PCOS and Endometriosis
Polycystic ovary syndrome (PCOS) and endometriosis are chronic conditions that often occur among women of reproductive ages. In this article, we’ll review the similarities and differences between PCOS and endometriosis and how you can treat both of these conditions using a root cause approach with targeted interventions.
What is PCOS?
PCOS is one of the most common hormonal disorders and may affect 10 to 20 percent of all women. While the name may lead you to believe PCOS only affects the ovaries, it involves many different hormones as well. Imbalances in hormones, like insulin, testosterone, and DHEA-S, can lead to typical PCOS symptoms like irregular periods, acne, facial hair growth, thinning hair on the scalp, and infertility.
For a PCOS diagnosis, women typically must meet at least two of the following three criteria:
- Signs and symptoms of high androgen levels (i.e., hormonal acne, hair loss, or irregular hair growth)
- Infrequent ovulation or absence of ovulation (which causes irregular or absent periods)
- Polycystic ovaries
PCOS presents differently in each person, so it’s important to work with a doctor trained in diagnosing PCOS if you suspect you have this condition.
Possible Root Causes of PCOS
While research does not point to one overall cause of PCOS, some factors leading to the development of this condition may include: high androgen (i.e. testosterone) levels, insulin resistance, adrenal dysfunction, inflammation, and imbalances in gut bacteria.
What is Endometriosis?
Endometriosis is a condition diagnosed when tissue normally found within the uterus grows in nearby organs like the ovaries, fallopian tubes, and lining of your pelvis. An estimated 11 percent of women are affected by endometriosis. Women with this condition can experience severe pelvic pain, heavy menstrual bleeding, and infertility. A doctor, typically an OBGYN, may diagnose endometriosis with various methods like an ultrasound, MRI, pelvic examination, and in some cases, a minimally-invasive laparoscopic surgery to look for tissue growth.
Possible Root Causes of Endometriosis
Similar to PCOS, there is not one overarching cause of endometriosis. Inflammation, a phenomenon called retrograde menstruation, and a dysregulated immune system are a few suspected causes of endometriosis. While it remains controversial, some researchers suggest endometriosis may actually be an autoimmune disease in which the body mounts an attack on its own tissues (1).
Similarities and Differences
PCOS and endometriosis both affect a woman’s reproductive system, and it is possible to have both conditions (2). Let’s review a few similarities and differences of PCOS and endometriosis.
Individuals with PCOS or endometriosis often experience irregular periods. The menstrual cycle begins with the onset of bleeding typically referred to as your period. From beginning to end, a healthy menstrual cycle lasts between 24 and 35 days.
Women with PCOS typically demonstrate longer menstrual cycles due to delayed or absent ovulation. In contrast, women with endometriosis may have shorter menstrual cycles compared to healthy controls (3). Individuals with endometriosis often have heavy periods while women with PCOS may have either heavy periods or irregular spotting.
Infertility affects an estimated 40 percent of women with PCOS and around 30 to 50 percent of women with endometriosis (4, 5). In both of these conditions, infertility is complex and multifactorial. For example, factors like hormonal imbalances, irregular periods and absent ovulation, inflammation, and disruptions in egg quality may contribute to infertility to these individuals.
PCOS is more significantly affected by hormonal imbalances than endometriosis. However, one study suggested variations of exposure to testosterone while in utero may determine if a woman is more susceptible to higher testosterone levels (as commonly seen in PCOS) or lower testosterone levels (endometriosis) (3).
Endometriosis is commonly described as an estrogen-dependent, chronic-inflammatory disease. Individuals with this condition often have higher levels of an inflammatory protein, called CRP, than healthy controls (6). Likewise, women with PCOS also tend to have higher levels of inflammation (7).
Root Cause Treatment of PCOS and Endometriosis
Conventional treatment of PCOS and endometriosis often revolves around managing symptoms with oral contraceptives, over-the-counter pain medications, and/or androgen blockers. However, in functional medicine, we address these conditions by identifying and treating the root causes. Here are a few interventions we may recommend for an individual with PCOS and/or endometriosis.
Follow an Anti-Inflammatory Diet
PCOS and endometriosis are both inflammatory conditions. So, aiming to lower inflammation throughout the body is crucial. Food is one of the most powerful regulators of inflammation! In essence, an anti-inflammatory diet is rich in fruits, vegetables, nuts, seeds, legumes, and lean protein.
Here are a few basic tips to follow an anti-inflammatory diet:
- Incorporate the PFC Method by including a protein, fat, and fiber-rich carbohydrate with each of your meals and snacks.
- Increase your intake of foods rich in omega-3 fats like salmon, oysters, sardines, chia seeds, and walnuts.
- Boost your antioxidant intake by aiming for 4+ cups of colorful, non-starchy vegetables per day.
- Limit foods that may worsen inflammation like refined grains, processed foods, alcohol, and added sugar.
Our Root Foundational Meal Plan is a great place to start as it provides simple and anti-inflammatory recipes.
Prioritize Gut Health
The gut is responsible for much more than digestion and nutrient absorption. In fact, the health of your gut also has a major influence on hormone balance and inflammation. For example, your gut bacteria significantly impacts estrogen levels. Imbalances in gut bacteria, known as dysbiosis, impairs estrogen metabolism and results in either too much or too little active estrogen. Having a healthy gut to balance estrogen levels is crucial in both PCOS and endometriosis.
Some people may require a comprehensive plan to treat complex gut imbalances. However, you can promote overall gut health by eating an anti-inflammatory diet rich in fiber and reducing gut disruptors.
Environmental factors that may cause gut disruptions include:
- Eating a diet high in added sugar and low in dietary fiber
- Drinking too much alcohol
- Inappropriate and/or excessively using antibiotics
- Regularly taking acid reflux drugs
- Taking hormonal birth control pills
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Balance your Lifestyle
Poor sleep and high stress levels can worsen hormonal imbalances and inflammation in PCOS and endometriosis. These lifestyle factors significantly impact your overall health and shouldn’t be ignored!
Aim for seven to eight hours of sleep every night. Reduce sleep disruptors, like alcohol, close to bedtime and avoid drinking caffeine after 1pm. If you struggle falling or staying asleep, consider a trial of magnesium glycinate before bedtime. Furthermore, while it is not realistic to eliminate all stress in your life, engage in stress-reducing activities to mitigate the effects it has on your body. Set aside at least 10 minutes of your day for a stress-reducing activity like yoga, meditation, reading, deep breathing, or walking.
Supplements to Reduce Inflammation
Inflammation is a primary root cause of both PCOS and endometriosis. Following an anti-inflammatory diet and treating gut issues are foundational to treating inflammation throughout the body. However, we may use targeted supplements to support this intervention as well. Omega-3, N-acetyl cysteine, and turmeric are a few examples of supplements we may recommend for anti-inflammatory benefits in women with these conditions.
PCOS and Endometriosis: Key Takeaways
PCOS and endometriosis are two chronic conditions that affect 10 to 20 percent of women. Both of these conditions can cause irregular periods, infertility, and hormone imbalances. While it is not common, it is possible to have both PCOS and endometriosis. By reducing inflammation and treating hormonal imbalances with diet, lifestyle, and targeted supplementation, you can treat the root causes of these conditions.
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Anxiety and Hormone Balance
Imbalances in progesterone, thyroid hormones, cortisol, and vitamin D may all cause or worsen your anxiety. Treatment of these imbalances may include diet, lifestyle modifications, supplementation, and/or medication when needed.
Magnesium for PCOS
Magnesium has various benefits for individuals with PCOS like reducing insulin resistance and testosterone levels, lowering anxiety, improving sleep, and preventing migraines.