Polycystic Ovarian Syndrome (PCOS) is a hormonal condition common among women of reproductive age that affects ovulation, menstruation, fertility, and hormone levels. Research shows it affects about 1 out of 10 women of reproductive years, however, we believe that statistic is much higher. Many women are not appropriately screened for PCOS or they may take oral contraceptives which mask the presentation of PCOS leading to a missed diagnosis. It is important to remember that PCOS is a syndrome and is not black and white. In fact, there is no universal definition of PCOS; however there are three features Healthcare Providers are often looking for including irregular menstrual cycles, symptoms of androgen excess (outlined below), and cysts on ovaries. At STAT Wellness, it is one of the most common conditions we see impacting fertility in women of reproductive years since a key component of PCOS is what is called anovulatory cycles. If you have been trying to conceive for 4-6 months or more without success, make sure to give us a call so we can take a deeper dive into your hormones.
So what are the symptoms of PCOS? There are several, but here are a few:
- Irregular cycles
- Weight gain
- Acne, specifically along jawline, neck and back
- Body odor
- Hair loss on head
- Unwanted dark hairs on chin, chest, etc (called hirsutism)
- Difficulty conceiving
- Food cravings
In Functional Medicine, we always want to uncover the root cause of symptoms, conditions, and diseases- PCOS is no different. We have identified three main types of PCOS at STAT Wellness, including:
- Adrenal driven PCOS
- Inflammatory driven PCOS
- Insulin resistant driven PCOS
Here is a breakdown of each potential “types” of PCOS:
Adrenal driven PCOS is seen during extended periods of high stress. This can be physical or mental stress. With this form of PCOS, an adrenal androgen called DHEA-S is often elevated and testosterone may be normal. Examples of physical stress include over exercising, under eating, infections, stimulants, etc where emotional stress is more related to relationships, work, finances, etc. When an individual is under high levels of stress, cortisol is typically elevated as well which increases our blood sugar levels (another driver of PCOS). Main goal when treating adrenal driven PCOS is to work on increasing stress resilience. This can be done by reducing overall stressors or helping your body manage stress more effectively.
A few recommendations to help with adrenal driven PCOS:
- Avoid caffeine and other stimulants
- Switch to more strength, walking, and yoga for exercise vs high intensity or steady state cardio until hormones are improving
- Prioritize sleep, aiming for 8 hours per night
- Sip adaptogen tea such as holy basil or lemon balm
- Incorporate deep breathing throughout the day
- Add electrolytes- specifically ones with vitamin C, potassium, and sodium to help with fluid balance and adrenals. We love the “adrenal cocktail” highlighted below.
- Talk with your healthcare provider about adding adaptogens such as Vitex (aka Chaste tree) or Ashwagandha, as shown below
Inflammatory driven PCOS is often seen with other systemic signs of inflammation such as brain fog, fatigue, joint pain, gut issues, etc. It is thought that some forms of PCOS may be autoimmune in nature due to the low levels of progesterone overstimulating the immune system. With this form of PCOS, it is important to get a thorough health history to uncover some potential root causes for inflammation and run additional tests including CRP, Sed Rate, and ANA with titer at the very least to track inflammation.
A few recommendations to help with inflammatory driven PCOS:
- Test for potential food sensitivities with STAT Wellness
- Evaluate gut health further with a comprehensive stool test (we offer both the GI MAP and GI Effects at STAT Wellness)
- Make sure your omega 3 fatty acids and vitamin D levels are optimal as they impact immune health
- Talk with your healthcare provider to see if you may be a candidate for LDN (low dose naltrexone)
Insulin driven PCOS is the most common form and thought to be about 70% of all forms of PCOS. With insulin resistance PCOS, women really struggle with weight and high levels of insulin increase testosterone causing more hair on face/chest (hirsutism), acne, and body odor. It is important with this form blood sugar levels are adequately being tested and managed. We recommend everyone get at least a fasting glucose, insulin, and hemoglobin a1c (3 month average of blood sugar control).
A few recommendations to help with insulin driven PCOS:
- Consider wearing a Continuous Glucose Monitor to track your blood sugar over a 2 week period to get better control (we offer THIS at home CGM + 2 Dietitian Consults)
- Make sure to eat blood sugar balancing meals- protein, healthy fat, and fiber with each meal
- Avoid/limit processed food and specifically sugar
- Exercise regularly - doing a combination of strength and cardio
- Get enough sleep and manage stress since both of these help with sleep
- Talk with your healthcare provider to see if you are a candidate for Inositol and Berberine; both of which we have seen excellent improvements with
- If the above, is not enough to move the needle. We will prescribe metformin to help with insulin sensitivity
As you can see, it is important to uncover the root cause so we can tailor the plan to focus on that vs just managing the symptoms with triad of treatment which includes birth control, metformin, and spironolactone. While all of these medications have a place and can help control unwanted symptoms of PCOS, it is not addressing the root cause so we don't want to rely on them solely.
In conclusion, PCOS is a complex condition that requires a multi-faceted approach to manage. Making lifestyle changes such as adopting a healthy diet, exercising regularly, managing stress, and getting enough sleep can help improve the symptoms of PCOS and reduce the risk of related health problems such as heart disease, diabetes, and more. Additionally, consider taking supplements and using herbal remedies under the supervision of a healthcare professional. Remember to work closely with your provider to develop a personalized treatment plan that is best for you. Don't settle for not having answers and just managing symptoms!
Book a FREE 15 min consult to see if we can help you today. You can book with THIS link or call/text 404-254-5905
In good health,
Kristin Oja, DNP, FNP-C, IFMCP
CEO + Founder