PCOS: Building Awareness and Empowerment for Managing the Experience
Whenever we hear the word ‘syndrome’ – it often indicates a set of symptoms that may comprise someone’s experience but vary amongst individuals. As a result, diagnosis and treatment are likely a time-consuming and confusing path. Regarding polycystic ovary syndrome (PCOS), this is very much the case, as some individuals go undiagnosed or may be misdiagnosed. The best way to shorten the distance between symptoms, diagnosis, and effective management is to be informed about the condition and options for management/treatment.
As women’s health author, activist, and naturopathic doctor Lara Briden puts it: “PCOS is best defined as androgen excess (hormones present in males and females, but at higher levels in males) when all other causes of androgen excess have been ruled out.”1 This often leads to a lack of ovulation because the high androgens cause the follicles in one’s ovaries to remain small instead of maturing and growing to prepare for ovulation. She states, “despite the name, polycystic ovary syndrome has nothing to do with cysts on the ovaries. For one thing, the so-called ‘cysts’ that are visible on ultrasound are not ovarian cysts but are instead actually follicles or eggs, which are normal for the ovary. (Large, abnormal ovarian cysts can cause pain and other symptoms. They are a separate issue and not the same thing as polycystic ovaries.) For another thing, there is no evidence that the presence of polycystic ovaries has any implications regarding the endocrine or metabolic features of PCOS. In other words, you can have polycystic ovaries and have perfectly normal hormones. Conversely, you can have normal-looking ovaries but still have the hormonal condition of androgen excess (aka PCOS).”1
In fact, polycystic ovary syndrome is not just one disease but rather a disorder with varying biological factors at play. The set of symptoms someone experiences may be caused or exacerbated by these different factors. Therefore, treatment requires proper identification of these underlying causes driving symptoms, which vary between the four functional types of PCOS.
With this in mind, what else are we looking for in terms of PCOS symptoms?
Common symptoms include:2
- Absent or irregular periods
- Infertility
- Blood sugar imbalances
- Difficulty losing weight or weight gain
- Acne
- Abnormal hair growth (chest, back, face)
- Male-pattern hair loss
- Fatigue
- Heightened anxiety
These symptoms are not experienced by all individuals struggling with PCOS and are not specific to PCOS, further complicating diagnosis and management. In an ideal scenario, practitioners will utilize a variety of diagnostic criteria. Current considerations to confirm diagnosis indicate an individual must meet at least two of three criteria:2
- Irregular periods – meaning cycles are shorter or longer than the average 21-35 days or missing entirely. Most often with PCOS, cycles are longer and occur without ovulation.2
- Cysts on ovaries – despite the name, this is the least common criterion noted for PCOS diagnosis. The National Institute of Health has even suggested changing the name of this disorder to reflect its complexity more accurately (involving metabolic, hypothalamic, pituitary, ovarian, and adrenal functions).2
- Elevated androgen levels – Androgens are often called the ‘male sex hormones’ although they are present in women as well, just in different amounts. Hormone testing for PCOS will assess levels of testosterone, DHEA (dehydroepiandrosterone), and DHEA-S (dehydroepiandrosterone sulfate) with comparison to reference ranges.2
Let’s shift to defining the 4 functional types of PCOS:3
- Insulin-resistant PCOS
- Estimated to be 70% of cases.
- Post-pill
- Temporary, results from a surge in androgen levels as part of the withdrawal process of stopping hormonal birth control.
- Inflammatory PCOS
- Adrenal PCOS
Insulin-resistant PCOS
Sometimes referred to as the ‘classic type’ of PCOS because it is the most common, this type is characterized by high insulin and leptin levels, which disrupt ovulation and stimulate the ovaries to make more testosterone.3 For more context, insulin is the hormone released to help our bodies make use of glucose. Think of insulin as a key that unlocks cells to get the energy, in the form of glucose, inside the cell. Having high insulin but being insulin resistant means our cells are seeking energy via glucose in our bloodstream but are unable to consistently access it due to this imbalance. Leptin is a hormone that helps to regulate hunger, appetite, and body weight. Insulin resistance commonly occurs in the presence of excess energy intake, too high or too low of carbohydrate intake, stress, excess body fat, chronic inflammation, and genetic predisposition.2
To determine if blood sugar imbalances are present, general practitioners may run a Hemoglobin A1C (HbA1c) test. This test measures the body’s ability to keep blood sugar levels in the optimal range over the course of a 3-month period. While this data could be useful, it may miss an important factor if the body is currently still effectively working in overdrive to maintain optimal levels. A fasting insulin test often provides further insight because an elevation of this hormone usually proceeds an elevated HbA1c and more accurately reflects the functional concern for this condition.
Rebalancing the body while managing insulin-resistant PCOS is a process and will take time for cellular receptivity insulin to be restored. Important lifestyle considerations for effective management will be detailed later in this article. Consistency is key regarding lifestyle practices and the use of supplements to reestablish balance within the body. Working with a dietitian or other knowledgeable healthcare provider is highly beneficial during this time.
Post-pill PCOS
It’s common to experience a temporary surge in androgens when coming off hormonal birth control pills, which essentially interrupts our body’s natural hormonal rhythm. This increase in androgens is linked to suppressed ovulation and can persist for months or even years in some cases.3 Under current diagnostic guidelines, a temporary surge in androgens is enough to qualify for the diagnosis of PCOS. While for most women, this effect is temporary, and ovulation will resume soon after the pill is stopped (3-6 months) and the body returns to its natural hormonal rhythm, that is not the case for everyone.3
Many women have heard at some point in their lives that hormonal birth control pills can be an effective treatment for hormonal imbalances or even for PCOS specifically. This type of PCOS is an example of why that is not always true. Though there are many products on the market and nuanced considerations for everyone’s hormonal health, birth control pills do not address the root cause of a hormonal imbalance and should not be considered a long-term solution or treatment option.
Inflammatory PCOS
Inflammation, which can also be thought of as sustained immune system activation, results from stress, environmental toxins (like pesticides, body care products, chemicals, and plastics), an imbalanced intestinal microbiome, and food sensitivities, and/or inflammatory foods. Inflammation becomes a barrier to ovulation as it disrupts hormone receptors and stimulates adrenal androgens.3
The approach to improving this type of PCOS is multifaceted, starting with the need to look deeper into the root causes of inflammation.2 Because of this complexity, improvement of symptoms is likely to take several months. Patience and consistency are key. Partnering with an experienced provider is also highly beneficial.
It’s also important to note that there can be an overlap between these four types of PCOS. For example, inflammation is a major driver in both the insulin-resistant and inflammatory types of PCOS.
Adrenal PCOS
Our adrenal glands produce hormones that help to regulate metabolism, immune function, blood pressure, and stress response, which are a few of their most essential functions. Adrenal PCOS is defined as an epigenetic condition where a genetic predisposition combined with lifestyle and environmental triggers can turn on or off the genes for this condition.4 Examples of such triggers that might “turn on” the gene include chronic stress, poor quality diet, disrupted sleep, excessive exercise, traumatic events, illness, hormone imbalances, and much more. As outlined previously in the section regarding diagnostic criteria, it’s quite common for women with PCOS to have an elevation of androgens.1
Specific details on these hormones is outside the scope of this article, see the resources cited below for further information, especially #4. An estimated 10-20% of PCOS cases are linked to the adrenals specifically.3
Steps Towards Managing PCOS Through Nutrition and Lifestyle
At Summerfield, many of our patients are familiar with what we call our “4 Pillars of Wellness”. These play a strong part role in the effective management of PCOS through key lifestyle practices that are shown to be highly beneficial for managing PCOS. The four pillars are interconnected in ways that support a stable foundation for health when optimized but can create imbalances in the body when one or more areas are out of alignment with our individual body’s needs.
Nutrition – A balanced approach to nutrition is very important for stabilizing blood sugar as part of PCOS management. We utilize a framework for building a plate that focuses on the quality and quantity of nutrients while remaining actionable to apply at all meals and snacks. The Plate Method consists of a half plate of colorful, non-starchy vegetables, 1/4 plate protein, and 1/4 plate starches. This concept ensures adequate fiber and protein, as well as key nutrients and the anti-inflammatory benefits of various produce.
Sleep – Striving for at least 7-9 hours of mostly uninterrupted sleep per night is key for optimal health. Inadequate or poor-quality (such as frequently interrupted) sleep can be a source of stress to the body, leading to hormone imbalances and may increase inflammation, therefore exacerbating underlying factors with most types of PCOS.
Activity – Regular physical activity is beneficial for everyone, but consideration for the type and amount is an additional factor for individuals managing PCOS. Excessive exercise can be a source of added stress on the body, so it’s important to ensure the forms and frequency of movement selected are optimal for PCOS and your body.
Stress – Reducing stress can mean a lot of things, and it varies from one person to the next. Many of us think of psychological stressors first when we hear the word stress, but other factors can be stressful to the body as well, including inadequate sleep, underlying inflammation, poor nutrition, or excessive exercise. This consideration reinforces the interconnectedness of the pillars of wellness – also reinforcing the fact that it truly is about the steps we take on our journey of health improvement vs. a specific destination of perfect health.
Speak to a trusted provider to determine the lab tests that may help identify the type/s of PCOS you are experiencing. It is highly beneficial to work with a dietitian knowledgeable on PCOS, as they are experts in the areas of health and lifestyle that are vital to supporting and rebalancing the body. Also, an experienced dietitian may be able to help you determine beneficial supplements. It is essential to work with a health professional experienced in the management of PCOS to help you develop the supplement plan that is appropriate for your specific PCOS type and to avoid exacerbating your symptoms.
In summary, diagnosing and treating polycystic ovary syndrome (PCOS) is a multifaceted process. Our hope is that this information will serve you in better understanding the condition and your experience, as well as empower you to make the changes that could improve your symptoms and ultimately improve your health. If a Summerfield dietitian can be of further assistance to you in this journey, please reach out to us to be paired with one of our dietitians today!
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