Treating PCOS: Finding Balance
A few months ago, I was diagnosed with polycystic ovary syndrome (or PCOS). I will definitely be opening up more about the process that led to the diagnosis, but want to start out by talking about what PCOS is and the research that’s out there in terms of treatment.
PCOS is generally categorized as a condition of hormonal imbalance. It’s scary because it is considered one of the leading causes – if not the leading cause – of infertility in women. PCOS is super interesting to me because not all women diagnosed with PCOS share the same signs and symptoms, and there is no set test to diagnose PCOS. According to my research, PCOS is diagnosed when you have at least two of the following*:
- Irregular periods: periods are very heavy and prolonged, or you menstruate less than nine times annually
- Excess androgen: elevated levels of a male hormone which can lead to excess hair (on face and body) and acne
- Polycystic ovaries: ovaries can be enlarged, and contain follicles that surround the eggs
The cause of PCOS remains unknown. There are some theories that chronic, low-grade inflammation may lead to its development. Another theory is that elevated levels of insulin may increase the production of androgen, which in turn leads to PCOS; this elevated level of insulin is termed insulin resistance. Insulin is a hormone that rises after a meal to help your body take the sugar from your bloodstream and transport it into your muscle, fat and liver to be used for energy. However, in insulin resistance, the body doesn’t recognize insulin as well so more and more insulin is released to help the body use that sugar. Over time, the cells that make insulin can’t keep up with this increased demand for the hormone, and so our blood sugar rises, explaining why insulin resistance leads to type 2 diabetes. We know that insulin resistance is associated with inflammation and is a precursor to type 2 diabetes, which those with PCOS are at an increased risk of developing.
You may be wondering – “OK, so what’s the big deal?”
As I mentioned, PCOS is one of the primary causes of infertility in women. It affects one in 10 women of child-bearing age. The condition not only increases your risk of infertility, gestational diabetes and miscarriage, but also for very serious chronic diseases like diabetes and heart disease.
How do I treat it?
For those that know me, they wouldn’t find it surprising that when I received the diagnosis, I hunkered down and researched. I was going to find a way to treat this as best I could through nutrition and lifestyle before turning to medications. I have been lucky at this point that my hormones have been within the “normal” range, and I haven’t had any of those issues associated with elevated androgen levels (i.e excess hair, acne, significant weight gain)- I did notice a few more breakouts than usual, but that was about it. However, I do have follicles on my ovaries and my periods have been irregular since going off the birth control pill almost a year ago, so I fit the criteria for PCOS.
I started reflecting on my functional medicine background and thinking about how everyone really is an individual. When someone develops a condition, it’s a result of their entire background – their genes, environment, use of antibiotics and other medication, stresses, sleep patterns, eating and exercise factors. I read a ton of research articles about PCOS, and also picked up a book called The Woman Code by Alissa Vitti after reading some testimonials about how her method has helped people improve upon their PCOS and other hormonal imbalances. I felt empowered and intrigued, and figured why not- let’s listen to what’s out there and give it a try.
Some believe that we have the ability to re-regulate our hormones through diet, exercise, our environment, and stress management. Even though my hormones were considered “within normal range”, maybe they aren’t within normal range for me. In regards to nutrition, the research supports eating lots of yummy veggies, healthy fats and including some (but not a TON of) lean protein, while limiting foods that turn into sugar because of the increased risk of developing insulin resistance and promoting more inflammation within the body. Now, I love fruit. I know- what a dietitian thing to say (cue eye roll). I mean sweet treats are cool too but fruit, I love. I am known in my family for having a big bowl of fruit for a snack mid-afternoon or after dinner. But this does not appear to be the best choice when you have PCOS. Not only do cookies, cakes and ice cream turn into sugar when you eat them, but so does bread, rice, pasta, cereal, dairy, and fruit. When this happens, your body can only use so much sugar at a time, and so the rest is stored as fat and may increase our risk for insulin resistance because of the overflow of sugar at one time. Now- I wasn’t going to give up fruit all together (it does have its benefits!!), but I now choose low sugar fruits instead and keep the portion controlled (i.e </=1/2 cup at a meal). I eat primarily berries as they are the lowest sugar fruits, but they’re also the highest in antioxidants (which help fight inflammation). I base my diet around vegetables and healthy fats, include small portions of lean protein (i.e an egg, piece of chicken), and keep the berries around too. I noticed that by doing this, my energy levels improved; I wasn’t experiencing that post-lunch energy crash and feel my energy has actually become more sustained and stable.
Healthy fats like avocado, good-for-you oils (i.e olive, avocado, flaxseed), nuts and seeds not only help us feel satiated, but there’s also evidence that they quell our sugar cravings. Monounsaturated fats and omega-3 polyunsaturated fats are crucial for helping to reduce inflammation in the body. In theory, if inflammation is reduced, our body can function better to work at its best. Ideally, this would then help me to improve the PCOS status. Vegetables are also packed with nutrients that fight inflammation, so I vary up my veg, trying not to stick with the exact same foods every day. Green leafy vegetables – like broccoli, spinach, kale, Brussels sprouts, asparagus – are particularly rich in B vitamins and have been shown to help stave off sugar cravings.
Not only does Vitti’s book say this, but also numerous research articles have been published establishing that a diet high in healthy fats and lower in carbohydrates (not zero carbs, but lower in carbs) can help to improve PCOS symptoms (weight status, and hormone levels including insulin).
Another piece of the PCOS treatment puzzle is physical activity. Admittedly, I really do love to exercise. That corny adage, “Exercise helps calm the mind”, is a reality for me. Without it, I don’t sleep as well and I don’t feel as good within my body. Before deciding to make some changes to improve on my PCOS, I will admit that I, at times, probably worked out harder than my body wanted to and I am sure this added unneeded stress. Now, I focus on listening to my body and what it wants. Something that I love about Vitti’s program is that there’s an associated app called My Flo, and it makes suggestions on what exercise may be best to do during different phases of your cycle to help optimally support the hormones. To be honest, these recommendations really do seem to align well with what my body is telling me to do. So maybe during my ovulatory phase, I do more kickboxing, and during my menstrual phase, I’m all about the yoga. It works.
Vitti also explains that it’s crucial to integrate other forms of functional medicine in to help support our bodies in this change, and there’s some research to support this. I started acupuncture – which also involves cupping and heat therapy – about three months ago and have had three sessions thus far. Let me tell you – I have never felt so zenned out in my LIFE as I do after these sessions. They’re about 90 minutes long and Pipper, my upbeat lovely acupuncturist, is making a difference – I just know it, I feel it.
And now to touch on two final factors that majorly impact hormones: sleep and endocrine disrupters in products. Research shows that when we don’t get enough sleep, this disrupts the function of our endocrine system and our hormones. As we talked about earlier, with PCOS, hormones are out of balance; not getting enough sleep can increase the risk for insulin resistance, increase levels of the stress hormone cortisol (which promotes inflammation), and reduce our sensitivity to hunger hormones that tell us we’re full. All of this contributes to hormonal imbalance, weight gain, and increased risk for inflammation and diabetes. In theory, if we get more regular, complete sleep, our hormonal balance can improve.
Substances like bisphenol A (BPA), PCBs, and parabens are considered to be endocrine-disrupting compounds (EDCs) because they mimic the hormone estrogen. EDCs can change the ways our hormones signal and therefore likely have an impact not only on risk for and severity of PCOS, but also on our metabolism in general and risk for chronic diseases like cancer. So check for them in your makeup, deodorant, plastic bottles, etc.
Talking helps too. Since my PCOS diagnosis, I have uncovered that a number of people close to me also have the condition and I feel part of that community now. We share stories about what we’ve tried and how we’re feeling, and the support truly makes a difference!
Since beginning to make all of these changes about six months ago, I have started to see changes in my body. I had never had skin issues until I went off the pill, and then I started developing some random more cystic pimples. Since making these diet and lifestyle changes, I rarely have any breakouts. I also notice I’m more energized, and my weight has been more consistent. I’ve felt confident that I can do something about this – I am supporting my body in making the changes it needs to function at its best and that makes me feel good! And this past month, I’m proud to say I got my period for the first time in five – instead of seven – weeks! More to come!
*Other conditions such as thyroid dysfunction and Cushing’s syndrome are ruled out before PCOS diagnosis.