PCOS: Deeper Than Your Ovaries
PCOS, or polycystic ovarian syndrome, is a term used to describe a wide array of symptoms surrounding an imbalance in a women’s menstrual cycle. These symptoms occur due to an autoimmune process that alters the communication from the brain the ovaries during certain parts of the cycle. There is a dysregulation in the ovulatory hormones, FSH and LH, that disrupts how eggs are released. This causes tiny follicular cysts (failed ovulation cysts) to build up on the ovary which results in large, often painful ovaries and even cyst rupture. As this occurs there is an imbalance of hormones, estradiol and progesterone, that are secreted by the ovary and it causes cycles to become irregular, heavy, painful, and even absent. This hormone balance causes downstream effects on other endocrine glands like the pancreas and thyroid often resulting in diabetes, insulin resistance, and/or thyroid disease. Many of the symptoms include, but are not limited to, acne, facial and body hair growth, weight gain, irregular or absent menstrual cycles, infertility, insulin resistance, and hormone imbalance. While all these symptoms are bothersome, they often get disregarded as a problem with weight or diet. I hear time and time again, that patients are told that if they “just lose weight all of the problems will be fixed”. This is actually, not the case and is devastating to hear every time I encounter it. So let’s dig into PCOS and find not only the cause… but how to reverse it.
PCOS, like all hormone imbalances, starts at a much deeper level. I find, in practice and research, that while most of the serious and profound symptoms occur in the late teens and early 20’s, there is a genetic predisposition. Typically the symptoms will present with irregular, painful, or heavy periods in the early teen years but worsen with age. The later stages will include acne, absent periods, weight gain or resistance to weight loss and hormone imbalances. The two most common imbalances reflect an elevated testosterone or an estrogen dominance. When testosterone is high symptoms typically look like absent menses, acne, facial hair growth and hair thinning. Estrogen dominance, while less common shows an increased ratio of estrogen to progesterone and typically presents with heavy, painful, menses. With both imbalances there is a profound insulin resistance and resistance to weight loss or even uncontrollable weight gain. Insulin resistance is a process that prevents the body from recognizing and utilizing insulin to bind with glucose and bring it into the cell for use as energy. This means the level of glucose in the blood stays high and it not able to be used by the cell effectively. This can result in diabetes, in the long run, but early stages are just as concerning.
As mentioned earlier, I have found that PCOS occurs due to a vast autoimmune response. This typically start in the gut due to dietary, lifestyle, or genetic factors that result in an inability to metabolize nutrients, see the MTHFR blog. 53% of women with PCOS have one or more of the mutations in the MTHFR gene and there are links to several other genes that complete the same process with high correlation in deficiency. So how do we fix a gene mutation? Unfortunately we don’t, but we can teach the body how to bypass this gene and allow the healing to occur.
The basic and foundational changes for PCOS include stating with diet and lifestyle by eating whole foods. This eliminates processed foods, white sugar and sugar substitutes, folic acid, and artificial dyes and additives and is a great place to start. By making these changes, over time, we help to heal the gut, resolve leaky gut, increase the quantity and quality of nutrients, and begin to make the correct balance of hormones allowing the autoimmune process to eventually stop. For more on the specifics see the “Gut Rest blog” or the “Ground Up Guide” in the store.
Often, by the time I see a patient or PCOS is “diagnosed” the process is quite advanced, so we want to attack the symptoms as well as the cause. So now let’s dive into the specifics on how to fix the hormones and symptoms with natural supplements, in addition to diet. We want to first correct vitamin deficiencies, like vitamin D, B-12, folate, ect. This is not only a simple change but deficiency worsens many of the symptoms like insulin resistance and hormone transportation. While we watch sugar intake, we should also improve how the insulin we make interacts with the cells. By adding berberine, inositol, l-theanine, zinc, and reshi mushrooms we can promote balance while the body is healing. There are many supplements available for these and dose will depend on severity but on average inositol should be between 2000mg and 5000mg in divided doses to promote hormone balance and insulin improvement. I prefer morning and night to keep blood glucose levels stable. Berberine should be taken up to 1,500 mg in divided doses, meaning 500mg three times pre day or 750mg twice daily, for weight and insulin management. L-theanine, max of 400mg per day, will also help anxiety, depression, and insomnia that are associated with hormone imbalance. Zinc is often found as a part of multivitamins, which I recommend taking, but ensure it is methylated, see my links for one I like, but it is not limited to that brand. Finally, reshi mushrooms work to balance hormones, mood, and overall inflammation, these can be taken as “mushroom coffee” or supplement. Before starting any of these always talk with your medical provider to decide which is best due to possible interactions with other medications. The most promising two I start with are inositol and l-theanine, as they have the most promising studies and are very well tolerated, despite other medications. Finally, more is not always better so start with 1-2 supplements at a lower dose and increase over time.
While this is not a complete management guideline, there is a lot you can do at home to help manage and even reverse your PCOS. I always recommend seeking supervised care under a medical provider that will help with this process because many times PCOS is multifaceted and blood work and ultrasound imaging might be required.
Until we meet again, remember, optimizing health is about finding the balance that fits your life.
Per request attached are some of my resources and studies that contain the actual data I use to make these blogs.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7028834/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040057/
https://www.whitelotusclinic.ca/pcos-treating-adrenal-androgen-excess/
