Polycystic Ovary Syndrome (PCOS) is a hormone imbalance disorder in women. This has a negative impact on a woman’s health, her ability to have a child, and to a great degree her emotional health and wellbeing. While young woman are often prescribed Spironolactone, The Pill and Metformin, Functional medicine focuses more on natural strategies to prevent and improve PCOS.
PCOS has a prevalence rate of about 6 to 21 percent in women of childbearing age and is a leading cause of infertility. In fact, about 72 percent of women experience infertility when they’re diagnosed with PCOS compared to only 16 percent of those who are not.
Knowing the numbers, it’s always a safe bet to get yourself checked preliminarily. There’s a whole sub-section of women that don’t realize they are at risk for PCOS and only get a diagnosis when they’re facing problems getting pregnant. Studies show that nearly 50 percent of PCOS diagnoses are not done appropriately so millions of women keep living with untreated ovarian dysfunction and menstrual irregularities.
The drawback of not diagnosing PCOS in time is that it comes with a score of side-effects and medical conditions that make life harder than necessary for the patient. Take for example, diabetes mellitus. Yes, it’s true. Untreated PCOS can put patients at an increased risk of developing Type-2 diabetes. This means they’re more likely to form insulin resistance in their bodies and with it they’ll have to cope with hypertension, metabolic disorders, and high cholesterol levels. If you’d like to know more about insulin resistance, click here.
What’s truly irksome is that there seems to be little awareness of PCOS-related issues. It’s not like the disease emerged only a few years ago. The disorder has been under study for 75 years.
But you shouldn’t let the lack of attention given to PCOS fool you. Be your own guard and know the causes, symptoms, and signs of PCOS. After all, there’s no better cure for an illness than its prevention.
What Is PCOS?
PCOS is a hormonal imbalance issue that affects about 5 to 10 percent of women across the United States. Known as the silent killer, PCOS is notorious for its two trademark symptoms; menstrual cycle irregularities and ovarian dysfunction. Allow us to explain this in a little more detail.
A woman’s ovaries have several follicles that are comprised of small sacs to hold an egg in place. Once the egg has matured, it leaves the sac and enters the uterus to get fertilized. Now this is where the trouble with PCOS begins. Women with the condition don’t experience proper ovulation cycles. The immature eggs in the follicles will clump together and form tiny cysts around the outer walls of the ovary and won’t release when they’re supposed to.
What’s the result of this? Women with PCOS tend to miss their periods and some don’t have them at all for long periods of time. And that explains why it’s the leading cause of infertility among women today.
What Are The Causes Of PCOS?
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.
Approximately 60-80% 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).
I consider insulin resistance the prime cause of PCOS because there’s an 80 percent PCOS prevalence rate among women who have insulin resistance problems. However, keep in mind that there are several risk factors that can exacerbate insulin resistance in you, such as a lack of physical activity and poor dietary habits.
Currently, a lot of research is being directed toward finding a correlation between PCOS and diabetes because insulin resistance lies at the center of both issues. Insulin is a type of hormone that’s produced in the pancreas and helps regulate glucose levels in your body. However, if you’re resistant to insulin, then your body isn’t going to be able to keep stable glucose levels. To counter this apparent ineffectiveness of insulin, the body produces more of it, thinking the system needs more. Excess insulin is linked with excess androgen production, which is another plausible explanation for PCOS.
Abnormal Hormone Excretion
High levels of androgens in the body lead to high levels of testosterone. The ovaries normally do produce some amounts of testosterone on a regular basis so the existence of male sex hormones isn’t a sign of alarm. Even males have some amount of progesterone and estrogen in their bodies. The problem lies in the excess. But where is all this testosterone coming from?
The pituitary gland located at the base of your brain is responsible for hormone secretion. In healthy females, it releases consistent amounts of follicle stimulating hormones (FSH) and luteinizing hormones (LH). These hormones signal the ovaries to produce the female sex hormones; progesterone and estrogen. But when the pituitary gland begins behaving abnormally, it signals an excess production of androgens like testosterone.
High levels of testosterone can lead to abnormal growth of hair in women such as coarse facial hair. It can also cause chronic acne that can be emotionally draining.
Studies show that immediate family members of women with PCOS are at a 50 percent higher risk of developing PCOS. There isn’t one particular gene that can indicate PCOS prevalence in a woman, but family history can play a key role in determining many health conditions.
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)
Signs That You Might Have PCOS
With researchers still working to determine the causes of PCOS, it’s difficult to say who fits the diagnostic criteria. PCOS is a complex issue and not everyone experiences all the symptoms listed.
One of the reasons why so many women remain elusive to a PCOS diagnosis is because doctors find it hard to detect cystic ovaries. Even if you go for a gynecological ultrasound, there’s no surefire way of knowing that you have the disease because some women tend to have normal looking ovaries even with PCOS.
A better option would be to look for signs of androgen excess. I’ve told you about high testosterone levels but that’s just one part of the picture. To get the big picture on PCOS you’ll have to get tested for various types of androgens in your body.
So what do you do until you’ve got a test scheduled? There’s got to be some observable signs of PCOS right? Correct. Here’s a list of things you should watch out for to know if you’ve got PCOS.
1. Problems in Ovulation Cycle
Ovulatory dysfunction is a key sign of PCOS and this can be noted in the irregularities of your menstrual cycle. There are two kinds of things you should be on the lookout for; if you’re missing out on some period cycles then you’ve likely got amenorrhea. However, if you’ve got irregular or delayed periods then you’re showing signs of oligomenorrhea. Both these conditions are closely linked with infertility among adult women and occur as key signs of PCOS.
2. Dark Patches on the Skin
If you’re noticing small circular patches emerging on your neck that are darker than your skin color then this might be a sign to note down. Dark patches on the back of the neck or sometimes on the elbows, symbolize a hormonal imbalance.
Many at times this imbalance may be caused due to insulin resistance, indicating that the woman’s body is facing difficulty regulating glucose levels. Hold a consultation to find out if it’s an impending sign of diabetes or PCOS.
Pimples aren’t just a thing of puberty. They can happen to adults too and when they do, they’re usually telling you it’s a sign of something internally wrong. What happens with PCOS acne is that the androgen excess in your body triggers the overproduction of testosterone and that hyper-activates your sebaceous glands. This, in turn, produces lots of sebum and clogs the pores of your skin, trapping bacteria in them. Inflammation begins and you’re met with red swelling and lesions on your skin. If you’re at risk of PCOS then you’re likely to get acne around the lower half of your face, such as the jaw, chin and neck.
4. Feelings of Fatigue
Trouble falling asleep or waking up feeling tired can be among the initial signs of PCOS. Insomnia and sleep apnea are both closely linked with the disease and are considered common by-products.
Sleep apnea, in particular, can occur even when you’re getting the recommended hours of sleep. Feeling tired during your waking hours can also be linked with insulin problems so be sure to get yourself checked.
5. Cravings for Certain Kinds of Food
Insulin problems will naturally make you crave certain sweet foods and with PCOS you’re likely to pine over the carbohydrates. This is because your cells need glucose for energy, but with an insulin resistance they’re unable to digest starchy foods for energy. I suggest you figure out a nutritional meal plan for your condition here.
When we‘re talking about insulin, let’s also address the elephant in the room. Diabetes is closely linked with the onset of PCOS. Women experiencing diabetes can also experience a variety of other health issues like high cholesterol, high blood pressure, and the increased risk of incurring a stroke. Match that with PCOS and there’s also a heightened risk of endometrial cancer.
7. Excessive Hair Growth
Hirsutism is the name of the condition that causes women with PCOS to grow hair in places where they normally don’t, such as the face, chest, or the abdominal area. You can link this back to the overproduction of male sex hormones during PCOS and the high levels of testosterone in the ovaries. Hair loss might be a sign that you need a Hormone Makeover
8. Thinning of Hair
Don’t let this sign confuse you. You might be growing hair in new places on your face and body but the scalp could be struggling to maintain your healthy locks. With high levels of testosterone, you can experience male patterned baldness—which is different from mild hair fall issues. If you suffer with hair loss, this video titled, “Top 5 reasons for Hair loss” explains the hormones that are typically some of the culprits.
9. Depression and Anxiety
There can be multiple confounding factors that can affect the onset of depression and anxiety in women but you shouldn’t count PCOS out of the list. Research suggests that women diagnosed with PCOS should also be screened for any underlying mental health issues since they’re more at risk. Mood changes are a common sign of PCOS. If you’re already struggling with your mental health, hormonal imbalances from PCOS can make you feel worse. Here’s a good read on the foods you should avoid for better mental health.
Natural Strategies to Prevent and Improve PCOS
There are many natural strategies to prevent and improve PCOS. 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, supporting gut health and supplementing with N-acetylcysteine, omega-3 fatty acids, vitamin D, and inositol.
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. 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 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.
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.
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.
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.
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. The ideal range for vitamin D3 levels is between 50-80 ng/ml.
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. Supplementation can ensure you are getting adequate vitamin D. It is also important to keep vitamins D3 and K2 in balance which can be done by taking a Vitamin D3/K2 supplement.
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)
Final Thoughts To Remember about todays article.
PCOS is a hormonal imbalance issue that can severely disrupt the endocrine system and lead to infertility among women of childbearing age. It’s a fairly common condition but detecting ovarian cysts can be tricky. However, the lack of diagnosis shouldn’t deter anyone from being on their guard. Untreated PCOS can give birth to several health problems. One of the most commonly associated issues with PCOS is insulin resistance.
The body’s inability to utilize insulin can trigger a spiral of endocrine issues that manifest themselves in ways. Excess hair growth, acne, and patches on the skin can confuse anyone to think it’s a passing dermatological issue.
That’s why it’s recommended that women remain knowledgeable about all possible signs of PCOS so they can seek treatment at the earliest.
Want Professional Help For PCOS Related Issues?
Dr. Hagmeyer clinic is leading the way in helping women with hormonal issues find ways to receive an early diagnosis. If you would like to learn more about working with Dr Hagmeyer or becoming a patient, take a few minutes and tell us a bit more about your health history. If Dr Hagmeyer and his team feels they can help, we will send you a link to schedule an initial free 15 minute consult.
If you’re not sure about the signs of PCOS and need help then simply fill out this health questionnaire and a member of my team will reach out to you very soon.