Everything you need to know about PCOS
Polycystic Ovarian Syndrome (PCOS) is a common hormonal condition that affects between 12-21% of reproductive age women. When something is classified as a “syndrome” it means that the signs and symptoms can vary from person to person. However when it comes to PCOS common signs and symptoms include hirsutism (facial hair growth), acne, irregular periods or no periods at all, male-pattern hair loss, infertility, and obesity. While the exact cause of PCOS is still in question, it’s well known that there are abnormalities of several hormones in these women including increased androgens or male sex hormones, and insulin resistance, where the cells do not respond to the normal actions of insulin. Early identification and treatment are critical, since PCOS and the underlying hormonal disturbances put women at risk for developing conditions like Diabetes and Metabolic Syndrome.
What we do know is that 65–70% of women with PCOS are found to be insulin resistant, even those who are not overweight or obese. When our cells stop responding to insulin, we see higher levels of circulating insulin in the blood, which stimulates the ovaries to secrete more testosterone and inhibits sex-hormone binding globulin production, thus leading to high levels of testosterone. This explains why many women with PCOS exhibit acne, facial hair growth, and male-pattern hair loss. Insulin resistance can be genetic, but it is also strongly associated with lifestyle factors like diet, exercise, and stress. This means that it is treatable – so let’s dive in!
How do we diagnose PCOS?
As discussed above, the most common symptoms of PCOS include hirsutism, acne, weight gain, and irregular cycles, but women experience these symptoms to varying degrees. In practice, we use something called the Rotterdam criteria to diagnose women with PCOS. This is what it looks like:
A diagnosis of PCOS requires two out of three of the following:
- Ovulatory dysfunction – usually leading to irregular periods or no periods at all
- Signs of androgen excess like acne and hirsutism; or elevated total or free testosterone on blood work
- Polycystic ovaries found by ultrasound
With your family doctor or naturopath, some basic testing should also be done to understand the whole picture. The blood tests I recommend to my patients include:
- Free and total testosterone, or free androgen index
- Fasting blood glucose
- Fasting insulin
- Day 3: FSH and LH
- Vitamin D
A pelvic ultrasound can also be done to evaluate the number of follicles in the ovaries.
Since PCOS is a collection of symptoms, each woman should be assessed and treated according to her individual presentation of signs, symptoms, and hormone levels, while considering her desire for future fertility. The goals of treatment ultimately should include managing blood sugar and balancing hormones.
#1. Balance Blood Sugar
When it comes to blood sugar, the foundation of treatment must include dietary modification, exercise and stress reduction. We also have many supplements that can be incorporated to sensitize the cells to insulin, in order to get to the root of PCOS. Here are some tips:
- I recommend a Paleo-style diet that includes abundant fresh vegetables, high-quality fats, and proteins
- This means cutting out sugar, most grains and ditching the dairy
- Exercise is beneficial for all women with PCOS, but in those who are overweight it is clear that a reduction in body weight of 5-10% can restore ovulation
- The goal of exercise in this population is to build lean body tissue to improve insulin sensitivity and increase the basal metabolic rate
- Insulin sensitivity is significantly reduced after only 1 week of sleeping 5 hours per night
- One study even showed that one night of sleep deprivation reduced insulin sensitivity by 33%
- Prioritize sleep: get at least 7-8 hours of uninterrupted sleep each night
- Chronic stress is associated with insulin resistance and may in fact contribute to the development of insulin resistance
- Find a mindfulness practice that works for you and practice it every day – even if it’s for 5 minutes. This can include meditation, yin yoga, breathing or journaling
- Recognize the things in your life that no longer serve you and make more time for fun!
My Favourite Supplements to Address Insulin Sensitivity:
- Vitamin D is essential for improving insulin sensitivity. Patients with PCOS commonly have lower levels of vitamin D which can compound the metabolic and endocrine disturbances. I recommend testing your levels before supplementing, to understand how much you need
- Myo-Inositol has been shown to increase insulin sensitivity and promote ovulation in women with PCOS
- Berberine is a compound that has been effective at improving blood sugar levels by increasing insulin sensitivity, similar to the drug Metformin
#2. Hormonal Regulation
Since insulin resistance plays such a critical role in the pathogenesis of PCOS, by improving insulin sensitivity the resulting hormonal dysregulation will begin to correct itself. Nevertheless, the treatment of PCOS can take months, and so many women are looking for strategies to reduce the unpleasant symptoms of PCOS at the same time. Here are a few of the supplements I like to use in practice to reduce testosterone levels and symptoms:
- Spearmint tea has been shown to significantly reduce free and total testosterone
- Licorice (the botanical medicine, not the candy!) can significantly reduce serum testosterone and has been used as an adjunctive therapy in women with PCOS
- White Peony can be used alongside Licorice to increase sex-hormone binding globulin and reduce free and total testosterone
- Omega-3 supplementation can also be used to decrease free androgen levels and has been shown to reduce hirsutism. Omega-3s may also help in increasing insulin sensitivity
Whether you are looking for clear skin, regular periods or are trying to become pregnant, there are many available treatments to help manage your PCOS. If you suffer from any of these symptoms listed, I recommend you see a healthcare practitioner to ensure you are receiving the appropriate diagnosis, so that you can receive the best possible treatment. I always recommend working with a naturopathic doctor to determine the best laboratory testing and treatment plan for your unique concerns.
To happy hormones and regular periods,