Your Ultimate Guide to PCOS
PCOS….one of the most common endocrine disorders among women in their reproductive age. On top of that, it’s the leading cause of ovulatory infertility.
So what is PCOS anyways?
What is PCOS?
Polycystic Ovarian Syndrome aka PCOS is a condition where ovarian follicles are prevented from reaching the ovulation stage, causing delayed ovulation or even ovulation from happening at all (irregular or skipped periods).
Each ovarian follicle contains an immature egg and when it doesn’t mature, it can become a cyst – hence the “polycystic” part of the name.
However, not all PCOS conditions contain cysts.
In fact, PCOS isn’t characterized by a few signature symptoms, rather it’s a group of symptoms with a fair bit of diversity and can range from person to person. This is one of the reasons why it’s so difficult to diagnose PCOS.
Photo credit: Mayo Foundation for Medical Education and Research
Diagnosis PCOS
To help create a standard when working with PCOS clients, the European Society of Human Reproduction and Embryology and The American Society for Reproductive Medicine use the Rotterdam Criteria to help identify and diagnose PCOS.
In order to be diagnosed with PCOS, 2 of the 3 conditions must be met:
Irregular ovulation or no ovulation
Elevated levels of androgens resulting in hyperandrogenism
Polycystic ovaries containing at least 12 follicles larger than 2mm
However, even with these criteria, it still doesn’t cover all the basis of diagnosing PCOS. Essentially, PCOS is really a diagnosis of exclusions – which is really unfortunate because that’s how women end up seeing several healthcare providers before actually getting correct support.
Luckily, there’s an increasing number of dedicated holistic women’s hormone health practitioners who are experienced in recognizing the hallmark symptoms of PCOS. Who can refer you to get specific testing done to make a quicker diagnosis and get you the support you need quicker too.
Types of PCOS
Remember when I said symptoms of PCOS can vary from person to person? That’s because PCOS can actually be categorized into four types.
PCOS types are categorized by the driving causes behind your PCOS. So, knowing and understanding your specific type of PCOS can help you start managing it quicker and better, rather than a one-size-fits-all treatment approach which tends to happen with conventional support.
1. Insulin Resistant PCOS
Insulin Resistant PCOS is one of the most common types of PCOS – accounting for 65-75% of those diagnosed. It is also often linked with inflammation-based PCOS.
Insulin is the hormone responsible for helping your body process and use the sugar (carbohydrate) from your food for energy. Remember, carbohydrates are your body’s preferred source of fuel. Insulin controls how much sugar gets moved into the cells, where energy can be used.
With Insulin Resistant PCOS, insulin is being produced, but the body, like your cells, muscles, fat etc. cannot use it and it stays in your bloodstream. This leads the body to think it needs to produce even more insulin, leaving your blood filled with unused insulin. Basically, your body is starving even if you’re full!
Signs of Insulin Resistant PCOS
Signs of hirsutism (abnormal hair growth on face, chest & back)
Male pattern hair loss
Dark patches on the neck, groin area or underarm
Struggle with weight management (overweight or having trouble losing weight)
Blood sugar fluctuations (elevated fasting insulin or “borderline diabetic”)
Tired after eating
Hungry between meals
Sugar cravings
2. Inflammation-based PCOS
Inflammation-based PCOS is, as you can guess all about inflammation. And this also includes low-grade chronic inflammation.
Short-term, acute inflammation is necessary. It’s your body’s natural defence mechanism against infections, injuries or when foreign invaders in the body are identified. However, when inflammation turns chronic and your body is constantly on alert trying to protect your body, that’s when issues arise.
Often associated with Insulin Resistant PCOS, Inflammation-based PCOS can really be driven by A LOT of different things. Anything such as digestive issues, gut infections, bacterial overgrowth, environmental toxins, and stress overload (just to name a few) can all accumulate and cause Inflammation-based PCOS.
Signs of Inflammation-based PCOS
Gut issues (IBS, bloating, gas, swelling discomfort after eating, etc.)
Food sensitivities (gluten, sugar, alcohol, dairy, etc.)
Low immunity
Skin issues (acne, eczema, psoriasis, dermatitis, rashes, rosacea, etc.)
Struggle with weight management (weight gain especially in the mid-section or trouble losing weight)
Joint pains
PMS/ painful periods
Irregular periods/ lack of ovulation
Signs of hirsutism (abnormal hair growth on face, chest & back)
Male pattern hair loss or baldness
Brain fog
Memory issues
Migraines/headaches
Mood disorders
3. Adrenal PCOS
With Adrenal PCOS, the focus is on the adrenal glands – so basically your cortisol levels! This type of PCOS affects 20-30% of those with PCOS.
In addition to cortisol level imbalances, Adrenal PCOS will also have elevated levels of DHEA-S, a hormone produced by the adrenal glands. The problem is that these hormones eventually get converted into testosterone. And as we saw with Insulin Resistant PCOS, excess levels of testosterone in the body can make PCOS symptoms worse and throw off your delicate hormone balance.
Adrenal PCOS is often correlated with Insulin Resistant PCOS – which is why many of the signs and symptoms are very similar.
Signs of Adrenal PCOS
Sleep issues (trouble falling asleep or waking up in the mornings)
Struggle with weight management (weight gain, especially in the mid-section)
Chronically stress
History of undereating or malnutrition
History of overtraining
Traumatic childhood/ adolescence experiences
Other factors to consider with Adrenal PCOS
No signs of inflammation
No signs of post-hormonal birth control symptoms
May still have normal ovulation
4. Post-Pill PCOS
While post-birth control pills PCOS isn’t technically a type of PCOS because research shows that it doesn’t actually cause PCOS, coming off the pill can create PCOS-like symptoms. Additionally, if you had PCOS before taking the pill, it can make your PCOS symptoms worse when you come off.
I completely understand why hormonal birth control gets recommended for those with PCOS because the pill does mask and cover PCOS signs and symptoms temporarily when you’re on it and it does make it appear as if your periods are “regulated” again.
However, the pill is preventing your hormones from naturally flowing and is adding synthetic hormones into your body. So when you do decide to come off the pill, it’ll leave your hormones even more out of whack.
Factors to consider with Post-Pill PCOS
You don’t have a genetic disposition for PCOS
No signs of insulin resistance
Had regular periods before the pill, but they’re missing or irregular after coming off the pill
You were diagnosed with PCOS after coming off the pill
Conventional PCOS Treatment
Often with conventional PCOS treatments, it will include some type of medication. While they can help temporarily, unfortunately, they don’t get to the root cause of your condition. This can lead to consistently needing to up your dosage, needing to take medication long-term and always needing to worry about your PCOS condition.
Some common conventional treatments include:
Hormonal birth control for those not looking to conceive
Clomiphene or Letrozole for those looking to conceive
Metformin for lowering insulin and blood sugar levels
Natural PCOS Support
At the core of PCOS, it comes down to diet, lifestyle and environmental factors as the key instigators for causing PCOS. I know this sounds too simple to be true, but the complicated part comes with working with YOUR PCOS. Because, as I mentioned above, there are different types of PCOS with different drivers.
For example, not everyone with PCOS needs to be on a low-carb diet or engage in high-intensity workouts. It really depends on YOU and YOUR needs.
Diet
Your eating habits are one of the most fundamental changes you can make to support your PCOS condition. Since insulin resistance is the core driving cause of PCOS, managing your blood sugar levels is key.
Movement
Moving your body is very helpful in improving your insulin sensitivity. However, as I mentioned above, high-intensity workouts may not be the best option for your type of PCOS. This is why I often recommend low-intensity, gentle movement first, along with some weight training.
Sleep
Just ensuring you sleep 8-10 hours is not enough. Because who else has slept the recommended hours and still woken up tired? Aim for good quality sleep too, so also focus on your night routine and sleeping habits.
Environmental toxins
Unfortunately, environmental toxins creep into our lives in almost every way and it’s pretty difficult to completely cut them out. This is where even a bit of effort can go a long way, like switching from plastic bottles to glass bottles is a great start!
Honestly, I’ve just scratched the surface with natural ways to support your PCOS. It always breaks my heart when I hear clients being told after their diagnosis of PCOS that they will not be able to get pregnant or that there’s nothing they can do because it’s genetics.
Both of those are just myths.
I want to start changing these narratives because these misconceptions are really harmful. They leave those diagnosed with PCOS feeling hopeless, defeated and despondent. And we all know how much of an impact our mindset can have on our bodies.
The holistic approach to supporting PCOS can be very powerful and successful. It is a long-term solution to keeping your hormones healthy and flowing even after you’ve successfully controlled your PCOS.
Resources:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3553224/
https://www.cdc.gov/diabetes/basics/pcos.html
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7879843/