If you have PCOS (polycystic ovarian syndrome), you know how hard it is to treat.
You were probably told to "lose weight." Easier said than done. You were probably also told to cut back on your sweets and carbs.
You may have even been prescribed metformin, which is a medication for diabetes. Or perhaps a birth control pill or an antidepressant.
Like most health problems, if you truly want to have success at reducing or eliminating your PCOS symptoms, you must get to the root causes instead of just treating symptoms.
In this article I will discuss PCOS, what causes it, common symptoms associated with it, how to diagnose it, and several natural treatments that can help you manage it.
Here we go...
What is PCOS?
PCOS (polycystic ovarian syndrome) is a combination of several hormonal imbalances in women. The symptoms that you have depend on which hormones are out of balance and to what degree.
Most PCOS patients have the following hormonal imbalances:
Not all women will have all of these hormone imbalances, but most PCOS patients will have 1 or more of them.
The primary culprit of all of these hormone imbalances is insulin.
Insulin resistance develops which starts a chain reaction that results in all of these hormonal issues - high testosterone, high estrogen, low progesterone, and leptin resistance. The symptoms of PCOS then follow.
These imbalances commonly result in the development of metabolic syndrome, which is a group of risk factors that increase your risk for heart disease, diabetes and stroke.
These hormonal imbalances prevent the normal ovulation cycle. As a result, multiple immature follicles or cysts develop in the ovaries which can be seen on ultrasound, which is where the name polycystic ovarian syndrome originated.
Common PCOS Signs and Symptoms
If you have PCOS, the symptoms you have will depend on WHICH hormones are out of balance and how MUCH they are out of balance.
Some of the more common PCOS symptoms include:
- Excessive Hair growth - Caused by excess testosterone and insulin resistance
- Weight Gain (even when eating well and reducing calorie intake) - Caused by a combination of leptin resistance, insulin resistance, and hypothyroidism
- Menstrual Irregularities - Caused by an imbalance in estrogen and progesterone
- Multiple Ovarian Cysts - Caused by an imbalance in estrogen and progesterone
- Hair Loss - Caused by hypothyroidism, nutrient deficiencies, and androgen/testosterone excess
- Depression and Mood Changes - Caused by hypothyroidism and sex hormone imbalances
- Fibrocystic Breast Disease, endometriosis, PMS - Caused by excess estrogen and/or low progesterone
- Infertility - Caused by hypothyroidism and low progesterone
How to Diagnose PCOS
PCOS is diagnosed if you have at least 2 of the 3 conditions:
1. Absence of ovulation, which leads to irregular menstrual periods or no periods at all.
2. High levels of androgens, or signs of high androgens, such as excessive body or facial hair.
3. Cysts on one or both ovaries.
If you are having some of the symptoms that we have discussed, it is reasonable to assume you either have PCOS or are in the process of developing it.
Natural Treatments for PCOS
The conventional approach to treating PCOS is to mask the symptoms.
This may make you feel better in the short term, but it does not result in long term improvement.
My conventional training taught me to treat PCOS patients with oral birth control pills, metformin, and anti-depressant medications.
While none of those treatments are bad in and of themselves, most of them don't get to the root cause of the issues.
Birth control pills artificially regulate the estrogen and progesterone levels, but they don't address the cause of the imbalance that is preventing you from having a period in the first place.
Anti-depressants may help you sleep better and will help control your mood swings, but it doesn't address the hormonal imbalances that are the cause of the moodiness.
Metformin has some practical use for treating insulin resistance.
If you decide to take these medications for a short time to control your symptoms while you make the other changes I discuss, that is reasonable.
However, PLEASE don't let these symptomatic treatments be the ONLY thing you do for your PCOS.
The sooner you can begin reversing the hormonal imbalances in your body, the sooner you can begin feeling better and avoid the future complications brought on by the imbalances.
If you remember anything from this article, please remember this:
All women that are diagnosed with PCOS should be treated for insulin resistance.
To read more about insulin resistance, please read my article here.
Every treatment that I discuss below focuses on reducing the insulin resistance in your body.
You will need to aggressively do ALL of the things discussed. Doing only 1 or 2 of them will most likely not be enough to give you the improvement you are seeking.
1. Change Your Diet
Changing your diet will not by itself completely reverse the symptoms of your PCOS, but nothing else will work if you don't address your diet.
So what dietary things can you do to treat your PCOS?
Let's start with some basic guidelines that are helpful for almost any health condition:
- Eat whole organic-based foods
- Avoid ALL processed foods
- Eliminate sugar from your diet
- Avoid most gluten and dairy-containing foods (some people can eat more than others)
- Not ALL carbs are bad (but most people eat way too many)
- There are times you should eat and times that you SHOULDN'T
These guidelines can be applied to whatever diet you choose.
All of these diets should be looked at as a starting point only.
Every person is different and may require slight modifications for their particular situation.
For example, someone with severe adrenal fatigue many need a higher ratio of healthy carbs than the diet suggests.
With that in mind, the following diets are approved for patients with PCOS:
I would strongly suggest hiring a nutritionist or health coach to help with your diet.
It can be very difficult and confusing to monitor your macromolecule ratios and make appropriate adjustments depending on your particular situation and symptoms.
Your diet will require some adjustments along the way that would best be monitored by a professional.
2. Exercise the Right Way
Exercise is critical to help reverse the hormonal imbalances of PCOS.
However, not all exercise is created equal.
Doing the right KIND of exercise and the right AMOUNT of it is vital.
Some forms of exercise such as walking on a treadmill for an hour may have very little impact on weight loss and hormone changes that are needed in PCOS.
There are 2 things regarding exercise that you should focus on when trying to reverse your PCOS:
1. Shorter and more intense exercises
2. Building up more lean muscle mass
I have mentioned high intensity internal training (HIIT) in several of my articles. It is an outstanding treatment for PCOS.
Because it helps reduce insulin resistance.
As a reminder, insulin resistance is the primary root cause of PCOS. If you want to reverse your PCOS, you must address the insulin resistance.
Increasing your lean muscle mass is also very helpful for PCOS because it increases your resting metabolic rate.
When exercising, it's important to match your level of exercise with your level of energy.
Over-exercising can be as harmful as not exercising because of its impact on cortisol levels.
3. Manage Your Stress
Stress may be the most overlooked cause of health issues that we have, yet it is one of the most important to address.
I'm not just talking about the severe forms of stress - divorce, loss of a loved one, severe sickness or injury, etc.
The daily stresses also take a toll on your body - traffic jams, family conflict, job issues, kid issues, and others.
These stresses affect our cortisol levels which can cause bad things to happen in our body.
Stress has been found to be associated with the following:
- Weight gain
- Hormonal imbalances
- Autoimmune diseases
- Premature death
Most people think stress is just "a way of life" and there isn't much they can do about it.
That just isn't true. We can do a lot to reduce the negative effects stress can have on our lives.
Here are some things that you can do to help you better manage your stress:
Pick at least 1 or 2 of the things above and start doing them each and every day.
You won't get healthy until you address your stress and improve how you manage it.
That is true for any health issue, not just PCOS.
4. Decrease Inflammation
Inflammation in the body is the root issue of almost all diseases.
That is true for PCOS as well.
Inflammation leads to insulin resistance, leptin resistance and weight gain.
It also worsens hypothyroidism by increasing the production of reverse T3.
As I have already discussed, PCOS is caused by inflammatory conditions such as insulin resistance and leptin resistance.
To make matters worse, PCOS leads to increased inflammation which will itself worsen the hormonal imbalances, thus creating a vicious cycle.
So what can you do about it?
Check your inflammatory markers (CRP and ESR). If they are elevated, begin looking for possible sources of the inflammation.
If you can find the source, you can work on eliminating it which will help to balance your hormones.
Some common sources of hidden inflammation in the body include:
1. Undiagnosed low grade food sensitivities
2. SIBO or other intestinal overgrowth issues
3. Chronic infections -EBV, CMV, H. pylori and others
4. Standard American Diet - high in processed foods
5. Autoimmune Conditions - Hashimoto's and others
6. Hormonal Imbalances - these alone can be bad enough to raise the inflammatory markers
5. Use the Right Supplements
Supplements should be a cornerstone in the treatment of PCOS.
Be very careful and selective with which supplements you consider using.
Make sure you get them from a reputable source. Not all supplements are created equal.
Supplement manufacturers are not under as strict of regulation as pharmaceutical companies. That's why it's critical that you buy only from good companies that self-regulate themselves.
Make sure you focus on the following areas when choosing your supplements:
- Reducing and reversing insulin levels
- Reducing inflammation
- Reducing leptin levels
- Reducing androgen and testosterone levels
- Improving the metabolism of estrogen
I will quickly go through each of these and give you my recommended brands for each supplement.
Supplements that Help Lower Insulin Levels:
- Alpha Lipoic Acid - ALA helps reduce insulin resistance and lower blood sugar levels. Use up to 1800mg per day in a sustained release form for best results. Use up to 6 months.
- Berberine - Berberine can lower the A1c as much as metformin. It also helps with weight loss in patients with insulin resistance. Use up to 2000mg per day for up to 3 months for best results.
- Glucomannan - This is a viscous fiber that reduces carbohydrate absorption and helps you fill up faster with results in weight loss. Use 4 tablets 15 minutes before a meal for best results.
- Krill oil + Astaxanthin - Fish oil can reduce insulin resistance by lowering inflammation and leading to weight loss. It can also increase lean muscle mass. You will need 2-4 grams per day to get this benefit.
Supplements that Help Lower Estrogen and Estrogen Metabolites:
- DIM - helps reduce the conversion of testosterone into estrogen, plus it helps the body metabolize estrogen through the least estrogenic pathway. Use up to 300mg per day for up to 3 months.
- Calcium D Glucarate - increases liver metabolism of estrogen and androgens. It can also increase the elimination of endocrine disruptors. Use up to 3000mg per day.
Supplements to help lower testosterone:
- Zinc + Saw Palmetto - Zinc and saw palmetto help reduce the conversion of testosterone into its active metabolite DHT. This can help reduce acne, hair loss and mood swings. Use 60mg of zinc and 600mg of saw palmetto together daily for best results.
6. Monitor All of Your Hormones
Remember, PCOS is usually caused from several hormones becoming imbalanced in the body.
Don't get stuck on just thinking about the sex hormones (estrogen and progesterone), since they seem to cause the majority of symptoms.
Consider monitoring these hormones as well:
- Leptin Resistance - Check your fasting leptin level. If you are overweight and your leptin level is above 12, you have leptin resistance.
- Insulin Resistance - a fasting total insulin level > 5 is indicative of insulin resistance. This should be your primary focus when treating your PCOS. Lowering your insulin will help to normalize all of the other hormone levels.
- High Testosterone - check the free and total testosterone levels. Most PCOS patients have high free testosterone and often normal or slightly high total testosterone levels.
- Cortisol - check your am cortisol level. Normal ranges are 14-16. Any level above or below this indicate adrenal issues and could be affecting your energy levels.
- Hypothyroidism - Hypothyroidism and PCOS are closely linked. Make sure you get a complete thyroid panel (TSH, free T4, free T3, reverse T3, TPO antibodies, thyroglobulin antibodies) plus a sex hormone binding globulin level.
- Low Progesterone - PCOS patients commonly have very low progesterone levels which should be addressed.
7. Consider Prescription Medications
I am all for doing as much as we can naturally to keep our bodies running smoothly.
However, there is a time and a place when prescription medication may be necessary.
Think of PCOS as a spectrum. On one end the hormonal imbalances are relatively mild. Making the lifestyle changes and using the supplements I have discussed may be enough to reverse the condition and improve symptoms.
On the other end of the spectrum, the hormonal disruptions are severe.
Lifestyle interventions and natural treatments may improve symptoms to some degree, but they may not be enough to fully reverse the condition.
In those cases, it may be necessary to consider medications to treat the insulin resistance, leptin resistance, and sex hormone imbalances.
You will need the guidance of a knowledgeable doctor to walk you through these treatment options.
Polycystic Ovarian Syndrome (PCOS) is a syndrome caused by several hormonal imbalances in the body.
These include elevated androgens, insulin resistance, low progesterone, and leptin resistance.
Rather than just treating the symptoms, it is important to identify the root causes and address each specifically.
All PCOS patients should be treated for insulin resistance.
Like most conditions, diet, exercise, stress reduction and proper supplementation are foundational to treatment. Medications are sometimes needed as well.
Now it's your turn...
Have you been diagnosed with PCOS?
What treatments have you tried?
What has helped? What hasn't?
Leave your comments below.