Causes of PCOS
Signs, Symptoms & Risks
Tests & Diagnosis
Menstrual Cycle Irregularities
Polycystic Ovarian Syndrome may be one of the most complex female health issues of our time. It is the most common endocrine disorder in women of reproductive age. PCOS is accompanied by a variety of different health issues, many of which directly impact fertility. Classic PCOS presents with obesity, polycystic ovaries (multiple ovarian cysts that look like a strand of pearls), elevated levels of androgens and absent or irregular menstrual cycles. Not all women who will go on to be diagnosed with PCOS will have these issues though.
What Causes PCOS?
Doctors are unsure of what causes PCOS, but information suggests there may be a genetic link, possible abnormal fetal development and inflammatory response contributing to the cause. PCOS is also negatively affected by diet, lifestyle and exposure to certain environmental toxins. PCOS directly impacts fertility, but has serious health implications as well, especially if left untreated.
Genetic Predisposition and Abnormal Fetal Development
Women whose mothers, sisters or grandmothers had PCOS are at a higher risk for developing PCOS. Research suggests that exposure to excessive amounts of male hormones (androgens) by the developing fetus may alter proper gene expression. This means that the affected genes will not function properly later in life, which may cause PCOS during the reproductive years of a woman’s life.
An interesting study of 235 women with PCOS were divided into two groups. The groups were categorized by 1. obese women with elevated androgens, elevated LH and testosterone and 2. by thin to normal weight women with elevated LH and normal levels of androgens. The results of the study showed a pattern in their both mothers weight and baby’s birth weight and fetal gestation time. Women in group 1 had above-average birth weight and were born to obese mothers. Group 2 were born after term (over 40 weeks gestation). The conclusion was that events occurring during fetal development may have long-term effects on endocrine function later in life.
It has also been found that women with PCOS have low-grade inflammation, which may be a cause for insulin resistance. White blood cells produce substances to fight infection, this is known as inflammatory response. In some predisposed people eating certain foods, or exposure to certain environmental factors may trigger an inflammatory response. When inflammatory response is triggered, white blood cells produce substances that may contribute to insulin resistance and atherosclerosis.
Signs, Symptoms and Health Risks
Signs and Symptoms of PCOS
- Irregular menstrual cycles
- Absent period
- Anovulatory cycles
- Abnormal mid-cycle bleeding
- Excessive or heavy menstrual bleeding
- Alopecia (balding)
- Hirsutism (excessive body hair)
- Acanthosis nigricans
- Polycystic ovaries
- History of ovarian cysts
- Mood disorders
- Recurrent Miscarriage
Health and Fertility Risks Associated with PCOS
- Menstrual cycle irregularities
- Possible increased risk for Endometrial and Breast Cancer due to unopposed estrogen
- Cardiovascular Disease
- Gestational Diabetes
How is PCOS Diagnosed?
When PCOS was first discovered it was named Polycystic Ovarian Syndrome because of the presence of polycystic ovaries seen by ultrasound. Over time doctors began to realize that PCOS was a complex array of health issues. This lead to certain criteria that must be recognized to be diagnosed with PCOS, rather than just the presence of polycystic ovaries. In fact some women with PCOS do not have polycystic ovaries. In order to be diagnosed with PCOS the following should be evaluated by your healthcare practitioner:
- Pituitary and Ovarian Hormone serum levels
- Luteinizing Hormone (LH)
- Follicle Stimulating Hormone (FSH)
- Circulating Androgens
- Free testosterone
- Free androgen index (FAI): 17-hydroxyprogesterone
- Sex hormone binding globulin (SHBG): 24 hr. urinary free cortisol
- Dehydroepiandrosterone sulfate (DHEA-S)
- Endometrial Biopsy
Glucose Tolerance Test
Blood Lipid Profile
Wondering what your test results mean? Please talk to your doctor in detail about what your test results mean for your fertility. Some doctors may tell you that you have mild PCOS. Women may have some or all of the symptoms of PCOS, some may have normal menstrual cycles and some may not. Testing is the best way to find out if you have PCOS for sure or not.
How PCOS Affects the Menstrual Cycle
What happens in a normal menstrual cycle?
In very simple terms the hypothalamus produces GnRH (gonadotrophin-releasing hormone) which signals to the pituitary to produce LH (luteinising hormones and FSH (follicle stimulating hormone). The release of GnRH is pulsatile in women with regular menstrual cycles. This normal pulsatile release of GnRh signals some of the follicles in the ovary to begin maturing and for the ovaries to release estrogen and progesterone. This estrogen/progesterone signal is recognized by the pituitary gland. As the follicles begin maturing they release and increase the hormone estrogen over time. The rising estrogen level signals the pituitary gland to curb release of FSH. This communication allows for ovulation to occur. In women with PCOS the menstrual cycle follows a different pattern of endocrine function and communication.
What the menstrual cycle is typically like in a woman with PCOS…
In women with PCOS the cycle begins irregular, with the hypothalamus releasing GnRH in a higher than normal pulsatile frequency. This allows for increased LH and decreased FSH, this in turn leads to excessive production of the androgens androstenedione and testosterone. This causes the follicle to only mature some, but not enough to achieve full maturity. This also allows for continued increase of estrogen, primarily estrone. During the development of the reproductive stage and during reproductive years for females, estrone is relatively low. Typically we think of estrone to be associated with menopause, not women of reproductive age. The higher levels of androgens and estrogen creates a chronic state of low to very low progesterone.
Classic polycystic ovaries are a result of chronic anovulation. Endocrine function is imbalanced from the very beginning of the cycle causing mild to severe hormonal imbalance, depending on the individual.
Excessive levels of estrogen may also cause uterine hypertrophy, also known as endometrial hyperplasia. Unopposed estrogen may cause excessive cell proliferation of the endometrium. The endometrium is the innermost layer of the uterus that is shed as menses during menstruation. Endometrial hyperplasia may cause heavy menstrual bleeding or prolonged bleeding during menstruation. The uterus may become bulky and larger than normal.
Medical Options for PCOS
- Oral Contraceptive Pills (birth control) are the number one most prescribed medication to regulate menstruation in women with PCOS. While this may help to create a regular menstrual cycle (which is important) it prevents pregnancy. This is not helpful for women with PCOS who are trying to conceive. OCPs do not solve the root of the problem.
Other hormonal medications may be commonly used as well. This is determined by case.
Clomid is commonly used for women with PCOS to hyperstimulate the ovaries to ovulate. Once again the problem we encounter here is that Clomid does not resolve PCOS, though it may help a woman to get pregnant.
Ovarian drilling done by laparascopic surgery. This is done with the intent to stimulate ovulation.
This drug is commonly prescribed for women with PCOS, even if they are not insulin resistant or have any signs of type 2 diabetes. Metformin helps to control the amount of glucose in the blood. Metformin is used to treat type 2 diabetes. PCOS can often be helped by specific diet changes, similar to a diabetic diet. Metformin comes with many risks and side effects. Talk to your doctor in detail before choosing to use Metformin to control PCOS. Many natural therapies may also be used with Metformin with your doctor’s approval.
There are a variety of other medications prescribed depending on the symptoms of PCOS. There are medications for hirsutism or alopecia, weight gain and more. Your doctor can provide you with specific information on medications.
Learn to Eat a PCOS Fertility Diet
Eating a specific PCOS Fertility Diet is one of the best things you can do to improve your chances of becoming pregnant.
A big part of the problem with PCOS is the high insulin resistance. Resistance to insulin increases the body’s insulin levels which effects normal ovulation by preventing the body from ovulating or limiting the maturation process of the released egg.
This directly has an affect on your fertility and ability to conceive.
Women who are insulin resistant are also 4-5 times more likely to have a miscarriage. Imbalanced insulin levels due to PCOS make it difficult for the embryo to attach properly to the uterus.
PCOS is also a huge red flag for the beginning of type 2 diabetes.
I do not say all this to scare you, but I do want you to know that this is a serious matter. But there is a lot you can do to turn this all around, naturally. The biggest step you can take is to change your diet to a PCOS diet.
The benefits of following a PCOS Diet are:
- Increases the rate of spontaneous ovulation.
- Significantly improves the environment of the uterus, preparing it for a healthy conception.
- Decreases the potential for miscarriage
- Prevents PCOS from turning to diabetes
PCOS Diet Guidelines
1. Balance your daily protein with equal amount carbohydrates
This will help to eliminate the insulin yo-yo. When you eat equal amounts of proteins and carbohydrates this helps to keep your insulin at a balanced level, thus increasing your fertility.
Low-carbohydrate, high-protein diet helped insulin resistance. High-carbohydrate, low-protein diet made insulin resistance worse.
-Medical Journal Metabolism; no. 12: 1481-1487
A diet containing 25% carbohydrates improved insulin resistance, whereas a diet that included 45% carbohydrates did not
-International Journal of Obesity and Related metabolic Disorders 20 no. 12:1067-1072
The types of carbohydrates you choose are also an important factor. Choose whole grain, or sprouted grain products. They contain more protein and fiber (thus balancing insulin better) than the processed counterparts. Avoid white processed carbohydrates which cause a spike in your insulin levels and provide no fiber, or nutrients.
Some examples of whole grain and sprouted grain products are:
- Ezekiel breads
- Whole spelt- pastas and breads
- Quinoa – pastas, flour, grain
- Millet- breads, grains, cereal
- Brown Rice- cereals, breads, grain
The best place to find these foods are at your local health foods store or Whole Foods Market.
Make sure the proteins you are eating are complete and organic. Organic meats and dairy contain essential fatty acids and will not contribute to any hormonal imbalances.
2. Eat foods low on the glycemic index and glycemic load list
Blood glucose rises and then falls when you eat a meal containing carbs. How high it rises and how long it remains high depends on the kind of carbs (glycemic index GI) and the amount you ate (glycemic load GL). Low glycemic index foods are carbohydrates that break down slowly in the body, and don’t cause such a dramatic spike and then drop in insulin levels. The glycemic load takes into consideration the amount of the glycemic index food you consumed and how that affects your blood sugar. The glycemic load combines both the quality and quantity of carbohydrate into one ‘number’. It’s the best way to predict blood glucose values of different types and amounts of food.
The serving size of the amount of carbohydrates consumed really matter here. Be sure to eat no more than 100g of low glycemic index carbohydrates a day if you have insulin resistant PCOS and are overweight. Increase the amount of low glycemic index carbohydrates consumed a day to over 100g if you are thinner or underweight.
Some examples of low glycemic index foods are:
- Kale, broccoli, asparagus
- Beans and lentils
- Unprocessed foods
- Grapefruit and apples
- Walnuts and almonds
Processed carbohydrates that break down quickly are likely to make the insulin levels jump dramatically.
Avoid foods that have a high glycemic index such as sugary and starchy foods: pancakes, syrups, sugar, white potatoes, jams, scones, white bread products, pasta.
3. Eat a diet high in fiber
Fiber helps in two ways with PCOS. The first way they help is by slowing down the digestion of sugars in the body, so there is no spike in insulin. The second way they help is by promoting healthy estrogen metabolism which aids in the reduction of elevated levels of androgens.
Great sources of fiber are: broccoli, celery, whole grains, Ezekiel bread, apples, and dark leafy greens.
4. Eat 5 meals a day
By eating more often, the body will not go into fasting mode. When you look at the way most Americans eat, it is usually three big meals a day. With such a large gap of time between meals the body goes into fasting mode which causes the metabolism to become imbalanced.
The five meals a day should consist of three regular meals and two healthy snacks or 5 small meals. The first snack should be eaten in the mid-morning before lunch and the second snack to be eaten less than an hour before bed. Between eating 5 meals a day and eating a serving of protein (3-4 ounces), low GI/GL carbohydrate (1/4-1/2 cup or serving size), vegetables (1/2 cup to 1 cup) each meal.
Here is what the 5 meals a day could look like:
- Breakfast (right away, when you wake up): 2 eggs scrambled in 1 tsp. coconut oil with spinach and 1/2 cup of black beans
- Snack: Smoothie with unsweetened coconut or almond milk, peaches, 1/4 tsp. of ground cinnamon, hemp protein powder and spirulina
- Lunch: Organic Turkey lettuce wrap with celery sticks and hummus on the side
- Dinner: Organic chicken with steamed broccoli and half a cup of baked yam
- Snack (less than an hour before bed): organic unsweetened yogurt with half a serving of low glycemic index fruit (blueberries, raspberries, papaya) and 1/2 tsp. chia seeds
Alternately, you could have your last snack between lunch and dinner, eating your dinner right before bed. Find out what works best with your lifestyle.
5. Eat essential fatty acids daily
Eating essential fatty acids (EFA’s) helps you to lose weight, produce balanced hormones, and creates a healthy environment for conception.
Omega 3 EFA supplement- Take 1-3 capsules daily with your snack. Make sure to use an oil that contains DHA which is essential for the baby’s healthy brain. You can take this daily and during pregnancy.
Evening Primrose Oil- Take 1500mg of this oil from day one of your cycle (menstruation) till ovulation. Evening Primrose Oil helps to increase cervical mucous and metabolic function. Use in addition to the flax or cod liver oils.
6. Exercise 30 min. 5 days a week
Exercise helps PCOS by improving your insulin sensitivity, increasing your metabolism and helping to shed any excess weight. Both aerobic and resistance exercises are good. Researchers found that participants of resistance exercises showed better improvement in insulin sensitivity than with aerobic exercise alone.
You could walk and lift weights or take a Pilates class and run on the treadmill. Discover what you enjoy doing and do this 5 days a week for at least thirty minutes.
7. Eat Organic
You will be eating a high protein diet, so it is essential that any animal proteins (meats and dairy) you are eating are organic. In commercial meats there are large amounts of added hormones (estrogens) that make the animals grow bigger, faster, and produce more milk. With PCOS there is usually a progesterone deficiency and adding more estrogens can make it even worse.
Studies have shown that organic foods contain more vitamins, minerals and healthier proteins.
8. Quit Coffee
Caffeine increases estrogen levels. A study from Fertility and Sterility shows that drinking just two cups of coffee a day boosts levels of estradiol, a natural estrogen. Women who drink 4-5 cups of coffee a day produce 70% more estrogen in the follicular phase of the menstrual cycle (when the body is trying to produce a viable follicle for ovulation, which is already and issue in women with PCOS.)
If you need help getting off the bean, check out Teccino. It is a coffee alternative that tastes great and is alkalizing for the body.
PCOS Herbs and Supplements
In addition to eating the PCOS diet, supplements have shown to be effective in helping those with PCOS boost there fertility and give birth to healthy babies. The overall goal with PCOS is to balance blood sugar levels in the body, maintain hormonal balance, promote healthy digestion for improved estrogen metabolism, while also working to promote regular ovulation and menses. Adaptogen herbs are also important, this is because adaptogens increase resistance to mind-body stress and enhance overall vitality and health through non-specific adrenal (known as stress glands) support. Plants recognized as adaptogens help to normalize the body’s functions, most importantly the endocrine system, even during diseased states, are non-toxic, nutritive, and have been deemed safe for long term use.
Herbs and supplements are not meant to be a substitute for dietary and lifestyle changes! If important diet and lifestyles changes specific to PCOS are not in place, herbs and supplements cannot aid the body properly!
Supplements that are beneficial for PCOS…
Whole Food Multivitamin
A major part of decreasing the effects of PCOS and preparing the uterine lining is to take a prenatal multivitamin. Making sure your body has all of the nutrients necessary is a lot easier when you are taking a whole food multivitamin. Synthetic multivitamins won’t have the same effect.
Other vitamin and mineral considerations…
This trace mineral enhances the action of insulin. Some studies have shown supplementing with chromium may improve blood sugar control. In one study women with PCOS were given 1,000 mcg per day of chromium for two months. In that time results showed improved insulin sensitivity by 30% and by 38% in obese women with PCOS.
Foods that are high in chromium are onions, tomatoes, brewer’s yeast, oysters, and whole grains, bran cereals. Most foods contain little chromium, so supplementation may be need to be considered.
Calcium and Vitamin D
Both calcium and vitamin D play significant roles in the health of many parts of the body. Where PCOS is concerned, calcium protects cardiovascular health. Vitamin D plays a role in glucose metabolism. Studies have shown that people with type 2 diabetes are often deficient in vit. D. A small study of 13 women with PCOS showed that 7 out of the 9 who had absent or irregular menstrual cycles, had a return of normal menstrual cycles within two months of being given 50,000 IU once or twice per week of vitamin D and 1,500 mg per day of calcium.10. This is a marked improvement! Of those 13 women, 5 were shown to be vitamin D deficient.
Good food sources of vitamin D are cod liver oil, eggs, salmon, mackerel, tuna and whole fat yogurt or other dairy products.
Vitamin D can also be obtained for free by sitting out in the sun for 15 to 20 minutes per day. Forget using sun block though as it will actually block the ultraviolet light that is needed to produce Vitamin D. The warm sun helps your skin to create Vitamin D3 that is then transformed into the active hormone form of Vitamin D by the kidneys and the liver. In fact, by being out in the sun for just a few minutes a day, a woman’s body can create between 10,000 to 25,000 IU of Vitamin D.
Calcium can be found in kale, turnip, collard, and mustard greens, kelp and wakame seaweed. Hiziki, a type of seaweed has 10 times more calcium than a glass of milk.
Herbs and supplements that promote hormonal balance and support regular ovulation:
Eating essential fatty acids (EFA’s) helps you to lose weight, produce balanced hormones, and creates a healthy environment for conception. EFA’s have been shown to support hormonal balance and production.
Licorice root (Glycyrrhiza glabra)
Helps to maintain proper hormone production and release. Licorice supports healthy insulin levels and liver health for hormonal balance support.
Maca (Lepidium meyenii)
Maca works to balance the estrogen and progesterone in the body, for a healthy menstrual cycle. Maca is an adaptogen and an incredible fertility superfood. It helps to balance the hormones, but does not contain any hormones itself. It is able to do this by nourishing and balancing the endocrine system.
Vitex (Vitex agnus-castus)
Vitex Extract (Chaste Tree Berry) is one of the most powerful herbs for women’s fertility and menstrual health. There are numerous studies and testimonials of Vitex and it’s effects on the body. One of the reasons Vitex is so effective for women who are not ovulating due to PCOS, is because of its ability to balance hormones while not containing hormones itself. Vitex supports hormonal balance in the body by having an effect on the hypothalamic-pituitary-ovarian axis (hormonal feedback loop), correcting the problem at the source.
Tribulus (Tribulus terrestris)
May normalize ovulation in infertile women when used prior to ovulation. This herb has been found to be wonderful in aiding women with menstrual irregularities, improving timing of the entire menstrual cycle. Tribulus has also been found to be a nourishing tonic for the female reproductive system as a whole, especially concerning the ovaries.
White Peony (Paeonia lactiflora) and Licorice Rt. (Glycyrrhiza glabra)
Most clinical trials have found that when White Peony is combined with Licorice Rt., it performs better, especially for relaxing muscles, reducing painful menstruation, as well as lowering serum and free testosterone levels in women with PCOS.
Natural Progesterone Cream
Progesterone cream can help to oppose the estrogen dominance that occurs with PCOS. By using progesterone cream you are able to mimic a natural cycle and help the body to establish its own cycle, including ovulating, again. Dr. John Lee believed that with progesterone cream, changes to the PCOS specific diet and exercise, PCOS could become obsolete.
Healthy Estrogen Metabolism
DIM balances the hormones and aids in the breakdown of estrogen. Estrogen is a major culprit to many of the fertility issues women face today including PCOS. Unopposed estrogen has been shown to cause menstrual cycle irregularities and in more advanced cases, endometrial hyperplasia. Removal of excess estrogen is vital to overall hormonal balance in women with PCOS.
Cinnamon (Cinnamomum spp.)
A pilot study published in 2007 by Fertility and Sterility showed cinnamon to greatly reduce insulin resistance in women with PCOS. Another study suggests cinnamon may also reduce insulin resistance by slowing the movement of food from the stomach to the small intestine. This slows the breakdown of carbohydrates, which is important for people with diabetes and women with PCOS.
Gymnema (Gymnema sylvestre, G.sylvestris)
Gymnema has been used for hundreds of years to reduce high blood sugar. This herb has a “sugar blocking” action on taste buds and the small intestine. Gymnema blocks the typical paths that sugar molecules take during digestion, delaying the absorption of sugar. It works by stimulating the regeneration of pancreatic cells that produce insulin, which aids in more insulin production; in turn stimulating production of enzymes that help with the uptake of glucose into cells; and then prevents stimulation of the liver to produce more glucose. Gymnema also appears to have a lipid-lowering effect, which aids in weight loss.
Hirsutism and Endometrial Hyperplasia
Saw Palmetto (Serenoa repens)
Saw Palmetto has been found to inhibit DHT production by reducing 5 alpha-reductase production, which may help prevent hirsutism in women with PCOS. This herb also helps to reduce endometrial hyperplasia and hormonal acne symptoms.
Because women with PCOS usually have low-grade inflammation constantly present in the body, it is important to support the body by promoting healthy inflammation response. Some foods are known to trigger inflammation in the body. If you have food allergies, avoid foods which you are sensitive to, they trigger inflammatory response.
Omega essential fatty acids decrease the risk of inflammation, especially omega 3 and 6. Getting enough essential fatty acids in the diet may help, whether through foods you eat or through supplementation.
Systemic Enzyme Therapy
Systemic Enzyme Therapy using systemic enzymes are another option. Systemic enzyme blends work as a biological response modifier; working with the bodies own immune defense system to moderate inflammatory response. They also break down the proteins in the blood that cause inflammation.
Royal Jelly and Bee Propolis
Royal jelly and bee propolis have been shown to reduce inflammation and naturally boost the body’s immune system. They may also aid in hormonal balance through endocrine system support.
PCOS is a complex female health issue. It consists of many different health issues and risks. If permanent diet and lifestyle changes are implemented, these risks and health issues may become obsolete. There are many ways to support the proper health of a woman’s body that is dealing with PCOS. Important key tips…
1. Make sure your doctor performs the correct tests and you get a proper diagnosis.
2. Follow a PCOS specific diet to help decrease insulin resistance, balance weight, promote estrogen metabolism.
3. Promote hormonal balance and support regular ovulation. Consider supportive herbs and supplements.
4. Support proper inflammatory response.
5. Stick to your plan, believe in yourself, you have the ability to change your circumstances!