PCOS (Polycystic Ovarian Disorder) is a hormonal imbalance found in 1 out of 10 women and 10 million worldwide in child-bearing years. This condition can cause difficulties in physical and mental health, including the inability to become pregnant.

Women with PCOS typically suffer with infrequent or prolonged periods and an excessive amount of male hormones called androgens.

Despite the name, many women with this condition do not have cysts on their ovaries though it may cause enlarged ovaries with small cysts on the outside edges. Infertility, low sex drive, weight gain + difficulty losing weight, fatigue, excessive hair growth or thinning hair, and acne are also common with PCOS.

Mental health concerns such as anxiety and depression can also become present or worsened.  As one of the most common endocrine disorders for women, it is the leading cause of anovulatory infertility, a condition where ovulation doesn’t occur.

Though the downsides of PCOS are plentiful, the good news is that natural strategies to prevent and improve PCOS are also plentiful and I will cover them in detail through this article as well as the best testing strategies for female hormone health.

What is PCOS

Simply put, PCOS is an endocrine disorder. Though first recorded in 1935, this condition is so far-reaching that it is estimated 15-20% of women in childbearing years have been diagnosed with it. 5 million women in the US alone suffer from it and 10 million across the globe.

Typically, the symptoms of PCOS are seen in the ovaries. They are often Enlarged with immature follicles that failed to properly mature. Because of this, ovulation doesn’t take place, leading to infertility.  This is one of the leading causes of infertility today.

Other prominent effects of this disorder are an overproduction of male hormones called androgens. This overproduction of androgens usually occurs in the ovaries and leads to a litany of unwanted symptoms including too much hair, thinning hair and acne.

Those affected by PCOS are generally insulin resistant as well. This results in an elevation in glucose which produces insulin. Because they are insulin resistant, their body produces more androgens and the cycle continues.

In addition to the insulin resistance, there is a common imbalance in gonadotropins which is produced by the pituitary gland.

The two gonadotropins it produces are luteinizing hormone (LH) and follicle-stimulating hormone (FSH). Because LH is elevated and FSH is the same or decreased in PCOS, the result is higher levels of androgens produced by the ovaries.

Symptoms of PCOS

PCOS symptoms can vary, but most sufferers will experience irregular or missed periods due to not ovulating. Some people develop this condition around puberty, but it can also develop in adulthood, especially after a significant weight gain.  Although some will develop cysts on their ovaries, many people don’t.

Other symptoms include:

• Weight gain
• Difficulty losing weight
• Acne
• Insulin resistance
• Fatigue
• Mood changes
• Depression
• Anxiety
• Bipolar disorder
• Binge eating disorder
• Male-pattern hair growth (hirsutism)
• Male patterns of baldness
• Thinning hair
• Pelvic pain
• Infertility
• Headaches
• Sleep problems

PCOS and Insulin Resistance

Insulin resistance results in increased glucose levels.  When this happens, the body creates more insulin and that leads to more androgen production which, in turn, stops ovulation.  Nearly 50-70% of people with PCOS are insulin resistant.

It is very possible that insulin resistance is a root cause of PCOS, both in bringing it about and making it worse. Stress and chronic inflammation are also contributors. Fortunately, it is possible to manage insulin resistance through lifestyle changes and medicine.

What Causes PCOS

While the cause of PCOS isn’t clear, there are some clear indicators that point to it such as chronic inflammation, genetics, insulin resistance, excess androgens, type 1 and 2 diabetes, and metabolic syndrome. We will explore a few of these possible causes in more depth below.

• Chronic Inflammation

We know that chronic inflammation is a heightened reaction of the body’s immune system to a perceived threat.  Blood work from women with PCOS show heightened levels of inflammatory markers, and we are more and more convinced that chronic inflammation is a main contributor to the development of PCOS.

When the body is in a state of chronic inflammation, due to exposure to foods and environmental factors that the body perceives as a threat, the immune system is triggered and sends white blood cells to fight the intruders.

While this response gives your body the ability to fight off infection, a prolonged state of emergency will eventually lead to the body attacking its own organs, tissues and cells. This is chronic inflammation and is increasingly thought to be a major factor in nearly all major diseases today by the medical community.

This cycle will continue until the root cause of the inflammation is addressed.

• Insulin Resistance

Insulin is a hormone produced by the pancreas that allows sugar in the body to be turned into energy and keeps the metabolism functioning properly.

Insulin resistance causes the blood sugar to rise and the pancreas to produce more insulin. When insulin levels are too high, the body may begin to produce more androgens (male hormones) and this results in difficulty with ovulation.

Not only do high insulin levels make PCOS worse, many believe it actually drives the condition and can also bring about high blood pressure, diabetes, infertility, an overproduction of estrogen, weight gain, heart disease, elevated cortisol and cancer.

• AGEs

Advanced Glycation End Products (AGEs) are highly reactive molecules that are present after glycation of lipids and proteins and are found at increased levels in women with PCOS.

Caused mainly by the Westernized diet (Standard American Diet), smoking and fast food, AGEs are another contributor of PCOS and plays a role in worsening PCOS symptoms.

This takes place because of inflammation and oxidative stress, producing damage to tissue through the body as well as attributing to the aging process, development of diabetes, female fertility issues, atherosclerosis and cancers.

Complications of PCOS

The complications of PCOS are extensive and can include:

• Sleep apnea
• Type 2 diabetes and prediabetes
• Depression and anxiety
• Eating disorders
• Infertility
• Miscarriage and premature birth
• Gestational diabetes
• Pregnancy-related high blood pressure
• Abnormal uterine bleeding
• High blood pressure
• Unhealthy cholesterol
• Endometrial cancer
• High blood sugar
• Nonalcoholic steatohepatitis: a severe liver inflammation caused by fat accumulation in the liver

Conventional Treatments for PCOS

PCOS sufferers have multiple options for treatment.

• Birth control – to regulate hormones and the menstrual cycle.
• Clomiphene/Letrozole – to aid in ovulation
• Metformin/Gonadotropins – to regulate insulin levels
• Spironolactone/Eflornithine/Birth Control/Electrolysis – to reduce excess hair growth

Unfortunately, there are numerous side effects with all of these treatments (Spironolactone, for example, can lead to birth defects). The good news is that Functional Medicine and Lifestyle changes are incredible effective and come without the side effects.

Natural Strategies to Prevent and Improve PCOS

Lifestyle changes can be very effective in preventing and managing PCOS.  These changes may include:

• Caloric intake timing
• Supplements
• Anti-inflammatory and nutrient-rich diet
• Decreasing AGEs
• Weight loss

Caloric intake timing has to do with consuming the majority of your calories in the morning as opposed to later in the day.  Women who did this for 12 weeks significantly improved their insulin and glucose levels as well as decreased their testosterone levels by 50 percent.

Supplements are significant in giving the body the support it needs to combat the symptoms and side effects of PCOS.  Magnesium, chromium, omega-3 fatty acids, vitamin D, N-acetylcysteine and inositol can offer significant benefits such as improved blood glucose and insulin levels, decreased androgen production, lower testosterone concentrations and regulated periods. Learn more about some of the best supplements that help with PCOS.

Anti-inflammatory and nutrient rich foods reduce inflammation, balances blood sugar and improves insulin levels. Learn more about the anti-inflammatory diet I recommend.

 Decreasing AGEs by avoiding foods high in them like animal products and heavily processed foods and avoiding high heat cooking (grilling, searing, roasting) can significantly reduce insulin levels.

Weight loss is also another important strategy to improve PCOS.  Just a 5% reduction in weight can help with infertility and improve overall health (source).

Anti-inflammatory Healing Diet

Chronic high inflammation is a root cause of many PCOS symptoms and can be reduced by avoiding foods that cause further inflammation.  Reducing these outside contributors offers many benefits such as reducing toxins, regulating blood sugar, diminishing insulin sensitivity, encourage healthy blood Ph levels, and equip the body with important nutrients. If testing for inflammation, I recommend you work with a functional medicine doctor who can order some of the blood testing that can assess your inflammation levels. These are the 5 best tests for monitoring and identifying inflammation.

Foods to Include

• Fish
• Legumes
• Nuts
• Olive oil
• Herbs
• Spices
• Green tea

In general, anti-inflammatory foods are whole and unprocessed. Pesticides can have a negative impact on estrogen and other hormones so eating organic is important.

To keep high blood sugar at bay, Low glycemic fruits and vegetables like berries, lemons, limes and Granny Smith apples are good choices.

Vegetables with high levels of phytoestrogens (dietary estrogens) are broccoli, cauliflower, cabbage, kale, bok choy, and brussel sprouts.  Phytoestrogens imitate the body’s normal estrogen and can aid in balancing hormones and regulating the menstrual cycle.

When eating meat, grass-fed, pasture-raised, and wild-caught meats and fish our best. Wild caught salmon, grass-fed beef and Dairy have the added benefit of increased omega-3 fatty acids and conjugated linoleic acid. They contain healthy fats which are also found in avocados, coconut, olives, and their oils, and in grass-fed butter and ghee.  Giving the body sufficient fuel from healthy sources helps it in fighting inflammation.

Foods to Avoid

Foods that cause inflammation in the body include simple carbohydrates, refined sugars and food that is easily turned into sugar by the body.  Unfortunately, the standard American diet is full of these foods. They contribute to inflammation, oxidative stress, and are often high in levels of AGEs.

Foods that should be avoided include conventionally raised meat and dairy, farmed fish and foods that contain endocrine disruptors like hormones, steroids, GMOs, antibiotics and pesticides.

A1 casein is a protein found in Dairy that stimulates the immune system, causing it to release inflammatory cytokines. This protein along with gluten should also be avoided.

Avoiding processed foods that have additives and preservatives is an important part of healing and lowering inflammation for PCOS sufferers. Processed vegetable oils like canola, grape seed and safflower should be replaced with healthier oils.

Lose Excess Weight

Weight loss can have a significant impact on restoring normal function to the ovaries and hormone production. This can help with excess facial and body hair, hair loss, and acne. A good place to start is with balancing your gut microbiome, improving insulin sensitivity, and healing a leaky gut.

Following a healthy, anti-inflammatory diet is key, and intermittent fasting can also help heal the gut and balance hormones.

For exercise, consider high intensity workouts. Not only will it help you maintain a healthy weight, but it will also increase anti-aging hormones and fat burning for 36 hours after a workout.

Improve Insulin Sensitivity and Balance Blood Sugar Levels  

Preventing and improving PCOS must include balancing blood sugar levels and improving insulin sensitivity.  Foods high in refined sugars and carbohydrates create a cycle in our body that contributes to insulin resistance can high levels of inflammation. These foods cause a spike in blood sugar which signals the pancreas to release more insulin so that the body can convert the sugar into energy.

When insulin levels spike, there’s a quick drop in blood sugar and a rise in cortisol. These fluctuations produce inflammatory cytokines that deregulate insulin production, spikes in blood sugar and increased insulin resistance.

The anti-inflammatory diet mentioned above can greatly help with balancing blood sugar and improving insulin resistance. Getting enough sleep, addressing thyroid issues, minimizing stress, and boosting vitamin D levels are also effective.

NuMedica combines three professional dietary supplements into a targeted daily regimen designed to provide advanced nutrition for managing your blood sugar level.

Provides the super antioxidant alpha-lipoic acid; Berberine and high potency extracts of fenugreek (15:1), gymnema and bitter gourd along with added B vitamins

Balance Hormone Levels

Woman suffering with PCOS often show signs of Excess Androgens or Androgen overload. In this scenario, the androgen overload causes oily skin, excess hair growth on the chin and sometimes the chest. Fortunately, there are supplements that can go a long way in preventing this. Phyto-antiandrogens are a class of phyto-compounds that decrease tissue sensitivity to androgens or decrease androgen activity, such as through the action of 5-alpha-reductase inhibition, which decreases conversion of testosterone to the more androgenic dihydrotestosterone (DHT).

Aromatase is the enzyme responsible for the conversion of androgens to estrogen. Aromatase activity is decreased in women with PCOS. Enhancing aromatase activity may be an effective strategy for women with PCOS, especially those with obesity.

Avoid Endocrine Disrupting Compounds

Toxins in our environment such as pesticides, polychlorinated biphenyls (PCBs), parabens, phthalates, and dioxins are called endocrine disrupting compounds (EDCs). These compounds are especially harmful to women with PCOS because of how they impact hormones in the body and can lead to other hormonal disorders.

Plastics contain xenoestrogen chemicals. They mimic naturally occurring estrogen in the body, contributing to excess estrogen production and lodging themselves in fat cells where they cannot be broken down.

A common xenoestrogen is called Bisphenol A (BPA), and is found in the lining of cans and plastic. This harmful chemical can leach into water and other foods and liquids heated in plastic containers.  When tested, women with PCOS had higher levels of BPA. This can lead to insulin resistance and higher levels of androgens.

In order to maintain a healthy hormone balance in the body, minimizing exposure to EDCs is crucial. Avoiding plastics is largely important but also avoiding soy isoflavonoids, sugars, grains, conventional meat and dairy, additives, preservatives, beer, and processed foods are also critical.

When possible, choose foods that are organic and hormone-free and read the labels of your personal care products.  You can also find a wide range of BPA-free cans and bottles in the marketplace.

Reduce High Cortisol Levels

Elevated cortisol levels are often caused by chronic stress, blood sugar imbalances and disturbances in the sleep wake cycle. This can come from not getting enough sleep, long work hours, excessive dieting, over-exercising, and other lifestyle contributors.

Other causes of chronic stress can be internal such as inflammation, autoimmune disease, environmental toxins, and chronic infections.  Taking a Functional Medicine approach to decreasing Cortisol levels also has the added benefit of improving PCOS. Here are 5 ways to reduce high cortisol levels 

Inositol and PCOS

This compound occurs naturally in the body and is part of the citric acid cycle.  The citric acid cycle causes food to be transformed into energy and can improve the reproductive, hormonal, and metabolic aspects of PCOS. Inositol also helps store and metabolize amino acids.

Inositol occurs in nine forms and can be found in beans, nuts, cantaloupe, oats, wheat germ, beef liver and fresh citrus (with the exception of lemons). Inositol stereoisomers, myo-inositol (MI) and D-chiro-inositol (DCI),the most abundant forms, help improve ovarian function, reduce insulin resistance and lower androgen levels in women with PCOS.

Omega 3 Fatty Acids and PCOS

Omega-3 fatty acids are proven to help reduce inflammation and regulate hormone production. Because women with PCOS often suffer with hormone imbalances, oxidative stress, and inflammation, these fatty acids are important and also improve insulin sensitivity.

Foods rich in Omega-3’s include fatty fish such as sardines and wild-caught salmon, pasture-raised eggs, nuts (especially walnuts), seeds like flax, hemp, and chia seeds, and grass-fed meats. Flax, hemp, and chia seeds also increase estrogen production.

Another fantastic source of omega-3 fatty acids is omega 950. It provides exceptionally high levels of the omega-3 fats EPA and DHA.

It is ideal for people wanting high intensity, therapeutic support in a smaller serving. Omega 950 provides an ultra-pure, molecularly distilled, natural marine lipid concentrate sourced from fish caught in cold, deep sea waters.

Omega 950 formula is molecularly distilled and is independently verified to ensure potency and purity according to the highest worldwide standards. The purity assay process includes testing for PCBs, heavy metals and pesticides.

EPA and DHA from fish oil promote cardiovascular health by supporting optimal triglyceride and cholesterol levels and reducing platelet aggregation.* Fish oil has also been shown to promote optimal joint function and overall brain and nervous system function.*

Vitamin D and PCOS

About 42% of the US population is deficient in vitamin D and around 70 to 80% of PCOS sufferers are deficient in vitamin D.

There’s a strong relationship between low vitamin D and insulin resistance.

A biologically active form of vitamin D is D3. It is more effective in raising and maintaining vitamin D levels than D2 with an ideal range between 50-80 ng/ml.  15 to 20 minutes of sun exposure daily helps your skin to create vitamin D3.

Other dietary sources of vitamin D are egg yolks, mushrooms, beef liver, grass-fed butter and raw cheese, cod liver oil, and wild-caught salmon and other fatty fish.

Although these sources are helpful, it is nearly impossible to get enough vitamin D from sun exposure and food alone.

Supplements can help with this.

N-Acetylcysteine and PCOS

N-Acetylcysteine (NAC), naturally occurring in garlic, is the acetylated form of the amino acid cysteine.

It improves hyperandrogenism, hyperinsulinemia and increases menstrual regularity. NAC has also proven to increase ovulation and pregnancy rate in PCOS patients.

One great source of NAC is Liver Defend.

Liver Defend contains targeted nutrition to help the body maintain healthy liver function.*

It contains four key ingredients:

• NAC (N-Acetyl L-Cysteine), which serves as a precursor for the synthesis of glutathione*

• Alpha-Lipoic Acid, a powerful antioxidant and free-radical scavenger.*

• Silymarin (standardized extract from milk thistle), which may help promote glutathione production.*

• Selenium, a trace mineral known to support the antioxidant enzyme glutathione peroxidase.

Conclusion:

Polycystic Ovarian Syndrome (PCOS), the most common endocrine disorder in women, and can be devastating to a woman’s health and appearance.

Common symptoms associated with PCOS pertain to menstrual dysfunction, ovulation, and excess production of androgens or male hormones.

Despite the name, many women with this condition do not have cysts on their ovaries though it may cause enlarged ovaries with small cysts on the outside edges. Infertility, low sex drive, weight gain, difficulty losing weight, fatigue, excessive hair growth or thinning hair, and acne are also common with PCOS.

Mental health concerns such as anxiety and depression can also become present or worsened.  It is also the leading cause of anovulatory infertility, a condition in which ovulation doesn’t occur.

Factors thought to be linked to PCOS include obesity, lipid abnormalities, hormonal imbalances, and genetics. Because insulin resistance and chronic inflammation are also major contributors to PCOS, natural strategies are important for improving and preventing PCOS.

Some of those strategies include correcting hormonal imbalances, improving insulin sensitivity, and eating an anti-inflammatory diet.

Losing weight, reducing high cortisol levels, avoiding endocrine disrupting compounds and supplementing with N-acetylcysteine, omega-3 fatty acids, vitamin D, and inositol have also proven to be effective.

Additional PCOS articles You Might Find Helpful 

1. Supplements to Cope With Your PCOS Symptoms
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3. Can you conceive when you have PCOS
4. Is the Pill the answer to your PCOS woes
5. Improve gut health for weight loss in PCOS patients
6. Diet and PCOS foods to eat and foods to avoid
7. What is adrenal androgen excess
8. 9 signs you might have PCOS
9. Understanding the relationship between PCOS and Acne
10. Hormonal imbalance and what you can do about it
11. The link between PCOS and Thyroid disease
12. PCOS and the Functional Medicine approach
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14. Understanding the Big Picture of PCOS
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