Last week we wrote about 5 common women’s health problems we frequently treat here at Root. Today, we are going to go more in depth about a condition mentioned in that post: Polycystic Ovarian Syndrome (PCOS).
How is it diagnosed?
PCOS is the most common metabolic and hormonal disorder in women of childbearing age, and is estimated to effect between 6-13% of women. It is the leading cause of female infertility in the United States. Per the Rotterdam Criteria, women must meet at least 2 of the following 3 criteria to be diagnosed with PCOS:
- Absent or irregular menstrual cycles (Oligo- or amenorrhea).
- Clinical or biochemical signs of hyperandrogenism (such as high testosterone)
- Polycystic ovaries (confirmed via ultrasound)
There is also emerging research that elevated levels of a protein hormone secreted by the ovaries called Anti-Mullerian Hormone (AMH) might be indicative of PCOS, but this is not currently used for official diagnosis. You can read more about that here.
It often takes several years and visits to several healthcare practitioners before women are correctly diagnosed. According to this study, it took one-third of women over 2 years and visits to at least 3 healthcare professionals before a proper diagnosis was made. It’s possible that you or someone you know has PCOS and you don’t even know it. The study also reported that a large percentage of women were unhappy with the education they received around the diagnosis.
Signs and Symptoms
The vast majority of women (around 70%) with PCOS suffer from insulin resistance, and therefore have difficulty losing weight. Insulin is a hormone produced by the pancreas that is released when carbohydrates (sugar) are consumed. Insulin’s job is to help bring sugar of out the blood and into the cell, but when insulin resistance is present, the cell’s receptors don’t open up efficiently to let the sugar in for absorption. This leads to both elevated glucose in the blood and elevated circulating insulin. Insulin is a “fat storage” hormone and therefore elevated circulating insulin can make it challenging to maintain a healthy weight. Because the cells are not able to utilize the glucose efficiently, this often leads to severe sugar cravings as well.
Other symptoms associated with PCOS include skin problems (acne), hair loss, unwanted hair growth (hirsutism), irregular or heavy periods, and mood disturbances.
Mainstream recommendations often tell women to lose weight and this alone will make their symptoms improve, but that is not necessarily the case, nor is it easy for women with PCOS to lose weight due to the insulin resistance described above. It’s also important to note that there is something called “Lean PCOS”, so giving the blanket statement that women with PCOS need to lose weight to improve their symptoms is incorrect again.
PCOS is an inflammatory condition. In order to effectively treat PCOS, it is essential to treat the root cause of the condition and work to reduce system-wide inflammation using a personalized approach.
Some women take the drug Metformin to help with insulin resistance and to improve their likelihood of getting a regular menstrual cycle, but this drug can come with many side effects. Hormonal birth control is often used as a treatment in traditional medicine, but this is more of a “band-aid” approach and isn’t truly getting to the root of the problem. Right when you go off birth control you will be right back where you started. It’s also important to note that the bleeding you get when you take the “sugar pills” in your monthly pack of pills is not truly a period. This bleeding is called “withdrawal bleeding,” meaning withdrawal from the synthetic hormones.
There are many diet and lifestyle changes that can be made to improve PCOS symptoms. One recent long-term study showed that 54% of women with PCOS were able to improve their menstrual cycle via lifestyle and behavior modification changes and 43% of women were ovulating regularly post intervention. It is interesting to note that these changes were with just a 2% loss of body weight, proving again that weight loss should not be the primary focus for PCOS treatment.
Dietary treatment is highly individualized and we always take into account a woman’s relationship with food and readiness to change when creating treatment plans. Some general recommendations often include:
– Eating a lower glycemic index diet
– Being mindful of the amount of carbohydrates you consume and balancing out meals with adequate protein and fat
– Including anti-inflammatory fruits and vegetables
– Eating adequate healthy fat
– Taking supplements proven to help with PCOS symptoms and cravings (these are discussed more in our 3-month program)
If you are feeling confused and frustrated with all of the conflicting advice about PCOS, let us walk alongside you and help you!
Gibson-Helm M , Teede H , Dunaif A , Dokras A . Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab. 2017;102 (2): 375-378
Marsh KA, Steinbeck KS, Atkinson FS, Petocz P, Brand-Miller JC. Effect of a low glycemic index compared with a conventional healthy diet on polycystic ovary syndrome. Am J Clin Nutr. 2010;92(1):83-92.
Rashidi B, Gorginzadeh M, Aalipour S. Age related endocrine patterns observed in polycystic ovary syndrome patients vs. ovulatory controls: descriptive data from a university based infertility center.Arch Encocrinol Metab. 2016;60(5):486-91
Obert E, Gidlof S, Jakson I, MItsell M, Tollet Egnell P, & Hirschberg AL. Improved mennstrual function in obese women with polycystic ovarian syndrome after behavioural modification intervention-a randomized controlled trial. Clin Endocrinol (Oxf). 2018. doi: 10.1111/cen.13919.