Polycystic ovarian syndrome (PCOS) is one of the most common endocrine conditions affecting women of reproductive age⁽¹⁾. This hormonal condition is characterised by irregular menstrual periods, excess male hormones, and/or ovarian cysts. PCOS is present in 8-13% of women of reproductive age, this number could be much greater as many women are going undiagnosed!
PCOS is a syndrome with a cluster of symptoms and presents differently from woman to woman. Some women may be overweight, and have irregular menstrual cycles, and excess hair growth; while other women are able to maintain their weight. These are some of the more common symptoms women with PCOS experience:
- Changes in menstrual cycle, such as irregular or infrequent menstruation
- Weight gain, or stomach fat that doesn’t shift no matter how well they eat and exercise
- Male patterned excess hair growth – can be whiskers, hair on nipples, excessive hair on the back of the neck
- Changes in skin such as acne which might appear on the chin, back, or on the chest; also oily skin, and darkening in some areas
- May have multiple ‘cysts’ (or partially formed follicles/eggs) on the ovaries, however not present for all women
- Difficulty becoming pregnant
- Sleep apnoea
- Changes in mood such as anxiety, depression, irritability or a short fuse
- Finding it hard to relax
These symptoms (as well as others), can cause anovulation (which is the lack or absence of ovulation and egg release).
How is PCOS diagnosed?
In order for a PCOS diagnosis to be made, the AE-PCOS Society diagnosis criteria⁽10⁾ is:
- Clinical and/or biochemical hyperandrogenism, which can be found on blood tests such as elevated testosterone and DHEA-S; or signs of high androgens such as facial hair, plus either of the following:
- Oligomenorrhea (less than 6-9 menstrual cycles per year) or Oligo-Ovulation
The AE Pcos criteria places little importance on the presence of cysts on the ovaries itself, as one in four women tested will have polycystic ovaries without having the syndrome. Therefore keep in mind this is not a defining factor.
When Diagnosing PCOS it is also important to determine your type of PCOS, as treatment needs to address the root cause of the individual.
Types of PCOS
- Insulin PCOS
This is the most common form of PCOS, where insulin resistance leads to elevated testosterone.
- Post pill PCOS
There can be a few factors driving this. The first is androgen rebound, where you can over produce testosterone after coming off the pill. This is because your brain & ovaries are trying to adjust to communicating with each other again. The second is insulin resistance from the pill. It can take up to 12 months or more for the hormones to self regulate, and if you are trying to conceive can feel frustrating and a long time. However by taking action using the suggestions in this article, as well as working with a health practitioner, you can regulate the menstrual cycle naturally and often sooner.
- Inflammatory PCOS
The underlying cause is driven by inflammation in the body.
- Adrenal PCOS
Adrenal dysfunction is the driver.
While some women may choose to treat PCOS through conventional medicine approaches which often recommends oral contraceptives or anti-diabetic medications such as metformin. For the women wanting to conceive there is also surgery where a gynaecologist may use a technique for stimulating your ovaries to release an egg, or if no success with this method, IVF.
We are fortunate to have these medical intervention methods, however unfortunately these conventional approaches do not determine what is driving this hormonal imbalance, and if using medications, may mask the underlying cause/s.
A holistic approach to PCOS not only applies evidence based medicine to reduce symptoms and correct hormonal imbalances, it also aims to identify the root cause or what is triggering hormonal imbalance and associated symptoms.
With individualised dietary and lifestyle recommendations, as well as a tailored nutritional prescription, women can work towards balancing their hormones naturally. No prescription should ever be the same, and as I said PCOS can be so different from woman to woman, however as a guide these are some of the natural treatments that can be used to improve PCOS symptoms naturally:
Modifying the diet can be one of the most important steps to managing PCOS. Specific recommendations include:
- Ensuring each meal contains a serve of protein (animal or plant protein/s), some nourishing fats (avocado, nuts, seeds, olive oil, fatty fish) and filling your plate predominantly with vegetables.
- Reducing (or even better avoiding) added/refined sugars. Sugar increases insulin-like growth factor-1 (IGF-1) and in turn drives testosterone production. Excess insulin also leads to fat storage, making it more challenging to decrease excess weight.
- Carbs are not the enemy, however when they are not paired with a source of protein, this can create a hormonal response and further affect testosterone. So swap refined carbohydrates with wholefood alternatives. Refined carbohydrates essentially act like sugar in the blood and spike blood sugar and insulin levels. Wholegrains are buffered with fibre and essential nutrients and are a healthier alternative to their white (and not as nutritious) counterparts, but should still be consumed in moderation for women with PCOS.
- Avoid processed/packet foods⁽2⁾. These foods are usually higher in sugar, salt and unhealthy fats that do not support healthy metabolic and reproductive outcomes.
- Removing dairy, gluten and alcohol should be considered. Dairy increases IGF-1 and is particularly problematic for PCOS symptoms such as acne and hirsutism. Gluten can be inflammatory, and from a clinical observation, people comment that they feel more energetic, less bloated, and mentally clearer when they remove it.
Exercise supports muscles to become more sensitive to insulin resulting in greater insulin uptake and lower fasting insulin levels⁽3⁾. Aiming for at least 30 minutes per day of exercise you enjoy which could be walking, resistance training, pilates, yoga, swimming, or bike riding.
Women with PCOS, and particularly adrenal driven PCOS are often very sensitive to the effects of stress. High cortisol can drive insulin production and making symptoms worse. It is important to implement daily stress management techniques such as breath work, mediation, yoga, and adequate sleep. I often hear women say they can’t stop their mind from chattering, and these are the women who need to implement stress management techniques the most. The key to making these techniques part of your daily routine, is to commit to doing just 5 minutes a day. Some days you may be able to (and want to) do more!
The following nutrients are some of the many highly beneficial in PCOS management:
- Zinc: particularly useful for symptoms such as acne, hirsutism or thinning hair⁽4⁾. Zinc helps to reduce testosterone levels, regulate insulin levels⁽5⁾, and is also an important nutrient for healthy ovulation and hormone production (among so many other functions in the body).
- Inositol: helps to improve the sensitivity of cells to insulin and thus reduce fasting insulin levels⁽6⁾.
- Magnesium: is important for stress support, insulin sensitivity, sleep quality and more.
- Chromium: can be an important nutrient to consider for blood glucose management⁽7⁾.
Research suggests that as little as a 2-5% body weight reduction can improve metabolic and reproductive outcomes in PCOS⁽8⁾. When it comes to weight loss for any person, it should be achieved in a realistic and sensible way. Extreme methods are not the answer. When addressing insulin resistance, typically women will experience a reduction in weight (if they are overweight to begin with). When insulin levels begin to drop, healthy weight loss can also help to achieve healthier ovarian function, regular ovulation and regular menstrual cycles.
Is your PCOS driver – Adrenal?
Women produce testosterone in multiple places in the body, including the ovaries, the adrenal gland, and various tissues. Research has shown that women with PCOS can have an overactivity in the hypothalamic-pituitary-adrenal-axis (HPA axis) which then impacts metabolic function and overall health⁽9⁾ which suggests how important it is to implement daily emotional wellness practices.
Doing things the natural way is not going to change things overnight. You can start making small changes, which will combine and make a bigger impact on your overall health.
The less demanding of yourself and the more nurturing you become, the more balanced you become within.
- March, W. A., Moore, V. M., Willson, K. J., Phillips, D. I. W., Norman, R. J., & Davies, M. J. (2010). The prevalence of polycystic ovary syndrome in a community sample assessed under contrasting diagnostic criteria. Human Reproduction, 25(2), 544–551. https://doi.org/10.1093/humrep/dep399
- Marsh, K., & Brand-Miller, J. (2005). The optimal diet for women with polycystic ovary syndrome? British Journal of Nutrition, 94(2), 154–165. https://doi.org/10.1079/bjn20051475
- Banting, L. K., Gibson-Helm, M., Polman, R., Teede, H. J., & Stepto, N. K. (2014). Physical activity and mental health in women with Polycystic Ovary Syndrome. BMC Women’s Health, 14(1). https://doi.org/10.1186/1472-6874-14-51
- Cervantes, J., Eber, A. E., Perper, M., Nascimento, V. M., Nouri, K., & Keri, J. E. (2018, January 1). The role of zinc in the treatment of acne: A review of the literature. Dermatologic Therapy. Blackwell Publishing Inc. https://doi.org/10.1111/dth.12576
- Marreiro, D. D. N., Geloneze, B., Tambascia, M. A., Lerário, A. C., Halpern, A., & Cozzolino, S. M. F. (2006). Effect of zinc supplementation on serum leptin levels and insulin resistance of obese women. Biological Trace Element Research, 112(2), 109–118. https://doi.org/10.1385/BTER:112:2:109
- Antoaneta Gateva, Vittorio Unfer & Zdravko Kamenov (2018) The use of inositol(s) isomers in the management of polycystic ovary syndrome: a comprehensive review, Gynecological Endocrinology, 34:7, 545-550, DOI: 10.1080/09513590.2017.1421632
- Amooee S, Parsanezhad ME, Ravanbod Shirazi M, Alborzi S, Samsami A. Metformin versus chromium picolinate in clomiphene citrate-resistant patients with PCOs: A double-blind randomized clinical trial. Iran J Reprod Med. 2013 Aug;11(8):611-8. PMID: 24639797; PMCID: PMC3941367.
- Moran, L. J., Brinkworth, G., Noakes, M., & Norman, R. J. (2006). Effects of lifestyle modification in polycystic ovarian syndrome. Reproductive BioMedicine Online, 12(5), 569–578. https://doi.org/10.1016/S1472-6483(10)61182-0
- Marco Mezzullo, Flaminia Fanelli, Guido Di Dalmazi, Alessia Fazzini, Daniela Ibarra-Gasparini, Marianna Mastroroberto, Jenny Guidi, Antonio Maria Morselli-Labate, Renato Pasquali, Uberto Pagotto, Alessandra Gambineri. Salivary cortisol and cortisone responses to short-term psychological stress challenge in late adolescent and young women with different hyperandrogenic states. Psychoneuroendocrinology. Volume 91, 2018. Pages 31-40. ISSN 0306-4530. https://doi.org/10.1016/j.psyneuen.2018.02.022.
- Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, Janssen OE, Legro RS, Norman RJ, Taylor AE, Witchel SF; Task Force on the Phenotype of the Polycystic Ovary Syndrome of The Androgen Excess and PCOS Society. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril. 2009 Feb;91(2):456-88. doi: 10.1016/j.fertnstert.2008.06.035.