PCOS (Polycystic Ovary Syndrome): What it is and how to treat it
Women with PCOS can experience symptoms in how they process blood glucose, menstruate, ovulate, carry weight on their bodies, and in their fertility.
·November 9th, 2021
PCOS is a common hormonal disorder that affects as many as 5-10% of women and others with ovaries. The full cause is not yet known and it is often misdiagnosed
PCOS can cause excessive facial hair, irregular menstrual cycles, acne, baldness, weight gain, insulin resistance, depression, and fertility issues
There are different types of PCOS, based on the symptoms people experience. It’s possible to have multiple forms of PCOS at lunch
PCOS can be treated and managed with medication, lifestyle and dietary modification, and complementary therapy–Sound Cycle’s practitioner search can help find the right provider for you
Polycystic ovary syndrome (or polycystic ovarian syndrome), known as PCOS, is a common hormonal disorder that can affect women during their reproductive years. There are three main factors that make up the disorder—polycystic ovaries, ovulatory dysfunction, and hyperandrogenism (an excess of hormones called androgens).
Polycystic ovary syndrome is something of an “umbrella diagnosis,” meaning that it involves multiple systems of the body and can present in different ways. Some common symptoms include excess hair growth on the face or body, missing or irregular period or menstrual cycles, acne, male-pattern baldness, weight gain, and obesity.
Other symptoms that are also common are less obvious, like insulin resistance (which can become metabolic syndrome, pre-diabetes, or diabetes), depression, and fertility issues.
Doctors don’t know exactly why some people get PCOS and others don’t—there is a strong genetic component, but researchers haven’t yet landed on a cause of the disorder. What is known is that women with PCOS can experience symptoms in the way they process blood glucose, how they menstruate and ovulate, how they carry weight on their bodies, and in their fertility.
It takes at least two out of the three symptom categories to be formally diagnosed with polycystic ovarian syndrome, so not every woman with PCOS will experience the disorder in all three areas. Many women aren’t diagnosed until they try to get pregnant and discover they have fertility problems.
To diagnose PCOS, a gynecologist or reproductive endocrinologist will look at your medical history and then typically perform a basic physical, looking at hair growth, body composition, and skin.
They will do a pelvic exam and ultrasound, which will show them whether a person’s ovaries have the specific type of cysts associated with PCOS (which are called “chain of pearl” cysts due to the way they drape around the ovaries like a necklace). They will also analyze the patient’s blood, looking at different hormone levels to assess their balance.
The hormonal facets of PCOS are the result of a domino effect of reactions within the body. Because the eponymous cysts grow on the ovaries, they influence how hormones are produced and released. The cysts are follicles (immature eggs) that don’t mature enough to trigger the process of ovulation in the body, and so they just remain in and around the ovaries, causing pain and disruption in ovarian function.
Many people with PCOS do not ovulate. To signal ovulation, the body needs enough of two hormones that are made by the pituitary gland: follicle-stimulating hormone, or FSH, and luteinizing hormone, or LH. In a balanced hormonal system, there is a ratio of estrogen, progesterone, and androgens that supports optimal functioning.
In PCOS, however, there’s a glitch in the hormonal trigger that uses FSH and LH to signal the body to ovulate—hence the backlog of partially-matured eggs that accumulate in the ovaries. This glitch causes issues because it affects the hormonal ratio. A hallmark of PCOS is elevated androgens (aka “male hormones,” though they are present in different amounts in bodies of all genders).
The different types of PCOS
There are four types of polycystic ovary syndrome: insulin resistant polycystic ovary syndrome (the most common type), adrenal PCOS, inflammatory PCOS, and post-pill PCOS.
Insulin resistant PCOS
The vast majority (up to 70%, according to some research) of people with PCOS have insulin resistance. Insulin is a hormone that is created by the pancreas to allow the body to process dietary sugars—you probably recognize its name from its role in diabetes. That’s an important connection, because the kind of insulin resistance that happens with PCOS can increase your risk of developing type II diabetes (or gestational diabetes if you become pregnant).
This blood-glucose facet of PCOS interfaces with the hormonal element because when the body is resistant to insulin, the pancreas is signaled to create more. The extra insulin it creates signals the ovaries to produce even more androgens, which were elevated to begin with.
When you stop taking hormonal birth control pills, there is an adjustment period during which the hormonal systems of the body attempt to re-regulate. For some people, this is quick and easy, with few side effects, but for others, the hormonal dysregulation is significant enough to create temporary PCOS. This happens because there is a surge in androgens during the withdrawal phase of birth control, which then can trigger the same bodily responses that occur in insulin-resistant or “classic” PCOS.
Post-pill PCOS typically resolves itself without intervention, though some herbalists and naturopathic doctors recommend taking natural anti-androgen supplements like zinc and licorice to speed the process.
There are many conditions that cause people to become overweight or obese, and these conditions all cause inflammation throughout the body. Chronic inflammation, in turn, is linked to overproduction of androgens. With inflammatory PCOS, it is important to figure out the underlying source of inflammation in the body, which can range from food reactions or histamine intolerance to issues with the gut biome. Inflammatory
PCOS is typically diagnosed if none of the criteria for insulin-resistant or post-pill PCOS are present and if the patient has concurrent digestive conditions like SIBO, IBS, or ulcerative colitis, an autoimmune skin condition like psoriasis or eczema, or a diagnosis or symptoms of another autoimmune disease, like Hashimoto’s disease.
When doctors look at blood hormone panels to check for imbalances that point to PCOS, they’re looking for elevated testosterone and androstenedione, which are created by the ovaries, and DHEAS, which is created by the adrenal glands. In some patients, there will be normal levels of the ovarian androgens, but elevated levels of DHEAS—that scenario indicates adrenal PCOS.
Typically, patients with adrenal PCOS don’t have issues with insulin resistance or with inflammation—their issues are concentrated in their adrenal glands.
The types of polycystic ovarian syndrome aren’t mutually exclusive, meaning that it’s very possible for any given case of PCOS to present as more than one type. A specialist like a reproductive endocrinologist or a functional medicine doctor can give the best advice on how to treat your PCOS according to its type.
Treatments for PCOS
Polycystic ovary syndrome is treated with a combination of medication and lifestyle consultations or interventions. PCOS causes many patients to gain and hold onto weight, and losing 5-10% of your body weight can radically improve the symptoms of PCOS. As a result, incorporating physical activity and a healthy weight-control diet can be transformative.
Low carbohydrate diets are particularly effective for weight loss with PCOS, because they work around insulin resistance without causing metabolic fatigue. Working with a registered dietitian who specializes in PCOS can be a game-changer.
The most common medical treatment for PCOS is hormonal birth control. It works to create a hormonal balance that restores and regulates ovulation—restacking all the dominoes that have fallen in the hormonal chain of events. It can also clear up many high-androgen side effects, like facial hair, acne, and balding.
Another common and effective treatment for PCOS is a prescription diabetes drug called metformin. Metformin works on PCOS by regulating insulin levels in the body, which can in turn regulate hormonal balance and signal ovulation.
Metformin is also an excellent low-intervention treatment for infertility from PCOS (though make sure you talk to your doctor about the safety of taking it during pregnancy). Another fertility drug that is commonly used for PCOS-caused infertility is called Clomid.
Outside of the pharmaceutical world, there are many complementary therapies that may improve the symptoms and severity of PCOS, though research is more limited. Natural supplements that inhibit androgens may be helpful—a naturopath is a great choice of practitioner with whom to explore those options.
A good acupuncturist, too, can help manage the condition (and may be covered by your insurance or HSA).
What it’s like to live with PCOS
Because the range of symptoms and severity is so broad with PCOS, there is a similarly wide range of experiences when it comes to living with the disorder. Some people are significantly impaired, suffering from intense pain with menstrual periods, struggling to control their weight, and facing infertility. Other cases of PCOS are so mild that they are never even diagnosed.
If you’re living with PCOS, it’s important to assemble a team to help you manage your condition. A great gynecologist or reproductive endocrinologist is key, and they may have referrals to the functional medicine doctors, dietitians, acupuncturists, and herbalists who can round out your roster.
If you think you may have PCOS, the right provider can help you build a personalized plan to support your wellbeing. Connect with a credentialed expert who serves your area here.