Polycystic Ovary Syndrome is one of the most common hormonal disorders women face today, with 5% to 10% of women of reproductive age being diagnosed. (1) That puts the number at around 5 million in the US alone, which is a hell of a lot! Sadly it is most closely associated with infertility which can make it a very emotional burden for the many women who suffer from it. Especially with doctors frequently under-diagnosing it due to its complex nature. Today we are going to dive deep into exactly what PCOS is, what the causes and symptoms are, and offer you some holistic perspectives on how to prevent and treat this disorder. I hope it makes it easier, and if you have any questions please feel free to reach out.
What is it?
PCOS is a complex condition that essentially impacts how a woman’s ovaries work. (2) It is described in western medicine as an inflammatory, deregulated hormonal state which affects everything from our cycle and overall well-being to our physical and mental health. (3)
Clinical Diagnosis:
Because it is such a complex disorder, many misconceptions surround it, which makes misdiagnosing it very common. There is still a lot we have yet to learn but the clinical diagnosis (according to western science) is based on the presence of at least two of the following:
An increase in Androgen hormones (male hormones like testosterone). (4) Normally the ovaries release a small number of male sex hormones but in women with PCOS, the ovaries start making slightly more androgens than usual. This can show up in a woman’s body as excess hair on the face, chest, and back as well as hair loss, acne, and sometimes a deepening of the voice. However, these symptoms can also be caused by other hormonal imbalances such as thyroid conditions, so on its own, it is not a diagnosis of PCOS.
Ovarian dysfunction, which is categorized by oligomenorrhea (when a woman regularly goes for more than 35 days without menstruating), amenorrhea (when the period is absent altogether), and chronic anovulation (when a woman doesn’t ovulate, doesn’t release an egg and therefore can’t get pregnant). (5, 6, 7)
Cysts on the ovaries or enlarged ovaries. (8) You actually don’t necessarily have to have formed cysts on your ovaries to be diagnosed. By looking at your ovaries doctors can see the number and volume of follicles per ovary, which is an indication of PCOS and a common diagnosis for many women.
Additional signs and symptoms may include:
Weight gain and/or trouble losing weight
Insulin resistance (which usually directly correlates to weight gain)
Higher levels of depression and anxiety due to an increase and overactivity of the sympathetic nervous system (your stressed fight or flight mode) (9)
Fatigue
Low sex drive
Lack of sleep quality
Dark patches on the skin, particularly along neck creases, in the groin, and underneath breasts
Skin tags, which are small excess flaps of skin around the neck or armpits
Causes and risk factors:
While the exact causes are still relatively unknown, there are a few different theories as to what causes PCOS in women. By no means are these a one size fits all answer, but rather the potential combination that could cause the development of this disease.
Some western causes are thought to include:
An imbalance of the female reproductive system in which the hypothalamus, pituitary, and ovaries are involved. In women with PCOS, the balance of hormones needed for ovulation and fertility becomes dysregulated. In a normal cycle, the hypothalamus gland produces a hormone called gonadotropin release hormone (GnRH). In women with PCOS, a change in the release of GnRH affects the responsiveness of the luteinizing hormone (LH) which directly affects anovulation (10)
Insulin resistance (which affects how your body uses and stores sugar) (11)
A genetic predisposition to hyperandrogenism (male hormones) (12)
Family history of PCOS (13)
Smoking
Sedentary lifestyle (14)
Metabolic syndrome (caused by abdominal obesity, high blood sugar, high blood pressure, or low levels of good cholesterol)
Some causes according to TCM:
Stress! In Chinese medicine, stress affects the liver by reducing its ability to detox excess hormones that build up in the body. Those hormones that didn’t get removed then circulate back around your body, affecting the balance of hormones needed for a healthy cycle and ovulation. This pattern is often seen for women with stress at work, a toxic home environment, or even frustration after a failed IVF treatment. All of the above reasons can cause liver stagnation and blood stagnation in the uterus resulting in menstrual delay and even amenorrhea. (15) In TCM, stress also increases blood stagnation in the meridians, which nourishes the hair follicles too much, and creates the coarse and unwanted hair that is common with PCOS. (16)
Contraceptive pill. (Yes, I know, western doctors recommend going on the pill to help the disorder and it breaks my heart). Ironically even in clinical trials, contraception has been linked to insulin resistance, inflammation, diabetes, weight gain, and even cysts on the ovaries! (17) In TCM the long-term use of contraception restrains the Kidney's Qi, resulting in coldness and blood stagnation in the uterus which leads to a longer menstrual cycle and infertility. (18)
Sedentary lifestyle. In Chinese medicine, a lack of movement causes blood stagnation in the body, therefore affecting your uterus and potentially causing cysts to build up.
Life environment or sudden changes in your environment that affect your mental health and ultimately your entire endocrine system. (19)
Holistic remedies:
Due to the complex nature of this disorder, the road to healing is not the same for every woman. Factors like stress, diet, and level of exercise all play an important role in a woman’s hormonal system. The most important thing to do for any woman is to focus on all aspects of health: eating a balanced diet and eliminating as much psychological stress as possible.
Meraki's top 6 tips:
1. Start looking to improve your diet:
With any change to a diet comes the fear of restriction and temptation. Please do not think of this as one of those situations. The most important thing you can do is to think about ADDING nutrients to your plate, and once you do that, you start to crave those foods, get off the sugar rollercoaster and feel mentally and physically stronger. Once you do that, you can start to think about swapping more processed carbohydrates for healthier delicious options. Again, I cannot stress enough viewing this as adding more foods to your diet rather than restricting all the things you love. A positive relationship with food is just as important as the food we put in our mouths. This being said here are some guidelines for you:
Inflammatory foods are your friend! The standard American diet offers so few nutrients, and your hormones just cannot function at their best without a variety of whole food sources of nutrients. Women with PCOS have a harder time controlling their cravings than normal healthy adults. The good news is cravings are just your body lacking a certain nutrient! The more you add the less you crave. Think vegetables, fruits, organic meats, wild-caught fish, nuts/seeds (chia, flax, hemp, walnuts, and almonds), and unrefined fats and oils (coconut oil, olive oil, and avocado). This type of diet has actually been shown to significantly reduce some of the metabolic symptoms of PCOS and improve insulin sensitivity. (20)
Swap high glycemic carbohydrates (white bread, biscuits, sugar, white pasta) for nutrient-dense options (sweet potatoes, colorful veggies, legumes, or whole wheat versions). A balanced healthy diet means a gentle rise and fall in our blood sugar levels. When we eat foods with a high glycemic load our blood sugar rockets, insulin is overworked, the excess sugar is stored as fat and we feel mentally worse. With PCOS insulin resistance is linked to infertility, so by being conscious of this knowledge and applying it to our diet we can improve the symptoms. (21) (22) (23)
Balance the carbohydrates on your plate with fats and proteins. This combination will slow the absorption of sugar and keep your blood sugar stable. Your mood will be greatly improved as well as your insulin sensitivity.
In general, any lifestyle change that positively benefits your hormones is going to have some benefit in restoring fertility and improving other conditions and symptoms associated with the disorder. All good news!
2. Limit exposure to endocrine disruptors chemicals:
This is a big one. Endocrine disruptors are chemicals that interfere with the production, release, and elimination of the body’s natural hormones. A study found that women diagnosed with PCOS had significantly higher levels of BPA in their system than healthy women. (24) To top this off higher levels of disruptors such as BPA may be directly linked to high androgens (testosterone) in the body. (25)
While it’s impossible to limit all contact with these disruptors, a few ways to reduce exposure include:
Replacing plastic water bottles or containers with glass or steel options (this includes storage of food - especially hot food!)
Use tin foil instead of plastic wrap
Buy foods that are in BPA free containers
Use sulfate and phthalate-free shampoos, body oil, and makeup (your skin is your biggest organ and absorbs everything you put on it)
Try and eat organic produce where possible
Swap your chemical cleaning products in your house for natural products
3. Get plenty of sleep and rest:
Sleep plays a role in every process in the body including hormone balance, stress regulation, and weight gain. (26) Higher levels of stress and anxiety cause a lack of sleep quality which is especially common for women with PCOS. Finding ways to slow down before bed, like practicing guided meditation, can lower your stress response and help you get a much higher quality of sleep.
4. Practise yoga:
Due to its effect on the parasympathetic nervous system (your rest and digest state), yoga is such a powerful tool to calm you down, lower cortisol in the body, and release powerful happy chemicals. Amazingly, it has been found to be more effective than other forms of exercise at improving PCOS. (27)
5. Supplement support.
Add some specific supplements to your routine. It is important to see a practitioner first as they can recommend the right options based on your lifestyle and genetics too! These are some of the different options to look into:
Magnesium
Zinc
Omega 3
Chromium
Ashwagandha
Folic acid
6. Invest in regular massage:
Through stimulating your lymphatic system, massage aids the body’s natural detoxification process by removing the excess hormones that are causing havoc in your cycle. It also lowers your stress response and encourages deep relaxation, something very important for your body to heal itself. It is important to drink plenty of water afterward in order to flush everything out of your system.
Treatment according to traditional Chinese medicine:
Acupuncture:
By improving blood flow to the ovaries, lowering cortisol levels, and unblocking energy acupuncture can restore balance to the body and improve fertility in the process. (28) It has also been shown to improve menstrual frequency and decrease levels of testosterone in the body which is fantastic news. (29)
2. Herbal remedies:
In traditional Chinese medicine, PCOS is often caused by kidney deficiency and an abundance of phlegm and blood stagnation in the body. Herbal remedies can be given to improve these issues based upon the individual diagnosis of the person. (30)
To quickly recap - PCOS is extremely complex and altogether hard to diagnose with many potential causes. While it may have genetic origins for some women, for most it is rooted in lifestyle choices. The most important thing you can do is arm yourself with knowledge, aid your body in re-balancing its hormones, and be kind to yourself. It will not happen overnight but I hope this article sheds some light on this common disorder from both a clinical and holistic perspective.
If you have any questions please feel free to message me!