammation—or chronic immune activation—results from by stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens such DHEA and androstenedione.
Is this you? You have other symptoms of immune-dysfunction such as recurring infections, headaches, joint pain or skin conditions. Your blood test shows inflammatory biomarkers such as vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid antibodies, or gluten antibodies. You may have elevated DHEA or androstenedione, and a positive urine test for intestinal permeability.
Treatment ideas: Reduce stress and exposure to environmental toxins like pesticides and plastics. Eliminate inflammatory foods such as wheat, dairy, and sugar. Treat intestinal permeability. Supplement magnesium because it is anti-inflammatory and influences adrenal hormones (HPA axis). Improvement is slow and gradual over 6-9 months.
4) Hidden-Cause PCOS
This is the ‘simpler-than-you-think’ type of PCOS. Fairly often (at least once per week) I encounter a PCOS patient who does not meet any of the criteria for the first 3 types of PCOS. These are my favorite cases, because it usually means that there is one simple thing that is blocking ovulation. Once that single thing is addressed, this type of PCOS resolves very quickly, usually within 3-4 months. Common hidden-causes of PCOS include:
– Soy, can confuse ovulation in some women.
– Thyroid disease, because lack of T3 thyroid hormone disrupts estrogen.
– Vegetarian diet, because it causes zinc deficiency, and your ovaries need zinc.
– Iodine deficiency, because your ovaries needs iodine. Please be careful with iodine supplementation as too much can harm your thryoid. Maximum dose 0.5 mg.
– Artificial sweeteners, because they impair insulin and leptin signaling.
Is this you? You do not exactly fit the criteria for the first 3 types of PCOS. You have tried a number of natural PCOS treatments and nothing seems to work. Look deeper.
Do you actually have PCOS? Which Type? Schedule an appointment to find out and develop a customized plan.