Polycystic Ovarian Syndrome (PCOS) is one of the most common conditions affecting reproductive age women, and it can wreak havoc on your hormones.
The presentation and severity of PCOS symptoms vary from person to person, and as such, treatment should be catered towards the patient’s individual picture, not the PCOS label. Like any other condition, it is important to rule out other causes first before arriving on a diagnosis of PCOS.
Classic symptoms of PCOS include:
Symptoms can vary heavily, depending on ethnicity and menopause life stage
- Irregular menstrual cycles & anovulation
- Excessive hair growth (hirsutism) – can be on face, chin, stomach, arms etc.
- Male pattern hair loss
- Acne
- Weight gain and weight loss resistance
- Skin tags
- Darkening of skin in the creases of your arms, neck, groin, under breasts.
Associated conditions with PCOS include:
- Infertility
- Pregnancy complications: gestational diabetes, preterm delivery, pre-eclampsia
- Endometrial cancer
- Obesity
- Sleep apnea
- Depression
- Type II Diabetes Mellitus
- Elevated cardiovascular risk
As seen above, PCOS comes with a milleu of symptoms stemming from a variety of physiologic drivers. Dr, Lara Briden ND, proposes four specific types of PCOS:
- Insulin resistant PCOS
- Pill-induced PCOS
- Inflammatory PCOS
- Adrenal PCOS
By treating the different underlying drivers, the syndrome can generally be managed very well.
Goals of treatment should include understanding the main drivers of your PCOS and taking into account individual factors such as personal health history, lifestyle, diet, and genetics. Some strategies that can be employed to manage your PCOS symptoms include:
Eating a low glycemic diet
- Insulin resistance is a feature in many cases of PCOS, and adopting a pattern of eating that aims to keep blood sugar levels stable will assist with mood, acne, weight loss resistance, and metabolic flexibility. In addition to eating low-glycemic foods, consider be cognisant of increasing fiber intake throughout the day, as fiber is slower to digest and will maintain even blood sugar levels for a prolonged period.
- A 2-5% weight reduction leads to a reduction in insulin, androgens and has potential to restore ovulatory function and menstrual regularity.
Acupuncture:
- Done over a period of 2-3 months, acupuncture can be used to assist with ovulation induction. In Traditional Chinese Medicine (TCM), there are specific patterns that correlate with different PCOS pictures. Individuals with higher testosterone and insulin levels typically do not respond as well to acupuncture for ovulation induction.
Reducing stress
- This is a key player in many cases of PCOS! An excess stress response stimulates the adrenals and can result in an increased androgen output, exacerbating many PCOS symptoms. Numerous herbal and nutritional agents can be used to acutely manage the stress response (such as l-theanine, phosphatidylserine, Hypericum perforatum, Rhodiola rosea etc), but lifestyle also plays an important role. Meditation, breath work, and visualization are all techniques that may also be employed to reduce stress.
Employing Common Pharmaceutical Options: Hormonal Contraceptives, Metformin, Spironolactone, Clomiphene Citrate, Progesterone
- Pharmaceutical options can be used in to manage many symptoms of PCOS and hormonal contraceptives are often the first-line option (depending on treatment goals)
Employing Common Supplementation Options: Myo-inositol, Berberine, Black Cohosh, Licorice
- Supplements can play a role in the treatment of PCOS by regulating insulin sensitivity, androgen levels, improving LH/FSH ratios (for ovulation), and acne.
PCOS is a complex condition with a myriad of underlying factors. It is important to test and understand the dysfunctional pathways in order to develop a holistic treatment plan. With time, understanding, and effort, PCOS is a condition that can be very well managed!
Please speak with your medical team to help you develop a clear understanding of your unique symptom picture and prescribe diet, movement, supplements, herbals or hormones to get you back to feeling your best.
References:
Colazingari S, Treglia M, Najjar R, Bevilacqua A. The combined therapy myo-inositol plus D-chiro-inositol, rather than D-chiro-inositol, is able to improve IVF outcomes: results from a randomized controlled trial. Arch Gynecol Obstet. 2013;288(6):1405-1411.
Grant P. Spearmint herbal tea has significant anti-androgen effects in polycystic ovarian syndrome. A randomized controlled trial. Phytother Res. 2010 Feb;24(2):186-8. doi: 10.1002/ptr.2900. PMID: 19585478.
Legro RS, Arslanian SA, Ehrmann DA, Hoeger KM, Murad MH, Pasquali R, Welt CK; Endocrine Society. Diagnosis and treatment of polycystic ovary syndrome: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013 Dec;98(12):4565-92. doi: 10.1210/jc.2013-2350. Epub 2013 Oct 22. Erratum in: J Clin Endocrinol Metab. 2021 May 13;106(6):e2462. PMID: 24151290; PMCID: PMC5399492.
Pizzo A, Laganà AS, Barbaro L. Comparison between effects of myo-inositol and D-chiro-inositol on ovarian function and metabolic factors in women with PCOS. Gynecol Endocrinol. 2014;30(3):205-208.
Teede HJ, Misso ML, Costello MF, Dokras A, Laven J, Moran L, Piltonen T, Norman RJ; International PCOS Network. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril. 2018 Aug;110(3):364-379. doi: 10.1016/j.fertnstert.2018.05.004. Epub 2018 Jul 19. PMID: 30033227; PMCID: PMC6939856.
