September is Polycystic Ovarian Syndrome (PCOS) awareness month. PCOS is a complex, multi-systemic condition that affects as many as 10% of women of reproductive age. PCOS is a significant endocrine, metabolic, gynecologic condition that goes undiagnosed ~50% of the time, therefore goes untreated about 50% of the time. Some common signs and symptoms include missed or irregular periods, excess bodily hair, acne, weight gain, infertility and pelvic pain.
In this condition, the cells become insulin resistant, leaving insulin circulating in the bloodstream. This then triggers the ovaries to produce androgens and also inhibits the liver from producing sex-hormone-binding globulin (SGBH), which as the name suggests, binds sex hormones. This then results in increased circulating free testosterone, resulting in PCOS.
Individuals with PCOS often have fertility issues due to an inability to ovulate. This is because the increased androgens (a group of sex hormones that give “male” characteristics, testosterone is the main sex hormone in men), get converted to estrogen. Now we have high testosterone AND estrogen levels which messes with the signaling between the pituitary gland and the ovaries. This results in stimulation of the ovaries to produce follicles, but not to ovulate (aka anovulation).
To be diagnosed with PCOS, you must have two of the following three symptoms:
- Infrequent periods more than 35 days apart or
- Polycystic ovaries seen on ultrasound
- Symptoms of excess androgens (acne, hair loss, hair in unwanted places/male pattern like on the upper lip, chin, chest, belly, nipples)
Some common symptoms of PCOS include:
- Infertility issues
- High rates of miscarriage
- Difficulty losing weight due to insulin resistance
- Increased anxiety and depression
- Sleep apnea
- Hirsutism (hair in unwanted places)
- Skin tags
- Darkened skin at the neck, armpits or groin
Many individuals struggling with the symptoms of PCOS will be put on oral contraceptives to mask the symptoms described above. However, this method of “treatment” does not address the root causes, thus leaving you still struggling with the symptoms.
Addressing the root causes of PCOS requires a multi-system approach and a high level of commitment. You most certainly cannot expect results overnight, but you can expect lifelong management of symptoms if you stay committed to the plan. So here it goes…
1. Support your Hypothalamic-Pituitary-Adrenal (HPA) axis
Your HPA axis is an intricate signaling loop between your brain and adrenal glands which controls cortisol (stress hormone) production and adrenaline release. This axis or feedback loop produces your stress response.
Stress gets a bad rap. Taken at face value, stress is a good thing!. It should go something like this- you encounter a stressful situation (eg. stress stimulus) and your body produces a stress response to overcome and adapt to the stress stimulus. However, when we are continuously overloaded with stress or have a maladaptive stress responses, your body no longer produces healthy stress responses.
For individuals with PCOS, a chronically activated stress response contributes to blood sugar problems and insulin resistance. Additionally, the high cortisol levels affect your thyroid gland which can lead to hypothyroidism. What can you do to support your HPA axis:
Stress management techniques. This can look like a myriad of practices. Some include meditation, yoga, breathing techniques like hypopressives (see my blog here for more info on hypopressives), tai chi, massage or acupuncture, walking barefoot in nature (i.e. forest bathing), and mindful eating. It’s important to talk to a healthcare professional or coach who can help you come up with a long-term plan that is individualized for you.
Sleep. One of the symptoms of a dysregulated HPA axis is difficulty sleeping due to the malfunctioning cortisol production. You might find that you are fatigued upon waking and all throughout the day, and feel wired right before bed. To support good sleep, you need to have a good routine consisting of a wind down period, eating the right foods, and even coming up with a morning routine. Again, talk to a health coach to come up with a sleep routine that is individualized for you.
3. Balance your blood sugars
We’ve talked about why your blood sugars are imbalanced. Let’s talk about what you can do about it. Again, this is not a simple fix or a one-size fits all approach. There is no “correct” PCOS diet. It needs to be individualized to you and your physiology. Some ways you can help manage your blood sugar:
Food is medicine. You can see drastic differences in your symptoms just by changing your diet and being consistent with these dietary changes. For individuals with PCOS, limiting processed and simple carbs and increasing your protein and fat intake can help with improving insulin sensitivity and decreasing testosterone. Other things that can help to improve insulin sensitivity: buckwheat, omega-3-rich foods, flaxseed, sesame seeds, legumes. Talk to a nutritionist or health coach to come up with an individualized diet for you.
Supportive nutrients. After getting your diet in order, you might want to consider adding in supportive nutrients or supplements. For individuals with PCOS, inositol can be extremely beneficial in reducing insulin sensitivity and restoring ovulation. Other supplements include: Vitamin D, Omega-3 fatty acids, N-acetyl-cysteine, Selenium.
4. Increase your brown fat
Your body makes two types of fat: brown adipose fat (BAT) and white adipose fat (WAT). You might have heard that brown fat is the “good” fat. This is because brown fat actually helps you to burn more calories at rest. Not surprisingly, women with PCOS have less brown fat which makes losing or maintaining weight more difficult. Here are some ways to rev up your brown fat production:
Exercise. The right exercise routine consisting of high intensity interval training (HIIT), cardio, yoga, hypopressives, and Pilates can significantly help to increase your brown fat production. Specifically HIIT has been shown to improve insulin sensitivity and reduce inflammation. However, overdoing it with HIIT can lead to increased cortisol production. You want to have a well-balanced weekly exercise routine that will support brown fat production AND your HPA axis. Again, talk to a healthcare provider or coach to come up with an individualized plan for you.
Other ways. Cold showers, sleep, and a healthy thyroid can increase brown fat production.
Implementing ALL of these methods consistently can significantly help with managing your PCOS symptoms. Again, there is no quick fix solution to this diagnosis. It’s going to require commitment and consistency for the long haul on your end, and choosing the right team of healthcare professionals to support you in this journey. You got this.
To learn more about holistic healing, contact me at Activcore Denver.
Disclaimer: The views expressed in this article are based on the opinion of the author, unless otherwise noted, and should not be taken as personal medical advice. The information provided is intended to help readers make their own informed health and wellness decisions.