Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of childbearing age (1). It is estimated that up to 70% of women with PCOS have not been diagnosed (2). PCOS is a disorder of the endocrine system affecting sex hormones, hypothalamus-pituitary communication, and insulin secretion/production.
My ultimate goal to help you with your PCOS is to regulate your cycle naturally and make sure that you are ovulating regularly. This includes educating you on WHY things are happening in your body.
Symptoms of PCOS include (3):
Irregular periods
Heavy bleeding
Increased hair growth (facial and body)
Acne
Weight gain
Darkening of the skin
Headaches
Gastrointestinal Issues
Insulin Resistance
What is PCOS?
PCOS is caused by an imbalance in the hormones in your brain and your ovaries. During a normal cycle, estrogen levels increase in the first half of the cycle. When there is an estrogen spike, this signals the brain to release Luteinizing Hormone (LH) and Follicle Stimulating Hormone (FSH). FSH stimulates the ovary to produce a follicle and LH triggers the ovary to release a mature egg (2). Read more about what a normal cycle should look like here.
When a hormone called LH is too high, this can cause the ovaries to produce too much testosterone (hence the increased hair growth and acne). In PCOS, LH levels are often high when the menstrual cycle starts. Because levels of LH are already elevated, there isn’t a surge that causes ovulation to occur (why the periods may be irregular). Some women may ovulate occasionally, or not at all. This may cause their periods to be close together, far apart, or not occurring.
Each month, the ovaries develop many follicles. Folliculogenesis (or development of the follicles) begins the last few days of the preceding menstrual cycle until the release of the mature follicle at ovulation. Women begin puberty with around 400,000 follicles!
The development of the follicles occurs in several stages. Multiple follicles develop at once, and by day 8 of the cycle, the body recognizes the “strongest” follicle and therefore promotes more growth of that follicle while suppressing growth of the other follicles (5). In women with PCOS, the ovary isn’t receiving the correct signals from the brain to produce the hormones that it needs to mature these follicles. Since there is a lack of communication, the body doesn’t ovulate (release of the mature egg) and the follicles continue to exist leading to “polycystic ovaries” (6).
What causes PCOS?
Insulin Resistance
PCOS may also be associated with insulin resistance or sugar handling issues. It is estimated that 65-70% of women with PCOS have insulin resistance (4). Insulin is a hormone secreted by the pancreas. When you eat, particularly carbohydrates, food gets broken down into glucose. As your glucose levels rise in your blood, the pancreas releases insulin to help bring those levels back down. It does this by helping to move glucose into the cells so that they can be broken down into ATP- aka energy. This can also prevent the body from using fat for energy. Increased insulin levels can cause the ovary to produce more androgen hormones, such as testosterone.
Inflammation
Research has shown that there is a strong inflammatory process associated with PCOS. It has been identified that elevation of multiple inflammatory markers including CRP, IL-18, MCP-1, and WBC are present in many women with PCOS (7). Inflammation can be caused by a number of things including: food sensitivities, infection, thyroid dysfunction, and stress- to name a few.
Genes
PCOS has been proven to be a familial condition. It is estimated that 20-40% of women with PCOS have a mother or sister with the condition (8).
Birth Control
Oral Contraceptives (OCPs) remain to be one of the most frequently prescribed medications for the treatment of PCOS. However, an article published by The Journal of Clinical Endocrinology and Metabolism suggests that OCPs may exert adverse metabolic effects. Meaning, OCPs may make insulin resistance worse and increase risk of other metabolic actions that can increase long-term risk for diabetes and cardiovascular disease (9). This journal suggests that more research is warranted before prescribing all women with PCOS Oral Contraceptives.
Thyroid Dysfunction
Thyroid disorders are more prevalent in women with PCOS than the general population.
Abnormalities in thyroid hormones may inhibit ovulation by affecting levels of FSH and LH (10). Being overweight or obese can also play a role in thyroid function, with most of these people showing an elevated TSH (suggesting hypothyroidism). Increased TSH can lead to increased adipose (fat) tissue, which can lead to increased inflammation and increased insulin resistance (10).
Diagnosing PCOS
Guidelines from the Endocrine Society utilizes the Rotterdam Criteria for diagnosis. Two of the following three criteria are required for a diagnosis of PCOS (11).
Oligo/anovulation (infrequent or absence of ovulation)
Hyperandrogenism (increased “male” hormones)
Clinical: hirsutism or less commonly male pattern baldness
Biochemical: Raised FAI (Free androgen index) or Free Testosterone
Polycystic ovaries on ultrasound
Natural Therapies for PCOS
Regulate Ovulation
Black Cohosh – Can be used to help induce ovulation.
Licorice Root – Can be used to regulate hormones and reduce cortisol production.
Chaste Tree – Can improve progesterone production.
Additional hormonal supplementation when indicated.
Improve Insulin Resistance and/or Metabolic Syndrome
Inositol – Helps to regulate levels and reduce insulin resistance.
Berberine – Can reduce blood sugar levels in people with diabetes.
Niacin – Can help reduce elevated cholesterol levels.
Reduce Androgens
Sal Palmetto – Can reduce symptoms of high androgens by inhibiting 5a-reductase
EGCG – Can be effective in supporting healthy androgen levels by regulating estrogens
Reishi Mushroom – Can reduce levels of testosterone and inhibits 5a-reductase
**These are some of the possible methods I may use to address your issues and not an extensive list.. However, I base my recommendations off of testing, your history, and specific needs to YOU. This means that recommendations may look different from one patient to another.
Testing
As mentioned above, there are many factors to consider when treating PCOS. This may include evaluating thyroid function, sugar handling, and determining what may be creating increased inflammation. It is important to consider all factors before prescribing medications. You can read more about some of the packages I offer here.
Work With Me 👇
If you are struggling to find a way to manage your PCOS, looking for preconception counseling, are having difficulty conceiving, and/or have suffered from miscarriage(s) you can click here to sign up with a complimentary 15 minute phone call with me. We can discuss your goals at that time and determine whether or not we will be a good fit for each other.
About Dr. Zaremba: Dr. Zaremba received her bachelor's degree from Western Michigan University in Biomedical Sciences and minored in Chemistry and Psychology. She completed her doctoral training at Palmer College of Chiropractic. During her time in school, she took post-doctoral training through The Clinic on Disease and Internal Disorders (CDID) earning her a Diplomate from the American Board of Chiropractic Internists (DABCI).
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References:
https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome
https://www.healthline.com/health/polycystic-ovary-disease#what-is-pcos
https://www.healthline.com/health/polycystic-ovary-disease#health-effects
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/
https://www.glowm.com/resources/glowm/cd/pages/v5/v5c012.html
https://fertility.wustl.edu/getting-started-infertility/infertility-factors/polycystic-ovarian-syndrome-pcos/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245829/
https://ghr.nlm.nih.gov/condition/polycystic-ovary-syndrome#inheritance
https://academic.oup.com/jcem/article/88/5/1927/2845085
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287775/
https://www.aafp.org/afp/2016/0715/p106.html
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