What is PCOS?
PCOS can be a confusing diagnosis. It is a syndrome, which is a set of related signs and symptoms, but you don’t have to have all the signs and symptoms to be diagnosed with PCOS, so it can present differently in different people. People often find out they have PCOS when they visit their doctor because of symptoms such as irregular periods, facial hair growth, acne, or hair loss. These symptoms often also present with trouble losing weight (though not in everybody).
PCOS is hallmarked by ovarian dysfunction and signs of excess androgen hormone production. I’ll delve into these a little deeper to help you understand what they mean.
Androgen hormones and PCOS
Androgens are hormones produced by the ovaries and adrenal glands. When in excess they can cause acne, hair loss on the crown of the head, hirsutism (dark, coarse hair growth on the chin, upper lip, chest and back), insulin resistance (more on this below) and delayed ovulation (which also means delayed or absent periods because you need to ovulate to have a period).
Ovarian dysfunction and PCOS
When you ovulate, you always get a period about 2 weeks later (unless you are pregnant). Those with PCOS often experience irregular periods or lose their period altogether because their ovaries are having trouble ovulating on a regular basis. The ovaries may appear enlarged, with many cysts, on an ultrasound. The cysts are little pockets where an egg tried to grow but didn’t mature enough to be released.
Many people think that polycystic ovaries are the main feature of PCOS but it’s important to remember that people without PCOS can have ovaries that appear polycystic too, yet no problems with ovulation or androgenic symptoms. Conversely, not everyone with PCOS will have ovaries that are polycystic - they may just have the androgenic symptoms and irregular periods and this is enough for diagnosis.
What causes PCOS weight gain?
It is thought that at least 70% of those with PCOS have insulin resistance. This means, that they can produce the hormone insulin, but their body doesn’t use it very well. Insulin is a hormone that promotes fat storage and blocks the burning of fat for energy, so it makes weight gain more probable and makes excess weight hard to shift.
It’s important to note that slim people with PCOS may also have insulin resistance because it can cause a number of effects other than weight gain. Insulin stimulates the ovaries to make testosterone (an androgen hormone), leading to the symptoms mentioned above, and it is associated with increased risk of developing type 2 diabetes. So, if you are insulin resistant, it’s important to know and do something about it.
What causes PCOS?
It is unknown exactly what causes PCOS but genetic factors certainly seem to be at play. This is why, although insulin resistance drives the condition in a majority of cases, not all women with insulin resistance develop PCOS.
Is it PCOS?
Sometimes PCOS is misdiagnosed so make sure you have had a thorough investigation and get a second opinion if necessary. Some other conditions that have overlapping symptoms with PCOS include hypothyroidism, hyperprolactinaemia (very high levels of the hormone prolactin), hypothalamic amenorrhoea (your period has stopped due to low body fat or intensive exercise), perimenopause and adrenal conditions, so make sure you’ve been checked for these.
Here are a list of hormone tests to consider to make sure you have been thoroughly assessed:
Am I insulin resistant?
This can be a tricky question to answer. There is no perfect test for insulin resistance so your doctor won’t offer to assess this as a routine. You can assume that if you have hard-to-shift weight (weight that won’t budge with diet and exercise changes), you have insulin resistance to some degree.
If you are struggling with weight, it’s a good idea to also request a metabolic health assessment, as insulin resistance can lead to metabolic syndrome and diabetes. This includes measuring your blood pressure, your waist circumference (under 80cm is ideal) and having blood tests including:
HOMA-IR (fasting insulin and glucose)
Hba1c (diabetes blood test)
fasting blood lipid panel (cholesterols and triglycerides)
If you are slim you may still be insulin resistant or have an ovarian sensitivity to a normal amount of insulin, so it’s still in your interest to keep your insulin levels low. I’ll discuss this more below.
PCOS and fertility
The irregular or absent ovulation associated with PCOS can make it difficult to fall pregnant because there are fewer chances to conceive over time, and it’s hard to time your attempt to conceive with ovulation when you don’t know when it may come.
There are other factors that may make conception with PCOS more difficult, such as increased risk of miscarriage, but it’s important to remember that having PCOS doesn’t necessarily mean you will have difficulty conceiving, you just may. So, factor the possible time-delay into your plan and follow the steps below to improve your fertility with PCOS.
What you can do to help your PCOS
Step number one: ensure healthy blood sugar levels after eating.
This is because insulin is our blood sugar regulation hormone and the higher our blood sugar (also known as blood glucose) spikes after eating, the more insulin we need to make to get it back down. Repeated blood glucose spikes can cause insulin resistance and stimulate the ovaries to make androgens (explained above).
Here are my top 3 tips to start making a huge difference to your post-meal glucose and insulin levels today. You’ll notice you’ll have way better energy too!
1. Choose mostly savoury foods. Keep any sweet tasting food, whether natural or not, to a minimum and eat it only after a meal as a dessert, rather than as part of the main meal or as a snack. This includes fruit and naturally derived syrups such as maple syrup and honey.
2. Eat 1-2 cups of veggies before your lunch and dinner regardless of whether the meal already contains veggies. This could mean a simple salad, veggie crudites (e.g. celery, carrot, green beans, snow peas, red capsicum, radish), or roasted veggies such as broccoli, cauliflower, asparagus, eggplant, zucchini or fennel. Avoid using potato, sweet potato and beetroot as your pre-meal veggies as these contain starches and sugars that will spike your blood sugar. The aforementioned veggies are low in starches and sugars, and high in fibre. The fibre will line your stomach and reduce the rate of absorption of your meal, meaning a smaller rise in glucose. This strategy is excellent to reduce sugar cravings too.
3. Include quality sources of protein with every meal & snack. Protein breaks down into glucose slowly, which is what we want to prevent a glucose spike. Choose from: fish, chicken, lean beef & lamb, ricotta, natural yoghurt, goats cheese, raw nuts (brazil, almond, walnut, cashew, hazelnut, coconut), seeds (pumpkin, sunflower, sesame, flaxseed, soaked chia seed), eggs, tofu, tempeh, chickpeas, beans, lentils.
Step number 2: exercise.
Exercise that increases muscle tissue is very good for PCOS because muscles are very insulin sensitive. This means they will use up a lot of the excess insulin and lower your insulin levels. Muscles will use glucose for energy too, disposing of excess glucose and giving you the energy to move and feel good.
Resistance exercise increases muscle tissue. If you don’t know how to do this already, you can start at home with a free 10-minute youtube workout for beginners and work your way up to 30 mins, a few times a week. If you aren’t sure if you are doing it correctly, it’s a good idea to have at least one session with a personal trainer to get your technique right and avoid injury.
If you are trying to lose weight, once you have your resistance routine in place, try to add some exercise that gets your heart rate up a few times a week. Again, start with 5-10 mins and increase length as you can.
Step number 3: get further help.
You don’t have to wait until you have mastered the above to get further help. Assemble a team that can help you achieve your goals. This may include a naturopath (see below section for how naturopathy can help PCOS), a GP and/or specialists. If you have been trying to conceive for 6-12 months with no success you may need to see a fertility specialist.
Medical treatment for PCOS
First line medical treatment for PCOS is diet and lifestyle. You may have been told to lose weight or increase exercise but sometimes it can be less obvious to know how to do that. If you are struggling follow the above tips and consider seeing a naturopath (read more below).
If you are not trying to conceive, chances are you will be offered the oral contraceptive pill to control your symptoms. It is important to realise that this doesn’t prevent your symptoms from coming back later if you come off the pill and it doesn’t treat insulin resistance, weight gain or prevent type 2 diabetes. Through it’s high doses of synthetic hormones, the pill shuts down our body’s own hormone production so that your hormonal symptoms stop.
If you are struggling with weight gain, or are trying to conceive you may be offered metformin - a diabetes drug. This can help some women with PCOS but may not be enough to get you where you want to be. Many patients who turn up in my office have tried metformin but cannot tolerate the digestive side effects (bloating and diarrhoea) and are looking for a different option.
If you are trying to conceive you may also be offered an ovulation induction medication such as clomid or letrozole by your specialist. These medications promote ovulation but they don’t always work for everyone with PCOS.
How a naturopath can help with PCOS
Diet and lifestyle education is one area that naturopathy shines for PCOS support. We can guide you through exactly what to eat in a way that is achievable for you and suitable to your lifestyle and preferences. We can coach you to make changes and help keep you accountable. I find that this brings better results with weight loss and creating lasting change. Diet and lifestyle habits are the way that you can manage your PCOS long term.
Naturopaths can also prescribe high quality, prescription-only nutritional medicines and herbal medicines to help you get to where you want to be quicker than with diet and lifestyle alone. These can help break you out of the hormonal pattern you are stuck in and enhance insulin sensitivity, thereby reducing insulin resistance. This can be the key to kickstarting that stubborn weight loss and ovulation, as well as reducing acne and hair growth.
I’d love to list my top herbs and nutrients for PCOS but there are literally so many to choose from and not all are suitable for everyone. Remember at the beginning of this article when I said that PCOS is a set of related signs and symptoms that presents differently in each individual? That’s why naturopathic assessment is necessary to determine the most appropriate herbal and nutritional medicines for you and at what doses will be effective for you as an individual.
So, in summary, although having PCOS can be confusing, difficult to understand, and overwhelming, once you have a better understanding of what is going on in your body and that you have the power to make significant change for the better, it becomes less intimidating. Good luck implementing the tips in this article but don’t forget to reach out if you need help as it can be hard and frustrating to go it alone.
Want to discuss things further now? Book in for a free 10 minute discovery call here.
Josephine Cabrall - BHSc (Nat)
Naturopath & Nutritionist
RH: Reproductive Health