When you think of PCOS, what do you think of? Many sources would lead us to believe that PCOS looks like chronic acne, a bit of a belly, and extra facial hair, but that’s not always true. It would be easy if PCOS looked a certain way, but unfortunately, that’s not how it goes. Women are complex in spirit and physiology, and many of the illnesses and diseases we experience are equally complex. That’s why I thought it would be helpful to create an “Executive’s guide to PCOS,” with all the insights you need, without the medical book.
What is PCOS?
PCOS stands for Polycystic Ovarian Syndrome. Essentially it’s a hormone and metabolic issue that causes multiple other symptoms and issues. Symptoms are usually non-specific, meaning the symptoms look like symptoms for many other diseases and aren’t specific to only people with PCOS. Things like irregular periods, unexplained weight gain, or persistent fatigue, could all be undiagnosed PCOS, but not necessarily. That’s what makes a diagnosis tricky.
Who’s affected by PCOS
Polycystic Ovarian Syndrome (PCOS) is a metabolic condition affecting 1 in 10 women from menses to menopause. In other words, it impacts women of reproductive age, typically. It’s usually characterized by a hormonal imbalance where the ovaries produce an abnormal amount of androgens – male sex hormones usually present in women in small amounts. Even though PCOS can exist in men, it’s usually categorized as a women’s issue because of the gynecologic impacts. Overall, PCOS manifests various symptoms that disrupt the reproductive system and beyond. However, that’s actually not the entire story.
The importance of understanding PCOS lies in its widespread impact — it’s not just a fertility issue. It’s associated with increased risks of diabetes, heart disease, and high cholesterol, as well. For example, people with PCOS have an increased risk of endometrial cancer, increased risk of cardiovascular disease including a 7x risk of heart attack, and increased risk of diabetes. Early detection and management can mitigate these risks significantly, though.
What causes PCOS
PCOS is primarily caused by an imbalance in hormonal levels, including elevated androgens, insulin resistance, and inflammation. What triggers the cascade isn’t clear though, because it can be a combination of things and the pattern looks different for everyone. The imbalance could come from genetics, childhood trauma, and lifestyle factors, including stress, diet, and exercise.
Research suggests that insulin resistance increases the body’s insulin levels, which may boost androgen production and contribute to the disruption of the menstrual cycle, leading to a PCOS diagnosis and symptom pattern. The relationship between insulin and estrogen, also plays a huge role, which we explore in more detail, if you wanna get nerdy with me. Genetic studies have also identified several genes linked to the development of PCOS, highlighting the role of heredity in this condition.
Insulin, Cortisol, and Aromatase, oh my!
For those that want a bit more science about what PCOS is exactly, we’ll explore the relationship among insulin, estrogen, aromatase, and cortisol. This is where the metabolic relationship becomes very apparent. When you are stressed out, not eating well, or generally dealing with the hard things that life throws at us, two things happen. First, cortisol, the stress hormone, is raised. Secondly, insulin doesn’t work as well, because the cortisol is blocking it from working effectively. To compensate, your body releases more insulin to buffer the impacts of the cortisol, and “give her more [insulin], Scotty.” This means your body is using more insulin that it would normally use under regular circumstances, thus leading to insulin resistance. In other words, the insulin you used to process that piece of pizza is going to take more insulin than it used to, because cortisol is rendering it less effective. As your insulin creeps up, so does the amount of aromatase in your body, feeding the inflammatory cycle.
Aromatase cycle
To take it a step further, the aromatase cycle is helpful to understand. It is all related, as you can see the cycle in the diagram, above. Aromatase is the enzyme responsible for converting testosterone to estrogen. The cycle starts with aromatase, created in the endometrial lining and breast cells. It’s a normal part of the regular metabolic process. When you have more estrogen than your body needs, AKA “excess estrogen,” you create two inflammatory chemicals called COX2 and PGE2, in the uterine lining. Their claim to fame is that they cause cramps and heavy bleeding during your period. When COX2 and PGE2 are high, your body creates more aromatase. This creates even more estrogen, creating more inflammatory chemicals and so-on. You can see how the cycle resembles a fly wheel and the more you input, the faster it goes, increasing the impact and symptoms. This is why your PCOS symptoms can continue to get worse and worse if they aren’t managed. Hopefully you’re starting to see how all these things connect.
Managing PCOS
The good news is that there are lots of things we can do to help minimize, or dare I say, reverse, the impacts of PCOS. There are several things you want to accomplish when treating PCOS and here are a few of them: Regulating insulin and blood sugar, regulating excess androgens, balancing ovarian hormones, and improving estrogen metabolism and excretion. The biggest target to start with is lowering the inflammation in the body. According to Dr. Wendy Warner, MD, “if we can lower the amount of inflammation, we can lower the amount of aromatase, [which] lowers the excess estrogen, making periods lighter and less cramp-y.” Managing PCOS involves a multi-faceted approach, combining lifestyle modifications with potential medical interventions. Consider the following:
Diet and nutrition
A balanced diet low in refined carbohydrates and high in fiber can help manage insulin levels, crucial in controlling symptoms. You really want a low glycemic load to help bring you insulin back into balance. Think healthy fats and tons of veggies. You also want less fruit, grains, sweets/sugar, and no alcohol, if possible. This is where the Mediterranean diet shines, because it focuses on lots of veggies, healthy fats and lean proteins.
Exercise
Regular and moderate exercise helps reduce insulin resistance and weight, mitigating some of the symptoms of PCOS. The key here is moderate because moderate exercise helps improve insulin sensitivity. Lifting heavy things is extremely important for people with PCOS because muscle helps us regulate insulin more effectively. Excess or highly stressful exercise on the other hand cause raise cortisol, contributing to insulin resistance. So, if you love those boxing, hot power yoga, and HIIT classes, they may be doing more harm than good.
Stress management
Managing stress through techniques such as yoga or meditation can also impact hormonal balance and alleviate symptoms. We talk about stress a lot here at Pomona Wellness and it’s for good reason. Stress impacts everything from our blood pressure, to the way we move through the world. It affects our periods and even our cognition, so we can’t talk about this enough.
Herbal Remedies
There are also a number of herbs that have been shown to be effective in clinical settings and studies, to help people manage the metabolic issues and reduce the impact of symptoms. Keep in mind that you using one herb at a time and/or throwing all of these into a formula could make the situation worse, depending on your symptom pattern, so it’s important to consult a trained herbalist and your medical practitioner for guidance. Additionally, like with medication, herbs do not work in a vacuum. They have to be included with other behavioral and lifestyle changes to be effective. Having said that, here are just a few of the herbs that have been really effective in helping to manage the causes of PCOS:
Astragalus – This has been shown to improve fasting insulin, along with normalizing the Luteinizing hormone (LH) to Folicular Stimulating Hormone (FSH) ratios.
Berberines – These are the herbal equivalent of drugs like Metformin, albeit less powerful. This family of herbs includes things like Goldenseal, Barberry, and Yellow Root. These have been shown to improve the function of drugs like Metformin and improve ovulation and pregnancy rates.
Fenugreek – This is a common spice with incredible benefits. Studies have shown that it helps to lower fasting and postprandial blood sugars and can help reduce systemic inflammation, which helps slow and reverse the aromatase–> estrogen cycle.
Medical treatments
There are also several medication interventions available to support PCOS. Medications like birth control pills can regulate menstruation and manage hormone levels, while anti-androgens can reduce unwanted hair growth and acne. Recent advancements include the use of metformin, which helps improve insulin sensitivity. However, like many Western treatments, most of these fail to address the underlying root causes. Drugs like metformin and the GLP-1s like Ozempic can be extremely beneficial to overcoming insulin sensitivity. However, if you don’t take care of the other underlying factors like stress, diet, and movement, you could be on these for the rest of your life and only be masking the symptoms. You never really solve for the primary PCOS issue with those other interventions – you just hide the symptoms, temporarily.
Additional lifestyle adjustments for PCOS
These changes can seem overwhelming at first. After all, for many of us are just trying to survive, so take things one at a time. Lifestyle changes can significantly improve the quality of life and symptom management for your PCOS, and you can start with small changes. Here are some things to consider incorporating:
- If you already workout, consider changing your workout to something more beneficial for PCOS, like resistance or weight training and pilates
- Start by making small dietary changes to help crowd out old habits
- Prioritize sleep
- Manage stress to improve overall hormonal health
- Increase resiliency by incorporating things like meditation or heart rhythm variability control/coherence training (Heartmath is a great option)
Still not sure where the start? Book a breakthrough session to learn more about how Pomona Wellness can help you. You can also check out more wellbeing content on Wellspiration or read my personal stories on Substack. Whatever works best, I’m so glad you’re here and I would love to help you achieve your wildest wellbeing goals. Until then, wishing you abundant health and limitless joy!
Medical Disclaimer:
These statements have not been evaluated by the Food and Drug Administration (FDA). Information provided in this blog post is for educational and informational purposes only and should not be considered as medical advice. The content is not intended to be a substitute for professional medical advice, diagnosis, treatment, cure or prevention of any disease. Always seek the advice of your physician or another qualified healthcare provider with any questions you may have regarding a medical condition.
Resources
- An, Y., Sun, Z., Zhang, Y., Liu, B., Guan, Y., & Lu, M. (2014). The use of berberine for women with polycystic ovary syndrome undergoing IVF treatment. Clinical endocrinology, 80(3), 425–431. https://doi.org/10.1111/cen.12294
- Di Guardo, F., Ciotta, L., Monteleone, M., & Palumbo, M. (2020). Male Equivalent Polycystic Ovarian Syndrome: Hormonal, Metabolic, and Clinical Aspects. International journal of fertility & sterility, 14(2), 79–83. https://doi.org/10.22074/ijfs.2020.6092
- Kassaian, N., Azadbakht, L., Forghani, B., & Amini, M. (2009). Effect of fenugreek seeds on blood glucose and lipid profiles in type 2 diabetic patients. International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition, 79(1), 34–39. https://doi.org/10.1024/0300-9831.79.1.34
- Lee, Y. S., Kim, W. S., Kim, K. H., Yoon, M. J., Cho, H. J., Shen, Y., Ye, J. M., Lee, C. H., Oh, W. K., Kim, C. T., Hohnen-Behrens, C., Gosby, A., Kraegen, E. W., James, D. E., & Kim, J. B. (2006). Berberine, a natural plant product, activates AMP-activated protein kinase with beneficial metabolic effects in diabetic and insulin-resistant states. Diabetes, 55(8), 2256–2264. https://doi.org/10.2337/db06-0006
- Mayo Clinic. (2022) “Polycystic Ovary Syndrome.” https://www.mayoclinic.org/diseases-conditions/pcos/symptoms-causes/syc-20353439
- Merz, K. E., & Thurmond, D. C. (2020). Role of Skeletal Muscle in Insulin Resistance and Glucose Uptake. Comprehensive Physiology, 10(3), 785–809. https://doi.org/10.1002/cphy.c190029
- Monika Joshi, Ravi Shankar, Kamla Pathak, Ramakant Yadav, Polycystic ovarian syndrome: A review covering phytoconstituents for its outstrip management, Pharmacological Research – Modern Chinese Medicine, Volume 1, 2021, 100011, ISSN 2667-1425, https://doi.org/10.1016/j.prmcm.2021.100011.
- Warner, W. (2024, May 21). Women’s Health – Endometriosis, Fibroids and PCOS. [Lecture and Presentation]. Dr. Wendy Warner, MD.
- Xu, Y., & Qiao, J. (2022). Association of Insulin Resistance and Elevated Androgen Levels with Polycystic Ovarian Syndrome (PCOS): A Review of Literature. Journal of healthcare engineering, 2022, 9240569. https://doi.org/10.1155/2022/9240569