PCOS

Polycystic Ovarian Syndrome or PCOS is a genetic, hormonal, metabolic and reproductive disorder all in one. PCOS affects 1 in 10 women and is one of the leading causes of infertility.

Polycystic Ovarian Syndrome (PCOS) is a chronic hyperandrogenic state often in combination with insulin resistance and metabolic dysfunction and can present with a variety of symptoms including: obesity, amenorrhea (no period), oligomenorrhea (infrequent periods), infertility or androgenic features (acne, facial hair growth, hair thinning). Women with PCOS have an increased risk of endometrial cancer as well as heart disease and diabetes so it is not something we should ignore.

What causes PCOS?

Elevated insulin is the most likely underlying cause. Elevated insulin leads to altered function of the hypothalamus which impairs secretion of Follicle Stimulating Hormone (FSH) and Luteinizing Hormone(LH). Increased LH causes more androgens to be made and ovulation does not occur. There is a mismatch then between progesterone (too little) compared to estrogen causing estrogen dominance. Elevated insulin also leads to decreased Sex Hormone Binding Globulin which leads to increase in free testosterone leading to the masculine features of PCOS. 

There is some research showing a link between the gut microbiome and PCOS. The hypothesis suggests that dysbiosis or a shift toward more pathogenic bacteria in the gut which can be caused by poor diet creates an increase in intestinal permeability resulting in systemic inflammation, contributing to PCOS. Studies have shown that women with PCOS tend to have lower diversity in the gut microbiome and increase intestinal permeability which leads to downstream inflammation. 

Complications of pcos can include:

• Infertility
• Gestational diabetes or Preeclampsia
• Miscarriage or premature birth
• Fatty liver disease 
• Metabolic syndrome — this is a cluster of conditions including high blood pressure, high blood sugar, and high cholesterol and triglyceride levels that significantly increase the risk of cardiovascular disease.
• Type 2 diabetes and prediabetes
• Sleep apnea
• Depression and anxiety
• Endometrial cancer

How should PCOS be treated? 

PCOS is a multifaceted disorder that should be treated as such. And no, the answer is not birth control or just “eat less and exercise more.” The first target should be normalizing insulin through nutritional and lifestyle strategies and reducing inflammation by incorporating the following:

• Increase fiber which can help with so many things! Fiber helps to slow absorption of carbohydrates when paired together, improves microbiome abundance and diversity and also helps with satiety cues.
• Increase fruit and low starchy vegetable intake (Eat the Rainbow!) to improve diversity of the gut microbiome
• Balance blood sugar – always pair carbs with protein, fat or fiber (more on balancing blood sugar here!)
• Include pre and probiotic foods like resistant starch and fermented foods to support the gut microbiome 
• Practice mindful eating – truly slow down and savor each meal, listen to hunger cues and improve digestion and absorption of nutrients.
• Emphasize omega 3 fatty acids from sources like fatty fish, nuts, seeds, avocados, and olive oil.
• Avoid artificial sweeteners which can impact the gut microbiome
• Ensure adequate hydration
• Lower stress to improve blood glucose levels and overall wellbeing
• Regular exercise in the form of cardiovascular and strength training to improve insulin sensitivity
• Get optimal sleep – aim for at least 7 hours or restorative sleep each night

What supplements can help with PCOS?

• N-acetyl cysteine (NAC): comparable to Metformin at improving insulin sensitivity
• Myo-inositol: decreases insulin resistance 
• Resveratrol: reverses excess androgens 
• Green Tea: helps to stabilize blood glucose
• Chaste Tree Berry (Vitex) helps support healthy hormones 
• Cinnamon: increases insulin sensitivity 
• Cyclic Progesterone on days 14-27

Consultation is Key

While these tips and supplements can provide valuable support, it’s essential to consult with a healthcare professional, such as myself, to develop a personalized plan tailored to your unique needs. Every patients PCOS journey and symptoms is unique, so should their treatment!

PCOS is a multifaceted condition, and addressing its metabolic implications requires a comprehensive approach. By incorporating these actionable tips and supplements into your lifestyle, you can take meaningful steps towards managing PCOS and promoting overall well-being.

If you have any questions or concerns about PCOS and metabolic health, schedule a consultation to discuss a personalized plan that aligns with your health goals.