Do you have PCOS and what can you do about it?
Polycystic Ovarian Syndrome is estimated to impact almost 15% of women of reproductive age worldwide, making it one of the most common endocrinology disorders in women. PCOS can be diagnosed in women at any age after puberty, from the teens to early 40’s!
Wondering if you have PCOS?
The most common symptoms of PCOS are:
-Irregular menstrual cycle
-Facial hair (hirsutism) or other excessive hair growth
-Acne
-Weight gain (particularly around the abdomen
-Infertility
However, these symptoms are not the only ways that PCOS may present.
Diagnosing PCOS
You can visit your Ob/Gyn and/or a Functional Medicine provider to begin your PCOS evaluation. They will utilize the Rotterdam Criteria for diagnosis:
The Rotterdam criteria requires the presence of at least two out of three of the following features for the diagnosis of PCOS:
Oligo-ovulation or anovulation (irregular or absent menstrual periods)
Clinical or biochemical signs of hyperandrogenism (elevated levels of male hormones) such as hirsutism (excessive hair growth), acne, or male-pattern baldness
Polycystic ovaries on ultrasound examination (presence of 12 or more follicles in each ovary measuring 2-9 mm in diameter, or ovarian volume >10 mL)
Elevated anti-Mullerian hormone
It is important to get the diagnosis from a medical professional so that they can help you rule out other causes of PCOS symptoms.
Types of PCOS
Polycystic Ovary Syndrome (PCOS) is a complex condition that can present in different ways. While there isn't a strict classification system for types of PCOS, clinicians and researchers often describe different phenotypes or presentations based on the specific symptoms and characteristics observed in individual patients.
Here are some commonly recognized types of PCOS:
Classic PCOS: This type is characterized by all three of the following features:
Oligo- or anovulation (irregular or absent menstrual cycles)
Clinical or biochemical signs of hyperandrogenism (elevated levels of male hormones), such as hirsutism (excessive hair growth), acne, or male-pattern baldness
Polycystic ovaries on ultrasound (multiple small follicles or cysts on the ovaries)
Non-Hyperandrogenic PCOS: Some women with PCOS may have irregular menstrual cycles and polycystic ovaries but do not exhibit significant signs of hyperandrogenism. This subtype is sometimes referred to as "non-classic" or "normoandrogenic" PCOS.
Hyperandrogenic PCOS: In this subtype, hyperandrogenism is the predominant feature, with significant symptoms such as hirsutism, acne, or male-pattern baldness, but menstrual irregularities may be less pronounced.
Lean PCOS: Some women with PCOS are not overweight or obese. Lean PCOS refers to individuals who have PCOS symptoms but have a normal body mass index (BMI). This does not necessarily mean that they do not have insulin resistance!
Obese PCOS: Obesity is commonly associated with PCOS and can exacerbate symptoms. Obese PCOS refers to individuals with PCOS who have a higher BMI.
Post-Pill PCOS: Some women may develop PCOS-like symptoms after discontinuing hormonal contraceptives, particularly if they had underlying hormonal imbalances that were masked by the contraceptive.
Inflammatory PCOS: Emerging research suggests that inflammation may play a role in the development and progression of PCOS in some individuals. Inflammatory PCOS refers to cases where inflammation is a prominent feature.
Risks of PCOS
PCOS is the leading cause of infertility in women, and is due to irregular ovulation or lack of ovulation. Women with PCOS are at increased risk for Metabolic Syndrome, a cluster of conditions including insulin resistance, high blood pressure, high blood sugar levels, and abnormal cholesterol levels. This puts them at risk for obesity, Type 2 diabetes, and cardiovascular disease. Women with PCOS are also at higher risk of anxiety, depression, and other mental illness due to the physiologic and psychologic effects of this syndrome.
What is the root cause of PCOS?
As you know, in Functional Medicine, we care deeply about the cause of the disorder. Here are some of the theories on the cause of PCOS.
Hormonal Imbalance: PCOS is characterized by hormonal imbalances, including elevated levels of androgens (male hormones) such as testosterone, and abnormalities in insulin, luteinizing hormone (LH), and follicle-stimulating hormone (FSH). These hormonal imbalances disrupt the normal functioning of the ovaries, leading to irregular ovulation and the formation of ovarian cysts.
Insulin Resistance: Insulin resistance, where cells in the body become less responsive to insulin, is a common feature of PCOS. High levels of insulin stimulate the ovaries to produce more androgens, which can disrupt ovulation and contribute to the symptoms of PCOS. Insulin resistance also increases the risk of developing type 2 diabetes and obesity, both of which are commonly associated with PCOS.
Genetics: There is evidence to suggest that genetics may play a role in the development of PCOS. Women with a family history of PCOS are at increased risk of developing the condition themselves, indicating a potential genetic predisposition. However, the inheritance pattern of PCOS is complex, and multiple genes may be involved.
Lifestyle Factors: Lifestyle factors such as diet, exercise, and stress can influence the development and severity of PCOS symptoms. Poor diet, sedentary lifestyle, and chronic stress can exacerbate insulin resistance and hormonal imbalances, worsening PCOS symptoms.
Inflammation: Chronic low-grade inflammation may contribute to the development and progression of PCOS. Inflammation disrupts normal hormone regulation and ovarian function, contributing to insulin resistance and other metabolic abnormalities associated with PCOS.
Environmental Factors: Exposure to environmental toxins, such as endocrine-disrupting chemicals found in plastics, pesticides, and personal care products, may contribute to the development of PCOS or exacerbate its symptoms by disrupting hormone regulation.
Gut Microbiota: Emerging research suggests that alterations in the gut microbiota (the community of microorganisms in the gut) may play a role in the development of PCOS. Imbalances in gut bacteria can influence inflammation, insulin sensitivity, and hormone metabolism, all of which are relevant to PCOS.
The Functional Medicine Approach to PCOS
1. Balancing Blood Sugar. Because insulin resistance is a driving force of PCOS, this is essential. For hormones to be regulated, blood sugar has to be balanced. We balance blood sugar utilizing nutrition and dietary interventions such as reducing refined carbohydrates and increasing fiber, healthy fat, and protein. We also can utilize supplementation to help regular blood sugar levels.
2. Support Adrenal Function and Stress Management. If the adrenal function is not well supported, the rest of the hormone balance is going to be affected. This of it this way, your body will prefer to go into “fight or flight” mode when it needs to, because in some cases this is what actually keeps us alive. Reproduction is not preferred over life. So, we need to decrease stress levels in order to keep other hormone production and metabolism balanced.
3. Manage Inflammation. Inflammation exacerbates hormone imbalances. This is similar to the issue of stress management- inflammation serves the body by fighting off disease and infection, however, when the inflammatory cascade is unable to be regulated, this can impact body functions on a macro and micro level.
4. Optimize Gut Health. There is growing evidence on the association between gut health and PCOS. Fostering a healthy microbiome and gut lining integrity is so important when it comes to balancing hormones because the production and metabolism of hormones is directly impacted by nutrient status, inflammation levels (which often starts in the gut), and the gut function.
5. Minimize Toxin Exposures. Endocrine disrupting chemicals (that are in toxic cleaning products, beauty products, plastics, and pollutants) can directly impact hormone production and metabolism. While we cannot avoid all of these chemicals, we can do our best to avoid and reduce our exposure. Focusing on cleaning products and beauty products first can be a really impactful step in managing PCOS.
As always, if you need more support, send questions our way!
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