Holistic Approaches to PCOS — Dr. Lana Wellness

PCOS was once viewed as strictly a gynecologic condition, however now it is being better understood as an endocrine condition that involves both gynecologic and metabolic factors. PCOS is the leading cause of infertility, affecting between 6-12% of women of reproductive age (around 5 million women) in the United States.

Symptoms of PCOS

• Amenorrhea (not getting a monthly period)

• Irregular periods (two in a month or skipping months at a time)

• Clotting

• Menorrhagia (heavy/excessive bleeding)

• Metrorrhagia (bleeding between periods)

• Anovulatory cycles

• Painful cramping / pelvic pain

• Mood disturbances / depression

• Acne, especially cystic acne along the jawline, chin, and neck

• Hair loss, thinning hair on the head

• Hirsutism – excessive hair growth in abnormal areas such as on the face (upper lip, chin, sideburns), chest, nipple, “happy trail” and back)

• Weight gain, difficulty losing weight

• Dysregulated cortisol levels

• Infertility

Types of PCOS

The four main types of PCOS are:

Insulin-resistant PCOS

The most common type of PCOS is insulin-resistant PCOS which accounts for about 70% of all cases and is caused by chronically elevated insulin, or hyperinsulinemia. Insulin resistance can lead to increased production of androgens (male sex hormones) which can lead to cystic acne and hirsutism. Women with insulin-resistant PCOS are more likely to experience weight gain, sugar cravings, mood swings/dips, fatigue and even skin tags due to the dysregulation of blood sugar and an improper production and secretion of hormones such as insulin, cortisol and even some thyroid markers.

Adrenal PCOS

Adrenal PCOS may be caused by chronic stress or an abnormal stress response. Women with adrenal PCOS will likely have elevated DHEA-S, with normal testosterone levels and dysregulated cortisol. Managing stress levels, eating meals at consistent times, watching caffeine intake and prioritizing rest and recovery are critical for managing this type of PCOS.

Inflammatory PCOS

Inflammatory PCOS is caused by inflammation which can lead to excess production of testosterone. Women with inflammatory PCOS will have elevated inflammatory markers, such as hs-CRP, homocysteine, and HOMA-IR. Symptoms of inflammatory PCOS may include fatigue, brain fog, skin conditions and even muscular and/or joint pains. Prioritizing gut health and removing inflammatory foods from the diet are critical for managing this type of PCOS.

Post-Pill PCOS

Post-Pill PCOS is the most common type of PCOS seen in our clinic. This type of PCOS is caused by a temporary dysregulation of sex hormones that one can experience when coming off of the pill. Anything from estrogen dominance, irregular ovulation, an increase in androgens, mismanaged or poorly responsive insulin, and elevated cortisol can be seen within this PCOS presentation. This type of PCOS requires patience, stress reduction, and lowering inflammation while balancing hormones through dietary and supplemental modifications. If you are wanting to come off the pill or are curious in learning more about the process of coming off the pill check out our blogs on birth control. 

Diagnosing PCOS

Because PCOS can present differently in different people and has a spectrum of severity, it can be difficult to diagnose. PCOS is typically a diagnosis of exclusion, and requires meeting at least 2 of the 3 criteria:

• Ultrasound showing ovarian “cysts”

• It is important to note these so-called “cysts” are not actually cysts at all, but rather ovarian follicles that never fully matured due to hormonal imbalances. Many women may have such immature follicle accumulation on their ovaries and not have PCOS, so an ultrasound alone is not sufficient for a diagnosis.

• Irregular or infrequent periods

• Blood test showing elevated androgens (testosterone, DHEA, DHEA-S, etc.) 

Nutritional Guidance for PCOS

(for more information on nutrition and recipes to support PCOS, check out our PCOS cookbook here.)

Adopting an anti-inflammatory diet with an appropriate balance of macronutrients is essential for keeping PCOS symptoms under control. Dietary recommendations for managing PCOS include:

• Adopting a Mediterranean-leaning diet that is low-glycemic and anti-inflammatory

• Reduce inflammation by avoiding processed foods, corn, gluten, and dairy. 

• Choose organic whenever possible to reduce pesticide and herbicide exposure

• Aim for 6-8 cups of non-starchy veggies daily

• Increase consumption of brassica vegetables (cabbage, cauliflower, bok choy, broccoli, kohlrabi, kale) as they contain compounds such as DIM (diindolylmethane) and I3C (indole-3-carbinol) which help to metabolize and eliminate hormones.

• Aim for around 1⁄2 cup of grains/legumes/starchy veggies 1-3 times daily

• Start your day with a well-balanced blood sugar stable meal, comprised of a healthy source of fat, lean protein, and fiber

• Dilute 1 T. of apple cider vinegar in an 8 oz glass of water and drink 10-20 minutes before meals to help reduce post-prandial (after meal) glucose spikes 

Supplements and Specific Nutrients for PCOS

• Omega 3 fatty acids help to decrease  inflammation, improve lipids, and may lower fasting blood sugar.

• Vitamin D

• ALA

• Chromium Picolinate

Lifestyle Support for PCOS

Adopting specific lifestyle changes play an important role in managing PCOS. Depending on the type of PCOS, recommendations may vary slightly, however a few tips remain constant among all forms of PCOS. These include:

• Remove or significantly reduce alcohol  as it has a negative effect on estrogen levels, liver health, hydration,  and mood stability. 

• Incorporate regular exercise and movement, especially resistance training, which has been shown to improve insulin sensitivity. This is of particular importance for individuals with insulin-resistant PCOS.

• Manage stress levels and prioritize rest and recovery, as elevated stress hormones (cortisol + DHEA-S) are often a key factor in PCOS.

• Incorporate short walks into your post meal routines to help with blood sugar stability (even 5 min will make a difference!)

• Reduce exposure to endocrine disrupting chemicals (“EDCs”) and toxins by taking a look at your household cleaning products, as well as food storage containers, makeup and skin care products. We love using the Skin Deep app from the Environmental Working Group when making skincare and/or make up decisions. Some of our favorite brands include: Naked Poppy, Green Envee, Routine, Dime, Oliver Care Co, Varuza, Think, W3LL People, and Juice Beauty.

PCOS may seem like a daunting diagnosis, but through diet, lifestyle and supplementation changes the symptoms are highly manageable and your quality of life can improve. Stay tuned for our upcoming PCOS Course to dive deeper into all things PCOS and in the interim check out our PCOS Cookbook.

Citations

Akre, S., Sharma, K., Chakole, S., & Wanjari, M. B. (2022). Recent Advances in the Management of Polycystic Ovary Syndrome: A Review Article. Cureus, 14(8), e27689. https://doi.org/10.7759/cureus.27689

Kiani, A. K., Donato, K., Dhuli, K., Stuppia, L., & Bertelli, M. (2022). Dietary supplements for polycystic ovary syndrome. Journal of preventive medicine and hygiene, 63(2 Suppl 3), E206–E213. https://doi.org/10.15167/2421-4248/jpmh2022.63.2S3.2762

Briden, L. (2022, January 29). 4 Types of PCOS (a Flowchart). Lara Briden – the Period Revolutionary. https://www.larabriden.com/4-types-of-pcos-a-flowchart/

Polycystic ovary syndrome (PCOS) – Diagnosis and treatment – Mayo Clinic. (2022, September 8). Polycystic Ovary Syndrome (PCOS) – Diagnosis and Treatment – Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

Polycystic Ovary Syndrome (PCOS). (2022, February 28). Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos