PCOS: Symptoms, Causes and Natural Support Strategies
Polycystic Ovary Syndrome (PCOS) is a hormone imbalance disorder in women. This devastating health condition has a negative impact on a woman’s health, her ability to have a child, and her physical appearance. Fortunately, there are numerous natural support strategies to improve hormonal health and I go over them in detail in this article as well as the best testing strategies for female hormone health.
PCOS is characterized by chronic problems with ovulation, menstrual dysfunction, and excess production of male hormones (androgens). Women with PCOS may have enlarged ovaries with small cysts on the outer edges (polycystic ovaries). PCOS is one of the most common endocrine disorders affecting women today. Around 1 in 10 women of childbearing age have PCOS. It is the most frequent cause of anovulatory infertility.
Symptoms of PCOS include infertility, irregular or missed periods, high male hormones, excessive hair growth, male patterns of baldness or thinning hair and low sex drive. Weight gain, difficulty losing weight, acne, and fatigue are common with PCOS. Many women with PCOS also experience anxiety and depression caused or exacerbated by PCOS.
What is PCOS?
First reported in 1935, PCOS is now a commonly recognized condition. PCOS is an endocrine disorder that affects as many as 15-20% of women of reproductive age (1). In the US alone, it is estimated that at least 5 million women have PCOS. PCOS adversely affects endocrine, metabolic, and cardiovascular health.
PCOS gets its name from changes typically seen in the ovaries. Polycystic ovaries are enlarged and contain many immature follicles. Development of these follicles is stopped before they are fully developed. The LH surge does not occur and the woman will not ovulate.
In addition to polycystic ovaries, the principal features of PCOS are excess androgens and ovulatory dysfunction (2). Other key features of PCOS are insulin resistance and imbalances in gonadotropins. Excess levels of insulin (hyperinsulinemia) is a key factor leading to the overproduction of ovarian androgens.
Imbalances in gonadotropin production is common in women with PCOS. The pituitary gland secretes two primary gonadotropins, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). With PCOS, LH is elevated while FSH is the same or decreased. The result is that high levels of androgens are secreted from the ovaries (3).
Symptoms of PCOS
PCOS is a heterogeneous disorder because not all women will express all of the symptoms associated with the disorder. Symptoms of PCOS can vary widely for different women. For example, not all women will develop cysts in their ovaries as the name “PCOS” implies.
Symptoms of PCOS may include infertility, irregular or missed periods, high male hormones, and low sex drive. Women with PCOS may have weight gain, difficulty losing weight, acne, insulin resistance, fatigue and mood changes. Depression, anxiety, bipolar disorder and binge eating disorder occur more frequently in women with PCOS.
Excessive, course, male-pattern hair growth (hirsutism) and male patterns of baldness or thinning hair are common symptoms of PCOS. Hirsutism is caused when the hair follicles are exposed to high levels of male hormone androgen in the blood and/or the hair follicle itself.
PCOS and Insulin Resistance
Approximately 50-70% of women with PCOS have insulin resistance. Obesity and lipid abnormalities often accompany PCOS, increasing the risk of developing diabetes or cardiovascular disease.
Chronic inflammation and oxidative stress are major contributors to the development of PCOS. Women with PCOS often have elevated levels of harmful advanced glycation end products (AGEs).
How is PCOS Different from Endometriosis?
Many women suffer from both PCOS and endometriosis. These conditions have overlapping symptoms, but there are clear distinctions between the two. Endometriosis is affected by hormones, but is not a hormonal condition like PCOS.
Endometriosis is a condition where the tissue that makes up the lining of the uterus is found throughout the pelvic cavity. The tissue can be found on the ovaries, ligaments, bladder, bowel, and the peritoneum (the lining of the abdominal cavity that covers your organs). This tissue causes chronic, inflammatory reactions that can lead to extreme pain and scarring.
Both endometriosis and PCOS cause irregular periods that are heavy and painful. Skin issues, abnormal hair growth, chronic pelvic pain, and infertility are common with both conditions. For more information about endometriosis, including natural strategies to improve the condition, read this article.
Causes of PCOS
While there is not a clear cause, there are numerous factors that may contribute to PCOS. These factors include inflammation, hormonal imbalances, insulin resistance, family history of PCOS (certain genes may be linked to PCOS), metabolic syndrome and type 1 and type 2 diabetes are associated with PCOS.
These influences have been associated with PCOS and must be addressed to improve PCOS. Let’s look more closely at a few of these.
It is increasingly clear that chronic inflammation plays a central role in the development of PCOS (4). Inflammation occurs when your body’s innate immune system reacts to foreign substances to protect your body from a perceived threat. Women with PCOS have higher levels of inflammatory markers on blood tests.
Chronic inflammation is a low-grade, systemic inflammation that occurs when our bodies are repeatedly exposed to various factors and influences. As a result, inflammatory mediators are produced throughout the body and can overwhelm the immune system.
The ongoing inflammatory stimulus results in more white blood cell recruitment, increased inflammation, and changes to cells. White blood cells will eventually attack internal organs or other tissues and cells. This inflammatory response continues until the factor that causes inflammation is addressed.
Insulin resistance is a major contributor to PCOS. Insulin is a powerful hormone that regulates your metabolism. It is produced in the pancreas and allows cells to use sugar for energy. With insulin resistance, your cells become resistant to the action of insulin. Then, your blood sugar rises and your body produces more insulin. Excess insulin may increase androgen production, causing difficulty with ovulation.
High insulin levels are very harmful for the body. Excess insulin and high blood sugar cause hormone imbalances. This is linked to weight gain, lack of ovulation, infertility, diabetes, cardiovascular disease, and cancer.
Blood sugar imbalances create stress on the body and cause the release of adrenaline and cortisol. Cortisol and progesterone are made from the hormone pregnenolone. When the body needs cortisol, the production of progesterone is sacrificed. This leads to higher levels of estrogen. Elevated cortisol production is linked to PCOS.
Women with PCOS also have elevated levels of Advanced Glycation End Products (AGEs) or glycotoxins. AGEs are highly reactive molecules formed after glycation of lipids and proteins. AGEs are compounds that form within the body, and also exist in foods.
Advanced glycation end products contribute to the development of PCOS as well as its consequences (5). AGEs cause inflammation and oxidative stress, damaging tissue throughout the body. They are implicated in the process of aging and the development of diabetes, atherosclerosis, female fertility, and cancers. The main sources of AGES are the Standard American Diet (SAD) or Westernized diet, fast food, and smoking.
Complications of PCOS
There are many potential complications of PCOS (6). These include:
- Gestational diabetes or pregnancy-induced high blood pressure
- Miscarriage or premature birth
- Nonalcoholic steatohepatitis: a severe liver inflammation causes by fat accumulation in the liver
- Metabolic syndrome: a cluster of conditions including high blood pressure, high blood sugar, and abnormal cholesterol or triglyceride levels that significantly increase your risk of cardiovascular disease
- Type 2 diabetes or prediabetes
- Sleep apnea
- Depression, anxiety and eating disorders
- Abnormal uterine bleeding
- Cancer of the uterine lining (endometrial cancer)
Conventional Treatments for PCOS
There are several options for the conventional treatment of PCOS. To regulate a woman’s menstrual cycle, doctors may recommend birth control pills or progestin therapy to regulate her hormones and periods.
Doctors often recommend medications to help women with PCOS ovulate such as Clomiphene or Letrozole (a breast cancer treatment). Metformin is often prescribed to lower insulin levels. Injectable hormone medications called Gonadotropins may also be used.
For excessive hair growth, doctors recommend birth control pills or Spironolactone, a medication that blocks the effects of androgen on the skin. Spironolactone can cause birth defects. A cream called Eflornithine or electrolysis may also be used to reduce excessive hair growth.
These conventional methods can be ineffective and have undesirable side effects such as post birth control syndrome. Fortunately, there are many natural strategies for PCOS without all of the negative side effects.
PCOS Support Strategies For Healthy Hormones
There are many natural support strategies to improve hormone health. Eating a nutrient-rich, anti-inflammatory diet is critical for reducing inflammation, improving insulin sensitivity, and balancing blood sugar.
Other strategies are losing excess weight, balancing your hormones, avoiding endocrine disrupting compounds, reducing high cortisol levels, and supplementing with N-acetylcysteine, omega-3 fatty acids, vitamin D, and inositol. While none of these are FDA approved to prevent, mitigate, treat or cure PCOS, they have been shown to improve blood sugar, detoxification and overall hormonal health.
Anti-Inflammatory Healing Diet
With inflammation being a major factor in PCOS, it is critical to consume an anti-inflammatory diet. Removing foods that cause inflammation and replacing those with anti-inflammatory foods helps reduce inflammation and balance your hormones.
An anti-inflammatory healing diet also improves insulin sensitivity, balances blood sugar levels, reduces the toxic load on the body, provides necessary nutrients, and supports healthy blood pH levels.
Foods to Include
The foods you should be eating on an anti-inflammatory, healing diet are whole, unprocessed foods. It is important to eat organic foods because pesticides can affect estrogen and other hormones.
Including a variety of low to medium carbohydrate fruits and vegetables is an important part of an anti-inflammatory diet. Low glycemic fruits include berries, granny smith apples, lemons and limes. A variety of herbs is a potent addition to this healing diet.
Cruciferous vegetables such as broccoli, cauliflower, cabbage, kale, bok choy, and Brussels sprouts contain high levels of phytoestrogens. These vegetables compete to occupy estrogen receptor sites to prevent estrogen from exerting its effects on the cell.
Choose grass-fed, pasture-raised, wild-caught meats and fish. Omega-3 fatty acids and conjugated linoleic acid (CLA) found in wild caught salmon and grass-fed beef and dairy have many health benefits.
Eat healthy fats at every meal. Healthy fats are found in coconut, olives, avocados, and their oils and in grass-fed butter and ghee. These healthy fats are an efficient source of fuel for the body to combat inflammation.
Foods to Avoid
Foods that contribute to inflammation and oxidative stress should be eliminated from the diet. Most of these foods are in the standard American diet. Many of the foods on the SAD diet contain high levels of AGEs (7). As discussed above, Women with PCOS often have higher levels of AGEs.
Inflammatory foods are refined sugars and carbohydrates, and any foods that are easily metabolized into sugar (high glycemic foods). These foods upregulate inflammation and create extra acidity in the tissues.
Conventional dairy products and gluten should be avoided. Gluten and A1 casein, a protein found in conventional dairy, stimulate the release of inflammatory cytokines and affect immune function.
Meat and dairy from conventionally-raised animals and farmed fish should be avoided. These foods contain endocrine disruptors such as hormones, steroids, pesticides, GMOs, and antibiotics.
Processed foods contain toxic additives and preservatives. Processed vegetable oils, such as canola, grapeseed, and safflower, promote inflammation and should also be eliminated. Avoiding these foods and replacing them with anti-inflammatory foods is a critical strategy for PCOS.
Lose Excess Weight
Obesity, particularly in the abdominal area, contributes to and worsens PCOS (8). 35% to 80% of women with PCOS are overweight.
There are several many steps you can take to lose the excess weight. Healing a leaky gut, improving insulin sensitivity, and balancing your gut microbiome are important first steps for weight loss.
Following the anti-inflammatory, healing diet outlined above is a powerful way to lose excess weight, reduce inflammation and balance hormones that can contribute to weight gain. You should also practice intermittent fasting daily to help burn excess fat and heal your gut.
Exercise, particularly high intensity interval training (HIIT), is important for maintaining a healthy weight and improving muscle tone. Full body exercises are sequentially performed at high-intensity for short time periods with little rest between sets. HIIT increases fat burning and ant-aging hormones for the next 36 hours.
Improve Insulin Sensitivity and Balance Blood Sugar Levels
Insulin resistance is strongly linked to PCOS. It is critical to improve insulin sensitivity and balance blood sugar levels to prevent and improve PCOS.
Consuming high glycemic foods, such as refined sugars and carbohydrates, causes our blood sugar to rise rapidly. When blood sugar rises, insulin is released from the pancreas to move the sugar from the blood into the cells. This spike in insulin leads to a quick drop in blood sugar and a rise in cortisol.
These massive fluctuations in insulin and cortisol cause inflammation by producing inflammatory cytokines. Inflammatory cytokines can interfere with insulin signaling, resulting in increased insulin resistance and spiked blood sugar.
There are many steps you can take to improve insulin resistance and balance your blood sugar levels. Consuming an anti-inflammatory healing diet as discussed above is key. Other steps include optimizing sleep, boosting vitamin D levels, correcting thyroid issues, and minimizing stress. For information about blood sugar instability and ways to test your blood sugar, check out this article.
Balance Hormone Levels
PCOS promotes a hyperestrogenic state. Lack of ovulation results in continuous high levels of estrogen and insufficient progesterone. Constant estrogen exposure and lack of progesterone may cause the endometrium to become excessively thickened. This leads to heavy and/or irregular bleeding. Over time, this may result in endometrial cancer.
Aromatase is the enzyme responsible for the conversion of androgens to estrogen. Aromatase activity is decreased in women with PCOS (8). Enhancing aromatase activity may be an effective strategy for women with PCOS, especially those with obesity.
Some key compounds that can help support liver health and balance hormones include vitex or chaste tree, polygonum and black cohosh, DIM and chrysin. These all act to support beneficial estrogen aromatase activity.
Another important compound found in many plant foods is calcium-D-glucarate, which promotes the proper elimination of excess estrogens by blocking the activity of the beta glucuronidase enzyme. Calcium D glucarate is a great part of a comprehensive strategy to improve sex hormone balance. You can find it in cruciferous veggies and many fruits but for therapeutic levels you will need to supplement with 400-1000 mg daily.
Avoid Endocrine Disrupting Compounds
Women with PCOS and other hormonal disorders are very sensitive to endocrine disrupting compounds (EDCs). Environmental toxins such as dioxins, pesticides, polychlorinated biphenyls (PCBs), parabens, and phthalates are all EDCs. Exposure to these compounds wreaks havoc on your hormones and contributes to PCOS and other hormonal disorders.
Plastics are one of the main culprits of EDCs. Plastics contain xenoestrogenic chemicals. Xenoestrogens are artificially created compounds that mimic the effects of naturally-occurring estrogen in our bodies. Xenoestrogens contribute to excess estrogen and lodge in fat cells where they are resistant to breakdown. These dangerous toxins leach into the water or anything heated in plastic.
Xenoestrogens and PCOS
Bisphenol A (BPA) is a xenoestrogen found in plastics and the lining of cans. Higher levels of BPA have been found in women with PCOS (9). BPA is associated with excess levels of androgens and to insulin resistance in women with PCOS.
It is critical for healthy hormones to minimize your exposure to EDCs. In addition to avoiding plastics, you should avoid conventional meat and dairy, soy isoflavonoids, sugars, additives, preservatives, grains, beer, and processed foods. Choose organic and hormone-free foods. Look for “BPA free” cans and bottles, and check ingredients in your personal care products.
Reduce High Cortisol Levels
Androgen excess in women with PCOS may be from the ovaries or the adrenal glands. “Adrenal PCOS” is the elevation of androgenic hormones by the adrenal glands that causes symptoms similar to ovarian-cyst driven PCOS. It is estimated that 20-30% of women with PCOS have adrenal androgen excess (10).
Increased cortisol production from altered cortisol metabolism may cause PCOS (11). Elevated levels of cortisol can also contribute to PCOS by causing hormonal imbalances.
Chronic stress is one of the biggest factors for elevated cortisol levels. Chronic stress can be from excessive dieting, over-exercising, not getting adequate sleep, long work hours and other lifestyle factors. It can also be internal stressors such as chronic infections, inflammation, autoimmune disease, and environmental toxins. Addressing these chronic stressors is can be an effective strategy for improving PCOS.
Inositol is a naturally occurring compound that helps store and metabolize amino acids. It is an important component of the citric acid cycle, which results in food being converted to energy. Inositol can improve the metabolic, hormonal, and reproductive aspects of PCOS.
There are nine forms of inositol. The most abundant inositol stereoisomers, myo-inositol (MI) and D-chiro-inositol (DCI), have been shown to reduce insulin resistance, improve ovarian function, and reduce androgen levels in women with PCOS (12). Food sources of these inositol include beef liver, beans, nuts, wheat germ, oats, cantaloupe and fresh citrus fruits (except for lemons).
Omega-3 Fatty Acids
PCOS is associated with inflammation, oxidative stress, and hormonal imbalances. Omega-3 fatty acids are essential fats that help reduce inflammation and regulate hormone production. These important fatty acids also improve insulin sensitivity which is beneficial for PCOS.
There are also food sources of Omega-3 fatty acids. Fatty fish such as wild-caught salmon and sardines, grass-fed meats, pasture-raised eggs, nuts (especially walnuts), and seeds (flax, hemp, and chia seeds) contain Omega-3 fatty acids. Flax, hemp and chia seeds have the added benefit of improving estrogen levels in the body.
Plant based omega 3’s such as flax oil only contain the small chain omega 3 called ALA and do not have any DHA. It is very hard for our body to convert ALA into DHA so it is best to get a high quality fish or krill oil that is rich in EPA and DHA. You want to find a brand that is molecularly distilled to take out any heavy metals and other unwanted contaminants.
Be sure to discuss with your physician before using as fish oils have a blood thinning affect and can be contraindicated if you are on blood thinning medications.
Around 70%-80% of women with PCOS are deficient in vitamin D (13). Low vitamin D levels are significantly correlated with insulin resistance in women with PCOS. D3 is the biologically active form of vitamin D. It is more potent in raising and maintaining vitamin D concentrations than D2.
Vitamin D3 is created in your skin in response to sun exposure. Most people should aim to get 15-20 minutes of sun exposure daily. In addition to sun exposure there are dietary sources of vitamin D. The best food sources are wild-caught salmon and fatty fish, cod liver oil, grass-fed butter and raw cheese, egg yolks, mushrooms, and beef liver.
It is difficult to obtain adequate amounts of vitamin D from the sun and food, especially if you are already deficient in this critical vitamin. The ideal range for vitamin D3 levels is between 50-80 ng/ml. Get tested regularly and look to get regular sun exposure and take vitamin D3 supplements to optimize your levels.
Glutathione has been coined with the term “master antioxidant” due to its essential role in maintaining exogenous antioxidants such as vitamin C & E in their active form (5, 6). Glutathione is like the cell’s security guard protecting the genetic equipment from outside attack.
It is estimated that each cell in the body withstands 10,000 hits by free radicals each day. Glutathione disarms these free radicals before they wreak havoc and cleans up the oxidative stress related damage that has occurred.
N-Acetylcysteine (NAC) is the acetylated form of the amino acid cysteine which is naturally present in substances like garlic. NAC improves hyperandrogenism, hyperinsulinemia, and menstrual irregularity in women with PCOS. A review of studies found that NAC showed significant improvement in pregnancy and ovulation rate for women with PCOS (14).
You can also find liposomal and S-acetylated forms of glutathione that bypass the digestive system and go right into the cells and improve cellular glutathione levels. The better your glutathione levels, the more effectively you will detox bad estrogen metabolites and reduce inflammation in the uterus, endometrium and ovaries.
Best Way to Test for PCOS and Hormonal Health:
The best way to test for PCOS and overall hormonal health is the Dutch Complete Hormone Panel. DUTCH is an acronym for Dried Urine Test Comprehensive Hormones. As the name implies, the DUTCH test is a urine test that can be performed at home. You simply collect a small amount of urine on filtered paper four times a day.
This comprehensive hormone test measures:
- Cortisol and cortisone rhythms and levels
- Estrogen metabolism pathways
- Etiocholanolone and androsterone
- 8-OHdG – a marker of oxidative stress
- Neurotransmitter metabolites
- B vitamins
There are many ways this test can be helpful for women with PCOS. This test measures androgen production, how you metabolize estrogen, cortisol and many cortisol metabolites. This test gives a complete picture of how adrenal and hormone imbalances contribute to PCOS.
Conclusion on PCOS:
Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder in women. This condition can have a devastating impact on a woman’s health and her appearance. PCOS is characterized by chronic problems with ovulation, menstrual dysfunction, and excess production of male hormones (androgens). Women with PCOS often have polycystic ovaries.
There are numerous symptoms and complications of PCOS. These include infertility, irregular or missed periods, high male hormones, excessive hair growth, male patterns of baldness or thinning hair and low sex drive. Weight gain, difficulty losing weight, acne, anxiety, depression and fatigue are common with PCOS.
Chronic inflammation and insulin resistance are the major contributors to PCOS. Genetics, obesity, lipid abnormalities, hormonal imbalances are other factors that are linked to PCOS.
Consuming an anti-inflammatory diet, improving insulin sensitivity, and correcting hormonal imbalances are important natural strategies for improving hormonal health. Other strategies include losing excess weight, avoiding endocrine disrupting compounds, reducing high cortisol levels, and supplementing with N-acetylcysteine, omega-3 fatty acids, vitamin D, and inositol.
The DUTCH test is the gold standard for testing your hormones and adrenal output. Women with PCOS, or who suspect PCOS, should consider this test for insight into their reproductive and adrenal health.
If you want to work with a functional health coach, I recommend this article with tips on how to find a great coach. At my clinic, we offer long-distance functional health coaching programs. For further support with your health goals, just reach out and our fantastic coaches are here to support your journey.