If you have ever tried to get pregnant and failed, you have most likely considered polycystic Ovarian syndrome (PCOS) or at least come across the term. PCOS is a leading cause of female infertility. It affects as many as 5 million women of reproductive age in the United States. Beyond fertility, PCOS also leads to other serious health conditions like diabetes, heart disease, sleep apnea, high blood pressure, and stroke, especially in women who are overweight.
What is PCOS?
PCOS is a disorder common among women of childbearing ages. PCOS symptoms are usually based on the interaction between your gene and the environment. Most women with PCOS have little or no period, excess facial hair, abdominal weight, acne, thinning hair, and skin tags which can affect their perception of themselves.
PCOS is characterized by little or no menstruation, excess androgens, and polycystic ovaries. You have to show at least two out of the three of these symptoms before being diagnosed with PCOS.
Although the exact cause of PCOS is unknown, some researchers believe that an over exposure of the fetus to elevated androgens may contribute to the development of PCOS. Other factors that may contribute to PCOS include exposure to environmental chemicals, oxidative stress, inflammation, and diet.
Types of PCOS
Contrary to what you may think, everyone does not experience PCOS in the same form. There are four major types of PCOS based on their triggers. Each of these types has different causes and treatment patterns. Knowing what type of PCOS you have is the first step in finding the right treatment and relief from your symptoms.
INSULIN RESISTANT PCOS
This is the most common type of PCOS. It is the type of PCOS that you imagine when you think about PCOS in general.
Insulin resistance affects about 65-70% of women with PCOS. Women with insulin-resistant PCOS have a high amount of Insulin and leptin ( a hormone that helps you maintain a healthy weight).
Under normal conditions, after eating, the level of Insulin rises briefly. Insulin helps the liver and muscles absorb sugar from the bloodstream and convert it to energy. When the sugar is converted to energy, the blood sugar level begins to fall, and so does the level of Insulin. However, in patients who have insulin resistance, the cells in the muscles and liver do not respond well to Insulin. Blood sugar levels continue to rise as a result of this. In order to keep blood sugar under control, the pancreas produces more and more Insulin.
Most people with polycystic ovary syndrome (PCOS) have insulin resistance or high Insulin. High insulin levels can tell the ovaries to make more testosterone and also impair ovulation.
How do you know you have Insulin resistance PCOS
To confirm your diagnosis, your doctor might ask you to run certain tests such as a 2-hour insulin glucose test, fasting blood glucose test, or oral glucose tolerance test. These tests will be performed to assess your blood sugar level to know how well your sugar is controlled.
What next after your diagnosis?
There are different paths to take in your journey to winning the battle against PCOS besides taking the prescribed medication. One of such ways is to address the causes of insulin resistance. Although scientists don’t know the exact cause of insulin resistance, they believe obesity, lack of physical activity, and diet plays a major role.
Your doctor may also prescribe some supplements that have proved helpful in insulin resistance and PCOS, like Inositol and magnesium. A study carried out in 2017 revealed that Inositol helps to regulate menstrual cycles, improve ovulation and induce metabolic changes in polycystic ovary syndrome.
Working closely with a registered dietitian nutritionist is a step in the right direction to improving your PCOS symptoms. They would help you with a personalized nutrition and supplement plan designed to achieve control of your blood glucose and hormonal balance, achieve a healthier weight, and rid you of the undesirable PCOS symptoms you are struggling with.
Another important contributor to this type of PCOS is stress. So, ensure your body gets enough rest by sleeping. If the source of stress is internal, like having chronic infections, you also have to address that.
POST PILL-INDUCED PCOS
This is the second most common form of PCOS found in women in practice. It is often found in women coming off birth control pills, especially those that contain androgen-suppressing forms of progestin like Yazmin, Yaz, or Ginet. If you notice signs of PCOS a few months after coming off your pills, it may be as a result of the temporary surge of androgens as ovaries begin to function again.
How do you know you have pill-induced PCOS?
You may have post-pill PCOS if your doctor has ruled out insulin resistance. Yet, you meet the criteria for diagnosis of PCOS characterized by excess androgens, little or no periods, and polycystic ovaries. In addition to this, your symptoms of high androgens started within a few months after coming off the birth control pills.
Women on birth control pills usually resume ovulation soon after the pill is stopped. But in some women, ovulation remains suppressed months after the pills have been stopped and can be a cause of concern.
What next, If you have pill-induced PCOS?
It is important to know this phase is transient. Soon, your hormones will find their natural rhythm, and things will most likely be back to normal. This is why a waiting period is usually advised for people with this type of PCOS. You also have to manage your stress and work with your healthcare provider to help you restore hormonal balance.
In addition, with the right diet plan, lifestyle changes, therapeutic supplements and nutritional support, post-pill PCOS will heal within a few months to a year. Zinc, and DIM ( a potent phytonutrient found in cruciferous vegetables like broccoli and kale) may be helpful in managing PCOS symptoms.
Chronic low-grade inflammation has been identified as a major factor in the development of PCOS. There are different triggers of inflammation. One of such triggers has to do with the foods you eat. Dietary triggers are a common cause of oxidative stress.
In Inflammatory PCOS, the ovaries make excess testosterone which affects ovulation. Some common signs of inflammatory PCOS include headache, swelling, unexplained fatigue, skin issues, joint pain, and bowel issues.
How do you know you have inflammatory PCOS
To be diagnosed with inflammatory PCOS, your doctor would rule out insulin resistance. You should also rule out the chances that you are experiencing a temporary post-pill PCOS. However, you may experience signs related to inflammation, such as
- unexplained fatigue that doesn’t go away with sleeping
- Joint pain
- chronic skin conditions like psoriasis, eczema, or hives.
- Bowel problems like IBS
What next after your diagnosis?
To properly treat inflammatory PCOS, you have to first identify the root source of inflammation. This could mean getting an insight into your gut health, identifying and eliminating foods that you might be intolerant to and reducing your exposure to environmental toxins.
Working closely with a Registered Dietitian Nutritionist can help you know what food might be driving your inflammation. They will also assist you in creating a personalized nutrition and diet plan with natural anti-inflammatories agents like turmeric, Zinc, N-acetylcysteine, and omega-3, which may be helpful in dealing with this type of PCOS.
Other ways to reduce the symptoms of inflammatory PCOS are to address gut health, get plenty of sleep, do regular exercises, and practice mindfulness and other stress-relieving activities.
This type of PCOS is usually in response to an abnormal stress response. Here, DHEA-S (dehydroepiandrosterone sulfate), a form of androgen released by the adrenal gland, is elevated while testosterone levels may remain normal.
How do you know you have Adrenal PCOS?
To confirm your diagnosis of adrenal PCOS, your doctor would first rule out insulin resistance and other forms of PCOS. After ruling out other forms of PCOS, you might be subjected to a series of tests to check your testosterone, cortisol, and DHEA-S levels. The presence of elevated DHEA-S and not other androgens is usually indicative of this type of PCOS.
What next, If you have Adrenal PCOS?
One way to deal with the symptoms of adrenal PCOS is to manage your stress. Practice yoga, mindfulness, or any stress-reducing activity. You also have to avoid high-intensity exercises as this can induce stress in this type of PCOS.
Other treatments include intake of magnesium, zinc, adaptogen herbs like Rhodiola and Schisandra, and pantothenic acid (vitamin B5), which modulates adrenocorticotropic hormone (ACTH). Work with a registered dietitian nutritionist to make the right balance dietary modifications and supplement plan for your unique needs.
How Can Holness Nutrition Help Me?
Nicole Holness is a Registered Dietitian Nutritionist who is experienced in helping women with their hormone health, reproductive health (fertility, pregnancy, postpartum), gut health, and overall wellness.
It is no secret that diet has a huge impact on PCOS. If you are looking for the best way to optimize your diet to help you reduce your PCOS symptoms, book a free PCOS strategy call. We are here to help you create a personalized nutrition, diet, and lifestyle plan based on your unique needs to help you live comfortably without your PCOS symptoms holding you back.
https://www.cdc.gov/diabetes/basics/pcos.html PCOS (Polycystic Ovary Syndrome) and Diabetes
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4499527/ Fetal programming of polycystic ovary syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277302/ All Women With PCOS Should Be Treated For Insulin Resistance
https://obgyn.onlinelibrary.wiley.com/doi/10.1111/1471-0528.14754 Inositol treatment of anovulation in women with polycystic ovary syndrome: a meta-analysis of randomized trials
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5831951/ Nutrients and Oxidative Stress: Friend or Foe?