PCOS: the basics
PCOS, or Polycystic Ovarian Syndrome, is complicated. It’s an endocrine condition that effects 8-20% of cisgender women of reproductive age worldwide (1) and it is characterized by at least two of the following three symptoms: cysts on the ovaries, elevated "male" sex hormones and/or absent or irregular periods. PCOS is a highly misunderstood condition whose symptoms manifest differently among women and non-binary folks. Many people with PCOS gain weight while others have thin body types; some have acne and regular periods while other haven’t menstruated in months. Because almost all people with PCOS test high in androgens (male sex hormones), many symptoms include infertility, male-pattern hair loss, oily skin and acne along the jawline, and facial hair growth. These symptoms can be frustrating to deal with because they are persistent and can often make people feel like they have no control over their bodies. But these symptoms appear for a reason. And usually that reason is that our bodies are chronically stressed and something about our lifestyles needs to change. People with PCOS are at increased risk for developing type 2 diabetes, hypothyroidism and cardiovascular disease, so acknowledging these signals from our bodies is key to keeping ourselves healthy for a lifetime.
WHAT CAUSES PCOS?
Genetics – while PCOS is not a genetic condition, per se, predisposition to PCOS can be passed down through generations. Those who are exposed to higher androgens by their mothers while in the womb are also at greater risk of contracting PCOS later in life.
Stress – both physical and emotional stressors can contribute to PCOS. Some examples of physical stressors include over-exercising, eating foods you are intolerant to, not eating enough and constant blood sugar issues. Many people who suffer from PCOS are stressed to the max in their everyday lives – they take on extra work at their jobs, juggle familial responsibilities, endure harrowing breakups and family stress and then often criticize themselves for not working or trying hard enough. These stressors can elevate cortisol levels, starting a cascade of hormonal imbalance in the body.
Blood sugar imbalances – this is one of the most common root causes of PCOS and often stems from excessive intake of refined sugars and carbs, or the standard American diet. It often leads to weight gain and involves chronically elevated blood sugar. These blood sugar imbalances cause systemic inflammation in the body and directly influence the production of testosterone, which then inhibits ovulation and fertility.
Over-exercising and under-eating – our society places a tremendous amount of pressure on people (especially women) to look a certain way. Many women internalize the pressure to be thin and spend years of their lives under-eating while engaging in excessive (usually cardio) exercise. High-intensity exercise always causes testosterone spikes, but they are usually temporary, subsiding when we refuel our bodies with calories. But when we exercise for too long without replenishing our energy stores, our hormone balance starts to suffer.
MEDICATION - If your doctor diagnoses you with PCOS, they will most likely send you home with a prescription for one or both of two medications: metformin for insulin regulation and spironolactone for decreasing testosterone levels. It is entirely up to you whether you decide to take these medications or not, and whatever your decision, here are a few herbal, dietary and lifestyle changes to implement to keep PCOS symptoms under control (and, as always, ask your doctor before making any major changes to your health plan):
SPEARMINT TEA - Two cups of spearmint tea each day has been shown to reduce free testosterone levels in women with PCOS and has resulted in reduced hirsutism with none of the side effects of pharmaceutical-grade drugs (2).
SAW PALMETTO - 400mg of saw palmetto, a plant native to the Americas, has been found to inhibit the 5-alpha reductase enzyme. The inhibition of this enzyme helps reduce the conversion of testosterone to DHT, which is the male sex hormone that leads to oily skin, hair loss, acne and facial hair growth (3).
BALANCE YOUR BLOOD SUGAR - Reduce your consumption of refined sugars and carbohydrates – ditch the morning cereals for eggs and greens; instead of a sandwich at lunch, try a salad with tuna or grilled chicken. And pasta for dinner? Zucchini noodles will do the trick. Eat plenty of good fats and protein and aim for three square meals a day to get your blood sugar on track and to give your digestion a break (4). Supplementing with chromium picolinate has also been shown to decrease insulin resistance in women with PCOS (5).
DIAL IN YOUR DIGESTION - Take a test to determine any foods you might not tolerate or try an elimination diet to get to the bottom of any digestive woes. This is hugely important because digestive distress is another physical stressor on the body that can ultimately contribute to elevated cortisol and testosterone levels. Similarly, make sure your elimination is on track – we flush excess hormones out of the body through our stool, so eat your fiber!
PRACTICE STRESS MANAGEMENT - This is absolutely huge. Take up meditation, improve your time-management skills, see a therapist to work through emotional stress, start a gratitude journal – do what you can to reduce chronic stress in your life as this is often the root cause of PCOS.
CUT THE COFFE - Not only does coffee contribute to acne, but it also elevates cortisol levels and contributes to systemic inflammation. Instead, try green tea, which has a healing effect on the skin due to its high anti-oxidant polyphenol content.
RETHINK YOUR EXERCISE REGIMEN - Instead of intensive cardio like running or hiit several days a week, switch these out for yoga, walking or light swimming. This will give your adrenal glands a break and will allow your body to more readily recover from stress.
SLEEP - Give your body a chance to do its healing work by getting a solid eight hours of restful and uninterrupted sleep each night. Try to make this a priority – this can have a huge impact on the health of our hormones!
TALK TO SOMEONE - Find a support group near you to work through your emotions around PCOS. It’s a tough condition to deal with so finding support in different areas of your life can be a huge relief.
Remember - If you struggle with facial hair growth, you are not alone. This can be particularly frustrating if it accompanies hormonal acne – they often show up in exactly the same places along the jawline and chin. Because of the cultural expectation that women maintain hairless faces, this type of hair growth can be rough – but there is absolutely nothing wrong with you, there is no reason to feel shame, and there is no reason for you to change in order to appease the people in your life. Having PCOS is hard enough without having to navigate gendered cultural expectations. We are all doing our best - do what you can to mitigate your symptoms and get to the root cause but try not to stress about changing your lifestyle too too much. Balance is key.
1. Sirmans, S. M., Pate, K. A. (2014). Epidemiology, Diagnosis, and Management of Polycystic Ovary Syndrome. Clinical Epidemiology. 6, 1–13.
2. Grant, P. & Ramasamy, S. (2012) An Update on Plant Derived Anti-androgens. International Journal of Endocrinology Metabolism. 2012 Spring; 10(2): 497–502. 3. Hudson, T. (2008) Polycystic Ovarian Syndrome (PCOS). Dec 8, 2008. 4. Liepa, G. U., Sengupta, A. & Karsies, D. (2008) Polycystic Ovary Syndrome (PCOS) and Other Androgen Excess-related Conditions: Can Changes in Dietary Intake Make a Difference? Nutrition in Clinical Practice. 2008 Feb; 23(1):63-71. 5. Rabinovitz, H., et al. (2004) Effect of Chromium Supplementation on Blood Glucose and Lipid Levels in Type 2 Diabetes Mellitus Elderly Patients. International Journal for Vitamin and Nutrition Research. 2004 May; 74(3):178-82.