While women with PCOS usually seek medical care due to a number of more immediate unwanted symptoms – namely irregular or absent menstrual cycles, increased facial hair growth, weight gain or acne, it is now well established that these same women are also at an increased risk for several major chronic diseases
Diagnosis of PCOS
According to the Rotterdam Criteria, at least 2 of the following 3 features must be present for the diagnosis of PCOS:
- Irregular ovulation of lack of ovulation
- Clinical and/or biochemical signs of excess androgens like abnormal hair growth or excess body hair, acne, hair thinning or male pattern baldness
- Polycystic ovaries (> 12 follicles of 2 – 9 mm or volume > 10 mL)
- Exclusion of other etiologies like hypothyroidism
Labs to Consider for PCOS
- Total Testosterone
- Free Testosterone
- Sex Hormone Binding Globulin (SHBG)
- Free Androgen Index
Common Signs and Symptoms of PCOS
- Menstrual dysfunction
- Increased risk of Type II Diabetes
- Increased risk of cardiovascular disease, endometrial hyperplasia, uterine caner
- Estrogen Dominance
Treatment Goals for Women With PCOS
Women with PCOS have two core imbalances, blood sugar dysregulation with insulin resistance, and excess androgens, like testosterone and DHT. Our treatment plans focus on several key areas important to women including:
- Improving menstrual regularity
- Protecting the uterine lining and preventing endometrial cancer
- Reducing androgens and treating the symptoms of excess including acne, hair thinning, and excess body hair
- Restoring fertility if desired
- Weight management if overweight to reduce the risks of diabetes and cardiovascular disease
General Dietary Approaches to PCOS
- Caloric restriction
- Higher protein
- Lower carbohydrate, less than 80 grams per day
- Emphasis on a plant based diet with plenty of organic fruits and vegetables
- Flax seeds can help to lower androgens and estrogens and may stimulate progesterone and increase the length of luteal phase
- Fiber can decrease post-meal blood glucose and insulin levels common in women with insulin resistance and blood sugar imbalances
- Soy can decrease aromatase activity and increase SHBG
- Wild caught fish that are high in omega 3 fatty acids, like salmon, sardines, mackerel
- Little or no grains, even whole grains as these can interfere with normal glucose and insulin levels
- Exercise, focusing on aerobic, high intensity interval training, and strength training/weight lifting, which can decrease belly fat, increase lean muscle, and improve insulin sensitivity
Botanicals for PCOS
We have many options for treating PCOS naturally with botanicals and nutrients.
Saw Palmetto inhibits the enzyme, 5 alpha reductase and inhibits the conversion of testosterone to DHT. DHT is the more potent androgen and causes symptoms like acne and excess hair growth, especially facial hair growth, so having lower levels of DHT treats many of the common symptoms women with PCOS endure.
Nettle Root can increase SHBG, which binds free testosterone and can decrease androgen related effects.
Green Tea increases SHBG and decreases serum free estradiol. It also stimulates thermogenesis, increasing fat burning and inhibiting fat absorption.
Gymnema can lower blood sugar levels, but it may raise insulin levels. Women with PCOS already have elevated insulin levels and insulin resistance, so even though this botanical is commonly used in women with PCOS, I would rather use other options, like diet and exercise to normalize blood sugar and insulin levels.
Fenugreek can delay gastric emptying, slow carbohydrate absorption and has some blood sugar lowering properties, however, like with gymnema, it may do this by increasing levels of insulin, which is counter-productive in most women with PCOS.
Licorice Root has been shown to decrease testosterone synthesis in women and lower body fat.
Maitake Extract has been compared to Clomid, a drug used in fertility management and was found to improve ovulation as well as enhancing insulin sensitivity and lower blood glucose levels
Spearmint Tea can lower total and free testosterone at just 2 cups per day.
Sarsaparilla and Bloodroot have a progesterone-like effect and has been used for this reason historically, but we do not have any studies to support this currently.
Bitter Melon has a blood sugar lowering effect after meals and can help combat the insulin resistance seen in women with PCOS.
Black Cohosh can improve ovulation in women with PCOS.
- Fish oil
- Vitamin D