What the heck is PCOS?
What is PCOS?
Polycystic ovarian syndrome, or PCOS, is an endocrine and metabolic disorder affecting up to 20% of women of childbearing age making it the most common hormonal disorder and cause of infertility in women of reproductive age.
PCOS involves hyperandrogenism (high androgen production from the ovaries or adrenals) and chronic anovulation (meaning fewer than 10 periods in one year or cycles of over 35 days).
This syndrome requires a diagnosis of exclusion, meaning doctors need to rule out other possibilities such as hypothalamic amenorrhea, hypothyroidism, and hyperprolactinemia in order to properly diagnose PCOS in a patient. Misdiagnosis is common and many women remain undiagnosed and have no idea they have the syndrome. Which is quite frustrating and harmful because without proper treatment, the risk for chronic complications like cardiovascular disease and diabetes increases.
In order to receive a proper diagnosis, you need to exhibit 2 of the following (per the rotterdam criteria)
Irregular or missing periods (fewer than 10 periods in one year or cycles of over 35 days)
Excess androgen levels on blood test or symptoms of excess androgens
Polycystic ovaries on ultrasound
PCOS is characterized by:
Irregular or missing ovulation
Increased LH to FSH on blood test
Decreased SHBG (Sex Hormone Binding Globulin)
Hair loss or thinning of hair
Hirsutism (excess hair growth on facial area, chest, belly, back..)
Polycystic ovaries (they look like a string of pearls on ultrasound)
Just because you have PCOS doesn’t mean you fit into every single one of these categories, and just because you tick off some of these boxes doesn’t necessarily mean you have PCOS either!
To receive a diagnosis you need to assess:
Blood tests (FSH, LH, total testosterone, estradiol, progesterone, DHEA-S, SHBG, prolactin, androstenedione, fasting insulin, fasting glucose, lipid profile)
Commonly, with a diagnosis, patients are given pharmaceuticals such as the birth control pill, metformin, spironolactone, or clomiphene citrate.
However, they are not taught about how nutrition and lifestyle habits make a significant impact on the development and severity of PCOS.
Though PCOS is a complex disorder with no confirmed causes, genetic and environmental influences have been studied and noted as potential triggers for PCOS.
When it comes to understanding PCOS and reversing symptoms, we need to address the core underlying imbalances, not just apply a band-aid.
Underlying foundations to address
Chronic low grade inflammation is a central factor to PCOS and plays a key role in symptoms such as acne, weight gain, hirsutism, irregular cycles, and cardiovascular risk. Inflammation worsens PCOS but PCOS can also create inflammation… it’s a vicious cycle.
Inflammation can stem from intestinal permeability, insulin resistance, toxin exposure, obesity, chronic stress, poor diet, and medications.
Inflammatory chemicals can damage our own cells while also disrupting hormones, damaging egg quality, worsening mental health, damaging the intestinal barrier, and promoting androgen production from the ovaries. Inflammation can be seen as a byproduct but also a trigger for PCOS, which is why it’s so important to address in any PCOS plan.
How do we calm inflammation?
Common allergenic foods such as corn, wheat, gluten, dairy, sugar, and soy can worsen intestinal permeability, but these foods will differ from person to person. A good way to identify which foods are problematic for you is to do an elimination diet. You may need to find a nutritionist or dietitian to follow this properly. Foods to avoid at all costs are trans fats, hydrogenated oils, processed foods, and refined carbs and sugars. These contribute to inflammation in everyone and should be avoided with PCOS.
I love using natural anti-inflammatories such as ginger, turmeric, and omega 3 fatty acids (found in fatty fish like wild salmon). You always want to start with diet before turning to additional supplements for support.
Note: PMS is a big indicator of inflammation going on in the body, which means your body is producing too many inflammatory chemicals which can cause symptoms like cramping and mood swings. Check out my free Anti PMS Guide Here.
The scientific evidence is becoming overwhelming in terms of how the microbiome influences our overall health. In addition, PCOS women have been shown to have a lower amount of bacterial diversity than women without the syndrome regardless of them being overweight or not.
The gut microbiome has a real influence on how PCOS can manifest as dysbiosis can worsen factors such as insulin resistance, inflammation, and obesity. Women with PCOS also exhibit mood imbalances and commonly complain of terrible mood swings, depression, and uncontrollable anger. We now know our gut has a direct link and can communicate with the brain via the vagus nerve as well as produce neurotransmitters like serotonin, the feel good hormone. So what you eat really does impact how you feel!
Studies are increasingly pointing towards targeting the gut microbiota to achieve results with PCOS and see shifts with inflammatory, cardiovascular, and metabolic markers.
Foods rich in fiber such as beans, legumes, non-starchy vegetables, oats, etc as well as prebiotics such as onions, garlic, asparagus, dandelion greens, artichoke, etc are an important part of a PCOS diet in order to provide the fuel for the beneficial microbes, alongside traditional fermented foods.
Stress is a significant factor for PCOS. Not only do PCOS symptoms cause stress but the underlying imbalances are also worsened by stress and create further stress on the body. Stress ultimately is defined as anything that puts the body out of homeostasis, or balance. Which means this isn’t only emotional stress but also physical and chemical! So yes, your beauty products, dieting, junk food, all nighters, alcohol, or crazy spin classes could all be putting your body under a lot of stress.
Most women with PCOS produce androgens from the ovaries and to a lesser extent, the adrenals. This can manifest differently inside of the body. For instance, it is more common to see adrenal androgen excess manifest in lean PCOS. Regardless whether you make up one camp or the other, women with PCOS are much more affected by stress and high cortisol levels than non PCOS women. When we are under chronic stress we see higher cortisol levels which result in hormonal imbalances like low progesterone, excess estrogen, and high androgens.
Another factor to consider is that women with PCOS are actually more prone to producing higher levels of stress hormones than women without while also have more difficulty coping with stressors. This is why stress management is a central strategy to managing PCOS.
How do we manage stress with PCOS?
If you are practicing intense workouts with lots of cardio… bring it down a notch. Take up yoga or pilates, include walking into your daily routine, and give yourself some rest days!
Adopt a bedtime routine. Sleep is such an important component of a healthy PCOS lifestyle in order to bring down cortisol levels and regulate the circadian rhythm. Aim for 7-9 hours per night. Avoid electronics 1 hour before bed and create a relaxed environment before bedtime.
Practice meditation. This practice has been shown to lower stress hormones, improve mood, bring down inflammation and support the immune system.
Avoid or reduce coffee. Caffeine has a stimulatory effect on the adrenals and can worsen hormonal imbalances like PCOS. If you find yourself depending on your coffee to start your day or get through the afternoon slump, this is a sign you are relying on it. Find alternatives like dandelion, chicory root, or herbal blends like Four Sigmatic.
I love Four Sigmatic as an alternative to coffee to help support the adrenals and energy levels throughout the day. Stressed and can’t sleep? They have a formula for that as well!
Insulin resistance is present in about 50-70% of women diagnosed with PCOS. Though it is more common in obese and overweight individuals it can also be present in lean PCOS women who do not have problems with their weight.
This is important to note when assessing the core imbalances for PCOS and explains why testing is so critical. Women with PCOS are more prone to insulin resistance due to genetic factors and the underlying chronic low grade inflammatory state.
What is IR? Insulin resistance happens when cells do not respond properly to the hormone insulin to let glucose enter the cell to be used as energy. Also known as pre-diabetes, insulin resistance is mainly caused by lifestyle factors such as lack of exercise, chronic stress, and poor diet consisting of refined carbs, hydrogenated oils, and excess sugars.
With PCOS the overproduction of insulin in the bloodstream triggers androgen production in the ovaries which can stall ovulation and promote symptoms like hirsutism, acne, and hair loss.
Signs and symptoms of blood sugar and insulin problems include abdominal adiposity, stubborn weight loss, dark pigmentation of skin folds, increased hunger and cravings, and skin tags.
One of the first things to do when it comes to balancing blood glucose and insulin with PCOS is to eliminate refined carbs and sugars which are void of nutrients and cause blood sugar spikes and crashes.
In addition, many of us don’t know that there are foods that spike insulin specifically, but not blood sugar, such as dairy and red meat. So it’s important to be aware that carbohydrates are not the only macronutrients to pay attention to. And to remember that carbohdyrates are not the enemy! Certain carbs can actually improve insulin resistance as high fiber diets have ben shown to improve metabolic conditions.
Always aim for a balanced plate of protein, complex carbs, non starchy vegetables, and a healthy fat to ensure blood sugar and insulin remain balanced.
Environmental toxins have been shown to play a role in the development of PCOS. Exposure to toxins such as BPA in utero increases the risk of PCOS which means that if the mother was exposed to toxins during pregnancy, there is a greater chance of her daughter showing signs of PCOS later in life.
Research has confirmed elevated levels of BPA in patients with PCOS in comparison with healthy controls.
BPA and other endocrine disrupting chemicals contain estrogen-mimicking compounds (xenoestrogens) that increase our body’s load of the hormone estrogen. This worsens PCOS symptoms and can contribute to obesity by altering fat storage, energy balance and promoting leptin and insulin resistance.
Though we don’t have much control over our mother’s health as an unborn child, we can support our detoxification pathways and limit our exposure to these chemicals as adults.
Fiber is especially important in order to bind to and eliminate excess hormones via bile and the colon. So eat your vegetables at every meal! And make sure you are pooping 2-3 times per day, I usually say that you should be aiming for the same amount of meals that you ate! I love adding 1 tbsp of chia or flaxseeds as an extra boost of fiber in the morning with lots of water.
Though we can’t control every toxin that we come into contact with, there are many ways to reduce exposure to endocrine disrupting chemicals at home. Switch out conventional beauty and body care products for organic brands or make your own, use ceramic, stainless steel or glass containers, open the windows everyday to filtrate the air inside your home, keep shoes at the door to avoid toxins being brought into the home, and clean your clothes and sheets with organic brands.
I always recommend my clients use ewg.org to verify their current products and find alternative clean brands.
Okay you made it this far, congrats! But you may be thinking this is a LOT.
Hold it right there sister. My biggest advice to you? One step at a time. This isn’t a race. PCOS is a lifelong condition which means every day counts. And small changes do add up.
Find a support system
Include more vegetables on your plate
Stop buying the foods you know you should not be eating
Love yourself. Give yourself the pep talk, book that massage, go for a walk, schedule a “me” day. Do it for you and leave the guilt behind.
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