How many times a day have you found yourself spiraling with confusion around this question: Will this help me?
For those who have PCOS, or Polycystic ovary syndrome, there is a lot of information out there, but you want absolute clarity to make empowered holistic decisions surrounding your everyday habits. You want to know which style of diet will help you, which supplements will help you, which exercise will help you, and more so that you no longer feel like everything you try isn’t really working.
Of all female hormonal disorders, PCOS is the most common, affecting 1 in 10 women of childbearing age. Women may experience irregular or infrequent ovulation and menstrual cycles and PCOS can cause other symptoms such as infertility, acne and excessive body hair on parts of the body where hair is usually absent or minimal. PCOS is associated with other health issues such as an elevated risk of cardiovascular disease and diabetes. Many interacting factors can lead to a manifestation of PCOS. Such factors include environmental exposures, your genetics, and your lifestyle.
When first studied in the 1930’s, the presence of cysts in the ovaries was thought to be the defining factor in the origin of PCOS. We now know that cysts are only one potential expression of what creates a disorder in the endocrine (hormonal) system.
While our current understanding of PCOS is that it is a phenotypic expression (the result of the interplay of your genes combined with your environmental influences) that results from hormonal imbalances…These are 3 prevalent theories for the development of PCOS:
1. An ovarian defect (with or without an adrenal defect) from a synthesis of steroid hormones that produce high levels of androgen-male sex hormones, such as testosterone.
2. A Metabolic disorder marked by a failure of a group cells that respond to specific hormones to increase glucose (blood sugar) disposal in response to insulin (a hormone that regulates the amount of glucose in the blood).
3. As your hypothalamus is the part of your brain that helps control the pituitary gland (which functions to secrete hormones into your bloodstream) and regulates many body functions…an origin for PCOS may lie in a hypothalamic-pituitary dysfunction. This causes malfunction in the release of hormones that affect ovarian hormone production.
The criteria for diagnosing PCOS (polycystic ovarian syndrome) relies on my patient having at least one of these stigmata of ovarian disease:
-a history of anovulation (not ovulating during menstrual cycle).
-polycystic ovaries showing up on ultrasound.
AND…they each consistently include either the clinical expression or laboratory confirmation of hyperandrogenism, or high levels of a group of hormones that play a role in male traits such as increased body or facial hair, and infrequent or absent menstruation. Lastly, it is essential to make sure we exclude any other hormonal disorders that may be mimicking PCOS.
As an Integrative Functional Medicine doctor I look at your health history timeline, do a physical examination, check for symptoms such obesity, increased facial hair, and utilize labs to help rule out other confounding diseases and to confirm PCOS. This thorough clinical assessment is critical for diagnosing and identifying the risk factors for how you will maintain long-term health. The information gathered helps me to prioritize the Integrative approaches we will follow, taking into consideration your concerns such as infertility, hair loss, acne, or weight management.
Weight Management Therapy for PCOS
As 50-70% of women with PCOS are obese, it is so critical to know that even a 5-10% weight loss of body mass is associated with significant improvements in your metabolic and hormonal imbalances. While insulin resistance often accompanies PCOS, making weight loss more difficult, exercise is key to improving this issue.
Current theories suggest the best exercises for PCOS may be interval training and full-body exercise. One study compared the effects of exercise versus a low-calorie diet in 40 women with PCOS. Despite less absolute weight loss, the exercise group had higher ovulation rates and better insulin sensitivity and a greater reduction in waist measurements.
Botanical Therapy for PCOS
Cinnamon Cassia: has been studied for its effectiveness in lowering glucose levels for those with diabetes, potential to help improve menstrual regularity and lowering AMH (anti-mullerian hormone-when level of AMH are high, it halts the ovulation process.) Try sprinkling Cinnamon Cassia on your coffee, tea, blend it into a smoothie, oatmeal or some savory dishes.
Triphala: A blend of three fruits native to India: Amalaki, Haritaki and Bibhitaki. Triphala is great for women with PCOS. This blend is loaded with antioxidant Vitamin C, to fight inflammation and free radicals. Triphala is an Ayurvedic medicine for PCOS that has been used for over 1,000 year for its cleansing and detoxifying properties.
Chaste Tree Berry: or Vitex, is believed to promote beneficial hormone balance by increased luteinizing hormones which can trigger ovulation. It also reduces prolactin secretion, which when elevated may inhibit fertility. Note that it may interfere with oral contraceptives and hormone therapy and is not recommended for use if pregnant.
Complementary Therapy for PCOS
Acupuncture: Observations from human and animal studies and clinical data suggest that electroacupuncture may exert beneficial effects on insulin resistance, ovulation, menstrual cycles, reduced testosterone levels and reduced waist circumference. It may be considered as a complementary therapy for direct impact on PCOS as well as for its associated mood disorders and stress as it has the potential to influence positive effects on the sympathetic nervous system, neuroendocrine system and endocrine system.
Mind Body Therapy for PCOS
Women who have PCOS may have an increased prevalence of anxiety and depression and mood disorders that may be directly related to the biochemical imbalances going on in their bodies. And mood disorders may be exacerbated by stress that is related to body image issues and infertility.
I encourage all women to address ANY health concerns such as PCOS to consider mind-body approaches towards healing. Whether it's cognitive-behavioral therapy, or self-care such as journaling, meditating, guided imagery, sound therapy…find the approach that aligns with your interests and that furthers your #pathtohealing .
Nutrition Therapy for PCOS
What you eat is so very important for healing and also for sustaining optimal well being. Much research needs to be done in regards to nutrition for those with PCOS, but there are some reported data that we can consider when personalizing your nutrition prescription.
For example, one study with overweight and obese pre-menopausal women with PCOS, who stayed on a low-glycemic index diet for 12 months showed improvements in their insulin-resistance and menstrual cycles. While no firm recommendations can be given regarding macronutrient content, it is suggested that women may do best on a low-carbohydrate, low-glycemic index, high-fiber carbohyrate diet. One of the best things you can do is to know which foods work best for you. Check out my anti-inflammatory Elimination Diet to find out.
Omega-3’s: Reducing your cardiovascular risks are absolutely CRITICAL for healing with PCOS, especially if you have elevated levels of total and LDL cholesterol and triglycerides. Making sure to have Omega-3 fatty acids will help you combat inflammation as well as support your heart, or cardiovascular health. My ABSOLUTE all-time favorite Omega-3 can be found in the lignans (antioxidant compounds) of flaxseeds. Plus, they may also support estrogen elimination, furthering their myriad of health benefits.
Soy: It is a complete protein that is low in fat and contains numerous vitamins, minerals, fiber and essential fatty acids…it also contains phytoestrogens which lead to the debate of its risks versus its benefits in PCOS. Current evidence does not suggest that soy prevents ovulation however, soy may delay it. So, for women who have PCOS and who struggle with infertility, who consume few calories or who eat a poor diet, may want to avoid or limit their use of soy products. Alternatively, a moderate to low intake of soy (about once a day or a couple times per week) may be included as part of a healthy diet for women with PCOS.
Supplement Therapy for PCOS
𝗗-𝗰𝗵𝗶𝗿𝗼-𝗶𝗻𝗼𝘀𝗶𝘁𝗼𝗹: A vitamin-like substance made naturally in your body that may benefit you by improving your insulin sensitivity, triglyceride and testosterone levels, blood pressure, ovulation and weight loss.
𝗖𝗵𝗿𝗼𝗺𝗶𝘂𝗺: An essential trace mineral that enhances the action of your insulin. A pilot study showed that women with PCOS who took chromium for two months experienced improved insulin sensitivity.
𝗩𝗶𝘁𝗮𝗺𝗶𝗻 𝗗: Plays a role in egg follicle maturation and insulin resistance, blood sugar regulation, and low levels of this vitamin are correlated with occurrence of type 1 and type 2 diabetes. Studies suggest that imbalances in calcium may be partly responsible for arrested follicular development in women who have PCOS.
𝗡-𝗔𝗰𝗲𝘁𝘆𝗹𝗰𝘆𝘀𝘁𝗲𝗶𝗻𝗲: Increases the antioxidant glutathione, which is made up of amino acids and found in every cell of your body. It lowers your inflammatory markers and increases insulin sensitivity.
***Check with your doctor before using these supplements to see if they are recommended for your specific bio-individual needs.***
Medication Therapy for PCOS
Oral Contraceptive Pills (OCPs): first-line options for androgen (male hormone) excess such as excessive hair growth (hirsutism) and acne. OCPs reduce the secretion and concentration of male sex hormones through increasing the levels of SHBG (sex hormone-binding globulin), a protein made by the liver that attaches itself to sex hormones.
Progestins: For women who need endometrial protection (the Endometrium is the tissue lining the inner cavity of the uterus) but who are not interested in or appropriate for OCPs. Cyclic progestins promote withdrawal bleeding (the monthly bleeding women experience while using hormones) and to prevent endometrial hyperplasia, or an abnormal thickening of the lining of the uterus.
Antiandrogens: Blocks androgen (male sex hormones) from binding.
Clomiphene Citrate: An antiestrogen and effective option that stimulates ovulation through medication. About 80% of women with PCOS ovulate in response and approx.. 50% conceive.
**Essential to note: although OCP use may help many women overcome issues with PCOS, these drugs are associated with higher risk for cardiovascular disease in the general population. Other concerns are that they may have a negative impact on your inflammatory markers and diabetes risk. Regular follow-ups of any metabolic and cardiovascular markers are important for any woman taking OCPs.**
Surgery for PCOS
When natural and pharmaceutical approaches are not successful and a patient has morbid obesity, bariatric surgery may be considered. A study showed that the postoperative benefit included some: resolution of irregular menstruation, improvement in reducing hirsutism (abnormal growth of hair on face and body), resolution of Type 2 diabetes, and the ability to cease medications for hypertension and hyperlipidemia.
A variety of ovarian surgeries are employed that may help to balance communication between your hypothalamus and pituitary glands which results in appropriate regulation of reproductive functions.
“Owning our story and loving ourselves through that process is the bravest thing that we will ever do.” -Brene Brown
Today is a great day to start living with this outlook. Too many wonderful people among us have lost faith in their inner healing abilities and lost heart for living out their best health potential. The medley of life's distractions and society's distorted ideas of what creates self-worth have prompted them to stop looking and listening from within, and have allowed judgement and fear to keep them playing small.
Within your existence—you and every single person in the world—has a mighty ability and potential to evolve well-being. Start with a small action. Dream big. Begin today. Do not allow your potential to whither. I am here to encourage you and reinforce your innate capacities. Please like, follow and share, and let's inspire the world!
To Your Health, Kiran Grewal MD
"My goal is to share my knowledge with the world. I believe in delivering valuable and ethical content that changes the lives of my patients." -Kiran Grewal MD