PCOS
PCOS, Polycystic Ovary Syndrome, is a condition affecting approximately 20% of the female population and according to the U.S. Department of Health and Human Services, 1 in 5 women of childbearing age have PCOS. However, less than 50 percent of women are properly diagnosed. This means millions have no idea what’s causing their symptoms. It is the number one most common reproductive health concern in women and affects not only fertility, but also emotional and physical well-being due to its many health implications.
Despite the name, many women do not have cysts on their ovaries. The name stem from the impact on a woman ovaries, and the association with these multiply cysts found there. But now we know that you don't actually have to have cysts on the ovaries to have PCOS, or that they can come and go. PCOS is more of an hormonal metabolic condition, so it affects the woman's entire hormonal system and also her metabolic system.
With PCOS, it's important to understand that it's really a disease process happening in the background. Some of the affects are related to fertility, but more so the general impact that it can have on a woman's health, and that treating it, regardless on whether or not she's trying to get pregnant, are very important as PCOS increases her risk of heart disease and diabetes. Once you go through menopause, and you don’t have menstrual cycles anymore, there are none of the menstrual related symptoms. However, the rest of the risks still exist – cardiovascular and metabolic diseases.
PCOS is a condition that isn’t black or white, but rather an issue that contains a spectrum of symptoms that you might experience at various levels of intensity. This also indicates that conquering PCOS does not always occur with a one size fits all approach. There is also not just one kind of PCOS, in fact there are several types.
What is PCOS
PCOS is one of the most common hormonal imbalances affecting women today, and the major cause of female infertility. PCOS can develop for a number of different reasons, and symptoms can vary a lot from woman to woman, although a common thing in which is pretty consistent in almost all women with PCOS, is irregular ovulations, leading to irregular cycles. It's also generally accepted that insulin resistance plays a role in the development of the disease. Often times PCOS is also involving androgen excess, a medical condition characterized by excessive levels of androgens. The condition develops due to the environment interacting with your genes. The ‘environment’ includes what you eat, how much you exercise, stress levels, environmental toxins, etc. So by addressing and removing the factors that contribute to PCOS, you can reverse your PCOS symptoms. Currently, there is no known “cure” for polycystic ovary syndrome, although the underlying hormonal causes are believed to be mostly reversible like mentioned, and many women find effective ways to lower their symptoms without the use of medications.
PCOS is often thought of as a condition associated with being overweight because the hormonal imbalances can make it easy to gain and difficult to lose weight. But about a third of all cases of PCOS occur in women which is not overweight. This type of PCOS is commonly called "lean" or "thin" PCOS.
The stereotype we're often times looking for is a heavy or overweight person with bad acne and cysts on the ovaries. This can be true, but the misconception that all women has to look like this causes many not to be diagnosed with PCOS, as the medical diagnosis system are often expecting it to be high testosterone or cysts on the ovaries, that isn't always the case. The reality is that you have this collection of symptoms and the symptoms may vary greatly.
What are the PCOS symptoms?
Irregular cycles or missed periods as a result of delayed or lack of ovulation
Some women may develop cysts on their ovaries, many women do not
Insulin resistance
Weight gain
Obesity
Fatigue
Unwanted hair growth (also known as hirsutism) on the chin, upper lip, stomach or chest due to the high levels of androgens
Thinning hair on the head
Infertility
Acne
Mood changes
Depression and anxiety
Heavy bleeding
Headaches
Sleeping problems
Sleep apnea
Cardiovascular disease risk
Diabetes type 2 risk
Diagnosing PCOS
1. Androgen Excess (Androgens: male sex hormones such as testosterone and DHEA)
Excess androgens are present in most women with PCOS and can lead to a variety of symptoms. You can find out either by looking at physical symptoms, for example hersitism (which is a specific kind of hair growth, in the face, like what you would see on a male), acne or male pattern hair loss. Any combination of these would qualify as an androgen exess symptom, or by elevated androgenic hormones such as DHEA-S and testosterone in the blood. However, the hormones is easy to miss due to the difficulties when it comes to measuring them.
In PCOS, it has been found that there are actually two different sources of androgens, the ovary and the adrenal. The ovary’s primary androgen is testosterone and the adrenal's primary androgen is DHEA. Some women are more “adrenal dominant” and others are more “ovary dominant” with respect to androgen production. It appears that the source of the androgens may make an impact on the metabolic and reproductive outcome of a woman with PCOS, as well as how to treat it.
2. Ovulatory Dysfunction
One of the most well-known effects of PCOS is problem with ovulation, like anovulatory cycles or delayed ovulation. This can manifest as oligomenorrhea (irregular periods) or amenorrhea (missing periods). Many women with PCOS experience abnormally heavy, short or long menstrual cycles, which also falls under the heading of ovulatory dysfunction.
3. Polycystic Ovaries on ultrasound
Some doctors will argue that unlesss you have polycystic cysts on the ovaries you don't have PCOS, but that's not correct. Some women with PCOS do not have cysts on the ovaries, and the cysts can come and go. However, many women with PCOS has ovarian cysts that can be identified on a vaginal ultrasound. Basically the cysts where follicles, that wanted to become the egg of the month, but that couldn't release because of high levels of testosterone. That's why women with PCOS can develop "cysts" due to eggs not being released over time. The follicles keep growing and form multiple "cysts."
There’s actually some controversy surrounding the criteria used to determine a PCOS diagnosis, and depending on what doctor you see, they may use different criteria to diagnose you, but according to The Endocrine Society, Rotterdam criteria is the best option for diagnosis. The Rotterdam criteria guidelines for the diagnosis of PCOS requires 2 of the 3 criteria above for a diagnosis of polycystic ovary syndrome.
The connection between insulin resistance and high levels of testosterone in PCOS
Insulin is a hormone made in the pancreas. One of insulin’s many roles is to keep blood sugar levels under control. When we eat or drink, our blood sugar levels will rise (how much and fast is spikes depends on what you ate), and when our blood sugar rises, or insulin levels rise accordingly, meaning that insulin is secreted in response to the amount of glucose, or sugar, in the blood.
Insulin is a like a key, it unlocks the door to allow glucose to enter the cells to be used as energy or fuel. Without it, our cells would starve. This leads to reduced amounts of sugar in the blood, and puts it where it is intended to go, into the cells for use or storage. This is important, because high amounts of sugar in the blood can have toxic effects and can cause severe harm. However, if you are insulin resistant, insulin (the key), doesn't work as good, because the cells has stopped responding to the insulin like they are supposed to. In other words, they become "resistant" to the the effects of insulin and instead of the glucose being used as energy, it builds up in the blood. When the body produces insulin under conditions of insulin resistance, the cells are resistant, or not at sensitive, to the insulin and are unable to use it as effectively, leading to high blood sugar. The pancreas increases the production of insulin, further contributing to a high blood insulin level.
PCOS and insulin resistance are frequently found together, because a high level of insulin causes the ovary to produce excess amounts of testosterone in which contributes to PCOS. The sluggish response to insulin will cause larger and larger amounts of insulin to be required before glucose is taken away from the blood and into the body, and if you have really high insulin levels all the time then it causes your ovaries to overproduce testosterone as high levels of insulin, allows the insulin to hang around longer, bind to the ovaries, and tell the ovaries to make more testosterone. The ovaries which already produces testosterone, but in small amounts, which we need, now starts making a lot of testosterone. So the insuline resistance interfere with the normal production of testosterone.
That's why too much testosterone is caused by too many spikes in blood sugar and too much insulin circulating in the blood the majority of the time, which again promotes testosterone production. The solution is to cut down on the food that causes spikes in the blood sugar as well as exercising because that will make you more sensitive to the insulin.
Naturally Occurring PCOS in puberty
A young woman's body needs to gain weight so that she can reproduce. To achieve this, her body becomes insulin resistant, which happens for all women. We all gain weight around 10 to 12 years old which is called adrenarche, that's when our adrenals glands activate and we get an increase in adrenal androgen production as well as cortisol. This means that we all are in that androgen excess at that age, which indicate that all young girls going through puberty have that temporary PCOS like look in terms of their hormones levels, while the body is maturing.
This means that young girls that go and get an ultrasound, can potentially have cysts on their ovaries in addition to really high levels of androgens, without anything being wrong, because it's a natural part of puberty. What most likely happens is that they get diagnosed with PCOS, and are put on birth control pills, instead of waiting and letting the menstrual cycle stabilize and become regular naturally. In general, it can take many years for the menstrual cycle to mature into an adult cycle and become robust, ovulatory and consistent, and by the age 20 or so, the symptoms of the youth PCOS could be gone.
A important question to ask is therefore: If these women were not put on hormonal birth control at for example age 15, and their cycles were allowed to mature naturally, would they then be having the same PCOS problems when they get off of it, and tried to get pregnant? Due to the thought that the body never got to develop naturally (away from youth PCOS and towards a natural cycle).
Inflammation in relation to PCOS
Inflammation is a good thing, and it's in our body for a reason. Inflamation is basically a chemical output by our immune system and it happens for a variety of different reasons. We need innflamation to fight infections and for cellular repair, and it has a variety of good functions for our health. But if you have inflammation at the wrong time, all the time, or in the wrong way, it can harm us. Because just as inflammation can damage innovator cells and bacteria and viruses, inflammation can also damage our own cells. In PCOS there's a lot of inflammation, a chronic, low grade inflammation, which means that it's a inflammation there all the time that interferes with the cells.
Gut-health
Many studies have found a correction between gut microbiota and metabolic dysfunctions, like PCOS. Women with PCOS have fewer good bacteria and higher levels of certain bad bacteria than non-PCOS women. Poor gut bacteria causes inflammation and insulin resistance which both contributes to PCOS. Excess androgens also cause the microbiome to be out of balance, so PCOS definitely makes this worse. A common ‘treatment’ for PCOS is the birth control pill, which further disrupts the gut. The pill negatively impacts the gut microbiome and those taking it are at a greater risk of developing inflammatory gut conditions.
Read more about how to strengthen your microbiome and immune system here.
Figuring out the reason why you are not ovulating regularly
60% of the time it's too much DHEA or too much testosterone, because your body can't ovulate in an environment with too much male sex hormones. That's the high androgen portion. Those ones are the ones were it's all to do with blood sugar, insulin and stress.
The other 40% requires more detective work to figure out. Is it too much prolactin? Is it not enough estrogen? Too much estrogen? Thyroid issues? Too much stress? Inflammation? Food intolerances? Low body weight? Over-exercising? Post pill? A combination?
The Birth Control Pill
Metformin and the birth control pill are two of the most common medical treatments for PCOS, but these medications are not really treatments at all, but rather band-aid solutions for a much deeper problem. The birth control pill just acts to mask the problems with PCOS. It may suppress symptoms short term, but they will return when you stop using it and they could be even worse than when you started. The pill happens to exacerbate many of the root causes of PCOS, including insulin-resistance and inflammation, meaning that the hormones that you’re given as a treatment for PCOS, could actually be causing it. The pill that you’re given to ‘regulate your period’ can therefore do more harm than good. A recent study of 42 women found that the pill caused inflammation and the beginnings of insulin resistance.
As mentioned, hormonal birth control are given to ‘regulate your period’, but the pill can never regulate your period, because what happens, referring to the menstrual cycle, when on the pill, has nothing to do with your natural cycle. The pill causes a ‘pill bleed’, not a real period. A period is a withdrawal bleed from the hormones estrogen and progesterone, made by your ovaries. A pill bleed is a withdrawal bleed from synthetic hormones. The pill masks the problem and you still won’t have a regular period once you come off it. The effects may seem subtle, but the pill may actually be causing huge changes. And as soon as you remove the synthetic hormones, you're back to start, because the actual disease process was happening in the background all along, but the birth control pill allowed those symptoms to be masked. Now you might also have developed insulin resistance too, which further worsen PCOS.
How to treat PCOS naturally
PCOS can be managed with dietary and lifestyle changes, which can help reduce symptoms and reset your hormones to a more balanced place instead of just masking the symptoms which the birth control does, as it's not addressing the underlying cause. With PCOS it's super important to lower your blood sugar levels, and thereby your insulin levels and making you more sensitive to it, which means you will require less.
1. Stabilize blood sugar by avoiding refined carbohydrates that spikes blood sugar and causes inflammation and eat more healthy fats like avocado, coconut milk, coconut oil, olive oil and hemp seeds. Combining protein with healthy fats at meals along with high fiber vegetables can help keep blood sugar stable.
2. Sleep. At least 8 hours a night.
3. Manage stress. Stress causes high cortisol, decreased digestion and an increased estrogen level as your body convert progesterone (pregnenolon) into the stress hormone cortisol under stress. This causes a depletion in progesterone, which essentialy balances estrogen in the body and helps to keep a normal mensural cycle. If progesterone gets too low because it's getting converted into cortisol, this is automatically going to have your estrogen levels be high. Stress will also put extra pressure on the liver as well as affecting insulin and blood sugar levels. Emotional stress is just as bad, so try to address all the stressors in your life.
4. Exercise. Exercise makes you more sensitive to insulin which will decrease the amount of insulin needed to signal cells to decrease blood sugar. However, be careful of over exercising, in which may increase the demand on your adrenal glands, which can cause more problems.
5. Eat wholefoods. Whole foods are foods that are as natural and unprocessed as possible. They are rich in fibre and take longer for the body to metabolize and break them down. This means that they are absorbed more slowly into the blood stream and you need less insulin to deal with them. Remember, less insulin means less testosterone.
6. Avoid dairy. Properties in dairy products can increase inflammation and lead to high androgens.
7. Eat anti-inflammatory foods like turmeric, ginger, coconut products and leafy greens.
8. Eliminate endocrine disruptors. Women with PCOS tend to have higher levels of Bisphenol A, or BPA in the body. Make an effort to reduce your exposure to endocrine disruptors by choosing natural cosmetics and household products as well as swapping out those plastic food containers or water bottles for glass and stainless steel. This will reduce your toxic load. Read more about hormonal imbalances, what causes it and how to prevent it here.
If a woman struggles with PCOS, she's also more likely to have a thyroid issue so this needs to be addressed.