Polycystic Ovarian Syndrome (PCOS)

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PCOS stands for Polycystic Ovarian Syndrome and impacts as many as 1 in 5 women. It is believed to be the most common endocrine disorder among women between 18 and 44 years of age and also the leading cause of infertility in women – Yikes.

“PCOS” is actually several different conditions all under the same name umbrella.

Despite the name, ovarian cysts are not required for diagnosis, and PCOS is being considered for a name change by the NIH for this reason.

According to leading Women’s Health Expert, Lara Briden (author of The Period Repair Manual), there are believed to be multiple different types of PCOS: insulin-resistant PCOS, post-pill PCOS, inflammatory PCOS, and adrenal androgen excess PCOS.

It’s crucial to understand which variety of PCOS we may be dealing with, as treatment for each variety varies vastly, and what may improve one condition may negatively impact another. Also worth mentioning that we symptoms see a blend of multiple types – which only lends to further confusion on diagnosis and treatment protocols.

It’s believed that as much as 20-30% of PCOS cases may encompass the Adrenal Androgen Excess variety, where both the adrenals and ovaries may be contributing to excess androgen production (aka male hormones, such as testosterone).

Acne, oily skin, dark hairs, and blood glucose dysregulation are all common symptoms that elevated androgens may be occurring.

Stress seems a big driver at play with Adrenal Androgen Excess PCOS. This could be a result of under-eating, over-exercising, blood glucose dysregulation due to food choices, inflammatory foods, job stress, work stress, “real life” stress… It’s likely we have numerous contributing factors.

The HPA axis stimulates the production of androgens. These can be converted by peripheral tissues to testosterone in the body.

This means that a woman can have normally functioning ovaries, no insulin resistance, and still have symptoms consistent with PCOS due to HPA axis dysregulation and subsequent conversion of those hormones to testosterone. Complicated, right?

Hormonal birth control and prescriptions like spironolactone are common medical solutions to PCOS. It’s worth mentioning that spironolactone is very chemically similar to drospirenone, the drug found in Yasmin/Yaz birth control types, and may interrupt ovulation.

In terms of hormonal birth control – insulin resistance is a big driver behind many PCOS symptoms. We see time-and-time again that hormonal birth control may impair glucose tolerance and create an altered insulin response. So attempting to improve blood glucose regulation while taking drugs that may contribute to further insulin resistance may not be a great fit.

As always – addressing root cause always wins. If the only solution your doctor offers is a prescription (and no suggestions to make changes to nutrition, lifestyle, exercise, environment, supplementation, etc), don’t be afraid to get a second and third doctor opinion and find one who’s interested in getting to your root cause.

As always, don’t forget to check in with thyroid function, as well as environmental exposure. Our thyroid function is intimately tied with all our other sex hormones, and if one department is unhappy, it’s likely leaking into other aspects of our health as well.

In terms of environment – we are what we eat and come in contact with, and ingredients in our skincare, body care, cosmetics, and hair care products could be negatively impacting our health. Check out our guide for safer beauty products, or look into brands like BeautyCounter.

Similarly, don’t forget to do an environmental audit for other known xenoestogens (natural or industrial compounds found either in the foods we eat or things in our environment that may mimic estrogen-like action in the body or interfere with estrogen signaling pathways), such as plastic. This might include swapping out plastic drinkware, meal prep containers, and tupperware.

Common Symptoms of PCOS:
– Failure to ovulate regularly
– Infertility
– Insulin Resistance
– Weight gain (especially around the midsection)
– Period irregularity or lack of menstruation
– Elevated levels of androgens (Testosterone, DHEA, DHT, Androstenedione, etc)
– Inappropriate hair growth (hirsutism – dark hairs above lip, around nipples, ab trail, etc)
– Acne (especially along jawline), darkened skin patches, skin tags
– Hair loss
– Ovarian cysts
– Poor sleep/insomnia

How is PCOS Diagnosed?
– May or MAY NOT have cysts on ovaries
– High levels of male hormones in the blood or symptoms suggesting their presence (like acne or excessive hair growth)
– Menstrual dysfunction – Period irregularity, lack of ovulation, or lack of period

Common Medical Solutions for PCOS:
– Metformin – A medication typically used to treat Type 2 Diabetes (it makes the body more sensitive to insulin)
– Spironolactone – Lowers androgen levels (leading to improvements in acne and hair growth)
– Hormonal Birth Control Pills (worth mentioning that insulin resistance is a big driver for PCOS and HBC contributes can contribute to insulin resistance)

Daily Habits That Might Improve Symptoms of PCOS Regardless of Type:

– Keep blood sugar balanced by eating at regular intervals during the day and get in a protein, carbohydrate, fat, vegetables, and plenty of fiber at every meal
– Avoid hormone birth control usage – HBC prevents ovulation. Anovulatory cycles are one of the root issues with PCOS
– Get 8-9 hours of sleep every single night
– Minimize caffeine & alcohol consumption
– Consider removing dairy/gluten (and see if it impacts menstrual cycle any)
– Consume 25-35g of fiber daily and drink ample water/fluids
– Consume plenty of cruciferous veggies (broccoli, cauliflower, brussels sprouts)
– Reduce training volume & intensity. Take more rest days in the gym & consider switching modalities to something like yoga, bodybuilding, or lifting (vs. high-intensity modalities like CrossFit, Orange Theory, etc). Check out Paragon Training Methods
– Optimize gut health via quality probiotics, fermented foods, bone broth, and collagen
– Reduce plastic exposure (tupperware, meal prep containers, water bottles, etc)
– Buy natural body care products, skin care products, deodorants, and household cleaners (we love Beauty Counter)
– Buy high-quality meats, minimize consumption of processed foods and refined sugar as much as possible
– Consider supplementing vitamin B Complex, vitamin C, vitamin D (if low on labs), zinc, magnesium
– Research & consider supplementing with Myo-inositol


Love these types of health and nutrition tips? My ebook (The Badass Nutrition Guide) is the ULTIMATE guide to your BEST you & has 125 pages of nutritional education, macro cheat sheets, information on how much to eat, tips on fat loss, deets on hormones, guides on cooking, macros, & SO much more!

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