Polycystic ovarian syndrome (PCOS) is the most commonly diagnosed endocrine disorder in women of reproductive age. As PCOS is a syndrome there is no exact diagnostic criteria – a women need to have 2 out of 3 of the listed concerns so it does vary from patient to patient. The 3 criteria are
- Anovulation or irregular menses
- Cystic activity on ovaries seen in the ultrasound
- Elevated androgens or symptoms such as cystic acne and hirsutism (unwanted hair growth)
PCOS often goes undiagnosed until a woman is trying to conceive and runs into difficulty.
There are 2 main types of PCOS one displays with more disturbances in blood sugar regulation and the other more with adrenal/hypothalamus dysregulation. We will discuss both types and approaches for each.
The more common and often easier diagnosed version of PCOS is the type with blood sugar regulation as the main concern. Women will generally present with the more classical symptoms of absent or irregular periods, missed ovulation, acne, unwanted hair growth and easy weight gain/difficulty losing weight. With this type of PCOS there are 2 supplements that I find particularly helpful. The first is a vitamin called myo-inositol. Inositol helps to sensitize receptors for insulin as well as other hormones such as testosterone and estrogen. This allows it help with the majority of symptoms women will experience. If blood sugars continue to be a concern or more support is needed N-acetyl cysteine or NAC also has some great research. NAC has been shown in research to be as effective as metformin for blood sugar regulation in woman with PCOS.
Diet is also an extremely important component to help manage PCOS symptoms. Working on increasing vegetables and fruits, lean proteins, and healthy fats such as nuts, seeds and avocados is a great place to start. It is also important to reduce the amounts of refined carbohydrates so foods such as sugars, white rice, flour and focusing carbohydrates on complex ones with lots of fiber such as quinoa, sweet potatoes and beets.
With the second type of PCOS that is more adrenal/cortisol focused symptoms can be a little different. We will still see concerns with menstrual cycle often absent ovulation or irregular menses, acne but these women often will come from an athletic background and have a lean body type. We can also see more concerns in these women with sleep patterns and energy which typically start to present into their later 20’s/early 30’s. For these women treatment needs to focus more on regulating our stress hormone cortisol as well as the balance between progesterone and estrogen. In practice I often find this type of PCOS gets diagnosed in athletes once they stop training at as high of a level. While they are training, they will often have missed periods that get attributed to their training and lower body fat percentage. However, once their training reduces their periods often don’t regulate which can be a sign that it may be PCOS.
There are some great changes that can be incorporated to support the stress response and cortisol regulation. Starting a daily breathing or mindfulness practice can play an important role in helping with regulation. Research has shown that starting with 2-5 minutes daily can help reduce cortisol levels. Spending time outside in nature often also plays a significant role helping with regulation.
There are also some nutrients and herbs that can be helpful as well some examples include B5 and B6, ashwagandha, licorice, holy basil and ginseng are all examples of adaptogens that can help regulate your stress response and cortisol levels.
For both types of PCOS exercise is an important part of helping to maintain symptoms. Exercise can take on different forms depending on your base level of activity could be as simple as walking or could be playing a sport, dancing, biking etc. You want to aim for at least 30 minutes of movement 5 days a week at a minimum. I find it helpful to put your exercise in your calendar as I find when schedules get busy this is one of the first things to go.
No matter which type of PCOS you have there are supporting diet, supplementation and lifestyle changes you can incorporate to help manage your symptoms and optimize your health. The majority can be used in combination with other pharmaceutical medications but make sure to speak to your health professional about the best ways to start incorporating changes.