You just got diagnosed with PCOS, or maybe you just found out what it is and think that it aligns with your symptoms. Regardless of where you are in the process, you might be wondering what happens next. So let's break down what PCOS is, how to diagnose it, and how to treat it naturally.
What is PCOS?
Polycystic Ovarian Syndrome (PCOS) affects up to 12% (up to 5 million) of women in the U.S and is one of the most common causes of infertility. Symptoms of PCOS include:
- Irregular or absent menses
- Excess hair growth on face, chest, abdomen, back, or upper thighs
- Thinning hair or hair loss on the head
- Acne and oily skin
- Dark or thick skin patches on the neck, armpits, or under the breasts
- Irritability and mood swings
The name might imply that having ovarian cysts are necessary to be diagnosed with PCOS, but that is not entirely true. The diagnosis of PCOS is based on the Rotterdam criteria and requires 2 of the following 3 symptoms to present: Signs of hyperandrogenism (i.e., elevated testosterone), oligomenorrhea, or amenorrhea (irregular or absent menses), and polycystic ovaries found on ultrasonography. Therefore, if you have elevated androgen levels and an irregular menstrual cycle, you can be diagnosed with PCOS. Case closed.
It is worth noting that even though the criteria are based around it being a hormonal and reproductive syndrome, PCOS affects a whole lot more than the reproductive system. People with PCOS are also at an increased risk of developing elevated cholesterol, cardiovascular concerns, and commonly (but not always) have some level of insulin resistance leading to an increased risk of Type II diabetes.
PCOS is most commonly treated with a combination of hormonal contraception, metformin, and occasionally spironolactone. And while these things can help manage the symptoms of PCOS, they aren't addressing the root cause or making any sustainable change towards treating the condition. So, here's the good news - PCOS is highly treatable, and successful change can be made with natural lifestyle, nutritional, and supplement interventions.
PCOS Heavy Hitters and How I Address Them:
PCOS is a multi-system condition, and it’s important to ensure you have foundational health goals set in place to address it. That being said, here are a few areas that I like to give a little extra love to.
Blood Sugar Regulation:
Insulin resistance isn't a requirement for PCOS, but the majority of people who have PCOS experience insulin resistance as part of their condition. In insulin-resistant PCOS, the dysregulation of blood sugar directly contributes to the increased production of androgens by the ovaries. Because of this connection, it’s crucial that we address it to work towards a healthy hormone balance.
Labs to assess for blood sugar dysregulation that I like to run include:
- Fasting Insulin
- Fasting Glucose
These labs provide us with information on current blood sugar status the day of the test, a 3-month snapshot of what your blood sugar has been up to, and how well your insulin is facilitating glucose movement into your cells. This allows us to get a broader picture of your blood sugar regulation and provide more effective treatment options.
Hypothalamic-Pituitary-Adrenal (HPA) Axis Function:
Our adrenal glands are small, pyramid-shaped glands that sit on top of our kidneys. While they might be little, their impact certainly is not. The adrenals are partly responsible for androgen production, mainly in the form of DHEA, which is an androgen hormone that acts as a precursor to other hormones such as testosterone. In addition to hormone production, it’s also largely responsible for how our body responds to stressors, which in turn can have downstream effects on our wider hormone picture. Needless to say, keeping these “little” glands happy is an important step in treating any hormonal concerns.
If possible, I like to run an Adrenal Stress Index. This marks your cortisol pattern over the course of an entire day and often also includes information about other hormones. However, if options are limited, I always make sure to run the following labs to get a snapshot of how the adrenals are functioning:
- AM/PM Cortisol
I’m sure this isn’t the first time you’ve heard that liver health is important. When talking about hormones alone, it helps properly metabolize and eliminate hormones to prevent imbalances. Another one of the liver’s jobs is to help regulate blood sugar. Why is this particularly important for people with PCOS? PCOS patients have an increased risk of developing fatty liver disease when compared to people without PCOS. In fact, 25% of people with PCOS develop non-alcoholic fatty liver disease. And when adipose tissue takes over our liver, it can’t function properly and pushes PCOS symptoms to become worse. In order to track liver function, there are a few tests I always run:
- Alkaline Phosphatase
Gut health might be a source of chronic inflammation that might be making your PCOS symptoms worse. Chronic inflammation may increase oxidative stress and ultimately cause a further increase in androgen levels. Chronic inflammation is also considered an internal stressor, which can put a strain on your adrenals and HPA axis resulting in further dysregulation as we discussed above.
I'm a big fan of comprehensive stool analyses. This test is not the most glamorous (as it typically requires stool sample collection), but it does allow us to take a deep dive into your microbiome and how your gut is functioning.
Hormone balancing is one of the biggest targets in PCOS. Here's the thing though, hormone balance is highly impacted by all the topics we’ve covered so far. While there are interventions that can target the hormone imbalances directly (like targeting reducing testosterone levels), their changes aren’t going to be sustainable if we don’t address all the other systems we’ve mentioned. Of course, that doesn’t mean we don’t address the hormones directly. Since everyone presents differently, I always make sure to get a good workup to see where someone’s imbalances are:
- Testosterone (free and total)
- Sex Hormone Binding Globulin
I’ll discuss specific supplementations below on how we can target some of those imbalances, but let’s get into some nutrition and lifestyle changes we can make to support.
The most important factor in PCOS is developing healthy lifestyle and nutrition habits. Now I'm not a big fan of restrictive eating and labeling foods as “bad”. Where I really like to focus is on what you can put into your diet to support your hormone levels. Some foods I like to emphasize with my PCOS patients are:
- Foods high in protein (aiming for animal products that are organically raised, pasture-raised products are a plus)
- Foods with lots of high-quality fats (salmon, anchovies, avocados, flax seeds)
- Incorporate at least 2-3 servings of vegetables in each meal
- Focus on carbohydrates that are high in fiber (minimizing grains when possible)
- Focus on anti-inflammatory foods/foods high in antioxidants (dark berries are a great place to start)
Another key part of nutrition in PCOS is making sure you're eating enough. No 1,200-calorie recommendations here. If we are not providing our bodies with adequate nutrition, it ends up harming us far more than helping us.
Exercise is obviously important for everyone, but it’s especially important for my PCOS people. I typically recommend focusing on HIIT and strength training to help increase muscle mass, reduce stress, and improve blood sugar regulation. Starting an exercise routine from scratch can be challenging, so I always recommend being kind to your body and not overextending yourself out the gate. If you haven't already incorporated exercise in your routine, start with 20-30 minutes of exercise 2-3 days per week and work up from there, until we reach the ultimate goal of 150 minutes per week.
Additional Supplements as Needed:
Supplementation can be a powerful tool when used in conjunction with lifestyle and nutritional changes. It can provide our bodies with the extra boost it needs to get back on track.
Here are some supplements I might incorporate into my PCOS treatments include:
- Inositol - helps reduce androgens, improve ovarian function, and improve insulin sensitization
- Vitex (Chaste-Tree Berry) - helps promote healthy progesterone levels
- Adaptogenic herbs - helps to support the adrenal glands and our body's response to stress
- High-quality fish oil - helps to reduce inflammation and supports hormone production
- Vitamin D - supports hormones and proper immune function (I typically make sure I test first to see how much to give)
- N-acetylcysteine - helps to reduce androgen levels
- Saw Palmetto - helps to reduce androgen levels
- Berberine - helps to support healthy glucose levels
- Milk thistle - helps protect the liver
Find a Practitioner That's a Good Fit:
Your doctor should be your cheerleader. If you don't feel heard by your doctor, or feel like you're being given limited options, it might be time to re-evaluate your care team. Your doctor should be providing individualized treatment that meets you where you're at.
Be Kind to Yourself:
Most importantly, be kind to yourself. Sustainable health change takes time, and healing hormones doesn't happen overnight. You might have some setbacks along the way, and that's okay. Lean on others for support when you need it and keep going.
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