Polycystic ovary syndrome (PCOS) is a common metabolic-hormonal condition that affects millions of women. The cause of PCOS may be multifactorial, and seems to involve a combination of genetics and environmental exposures. Some women with PCOS have cysts on their ovaries, but many don’t, and we now know that the condition involves multiple physiological components. At the root it involves a predisposition to insulin resistance, the consequences of which are hormonal imbalances – including estrogen dominance, progesterone deficiency, and most notably an excess of androgens (“male” hormones). Symptoms associated with PCOS vary among affected women, but may include acne, excess facial hair, male-pattern hair loss, menstrual irregularities (such as absent, infrequent, or heavy periods and PMS), difficulty getting pregnant or maintaining a pregnancy, and sometimes considerable difficulty managing weight – even with a woman’s best efforts to maintain a healthy lifestyle with clean eating and exercise. The insulin resistance and hormonal imbalances in PCOS can also predispose a woman to depression and anxiety. It’s important to actively address PCOS, as insulin-resistance increases the risk of developing Type 2 Diabetes and all the consequent cardiovascular risks of heart disease and stroke. Thankfully, there are a great number of evidence-based treatment options and lifestyle factors that can help women with PCOS improve their insulin sensitivity and hormone balance.
How Do You Know If You Have PCOS?
Diagnosis may be made based on the presence of several symptoms and the results of diagnostic tests. Conventional testing usually includes luteinizing hormone (LH), follicular stimulating hormone (FSH) and testosterone. However, these tests may or may not be abnormal in someone with PCOS, as their values depend on multiple factors. Sometimes an ultrasound is performed to look for cysts on the ovaries, but again cysts may or may not be present. Dry urine hormone testing is specialized testing available through naturopathic doctors, and offers a much broader analysis of a woman’s sex hormones and their metabolites, as well as adrenal function. This is a crucial and often overlooked element of testing as the adrenal glands produce pregnenolone (the precursor to sex-hormone and cortisol production) and regulate our cortisol (a stress hormone), which has significant implications for weight management and insulin sensitivity. For many women, adrenal care is an important factor in the management of PCOS.
Another often-overlooked assessment is vitamin D testing. Vitamin D is used in abundance by the ovaries, and adequate vitamin D is required to maintain good insulin sensitivity, and also affects mood. In Canada vitamin D deficiency is extremely common, so it’s important to test and ensure adequate nutritional status.
So you have PCOS. Now what?
Metformin is the main medication that is prescribed for PCOS, as it helps to get blood sugar under control. For some women, this can be a very practical option. However, long-term use of Metformin comes with some concerns that need to be managed. As alternatives, dietary interventions (generally lower in carbs and higher in protein) and exercise can significantly improve insulin sensitivity, and when needed, the addition of certain evidence-based supplements and herbs can further correct blood sugar dysregulation and hormone imbalances. After a thorough evaluation of your history, your naturopathic doctor will counsel you as to any testing that may be indicated for you, and whether any diet and exercise modifications, nutritional supplements or herbs could help to support your physiology. The choice of any supplements or herbs would depend on your unique presentation of symptoms and test results. Here’s a list of a variety of the evidence-informed supplements and herbs that are sometimes prescribed to women with PCOS:
- D-chiro-inositol and myo-inositol: the ovaries use inositol in abundance, and these nutrients can significantly improve insulin sensitivity and ovulation. Legumes are a moderate source of dietary inositol, so including chickpeas and organic soy in the diet may be beneficial.
- Alpha-lipoic acid and chromium: can benefit insulin sensitivity.
- Vitamin D: if you’re found to be deficient, larger doses may be needed for 2-3 months (often paired with vitamin K2 to balance calcium deposition into bone), after which time a lower dose may be indicated for maintenance.
- N-acetyl-cysteine (NAC): this amino acid aids liver detoxification and can benefit insulin sensitivity, resolution of cysts, reduce testosterone levels and excess hair growth.
- Adrenal adaptogenic herbs: examples are ashwagandha, rhodiola, licorice root, Siberian ginseng, schisandra, and maitake mushroom.
- Black cohosh: reduces excess androgens and benefits ovulation.
- Peony and licorice root: these herbs reduce testosterone, and improve ovulation and fertility.
- Chaste Tree (aka Chasteberry, Vitex agnus castus): supports ovulation, fertility and balanced progesterone production.
- CoQ10 and L-Carnitine: these nutrients significantly improve ovulation and pregnancy rates when used in conjunction with the fertility drug clomiphene.
- High quality fish-oil has multiple benefits, including improving fatty liver, helping to reduce triglyceride levels, decreasing inflammation, lowering testosterone and regulating menstrual cycles.
- Stress management is extremely important for our overall health, and even more so in women with PCOS, as stress can affect blood sugar regulation and adrenal hormone production. As needed, your naturopathic doctor may support you with counselling, Emotional Freedom Technique, acupuncture, meditation or other stress-reduction techniques, or refer you to a counsellor for additional ongoing support.
- Acupuncture can provide further support for menstrual difficulties, fertility and stress-reduction.
- Avoiding hormone-disrupting environmental toxins: avoiding eating and drinking out of plastics, eating organic foods, and using non-toxic cleaning products is a great way to start.
- Exercise: the right balance is needed. A woman needs enough to support insulin sensitivity, but exercising too aggressively can increase cortisol production, which can actually impair weight loss by contributing to blood sugar dysregulation. If you feel drained rather than energized after you exercise, if it takes a long time to recover your energy, and several days for your muscles to stop being sore, you’re doing too much too fast.
There is so much hope!
As someone with a history of PCOS, I have experienced the frustrations and challenges that come with hormone and insulin dysregulation. When I was younger I had debilitating heavy and painful periods with severe PMS that significantly affected my activities of daily living and quality of life. Weight management is something I’ve always had to work extra, extra hard at, and with a family history of Type 2 Diabetes I know I’ll always need to be proactive to reduce my risk of developing it when I’m older. Thankfully, with diet, exercise, maintenance doses of certain nutrients and occasional herbal support, I no longer experience any PCOS signs or symptoms that affect my ability to do what I love and enjoy life to the fullest. It gives me tremendous meaning to be able to pass on my knowledge and experience to assist other women with PCOS and reproductive health concerns. Every woman’s journey with PCOS is unique, as are treatment requirements. Addressing genetic tendencies toward metabolic and hormone imbalances requires commitment and long-term management, but once a more balanced state is achieved maintenance can be quite manageable.
If you or someone you know has been touched by PCOS, naturopathic doctors can be of tremendous support.
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Information can be empowering, but we all have unique health profiles and needs. Health-related information contained in this article is intended to be general in nature, is not individual advice, and should not be used as a substitute for a visit with a Naturopathic Doctor. Always consult your licensed Naturopathic Doctor or other health care provider.