PCOS: Polycystic Ovarian Syndrome
What is PCOS?
PCOS stands for polycystic ovarian syndrome. It is a metabolic disorder that has nothing to do with the cysts on your ovaries. In fact, there are many people with PCOS who don’t have cysts and many people with cysts who don’t have PCOS. Ovarian cysts don’t mean there is a hormone imbalance necessarily. There is no physical pain associated with PCOS, please do not confuse your diagnosis with endometriosis.
PCOS is really defined as high androgens (male hormones) when every other possibility of high androgens has been ruled out. The second criteria for a PCOS diagnosis is either irregular periods or polycystic ovaries. You must have 2 of these 3 in order to be diagnosed. PCOS is a broad diagnosis that can accompany many different hidden stressors. We often associate estrogen dominance and hypothyroidism/hashimotos with PCOS.
Common Symptoms of PCOS:
Hair Loss/Thinning Hair
Estrogen Dominance Symptoms
Since PCOS looks very different on everyone, it’s important to know which type you have and the driving factors in order to best support your metabolism. The first questions we investigate with our clients are; is it truly PCOS? is it driven by insulin resistance (80% of cases are)? is it temporary post-pill PCOS?
Four Types of PCOS (Root Causes):
Also known as pre-diabetes. About 70-80% of PCOS cases are due to high insulin levels. Insulin resistance happens when your pancreas needs to pump out more and more insulin due to high blood sugar. Insulin is a hormone that lowers your blood sugar by storing glucose in the cells. It is a fat storage hormone that concentrates fat in your abdominal region. Eventually, your cells become resistant to the constant insulin resulting in blood sugar issues. PCOS women can make insulin but just can't use it effectively. If insulin is high then that will tell the ovaries to make more testosterone and drive androgens up causing the most common PCOS symptoms like acne, hair loss, hirsutism and weight gain.
Did you have regular periods before going on the pill? Now you're wondering where your period is and have a bunch of symptoms to deal with? This is post pill PCOS and it is usually diagnosed after going at least 3 months without a period. It’s far too common to experience amenorrhea (no period) and a temporary surge in androgens when coming off the birth control pill. Good news; this can balance itself out in a few months with proper nutrition, supplementation and lifestyle habits that get you ovulating again. However, you can easily go down the wrong pathway, further damaging your hormones and metabolism resulting in a 1-2 year long journey. It may also take longer if digestive symptoms are present due to the birth control pill killing all your good gut bacteria.
Chronic inflammation can cause the ovaries to produce excess testosterone and estrogen which causes PCOS symptoms. This is usually related back to the gut and is accompanied with bowel issues like IBS and/or SIBO. If there is any infection in the gut, estrogen will increase as an inflammatory response. Typically, we will see inflammatory markers like CRP or fasting glucose/insulin on blood work high. However, gut inflammation and digestive issues are pretty easy to notice without blood work. These patients usually have a lot of food sensitivities and a leaky gut. We need to eliminate pathogenic bacteria and dysbiosis in order to bring the microbiome back in balance and optimize digestion in order to heal from inflammatory PCOS. Reducing external sources of inflammation like EMF and toxic personal care products will also be helpful.
If you have elevated DHEA-S but every other androgen level is normal, then it is likely adrenal PCOS. This is only the case about 5-10% of the time. It is driven by an abnormal response to stress, dysregulating cortisol production. Stress has a massive impact on our hormones as it steals progesterone. This is called the pregnenolone steal. Basically, when the demand for cortisol is high, pregnenolone is going to use all of its resources to produce cortisol, leaving none for the production of progesterone. This is problematic as PCOS patients are already suffering from androgen dominance and low progesterone levels. If you have this type of PCOS like Katie did, be sure to decipher which phase of HPA dysregulation you are in with a DUTCH test and then heal your adrenal glands as well as your nervous system.
REMEMBER: it is possible to have multiple types of PCOS which is when it can get confusing.
How Do You Treat PCOS?
The conventional treatment for PCOS is concerning and not recommended by us. Medical doctors will typically put you on the hormonal birth control pill (even if that is what caused your PCOS in the first place) and/or metformin. Like all drugs, these only mask symptoms and don't treat anything. They come with a lot of long term negative effects. Hormonal birth control is pumping you with synthetic hormones like progestin which is only helping temporarily because your body is not producing progesterone due to the lack of ovulation. Wouldn't you rather nourish your body so it feels safe enough to ovulate again? That way you can naturally produce progesterone and not cut off the brain-ovary communication. Metformin is usually used to treat type 2 diabetes by decreasing glucose production. If you have insulin resistant PCOS, you will likely see your symptoms improve when taking metformin. However, you have now cut off your cells primary source of fuel rather than teaching your body how to properly use glucose. Glucose production will surge once you come off metformin, leading to worse PCOS symptoms. We also see metformin causing long term B vitamin deficiencies which is problematic for women with PCOS as you need B vitamins for phase 1 liver and estrogen detoxification. In addition, a lot of medical doctors will inform their clients to lose weight and exercise more as a treatment mechanism. You do not lose weight to heal PCOS. When your PCOS heals, you will lose weight (if excess fat is a problem for you). When your hormones are balanced and your digestion is optimal, your body will settle at a weight that feels safe and comfortable. Weight loss should never be your main goal as it should be viewed a result of a healthy internal body when executed properly. Daily movement is great and moderate strength training can often be very helpful for PCOS women but overdoing intense cardio is only going to make your PCOS worse long term.
Instead, we recommend finding out which type(s) of PCOS you have and work on rebuilding that system of your body through nutrition and lifestyle changes. Generally speaking, this may include things like;
Eating balanced meals regularly (animal protein, saturated fat and whole food carbohydrates)
Always pairing carbs and protein together
Aiming for 8-10 hours of sleep every night and getting to bed by 10pm
Leveraging quality whole food supplements and avoiding synthetic supplements
Replacing unsaturated fats with more saturated fats
Sourcing organic produce and grass fed/pasture raised animal products
Daily grounding and meditation work
Red light therapy and EFT
Daily sunshine and nature
Cooking more food at home
Replenishing vitamin and mineral stores
The list goes on. Although rebalancing your body naturally is not a quick fix, it is the ONLY way to reverse PCOS permanently. And yes, PCOS is curable. Don't let your doctor or anyone tell you it's not. Katie has done it not only for herself, but for a multitude of women.
What is The Difference Between Hypothalamic Amenorrhea (HA) and PCOS?
These conditions often get misdiagnosed with each other. This is because both conditions typically present ovulation dysfunction and irregular periods. They can also both present with polycystic ovaries making it even more confusing if you get an ultrasound done. The key difference is PCOS will have high androgens present which are usually driven by insulin resistance (not always though). HA is due to the stress of under-eating and/or over-exercising. People with HA are very insulin sensitive normally and don't present with high androgens. They tend to be very under-weight, experience bone loss and have a low LH to FSH ratio on bloodwork. Women with PCOS usually have a high LH to FSH ratio on bloodwork, tend to experience weight gain easily but have no risk of bone loss. If you are confused, ask your doctor for a fasting insulin test, an androgen panel and LH/FSH test to determine.
As research is evolving, we are noticing a link between PCOS and a certain autoimmune disorder. This is leading some to believe that PCOS itself is in fact an autoimmune condition. Hashimoto's (autoimmune thyroid disease) has been reported in just under half of PCOS women. We always recommend a full thyroid panel for our PCOS clients, which includes thyroid antibody testing to detect or rule out Hashimotos. Although research is limited, they have actually detected the presence of an autoimmune reaction against ovarian tissue in PCOS women. There are three main reasons why PCOS is being compared with Hashimotos. It all comes down to insulin resistance, sex hormones and vitamin D levels. We often see insulin resistance and inflammation present in both our Hashimotos and PCOS clients. We know that both estrogen and progesterone play a critical role in autoimmune activity. When it comes to PCOS, almost every women is suffering with low progesterone due to fact that they are not ovulating regularly. Low levels of progesterone can cause an overstimulation of the immune system leading to more estrogen dominance and various autoantibodies. This sex hormone imbalance can increase the likelihood of autoimmunity. Lastly, vitamin (hormone) D has been associated with several autoimmune disorders, but most significantly associated with the thyroid in PCOS women. We do not have enough conclusive answers yet to determine whether PCOS is an autoimmune condition or not, but these connections are undeniable.
What Bloodwork Should I get for PCOS?
Total Testosterone & Free Testosterone
Androgens: DHEAS & Androstenedione
LH & FSH
Blood Sugar: Fasting Insulin, Fasting Glucose, Glucose Tolerance Test & Cortisol
SHBG, Prolactin & AMH
Sex Hormones: Progesterone (if ovulating) & Estradiol
Thyroid: TSH, T3, T4, rT3 & Anti TPO's
Liver: ALT, AST & Bilirubin
If you are wanting a proper diagnosis or to investigate PCOS further, we recommend asking your doctor for the bloodwork above. Although not as good as functional testing, it provides a bit more info as to what is going on inside your body and is free or fairly cheap for most. We often will get our clients to run this bloodwork after our initial appointment together and if we don't get any conclusive answers, we move on to running a DUTCH hormone panel and HTMA test. Don't lose hope if your doctor says your lab work looks normal. There is more to the picture, keep digging.
Acne is one the most reported PCOS symptoms along with hair loss and hirsutism. When there is an increase in androgens like testosterone due to one of the reasons listed above (often insulin resistance), sebum and skin cell production can increase leading to acne. This is called hyperandrogenism. This increase in sebum can cause oily skin as well as cystic like lesions on the face, neck, back and chest. These are often very painful, inflamed and red, leaving behind scarring. One of the androgens typically high in PCOS women upregulates acne. It is called DHT and it resides in our skin and hair follicles. We often use herbal medicine and nutrition to inhibit the conversion of testosterone into DHT in order to reduce the intensity of PCOS symptoms like acne. Another reason acne is usually present in PCOS women is due to their low progesterone levels or absent progesterone altogether. If you are not getting your period regularly, you are not ovulating regularly and thus not producing progesterone as that only can be produced after ovulation has occurred. Progesterone is a regulatory sex hormone that counterbalances the amount of estrogen and even testosterone in the body. Low progesterone can result in estrogen and androgen dominance even if estrogen is not high or out of the lab range (usually androgens are in this case). We do believe estrogen dominance is responsible for part of the picture when it comes to PCOS and of course, hormonal acne. Unfavourable estrogen metabolism and high levels of free circulating estrogen can cause inflammation and burden our elimination pathways resulting in acne. Estrogen can easily start to accumulate in the tissue due to stress, xenoestrogens and phytoestrogens. Not to worry, PCOS acne can easily be treated naturally with the help of an educated professional.
Check out our 1:1 membership to discover what is causing your PCOS and how to improve your metabolic health in order to reverse it. It is your right as a woman to have clear skin, balanced hormones and a natural healthy menstrual cycle! Our PCOS nutritionist offers in-person appointments in Toronto, ON and online worldwide!