PCOS: The no nonsense guide to diagnosis, type, and healing protocols
P.C.O.S…. ever heard of it? No?!
PCOS stands for Poly Cystic Ovarian Syndrome and it is estimated that 8-10% of childbearing-aged women are affected with it in The United States, AND that doesn’t account for many of the women with subtypes not currently recognized by a lot of mainstream doctors (we’ll get to that).
In order to be officially diagnosed with PCOS you have to have to fall under 2 of the 3 following criteria:Absent or irregular menstrual cycles Elevated male sex hormone levels (like testosterone, androstenedione, etc)* Multiple cysts on ovariesSo, as you can see, the name ‘polycystic’ ovarian syndrome is a little bit misleading considering a woman can have PCOS WITHOUT any cysts. NOte that I starred in criteria 2, that is because an imbalance in male sex hormones is almost inevitably what CAUSES 1 and 3. Cysts don't start growing out of nowhere, and your period doesn't go bye-bye for nor reason. Having an imbalance between male and female sex hormones is what PCOS is all about, and THAT imbalance is what the healing solutions will be targeting later in this post.
First and foremost, PCOS at its root is a hormone imbalance, between female sex hormones and male sex hormones in the body. More often than not, we see elevated testosterone and DHEA-S. Sometimes this is accompanied by low estrogen and progesterone, sometimes it isn’t. But remember, even if your Estrogen and Progesterone are in ‘normal’ ranges, they will still be too low IF your testosterone is through the roof--Hormones are about RATIOS!!
Here are common symptoms associated PCOS-irregular or missing periods-acne along the jawline, chin, mouth, and neck-hirsutism (male patterned hair growth-like on the face and back)-inconsistent ovulation or NO ovulation at all (‘anovulation’) - Alopecia (male patterned hair LOSS--like along the temples and top of scalp)-weight gain, particularly around midsection-Low sex drive-difficulty sleeping-mood swings-infertility/unable to conceive
If you’ve been diagnosed with PCOS, or THINK you may have it, and are freaking out right now, don't!
The amazing news is that because PCOS at its core is a hormone imbalance, using natural methods to bring the body back into balance has proved so successful in women conceiving naturally, relieving symptoms, and even reversing it!
SO. Let’s first dig into testing and Types so we can understand how to get a proper diagnosis in order to create the best healing plan for you.
TESTING:Most doctors will complete blood work AND THEN if need be, an ultrasound to detect cysts. If you suspect you have PCOS, I highly suggest getting the following hormone panel done through your doctorFree TestosteroneEstrogenProgesteroneSex hormone binding globulinLHFSHDHEA-S*AMH (Anti-Mullerian Hormone)--> not tested by most doctors but recent studies are showing this hormone is elevated in women with PCOS and has far-reaching implications in the hormonal environment created for offspring, so I recommend getting it tested!
WHICH TYPE ARE YOU??
PCOS, for the longest time, was commonly associated with 1 thing: insulin resistance. The PCOS stereotype was of an overweight woman with blood sugar dysregulation and often pre-diabetic. The solution was some combination of birth control and blood sugar stabilizing drug….simple, yes?
What we see in the medical literature is a lot more varied. Women can develop PCOS as a SECONDARY condition from thyroid dysfunction, adrenal fatigue, eating disorders, etc. Making the simple explanation of ‘you eat too much sugar’ far too simplistic and UNnuanced to settle with me.
From what we know, though there are multiple different types/causes, there are 2 MAIN types of PCOS I want to discuss today. They makeup up the majority of cases, and knowing WHICH ONE you fall into is critical for going down the RIGHT healing path.
TYPE 1: INSULIN RESISTANT
This is the ‘classic’ PCOS type that makes up more than 60% of the cases. The primary cause: excess testosterone produced by ovaries which is stimulated by excess insulin levels in the blood. Women are insulin resistant (meaning they don’t process blood sugar efficiently) and sometimes pre-diabetic by the time they are diagnosed with PCOS. The constant rise of insulin stimulates the ovaries to produce excess testosterone, throwing off our sex hormone balance and leading to a dominant male/female sec hormone ratio. This kind of PCOS is what most books and doctors talk and write about. Which is why if you look up PCOS solutions on google, a lot of them will include things like ‘lose weight, cut out processed sugar, exercise more’ etc. Though it is oversimplified, the advice isn't altogether wrong, besides the 'lose weight' part.
READ: You can absolutely make healthy choices and regulate your blood sugar without obsessively making weight your focus and simply allow your body size to settle into it's naturally healthy place. #healthateverysize
In addition to the symptoms marked above, this insulin resistant type will often see -accumulation of fat, particularly in the midsection-weight loss resistance-mood swings and blood sugar dips*note: this type is thought to only exist in overweight women but women of ALL shapes and sizes can have insulin resistance, so best rely on lab work for diagnosis
Some specific blood markers for this type include:-high testosterone levels-LH:FH ratio higher than 1:1-elevated fasting glucose
TYPE 2: STRESS INDUCED PCOS
This type of PCOS is commonly coined as “lean PCOS” because it is seen in thinner, sometimes underweight, women. But REALLY the cause of it is physical and/or psychological stress. This form of PCOS is VERY common in women with eating disorders, dramatic weight loss, restrictive food tendencies, and athletes. Where type 1 is characterized by an EXCESS of testosterone, type 2 is often more characterized by a DEFICIT of female sex hormones (estrogen and progesterone), therefore throwing the hormones out of balance. That is because emotional stress like toxic relationships or a negative body image, as well as PHYSICAL stress, like over exercising and under eating, send the signal to our pituitary gland that it is NOT a good time to be making babies! So our brain (wisely) downregulates fertility and we end up with insufficient progesterone and estrogen. Here are some of the common characteristics in Type 2 PCOS:-chronic dieters- weight loss over 25 lbs and/or at very low body fat percentage (estrogen is produced in fat cells, so if we don’t have enough fat we don’t have enough estrogen)- *at a weight lower than when first received period during puberty- over exercising-undereating-extreme emotional stress-disrupted sleep-negative, obsessive thoughts on body-athlete (undergo a LOT of physical stress)-Have lost or currently lost their period (amenorrhea)
Blood markers *don’t need to have all, but these can all co-occur:-LOW FH, LH, and estrogen - high-stress hormones (cortisol, DHEA-s)-average or high testosterone-low prolactin-*possibly high AMH
Though these two types differ in the main mechanism at play, there are a LOT of similarities in the way you want to approach healing with only a few tweaks. Let’s dig into that, shall we!
1. Nutrient-dense diet
No matter the type of PCOS, focusing on eating ENOUGH nutrient-dense whole foods of EVERY macronutrient is going to help stabilize blood sugar levels, feed our endocrine system, and ensure that we are fed and full (2 things that are VERY important to the female brain). Let the focus move away from calorie counting and diet food and onto maximizing nutrients from whole foods in their natural state. For type 2, getting enough food in general is the most critical for healing. Particularly a proper balance of all three macronutrients: Carb, protein, and fat. No low carb or low fat! That is a hormonal nightmare for most women, especially PCOS. And for Type 1, resist the urge to eliminate carbohydrates completely and Choose nutrient-dense sources of carbs like starchy vegetables. For my more info about nutrition and a list of my favorite healing foods to focus on, go HERE.
2. Adrenal Care/ Stress reduction
The adrenal glands are an often overlooked source of androgens at play in PCOS. They secrete Cortisol in times of perceived stress as a way to modulate inflammation. Great in acute times of stress, but a hormonal nightmare when sustained all day every day like most modern cases. If you've read, like, ANY of my articles before you know that the number ONE cause of hormone imbalances is....STRESS!! Above food, above toxins, above birth control. Truly truly, if our uterus is Batman, stress is the joker and Riddler COMBINED (where my comic book fanatics at?!)
Our adrenals deal with a lot between the over-exercising, chronic dieting, processed food, emotional stress, negative self-talk, etc. Threat on threat on threat. Here are some ways to nourish them, a necessary step in PCOS healing:-STRESS LESS (you saw this coming..read practical tips for doing so in my post about stress)-SLEEP: get in bed by 10 pm, with dark lights and a cool room, and DON’T be looking at your phone or computer at least 1-2 hours before bed. (I discuss sleep more below)-Supplement with Magnesium: this is huge for stress management, adrenal health, and anxiety. I recommend THIS FORM to everyone and take it before bed.-EAT Vitamin C rich foods or supplement, do the same with B vitamin Rich foods like pasture raised eggs, leafy greens, and sweet potatoes…-Use Adaptogens Therapeutically: this is a cherry on top of the others I listed above. Here are a few of my favoritesRhodiolaAshwagandhaHoly BasilReishi Mushroom
3. Detox your home
One study showed that mice exposed to BPA (a common element found in all plastic) developed PCOS following injection! Not to mention endocrine disrupting ingredients found in most makeup, cleaning solutions, and other personal care products have been correlated to hormone imbalances and disorders. Protect your hormones not just from what you eat but what you store your food in, what you use on your face, what you clean your home with, etc. I highly recommend minimizing the amount of plastic you use in your house and switching to all nontoxic personal care products like skincare, makeup, and house cleaners. For a list of my favorites, see my recommendations tab.
4. Type-specific exercise
Exercise is an amazing tool to use in most all healing protocols. Mostly because there is such a variety to choose from depending on the patient's needs. This is also where you will see the biggest difference in recommendations between Type 1 and Type 2. Type 1: HIIT training, Weight lifting, and Yoga are the 3 best forms of exercise for sensitizing yourself to insulin and also relieving stress. Including some mix of sprint work and weights 3x a week can do wonders for insulin sensitivity and yoga does wonders for stress!Type 2: Low intensity movementSince this type is suffering from a LACK (lack of balance lack of food, lack of boy fat, etc) and often (though not always) recovering from a period of restriction, we really want to be careful with the amount and type of movement you are doing. Sticking with things like long walks and gentle yoga during at least the first couple months of healing is amazing because they allow you to move your body without causing any more stress on your HPA axis. To learn more about which types of exercise are best for hormones, read my post HERE.
I talk about sleep almost EVERY post, and there is a reason! Sleep is the FOUNDATION from which healing takes place. It is when cells regenerate, when tissue is mended, when the brain detoxes, and where ALL restoration takes place. If you aren’t sleeping, you aren’t healing. To get more specific, sleep is critical for PCOS healing for 2 main reasons: blood sugar and Adrenals. Sleep is one of the most underrated but IMPACTFUL strategies when it comes to regulating blood sugar, and therefore PCOS. have even shown that a SINGLE night of less than optimal sleep (<7 hours) can induce insulin resistance for an entire 24 hours. Compound that for every time you have a restless or late night and you are looking at a LARGE blood sugar nightmare. Study after study has been published showing us how sleep is not only an important role in blood sugar regulation, but it is arguably one of the most important ones!Sleep is ALSO the number ONE healing tool in restoring adrenal function . Like I mentioned in 2, when we go through periods of stress (like restrictive dieting, undereating, emotional trauma, negative self-esteem, etc) our adrenals are being put in overdrive to produce enough of our main stress hormone CORTISOL. This is the hormone we produce in response to any kind of threat (aka stress). This is fine and normal, EXCEPT for when we are pumping out cortisol ALL THE TIME because of our lifestyle and negative thoughts. The body stops responding to the cortisol, the adrenals are overworked, and they send the signal to our pituitary gland in our brain that we are overwhelmed and need to down-regulate hormone function. The antidote to this gnarly process? REST. Sleep, socialize, play, etc. The opposite of overworking. Simple? Yes. Easy? Not for many of us. Necessary? WITHOUT A DOUBT.
6. Gut and Liver love
Though both type 1 and 2 PCOS benefit from extra organ support, Type 1 especially need to focus on gut and liver function. WHY? Because BOTH are heavily involved in blood sugar regulation and hormone balance. I won’t go into too much detail here because I’ve written a post ALL about liver detoxification HERE and one all about gut healing HERE. Go there to learn how to make liver and gut support a cornerstone in your PCOS healing protocol.
7. Smart supplementation
Focusing on whole foods and optimizing nutrient density is critical in both types, but sometimes we can use a little help. Here are some of my favorite supplements for PCOS*any new supplements should be discussed with your healthcare provider*Type 1:-B complex-- high homocysteine levels have been correlated to PCOS, which is something that happens in protein metabolism (which is why a lowish protein diet is sometimes recommended for PCOS). Taking a B complex is very helpful in reducing Homocysteine and regulating blood sugar. -Chromium--intricately involved in glucose utilization, chromium deficiency can actually induce insulin resistance. Supplementing with it has been shown to be helpful for blood sugar regulation-Calcium and Vitamin D TOGETHER-- because absorption and levels can be so fickle when supplementing, I highly recommend getting some sun daily or supplementing with a liposomal D spray in conjunction with eating high calcium foods like seeds and BONE IN salmon/sardines-Coq10--extremely helpful for regulating blood sugar
TYPE 2: -Magnesium: CRITICAL in relieving stress, anxiety, and facilitating vitamins and minerals INTO the cell. Type 1 would highly benefit from Magnesium supplementation as well. Make sure to choose a chelated Magnesium GLYCINATE or citrate form!-Zinc-- being under such high levels of stress suppresses the immune system and increases our need for zinc, a mineral most of the population is already low on. -probiotics: though Type 2 could benefit as well, this is helpful for women who have binged, purged, or experienced swinging extremes in their eating habits. That can wreak havoc on gut flora. *the biggest ‘supplement’ type 2 needs really are REST, increased nutrient-dense calories of all macronutrients, and lower emotional stress.
There you have it! The foundations for building a solid holistic healing plan for PCOS. Remember, stress reduction and nourishment trump all in the hormone balancing game. Be kind and gracious to yourself in this process and allow your body to heal at the pace it needs to.