PCOS
Polycystic Ovarian Syndrome (PCOS) is a genetic and metabolic condition. By definition, polycystic ovaries means there are cysts on the ovaries. These cysts are created when a follicle doesn’t mature completely and release an egg (ovulate). This causes the ovaries to produce more androgens (male hormones such as testosterone and DHEA) which then cause more insulin to be released. PCOS is a metabolic disorder, with insulin resistance at its core. This life-long condition can be mitigated and overcome with proper hormone therapy and lifestyle optimization.
Signs, symptoms, and complications
Symptoms vary widely among women and can include:
Excess body weight (BMI >25)
Inability to lose weight despite intense effort
Sugar cravings
Painful heavy periods
Irregular periods
Lack of ovulation
Male-pattern hair loss
Excess facial and body hair (especially on the lip, chest, abdomen, chin, and thighs)
Acne
High triglycerides
High blood sugar
High blood pressure
Skin darkening in the folds of the body (breasts, neck, armpits, and thighs)
Miscarriages and difficulty getting pregnant (infertility) — PCOS is sometimes referred to as “metabolic infertility”
Cysts on one or both ovaries (detectable by ultrasound)
*Women report a wide variety of these symptoms with the lowest number reported being 1-2 symptoms. Obesity, hirsutism (hair growth), and infertility can be found in about 50% of women diagnosed with PCOS. Because of the complex nature of PCOS, diagnosis is based on lab results and reported symptoms. Confirming cysts on the ovaries by ultrasound is not necessary for diagnosis.
What causes PCOS?
At present, there is not a direct known cause of PCOS; however, there is a strong connection to insulin resistance. PCOS is a genetic condition as it is consistently found in female family members. Hormonal imbalance is at the root of this syndrome and leads to the symptoms commonly associated with PCOS.
Consumption of processed foods along with high-stress levels make the underlying condition even worse; this is why optimizing diet and lifestyle are so important. Here are some initial first steps you can take to treat your PCOS:
Clean up your diet by avoiding processed and high sugar foods.
Focus on nutrient-dense foods such as animal products and vegetables. Fruit is also nutrient dense but contains a lot of fructose (some more than others). So choose your fruit wisely and eat in moderation.
Reduce stress by participating in yoga, reading, meditating, taking a bath, or exercising, etc.
Move frequently throughout the day and exercise at least twice a week . *See the MTN HLTH Fitness Pyramid
Treatment
Insulin control is extremely important as insulin resistance is the underlying issue in PCOS. Women can become more insulin sensitive by controlling carbohydrate consumption, exercising (including building muscle with resistance training) and following your MTN HLTH treatment guide (including medications).
Thyroid optimization is especially important for those with PCOS. It helps us to burn fat, regulate menstruation, improve energy levels, and decrease cholesterol, among other benefits. Women with PCOS tend to either have an under-active thyroid, or poor thyroid hormone function at the cell level.
Progesterone optimization is absolutely necessary for women with PCOS due to the lack of a progesterone surge in the second half of the menstrual cycle. Not only will this help you to sleep better (reducing stress and increasing energy), but it will also regulate your cycles, decrease PMS, improve mood, and decrease risk of endometrial, ovarian, and breast cancer.
Lifestyle Optimization:
Regular exercise is crucial to all metabolic processes of the body especially for those with PCOS. Exercise will improve all symptoms listed above and regulate blood sugar levels. Building muscle is extremely important.
Incorporating good nutritional practices will also aid in weight loss and maintaining low insulin levels.
These practices include increasing good fats and protein in your diet and limiting carbohydrate intake.
Medication and Supplements:
Metformin has been used for years to treat both pre-diabetes and diabetes. Metformin’s function is to increase the body’s sensitivity to insulin, making it easier for your body to utilize it. Additionally, metformin has been shown to prevent certain cancers and promote autophagy (natural cleaning of unnecessary substances in the body’s cells).Some of the reported GI Side Effects from Metformin include nausea, upset stomach, and bloating. These can be easily mitigated through the use of a sustained release pill and a slow titration schedule.
Berberine is a plant extract used anciently that can be used in conjunction with metformin to help control blood sugar. However, its proven benefits go beyond just blood sugar and insulin stabilization. These benefits include weight loss, decreased blood pressure, support of the gut microbiome, and has a positive influence on metabolism. *See our article on Berberine
Spironolactone works by antagonizing (fighting against) androgens (testosterone and DHEA) in the body specifically at the hair follicle. This medication is very important for decreasing acne and hirsutism (hair growth). It is a diuretic (water pill), so staying hydrated with water and electrolytes is important when taking spironolactone.
Vitamin D plays an important role in decreasing inflammation in the body, regulating mood, increasing immune function, and preventing cardiovascular disease. *See our article on Vitamin D
Inositol aids in the metabolism of fat, converting food into energy, and helps to regulate insulin and blood sugar. It also helps control mood and appetite and regulate the hormones TSH, FSH, and Insulin. You can find out more about Inositol in our Vitamin B12 + MIC blog post.
Why does this matter?
PCOS only gets worse with age unless intentional treatment is implemented. Untreated PCOS can lead to permanent infertility, metabolic syndrome, obesity, type 2 diabetes, irritable bowel syndrome, depression, anxiety, hypertension (high blood pressure), heart disease (stroke & heart attack), fatty liver disease, endometrial cancer, and breast cancer (5-fold increase). The best way to avoid these debilitating diseases is through prevention counseling, lifestyle changes (diet & exercise), hormone optimization, and medical management.
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