A Woman’s Guide to Treating PCOS Naturally
PCOS is a really common condition among women that causes irregular or absent periods and a number of awkward and embarrassing symptoms. To fit the criteria for PCOS, a woman should have 2 out of these 3 criteria:
- Lack of ovulation of irregular ovulation
- Signs of androgen excess (such as acne, facial and excess body hair)
- Polycystic ovaries on ultrasound
This is interesting because with this criteria, you don’t need to have cysts on the ovaries to have the diagnosis of PCOS, you could just have irregular periods and acne. Another interesting finding is that you can have normal, regular periods, but not be ovulating regularly, or even at all.
The signs and symptoms of PCOS include:
- Irregular or absent periods
- Recurrent miscarriage
- Oily skin or acne
- Hair loss
- Hair growth where we don’t want it, like the face
- Skin tags
Both women who are overweight or normal weight can have PCOS because they have higher levels of insulin and more insulin resistance.
Excess unwanted hair growth and acne are present in 70% of women with PCOS and only 10% of women without PCOS. Infertility can affect up to 70% of overweight women who have PCOS.
Your doctor can run some specific labs and imaging to determine if PCOS is a problem for you. Some of the lab findings include:
- Cysts on the ovaries
- High testosterone
- Elevated insulin
- Elevated LH
- Decrease SHBG
- High cholesterol and triglycerides
- High blood pressure
If you have had a fasting insulin level tested, the goal is to have it less than 6. Blood sugar should be less than 90 and HbgA1C should be less than 5.4. When SHBG is low, there is more testosterone floating freely in the blood, and this can cause symptoms like acne and unwanted hair growth. Elevated insulin levels are what causes SHBG to drop, leading to more testosterone in circulation. Insulin, along with LH, also stimulates more testosterone to be produced by the ovaries.
The Genetic Link To PCOS
Many scientists believe that PCOS has a hereditary component. Women with PCOS may be born with a gene that triggers higher than normal levels of testosterone and insulin Follistatin is a gene that has been linked to PCOS as it plays a role in the development of the ovaries and is needed to make insulin.
The Environmental Connection to PCOS
Pthalates, BPA, cadmium, and mercury toxicities are all endocrine disruptors that can all be related to PCOS by altering hormone levels and causing irregular ovulation, causing insulin resistance, and causing elevated testosterone levels.
The Stress Connection To PCOS
Stress is a contributing factor to PCOS and studies show many women with PCOS cannot process cortisol properly, leading to elevated levels of cortisol and prolactin, which can cause the ovaries to produce too much testosterone.
Since cortisol stimulates the release of cortisol and insulin, managing stress is an important part of managing PCOS naturally. If cortisol is increased, progesterone production is decreased, leading to estrogen dominance. Cortisol also competes with progesterone for a common receptor, and if there is more cortisol in circulation than progesterone, guess who gets to the receptor first? Cortisol! The effects of cortisol than lead to more insulin, more fat storage, increasing cholesterol levels, all of which contribute to PCOS. Elevated levels of cortisol make the symptoms of PCOS worse.
PCOS can be a risk factor for the development of other conditions including:
- Heart disease
- High blood pressure
- High cholesterol
- Hormonally related cancer
PCOS and Diabetes
Women with PCOS are 7x more likely to also get diabetes, even if they are normal weight. More than half of all women with PCOS also have insulin resistance. This is why balancing your blood sugar is one of the key ways to combat insulin resistance and treating PCOS naturally.
PCOS and Heart Disease
Up to 70% of women with PCOS also have high cholesterol and high LDL. Berberine is an herb that can lower both blood sugar and cholesterol levels. Many women with PCOS also have elevated homocysteine, which increases their risk for a cardiovascular event like heart attack, stroke, and memory loss. Elevated homocysteine can also be a sign of abnormal estrogen metabolism, which comes with a whole host of other problems, namely any conditions with estrogen dominance such as breast cancer. You can test to see if you have good estrogen clearance by running a urine test that looks at the 2, 4 and 16 estrogen metabolite pathways. Women with PCOS also have a higher than normal CRP level, which is a strong marker used to predict future cardiovascular events. PCOS women also have low levels of antioxidants, which cause increased oxidative stress and can contribute to the causes of heart disease in women. We also see 4 x the rate of high blood pressure, which is caused by elevated levels of insulin in women with PCOS.
PCOS and Infertility
In women with PCOS, the ovaries fail to properly ripen and release a maturing follicle (or egg). This follicle stays in the ovary, rather than travelling towards the uterus and continues to produce hormones like estrogen. This increase in estrogen is what can block future ovulation. High levels of testosterone can also block ovulation. Insulin also plays a role in ovulation because the ovaries have receptors for insulin. Insulin stimulates an increase in LH and testosterone levels and decreases SHBG. This drop in SHBG leads to even higher levels of testosterone being free in circulation. In the presence of high testosterone, LH levels increase further and cause poor follicle development and failure to ovulate.
PCOS and Hormonally Related Cancers
Women with PCOS and irregular periods have a 5 x increased risk of endometrial cancer and may have an increased risk of ovarian cancer and breast cancer.
PCOS and Weight
The sad news is that women with PCOS store fat better and burn calories at a slower rate than women who do not have PCOS. Of course, there are so many ways to turn your metabolism around a get the weight off using specific diet strategies, exercise, nutrients, and herbs.
Treating PCOS Naturally
Conventional Treatments Include Medications
Metformin can be used in women who are insulin resistant and can lower testosterone. If you are taking Metformin (usual dose in 500 mg in the morning) for your PCOS or infertility, you may want to consider adding in a B Complex, methyl B12 and Coenzyme Q10, as Metformin depletes these nutrients. If taking Metformin give you uncomfortable GI side effects, there are compounded versions available that can be applied to the skin instead of taking it orally. Spironolactone 100 mg BID can be used as a last resort to manage acne and unwanted hair growth.
Targeted Nutrition for Treating PCOS Naturally
A low glycemic diet with exercise can lead to weight loss, decreased insulin and LH levels, and improve ovulation. Lentils, chickpeas, fiber, and broccoli all decrease insulin levels. Fiber can lower blood sugar, cholesterol, and blood pressure.
Drinking water sounds so simple, but it actually works. A good rule of thumb for water intake is half of your body weight in ounces per day.
Botanicals for Treating PCOS Naturally
- Saw palmetto (sernoa repens) can lower testosterone levels and the conversion of testosterone to DHT. DHT is the hormone that causes acne and unwanted hair growth.
- Fenugreek can block absorption of sugars.
- Gymnema sylvestre can improve insulin sensitivity and blocks absorption of glucose. It can also lower cholesterol levels.
- Cinnamon improves glucose metabolism and increase insulin sensitivity.
- Black Cohosh (Cimcifuga racemosa) can bind to estrogen receptors and lower LH.
- Chasteberries (Vitex agnus castus) lowers prolactin and increases progesterone.
- Stinging nettle root (Urtica diocia) binds to and increases SHBG which lowers free testosterone.
- Green Tea (Camellia sinensis) increases SHBG and lowers testosterone, also promotes weight loss.
- Licorice Root (Glycyrrhiza glabra) can decrease testosterone production.
- Spearmint tea lowers testosterone levels which may improve unwanted hari growth
- Maitake mushrooms (Grifolia frondosa) works almost as well as Clomiphene to stimulate ovulation but does so without side effects.
Nutrients For Treating PCOS Naturally
The goal of using these nutrients for managing PCOS naturally is to decrease sugar cravings, improve insulin sensitivity, improve carbohydrate metabolism, balance blood sugar levels, and balance hormones.
- Chromium picolinate
- Lipoic acid
- Vitamin E
- Essential fatty acids and omega 3
- Co-enzyme Q10
- B Complex
- Vitamin C
- Vitamin D
Hormones For Treating PCOS Naturally
Progesterone used during days 14 – 28 of the cycle can also improve PCOS. Progesterone also increases fertility.
Stress Management For Treating PCOS Naturally
Yoga, meditation, mindfulness, gratefulness, journaling, and any other mind-body techniques can be used to lower cortisol levels. Botanicals that can help include phosphatidyl serine, chamomile, lemon balm, ashwaganda, ginseng, and rhodiola.
As with any other hormonally related condition, proper testing is key. Working with a functional medicine or naturopathic doctor can ensure that you get a proper evaluation and a customized, effective treatment.