PCOS 101

September is PCOS awareness month and so for today’s episode, I wanted to do a quick deep dive into some basics about PCOS. It is actually the number one hormonal imbalance condition among reproductive-aged women and sadly, the leading cause of female infertility. So, this condition affects a lot of women and like many other hormonal issues, it can take a long time to get a proper diagnosis. So I want you to be informed about what PCOS is, what some of the common symptoms are, and if you or someone you love has PCOS, what we can do to help with it!

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PCOS is a common hormone and metabolic condition that affects up to 15% of reproductive-age women. It is associated with a higher risk for long-term health issues such as heart disease, diabetes, hypertension, sleep apnea, and infertility. Higher instances of insulin resistance, IBS, and depression/anxiety are also reported with PCOS. 

Symptoms often associated with this disorder are absent or infrequent menstrual cycles, excess weight gain or inability to lose weight, excess facial or body hair, head hair thinning or loss, severe acne, and often (but not always) insulin resistance and polycystic ovaries. 

PCOS is the most common form of hormonal imbalance and while experts know that it is rooted in inflammation and insulin dysregulation, what actually triggers PCOS is not understood. There seems to be a genetic factor, as women with moms or sisters diagnosed with PCOS are likely to have it as well. Also, as with any hormonal condition, gut health plays a major role. Some believe that it can possibly be linked with a combination of imbalanced gut flora and increased intestinal permeability, which leads to increased inflammation in the body. This can cause cells to become rigid and unable to receive the signal from insulin to let glucose into the cell (which leads to your pancreas continuing to pump out more insulin, and left untreated eventually becomes insulin resistance). Although ovaries do not become insulin resistant, when bombarded with insulin, the ovaries can respond by secreting testosterone. An excess of insulin can also inhibit the secretion of sex hormone-binding globulin (SHBG) which is the protein that binds excess sex hormones like testosterone and estrogen. This creates a perfect storm for these common PCOS symptoms.

PCOS is a clinical diagnosis, which means that it’s based on having a grouping of some PCOS symptoms and ruling out other diagnoses. Often a physician may want to perform an ultrasound to check the ovaries for cysts, but it is important to note not every woman with PCOS will have polycystic ovaries (despite the name). Most women with PCOS do have insulin resistance, but again - not all. It’s important that you work with your physician and be informed on the recommended lab tests that can be helpful for making a diagnosis. Functional medicine practitioners recommend a full thyroid panel, a full hormone panel including estrogen, testosterone, DHEA, SHBG, progesterone, prolactin, LH, FSH, and AMH, as well as a lipid panel and fasting blood glucose and insulin, and A1C. There may also be other tests as well as research about PCOS continues to be published. 

Once someone receives a PCOS diagnosis there really aren’t a lot of great conventional treatment options. The most common option is to take hormonal birth control and while that can help with symptoms, unfortunately, it doesn’t do anything to actually heal the cause of the symptoms. Not only that, but some believe that it may actually worsen the condition over time. Metformin is also a common medication given to women with PCOS. Just be sure to research and speak with your doctor about the common negative side effects that can be associated with it. 

While there is no cure for PCOS, there are things that a woman diagnosed with PCOS can do to help with symptoms as well as target the underlying known contributors to PCOS - blood sugar dysregulation, poor gut health, and inflammation. 

When I work with clients who have PCOS the first two things that we work on are supporting balanced blood sugar and healing their gut. So let’s talk about some foods, supplements, and lifestyle modifications that can help with those things.

When it comes to food, the first thing to remember is that your body needs to feel safe and know that it can count on adequate fuel throughout the day. The best way to do this is to eat a balanced meal (meaning fiber, protein, and fat) about every 3-4 hours. So that typically looks like breakfast, lunch, dinner, and at least 1 snack, maybe 2. You don’t want to eat continually or fall into grazing throughout the day, but also don’t skip meals or go long periods of time without eating. 

Some specific foods that can help:  

• clean sources of protein: wild-caught, omega-3 rich fish such as salmon, cod, trout or sardines; bone broth, grass-fed beef

• High fiber carbs:  cruciferous veggies, pumpkin, beans, rice, berries, goji, cherries, onion, parsley, garlic, freshly ground flax seeds 

• Healthy fats: walnuts, coconut, olives, 

• Herbs, spices, teas: cinnamon, turmeric, ginger, decaf green tea, Holy Basil tea, liver support teas - like milk thistle or dandelion 

There are some supplements that may also be helpful. I do just want to remind you that everyone’s body is different and may respond differently to herbs/supplements. It’s really best to work with a practitioner who is knowledgeable about these supplements and your particular healthy history. With that said, Vitamin D and methylated B-complex can be helpful because a lot of women (in general), especially with PCOS, are deficient in these. Herbs like Vitex, Dong Quai, saw palmetto, nettle root, and licorice can help with some of the common PCOS symptoms. Inositol is another common supplement given to help with insulin sensitivity and other common issues with PCOS.

There are also some lifestyle recommendations and alternative therapies that can be helpful as well. We all know that regular exercise is good for us, but especially for women with PCOS daily movement is vital for reducing inflammation, balancing blood sugar, and supporting gut and liver health. It’s also important to participate in weight training at least 2x per week (either bodyweight or added weights) which has been proven to help increase insulin sensitivity, allowing it to be more useful in the body. It’s also recommended that women with PCOS prioritize getting 8-9 hours of sleep each night and commit to stress-reducing routines like daily walks and downtime from social media and other emotional stressors. Acupuncture can also be helpful. Many women have also found seed cycling to be helpful - and that probably needs its own episode but essentially is eating certain types of seeds in the follicular phase of your cycle and then switching to other seeds in the second type of your cycle. This can help the body get rid of excess hormones more efficiently and may support more balanced hormone levels. It also provides a great source of fiber which is helpful for gut and liver health  

Ultimately, if you or someone you love has PCOS it’s important to know that even though there isn’t a cure, symptoms can be managed and your body can be supported in such a way that the condition doesn’t have to take over your life. Make sure to get a good team of healthcare professionals on your side that can help you with all aspects of your health and really take the time to learn about PCOS and about how your own body responds - what works for you and what doesn’t. 

Friends, I hope that this episode has been helpful for you. If you’re struggling with PCOS know that you aren’t in this alone and that there is help available for you. Start with some of these things that I’ve mentioned today and build a team of people around you that can support you in this journey. As always if you have any questions, you can send an email to info@yourhealthforward.com. 

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• What are some common issues with women’s health that you see in your practice and what do we need to be aware of?

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• UT Medical Center TRE Research Study - Jill Maples (jmaples1@utmck.edu/865.305.9367)

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The rest of this summer is going to be a little different around here and I wanted to share a little of what is going on behind the scenes, rather than just disappearing for a month and you wondering what was going on. 

As I’ve mentioned a couple of times now, I started having symptoms of what I call an “endo flare” last fall and after seeing my dr and fertility specialist, both confirmed that it’s time for another excision surgery. That is coming up at the end of next week. So obviously, I’m not thrilled but I’m ready to get it over with and hopefully get back to feeling like myself again. (for more of my endo journey, listen to episode 31 and episode 61). 

That being said, it’s not a super fun recovery and based on my last couple surgeries, I’m not going to really feel back to normal for at least a few weeks - so there won’t be any new podcast episodes again until mid-August.

I am planning to document/share some of my recovery process because I feel that could be helpful for any of you who are also dealing with endo or having surgery soon (of any kind). I plan to share what I’m doing to assist my body in healing and managing symptoms/inflammation after I’ve recovered a bit.

With all of that said, I am really excited for the fall. Episodes will start back in mid-August and I have some guest interviews lined up that I can’t wait for you guys to hear. I think you will really enjoy them and find them so helpful. I will also be taking on a handful of new clients in the fall and may have a few fun surprises brewing as well. 

So, I hope that you enjoy the rest of your summer. I appreciate your well-wishes and prayers, and can’t wait to talk to you again soon! 

Keep moving forward, friends. Go love your people well, and I’ll talk to you soon!