PCOS: the why and the how. 10 steps to managing it.
PCOS stands for polycystic ovary syndrome, and it is a complex endocrinological and gynaecological condition affecting up to 15% of women of reproductive age.
It is an incredibly complex condition, characterised by a set of symptoms driven by several different, although possibly interconnected, clinical factors.
The diagnostic criteria have evolved through the years and although there is no agreement on definitive markers for a clinical diagnosis, the ones more commonly used are the Rotterdam 2003 criteria.
They require 2 of the following 3 symptoms to be present:
1. Hyperandrogenism: High levels of DHEA, Testosterone, HbA1c, GGT and blood lipid markers. Low level of Sex Hormone Binding Globulin.
2. Ovulatory Dysfunction: High levels of LH/FSH, Anti-Mullerian hormone and Prolactin.
3. Polycystic Ovarian Morphology: 12 or more follicles of 2-10 mm in diameter in each ovary, and/or increased ovarian volume (>10 ml).
Several clinical manifestations can be observed in people affected with PCOS, depending on the main drivers for each individual person.
Metabolic dysregulation is common, and this can include:
– overweight and obesity: estimated to impact 38-88% of women with PCOS
– insulin resistance, linked to failure to suppress glucose production: estimated prevalence of 35%-80%. Obesity and PCOS can also have a compounding negative effect on endogenous glucose production.
– increased lipids and elevated cardiovascular risks.
Other symptoms like hair loss on the scalp, hirsutism, acne, non-alcoholic steatohepatitis and sleep apnea, mood disorders, and binge eating are also common.
But the question remains, WHY are 15% of women in reproductive age diagnosed with PCOS?
There are many factors at play, and it is so important to understand that they can be interconnected so addressing one driver, while ignoring the other, is not always a good solution.
Genetic: PCOS tends to run in families. Studies have shown that women with PCOS are more likely to have close relatives, such as sisters or mothers, who also have the condition. Possible genes at play are those involved in hormone regulation, insulin signalling, and inflammation.
HPA axis dysfunction: A disrupted communication system between the hypothalamus, pituitary gland, and adrenal glands can lead to imbalances in stress hormones (e.g. cortisol), androgens (e.g. testosterone), sex hormones (e.g. oestrogen and progesterone).
HPO axis dysfunction: A disrupted communication system between the hypothalamus, pituitary gland, and ovaries can lead to increased levels of luteinizing hormone (LH) and decreased levels of follicle-stimulating hormone (FSH). This imbalance disrupts the normal development and release of eggs from the ovaries.
Insulin Resistance: Elevated insulin level has been linked to increased ovarian and adrenal androgens, which is further exacerbated in obese PCOS women in light of the aromatisation of androgen in oestrogen.
Inflammation: Oxidative stress and systemic inflammation alongside insulin resistance seem to promote the dysfunction of endothelial cells and dysregulation of the ovarian thecal compartment leading to hyperandrogenism, anovulation and CV disorders.
The above should serve us as a guide to understand the possible focus points when trying to address the root causes rather than just the symptoms.
But the allopathic treatments often used include:
- Oral Contraceptive pill: to address menstrual irregularities and hyperandrogenism.
- Metformin: to address insulin resistance.
- Spironolactone and topical treatments: for acne.
- Clomiphene citrate: to induce ovulation.
And one cannot help but notice that they are very much focused on addressing the end symptoms, individually. Without looking at the upstream causes or the holistic picture.
So, HOW can we address PCOS from a functional medicine standpoint?
While everybody’s symptoms and drivers will differ, there are key common denominators when dealing with PCOS.
Working with a healthcare provider will allow you to be more focused and targeted towards the drivers, but in the meantime, I’d like to offer my top tips from both a dietary and lifestyle perspective.
From a dietary standpoint:
- Balance your meals: Protein, Carbs, Fats at every single meal. Carbs component should vary per meal and based on insulin resistance.
- Introduce colours: 5 different colours at every meal, to vary through the day. Aim for 70-80% veg and 20-30% fruit.
- Introduce healthy fats for mitochondria and cellular health: Avocado, olives, olive oil. Omega 3 rich foods: Oily fish, flaxseeds, chia seeds, walnuts. While reducing saturated fats.
- Support the liver detoxification process: Cruciferous vegetables, proteins, colours, herbs, fibre, water. While reducing alcohol.
- Remove foods that cause symptoms and increase nutrients that support healing: probiotics, prebiotics, magnesium, chromium, ALA, Cinnamon, Zinc, Vitamin D.
While when it comes to lifestyle:
- Support stress level: meditation, breathing, forest bathing…
- Introduce physical exercise: Type and timing of exercises is key. HIIT or other cardio activities in the evening or too often can further exacerbate high cortisol level. Balance is key.
- Ensure hydration: 2L of water a day.
- Reduce plastic exposure and use chemical free / natural products where possible.
- Consider Intermitted Fasting, overnight calories restrictions, depending on insulin resistance.
Nutrimente is a Nutrition and Functional Medicine clinic specialising in Women’s Health.
The majority of our clients have PCOS, so we have a wealth of experience in this field.
Book your free Discovery Call if you’d like to know more about how we work and whether we could help you.
References:
Diagnosis and Treatment of Polycystic Ovary Syndrome | AAFP
Diagnoses, Syndromes, and Diseases: A Knowledge Representation Problem – PMC (nih.gov)
Role of insulin and insulin resistance in androgen excess disorders (wjgnet.com)Hepatic insulin resistance, metabolic syndrome and cardiovascular disease – ScienceDirect