PCOS: Myths, Facts, and Natural Symptom Management

Have you struggled with painful and/or heavy periods, infertility, or chronic acne? Are you having trouble losing weight? Have cysts been found on your ovaries?

If you said yes to a combination of these symptoms, you may be dealing with one of the most common (and misunderstood) hormonal disorders impacting women – Polycystic Ovarian Syndrome (PCOS).

PCOS affects as many as 5 million women in the US, yet there is so much we don’t understand about this condition.

So, whether you have recently been diagnosed with PCOS or you’ve been dealing with it for a long time, I want you to know that having PCOS is NOT your fault! (We’ll get into this in this blog.)

And also, it’s important to know that you are not destined for a life of chronic health problems or infertility.

Even though there is no known cure for this condition, there are natural ways to help manage it. And for you to live a flourishing life.

The first step in tackling PCOS is understanding what it is.

What is PCOS?

Polycystic Ovarian Syndrome (PCOS) is a set of symptoms that cause problems with hormones and impacts as many as 5 million girls and women in the US alone.

PCOS is an endocrine disorder that results from an imbalance in hormone pathways that drive downstream hormonal changes in the entire body. It is believed that the initial imbalance is due to underlying insulin resistance. Let’s dive into some of these hormonal pathways and changes.

During a woman’s menstrual cycle, follicles develop in the ovaries, and one is released as an egg at ovulation. In PCOS, high levels of androgens (DHEA, Testosterone, and Androstenedione) surround the ovary and stunt the growth of these follicles, resulting in a delayed or no egg released at ovulation time. Instead, in some, but not all women with PCOS, the follicles become “cysts” within the ovary, leading to polycystic ovaries. These hormonal changes can lead to menstrual irregularities and infertility.

PCOS also affects the adrenal gland and stress hormones significantly. High levels of androgens cause cortisol (our stress hormone) to break down prematurely. This tells the brain to signal the adrenal glands to make more cortisol, triggering more DHEA to be made, which further increases androgens in the ovary. So people with PCOS often have high cortisol but are ripping through it and feel exhausted. The high cortisol and DHEA levels can further exacerbate the symptoms of PCOS discussed below.

We know that women with PCOS often have insulin resistance, which can fuel all of the hormone pathways affected in women with PCOS. Insulin resistance can further increase testosterone in the blood, cause weight gain or difficulty with losing weight, and lead to high estrogen in the blood.

Finally, PCOS is a condition that affects women beyond their reproductive years. Women with PCOS have a significant risk of developing Type 2 Diabetes and metabolic syndrome, which is why it is an important condition to treat properly and holistically.

How is PCOS diagnosed?

Traditionally, PCOS is diagnosed when women have at least two of these three symptoms:

• Irregular, infrequent or no periods.
• High levels of androgens - testosterone and DHEA.
• Polycystic ovary morphology (cysts found on the ovaries on ultrasound).

To clarify, having just ONE of these symptoms (polycystic ovaries, for example) does not automatically mean you have PCOS. Also, NOT having one of these symptoms does not completely rule out PCOS. Many factors actually go into the diagnosis of PCOS.

In addition, women with PCOS commonly experience insulin resistance, even though this is not a part of the current diagnostic criteria.

Symptoms of PCOS

PCOS symptoms are all over the map and may vary for each woman. Symptoms of PCOS can include:

• Irregular or absent periods.
• Lack of or delayed ovulation. This is common with PCOS and means that cycles are often longer than normal, causing some women to get fewer than eight periods a year.
• Heavy and/or painful periods. With irregular periods and longer cycles, the uterine lining builds up over time, so the periods you get can be heavier and more painful than usual.
• Acne. PCOS-related acne results from an overproduction of androgens, which stimulate oil production in the skin.
• Unwanted hair growth. 70 to 80 percent of women with PCOS experience hirsutism, where excess hair gradually develops on their face and body.
• Weight gain. Women with PCOS often experience weight gain or struggle with weight loss, which is exacerbated by insulin resistance and high testosterone in the blood.
• Infertility. The inability to get pregnant is common with PCOS due to the hormonal signaling that delays or prevents ovulation.
• Recurrent miscarriage. Women with PCOS are also more susceptible to recurrent miscarriage due to the underlying inflammation, elevated androgens and lack of circulation to the placenta.

What causes PCOS?

We don’t have a long understanding of PCOS, nor have we identified what causes it. One thing's for sure - YOU did not cause PCOS in your body. In fact, PCOS is likely caused by a combination of genetics and environmental factors.

Recent research reveals that PCOS likely starts with chemical changes in you when you were in your mother’s womb. How fascinating! And by the way, it’s not her fault either!

9 Myths About PCOS

There is so much information on the internet about PCOS. Let’s bust some of the myths out there!

Myth #1: All women with polycystic ovaries have PCOS.

Polycystic ovaries do not automatically diagnose a woman with PCOS.

A PCOS diagnosis is largely based on the presence of at least two of the following three symptoms and other causes have been excluded:

• Irregular or no ovulation. This can present as absence of your period or longer cycles. Women with PCOS may have fewer than six periods per year, or your periods are more than 35 days apart.
• Excess androgens. This is typically confirmed through blood work.
• Polycystic ovaries. On ultrasound, the ovaries are found to have more than 20 follicles on one or both ovaries or ovaries have increased in size.

Myth: You cannot get pregnant or maintain a pregnancy if you have PCOS.

PCOS is a common cause of miscarriage or infertility primarily due to the hormonal effects on ovulation, insulin resistance, and inflammation. But the good news is that we can address and manage these, and many women with PCOS can get pregnant naturally and carry a healthy baby to term.

Further, miscarriage in women with PCOS is three times as likely as in women without PCOS. Studies have found higher levels of inflammation in women with PCOS (compared to women without PCOS), leading to decreased blood flow to the placenta causing a miscarriage

Ongoing research has found that when homocysteine, CRP, insulin, Testosterone, and SHBG are improved in women with PCOS, their pregnancy rates are improved, and women can carry a healthy baby to term.

Myth: An irregular menstrual cycle means you have PCOS.

There are so many reasons for an irregular cycle, and PCOS is just one of them. Factors such as overexercising, stress, pelvic inflammatory disease, uterine fibroids, breastfeeding, and thyroid disorders are all potential causes of irregular cycles.

Myth: PCOS is all my fault.

No way! Not true!

Having PCOS is not your fault.

On top of that, your diet, exercise routine, or lifestyle choices didn’t cause PCOS either.

We are learning more about how genetics and the chemical changes that occurred while you were in utero set the stage for PCOS.

With that being said, there is a holistic approach to PCOS that can help you feel better.

Myth: If you have PCOS, you can’t lose weight.

Weight loss can be harder for women with PCOS, but it’s not impossible. Many women with PCOS experience insulin resistance – a lowered sensitivity to insulin, a hormone that regulates sugar in the blood – which may make it more challenging to lose weight.

Diet and lifestyle changes can reduce insulin resistance. See below for more on this.

Myth: Unwanted hair growth and acne are sure signs of PCOS.

Indeed, hirsutism (growth of dark, coarse hair on the face, chest, and back) is usually an underlying sign of PCOS, but not every woman will have this symptom.

Facial acne is one of the most notable symptoms of PCOS. While acne is a common symptom of PCOS, it’s estimated that only 10% to 35% of patients will have this symptom. Additionally, teenage girls whose acne is resistant to Accutane treatment have a 40% increased risk of developing PCOS.

Myth: Basic blood work and an ultrasound will provide enough information to treat your PCOS symptoms.

Most commonly, providers will order a basic panel of blood work including glucose, insulin, thyroid, testosterone and DHEA to help diagnose and manage PCOS. Some additional labs may be beneficial when addressing PCOS symptoms, including:

• Homocysteine. This is a key inflammation indicator in women with PCOS and elevated homocysteine can significantly contribute to increased miscarriage rates. Research has found that women with PCOS commonly have elevated homocysteine levels due to insulin resistance and elevated androgens. If you are struggling with infertility, ask your doctor about ordering homocysteine for you!
• C-Reactive Protein (CRP). CRP is a more general inflammation marker that is commonly elevated in women with PCOS. This can help us gauge the level of inflammation in the body and treat appropriately.
• Sex Hormone Binding Globulin (SHBG). SHBG helps control the amount of free (active) sex hormones working in your body. Women with PCOS typically have reduced SHBG, which can contribute to higher testosterone levels that can interfere with ovulation and drive up insulin resistance and inflammation.

Begin Reducing PCOS Symptoms Naturally

PCOS is a multi-faceted issue requiring a unique and holistic approach based on your symptoms and testing. Treatment options vary between individuals and will focus on areas most concerning to you, including fertility, unwanted hair growth, acne, or weight gain.

Below are the first things I typically implement with my patients with PCOS.

Nutrition

Nutrition is one of the most valuable tools for managing PCOS symptoms.

Here are a few of the most common nutritional adjustments I recommend for my PCOS patients.

• Protein. Adequate and good quality protein can hugely improve cycle regularity, weight loss, mood, energy, sleep, and insulin resistance.
• Fiber: at least 35g/day to best support the microbiome and healthy hormone metabolism
• Probiotic foods such as kimchi and sauerkraut. This can be game changing for those with PCOS. The microbiome is typically less diverse in the bellies of those with PCOS.
• Low glycemic (GI) index foods. High glycemic foods like refined grains and sugars can spike insulin, leading to and exacerbating all symptoms of PCOS. Low GI foods include whole grains, non-starchy vegetables, berries, citrus, lentils, and beans.
• Antioxidants by eating a variety of fruits and vegetables and aiming for different colors of these foods throughout the week.
• Decrease dairy intake, especially if acne is one of the main symptoms. Dairy affects the androgens in the skin leading to the development of acne.
• Adjust the timing of the biggest meals to earlier in the day. For example, I recommend focusing on a robust, high protein breakfast and a proportionally smaller dinner.

Decrease AGEs

Food quality matters! Advanced Glycosylated End Products (AGEs) are inflammatory products from cooking methods like frying, high dry heat, and high heat roasting or grilling that increase inflammation and worsen glycemic control in patients with PCOS.

Lower the amount of AGEs in the body by limiting packaged cookies, chips, crackers, grilled or fried protein, and vegetable oils.

Correct Vitamin D Deficiency

Vitamin D can help improve hormones and inflammation, reduce insulin resistance, and regulate menstrual cycles making it incredibly beneficial for women with PCOS. Plus, adequate vitamin D can help the body eliminate AGEs.

Research has also indicated that 67 to 85 percent of women with PCOS are vitamin D deficient. So, make sure your vitamin D levels are adequate. I recommend keeping blood levels between 60-80.

Become Confident in Your Body and Your Cycle!

By understanding what is going on in your body and with your hormones, you can better manage your PCOS symptoms naturally and begin to feel like you again. Identifying your underlying causes of PCOS will allow you to manage long-standing symptoms and regain confidence in your body and your hormones.

You can rediscover your natural and healthy cycle again! And have a healthy pregnancy, if you desire! Or have the confidence to do whatever it is that you are called to do in this lifetime!

Schedule a free alignment call today if you’re ready to understand your hormones, your cycle and your body and naturally manage your PCOS!

Resources

1. "PCOS (Polycystic Ovary Syndrome) and Diabetes - CDC." https://www.cdc.gov/diabetes/basics/pcos.html. Accessed 16 Dec. 2022.

2. "Polycystic Ovary Syndrome (PCOS) | NICHD." 31 Jan. 2017, https://www.nichd.nih.gov/health/topics/pcos. Accessed 16 Dec. 2022.

3. "What causes PCOS? | NICHD." 29 Sep. 2022, https://www.nichd.nih.gov/health/topics/pcos/conditioninfo/causes. Accessed 16 Dec. 2022.

4. "Long and irregular menstrual cycles, polycystic ovary syndrome, and ...." 6 Oct. 2016, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5542050/. Accessed 16 Dec. 2022.

5. "Prevalence of acne vulgaris among women with polycystic ovary ...." 23 Dec. 2020, https://pubmed.ncbi.nlm.nih.gov/33355023/. Accessed 16 Dec. 2022.

6. "Hirsutism in Polycystic Ovary Syndrome: Pathophysiology and ...." https://pubmed.ncbi.nlm.nih.gov/27510481/. Accessed 16 Dec. 2022.

7. "Obesity and Polycystic Ovary Syndrome: Implications for ... - NCBI." 9 Sep. 2019, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734597/. Accessed 16 Dec. 2022.

8. "Treatment of infertility in women with polycystic ovary syndrome - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642490/. Accessed 16 Dec. 2022.

9. "Rotterdam criteria, the end - PMC - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8409808/. Accessed 16 Dec. 2022.

10. "updated threshold for diagnosis of hyperandrogenic anovulation." https://pubmed.ncbi.nlm.nih.gov/25088509/. Accessed 16 Dec. 2022.

11. "Treatment of infertility in women with polycystic ovary syndrome - NCBI." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4642490/. Accessed 16 Dec. 2022.

12. "Prevalence of acne vulgaris among women with polycystic ovary ...." 23 Dec. 2020, https://pubmed.ncbi.nlm.nih.gov/33355023/. Accessed 26 Jan. 2023.

13. "GUIDE TO THE BEST PRACTICES IN THE EVALUATION ... - PubMed." https://pubmed.ncbi.nlm.nih.gov/26509855/. Accessed 26 Jan. 2023.

14. Does PCOS affect pregnancy? | NICHD." 31 Jan. 2017, https://www.nichd.nih.gov/health/topics/pcos/more_information/FAQs/pregnancy. Accessed 26 Jan. 2023.

15. "A Narrative Review of Placental Contribution to Adverse Pregnancy ...." https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6767873/. Accessed 26 Jan. 2023.

16. "Association of Insulin Resistance and Elevated Androgen Levels ...." 21 Mar. 2022, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8959968/. Accessed 26 Jan. 2023.

17. "Advanced Glycation End Products: Link between Diet and Ovulatory ...." 4 Dec. 2015, https://pubmed.ncbi.nlm.nih.gov/26690206/. Accessed 26 Jan. 2023.

18. "Vitamin D improves levels of hormonal, oxidative stress and ...." https://pubmed.ncbi.nlm.nih.gov/33545754/. Accessed 16 Dec. 2022.

19. "Effect of vitamin D supplementation on polycystic ovary syndrome." https://pubmed.ncbi.nlm.nih.gov/32256745/. Accessed 16 Dec. 2022.

20. "The Role of Vitamin D in Fertility and during Pregnancy and Lactation." 12 Oct. 2018, https://pubmed.ncbi.nlm.nih.gov/30322097/. Accessed 16 Dec. 2022.

21. "Vitamin D in the aetiology and management of polycystic ovary ...." https://pubmed.ncbi.nlm.nih.gov/22574874/. Accessed 16 Dec. 2022.