By Dr. Erin Stefanacci DC CFMP
What is PCOS?
Did you know, it is estimated that 1 in every 10 women are living with polycystic ovary syndrome (PCOS) and it is believed 50% of those women are living without a diagnosis? Women typically spend years with symptoms and have seen multiple providers before a diagnosis is achieved. PCOS is generally hard to diagnose because there is no single test for diagnosis and despite the name, there actually doesn’t have to be any cysts on the ovaries for diagnosis. I know, so confusing!
So, what is this syndrome impacting an estimated 10% of women? PCOS is a complex disorder that typically presents with metabolic, endocrine and reproductive abnormalities. The pathogenesis of PCOS is not well understood, although many believe that it is the result of interactions between genetic and environmental factors. It primarily impacts women of childbearing years and the symptoms can continue into menopausal years. PCOS is widely known as the leading cause of anovulatory infertility, yet there are many other health conditions that have been correlated with this syndrome, including type 2 diabetes, obesity, endometrial cancer, cardiovascular disease and liver disease.
Women can be diagnosed in a variety of ways, including hormone levels, presence of cysts and various symptoms.
Symptoms and Signs
There are many signs and symptoms of PCOS that women may believe to be normal but we choose to refer to these symptoms and signs as common rather than normal.
Cycle irregularity
Heavy periods
Absence of period altogether
Unwanted facial hair
Hirsutism (excessive body hair)
Acne, especially around the jawline, back, chest
Small cysts on ovaries
High blood sugar
Insulin resistance
Inability to lose weight
Infertility
Fatigue
Anxiety and depression
Excess male hormone levels
As mentioned above, there doesn’t actually have to be any cysts found on the ovaries to be given a diagnosis of PCOS. However, to be diagnosed with PCOS there typically is an androgen excess (high male hormones) with all other causes of high androgens being ruled out.
Two alternative reasons for high androgens include the use of androgenic progestins and hypothalamic amenorrhea. Wait, huh?
Androgenic progestins are certain types of birth control that cause high androgen levels. The birth controls included in this category are medroxyprogesterone (Depo-Provera injection), levonorgestrel (many pills, Norplant implant, Mirena hormonal IUD, the morning after pill), etonogestrel (many pills, Nuvaring, Nexplanon implant), norgestrel, gestodene, desogestrel, norelgestromin and norethindrone (combination oral contraceptives).
Hypothalamic amenorrhea is where menstruation stops for several months typically due severe stress or poor nutrition. Women in this category are typically severely restricting caloric intake, exercising more than 2 or 3 hours daily or under major psychological stress.
What can you do about it?
Addressing PCOS largely depends on what type an individual is experiencing. There are actually 4 types!
Insulin Resistant PCOS. This is the most common type of PCOS experienced. An estimated 70% of cases are insulin resistant. Some signs and symptoms of insulin resistance include craving sugary foods, fatigue after meals, inability to concentrate and sleep disturbances. The easiest way to check for insulin resistance is to test insulin. If this type of PCOS seems likely there are many things that can be done! Limiting carbohydrates and resistance type exercises are a great place to start. Sometimes that is not enough and supplementing with things like inositol, chromium, magnesium and folate may be beneficial.
Birth Control Induced PCOS. Some women experience a surge in androgens when stopping a birth control pill. But not to fear, this is temporary! Birth control induced PCOS is pretty easy to spot because it happens after coming off the pill and other causes are ruled out such as high insulin. Typically women with this type of PCOS feel better within months of coming off the pill but if the symptoms experienced are unbearable, one might consider using zinc, saw palmetto, licorice, DIM or a combination for a few months.
Adrenal PCOS. This type is driven by dysfunction of the hypothalamus-pituitary-adrenal axis (HPA-axis) or more simply put, the miscommunication between the brain and adrenal glands. This miscommunication happens over time due to the stressors of life. Women with PCOS typically have elevated androgens, testosterone and androstenedione, plus elevated DHEA-S which comes from the adrenal cortex. If DHEA-S is elevated but your androgens are normal, you may have adrenal PCOS. With this type of PCOS it is important to prioritize sleep and stress reduction! The type of exercise of choice is also important with calmer styles of exercise being more beneficial. Examples of calmer exercises include restorative yoga, tai chi or walking rather than high-intensity styles of exercise. While addressing the stress in your life it might be a good idea to supplement with adaptogenic herbs (read my blog post about adaptogens here), magnesium and vitamin B5.
Inflammatory PCOS. First, it’s important to be able to recognize the signs of inflammation which can include excessive mucus production, joint pain, skin rashes/itchiness, digestive problems or difficulties (bloating, constipation, diarrhea), fatigue and headaches. If you have any of these symptoms and do not have insulin resistance and are not in a post-pill phase, you may fit into the inflammatory category. It’s important to figure out where the inflammation is coming from, it’s a good idea to start with what foods are being consumed. It may be beneficial to do an elimination diet to rule out common allergies such as dairy, gluten, soy or corn. There are also other common causes of inflammation such as gut health issues, chronic mast cell activation or histamine intolerance that may need to be addressed as well. While working on the root cause of inflammation some supplements that may help with this type of PCOS are omega-3’s, zinc and n-acetyl cysteine (NAC).
It is possible to fit into multiple categories in which case multiple areas of PCOS would need to be addressed. By bringing awareness to PCOS, together we can help more women receive the relief they deserve. If there is someone in your life that may benefit from the information in this article, please share!
As always, I would love to discuss what your journey to optimizing your health could look like during a free 15-minute health strategy session.
**Reminder: This is an educational article that does not constitute medical advice. I am a doctor but I’m not YOUR doctor. It is always recommended to speak with your healthcare provider before implementing any of the above recommendations, especially if you have pre-existing conditions or are taking medications.