In Polycystic Ovary Syndrome there is too much of the androgen testosterone due to insulin resistance. Insulin stimulates the secretion of testosterone by the ovaries, but also inhibits SHBG (Sex Hormone Binding Globulin) which normally reduces the levels of testosterone in the body. Because there is excess production of testosterone and a lack of SHBG to balance out these levels, high levels of free testosterone accumulate in the blood and body leading to ovarian dysfunction.

*Insulin resistance (IR) occurs when the body’s cells are unable to use insulin effectively, which leads to high blood sugar levels.

As of yet there is no official cause of PCOS, rather a variety of environmental factors, lifestyle and genetics play a part and present as a wicked trifecta of constant inflammation, insulin resistance, and an overactive immune system.

How is PCOS Diagnosed?

Your doctor may use the following diagnostic tools to get a clearer picture of your exact presentation.

Blood Glucose Levels - looking for Insulin Resistance + Abnormal Levels
Blood Levels in Hormones - looking for Higher Levels of Testosterone, Low Levels of SBHG, LH:FSH ratio of 2:1 instead of 1:1.
*Please note, hormone levels change throughout a cycle which means results will vary depending on when in your cycle your levels are checked.

Physical Symptomology - Excess hair growth, acne, weight gain, poor blood sugar regulation, irregular, absent or prolonged periods
Pelvic Exam and/or Ultrasound of Lower Abdomen - the presence of growths on the ovaries (note that growths do not occur with all PCOS cases) + thicker uterine lining due to lack of menstruation.

There are varying criteria for the diagnosis of PCO (PCOS) -

If you follow the Rotterdam criteria, diagnosis requires the presence of at least 2/3 of the following:

Hyperandrogenism (High Androgen Levels) - This will show up in blood tests or physical signs that present with high testosterone levels.
Ovulatory Dysfunction (Anovulation - Lack of Ovulation) - This will present as irregular periods, a lack of menses, or lengthy cycles.
Polycystic Ovaries - This can be checked with a pelvic ultrasound.

If you follow the NIH: National Institutes of Health criteria the diagnosis requires the presence of 2/3 of the following:

Menstrual Irregularities due to ovarian dysfunction.
Hyperandrogenism (High Androgen Levels) - This will show up in blood tests or physical signs that present with high testosterone levels.
Exclusion of other disorders - This occurs when all other possibilities have been ruled out.

A diagnosis of PCOS can be overwhelming and confusing, but do not worry, there are 5 million other beautiful women on this boat with you and brilliant doctors and practitioners like myself determined to support and help you. Keep reading for some helpful tips in navigating your diagnosis!

PCOS + FERTILITY

PCOS can make getting pregnant difficult as it has a direct connection to ovarian dysfunction. Many women with PCOS do not ovulate, ovulate so irregularly that it is hard to track, or have such long cycles that their endometrial lining is no longer supportive and viable for a pregnancy leading to repetitive early miscarriages. It is absolutely possible to get pregnant with PCOS- you can work with alternative medicine practitioners in tandem with your doctors and fertility specialists. Together they will work to support you in having the best possible outcomes.

BBT CHARTING WITH PCOS

It is often recommend to follow your cycle with a BBT chart to track ovulation. With PCOS, it may be hard to figure out when you ovulate due to an irregular cycle, especially when most fertility tracking devices only work for menstrual cycles between 23-35 days. However, it is still very helpful to chart manually even if your cycle is irregular or prolonged (there are quite a few apps that allow manual charting!)

Charting your cycle helps you keep track of your progress and recognize how changes in your life such as the food you eat, the amount of sleep you get, and other events may affect you. It is also a helpful tool to share with your doctor if you are looking to get help through ARTs like IVF. In a BBT chart with PCOS, there may be many false peaks or false rises in temperature that are short lived throughout a cycle and are not followed by ovulation.

IMPORTANCE OF EARLY DIAGNOSIS + LONG TERM MANAGEMENT

Women are often given a hormonal birth control prescription to “treat” PCOS. This creates a false cycle and masks the symptoms of PCOS without getting to the underlying factors that may be adding to it. I have heard first hand from clients who recieved a PCOS diagnosis from their doctor and were told not to worry unless they have trouble conceiving down the road. This is a detreament to all women; when PCOS can be vastly improved through patient education and lifestyle changes, the long-term risks with 40% of women developing pre-diabetes and diabetes by age 40 and a higher risk of fatty liver and cardivascular disease make patient education on PCOS an absolute must.

Lifestyle Factors that Contribute to PCOS

Chronic Stress + Adrenal Fatigue
Diet - Unbalanced, Lack Thereof OR Too Much
Environmental Load - Toxicity + Endocrine Disruptors
Sleep + Circadian Rhythm
Exercise - Too Extreme OR Too Little

PCOS Support

Stress Management
Food Therapy + Exercise
Hormone Regulation
Clean Living
Supplements

Stress Management:

We all know any and all conditions no matter their origin are exacerbated by stress. Stress is one of the biggest causes of hormonal imbalances in women and is exceptionally potent in PCOS due to the fact that cortisol, the primary stress hormone, increases sugars (glucose) in the blood stream.

There’s no quick fix for stress, and the management of it may look different from woman to woman. For you it may mean adding walks to your daily regimen or adding massages and acupuncture into your monthly schedule. Find what resonates with you and stick to it!

FOOD + EXERCISE:

What you eat and how you eat it is one of the most important contributing factors to PCOS. When gut health is not optimal, hormones become imbalanced as the microbiome of the gut plays a huge role in estrogen regulation, immunity, and mood. This becomes even more important with PCOS where insulin resistance is at the forefront of dysregulation.

Diets can be hard. Knowing which diet to follow when a new one trends every month is even harder, and sticking it out 100% nearly impossible. Go easy on yourself. Here are some simple recommendations and helpful hacks for blood sugar balance -

Learn how eating foods in the right order can help balance blood sugar levels
- This is the BEST and EASIEST place to start.
  - Check out Biochemist Jessie Inchauspé author of Glucose-Revolution and founder of Glucose Goddess. (See links below!)
    - For easy to follow infographics on how to combine foods to avoid major blood sugar spikes follow her on instagram @glucosegoddess
    - For more detailed information and her latest research check out her new book Glucose-Revolution here.
    - For a free 1-Week Meal Plan click here.
After learning what foods to combine and in what order, you can also limit inflammatory foods in your diet - this looks like dairy, eggs, red meat, sugars and refined carbohydrates.
- Add in antioxidant support and anti-inflammatory foods like berries, leafy greens, and green tea!
Add a probiotic to your regimen - a skilled practitioner from a functional medicine doc to an acupuncturist can help you pick the right one
Exercise. The right kind! Too much exercise of a high intensity can actually worsen PCOS and cause an increase in cortisol production leading to hormonal imbalances.
- Pick a supportive exercise that nourishes you and gets your blood flowing - pilates, yoga, walks, running at a gentler pace and distance. A helpful way to gage what exercise is right for you is to find what exercise brings you joy and makes you feel rejuvenated after partaking in it. If you are exhausted, run down, yet still wired after a certain type of workout, that workout may be doing you more harm than good.

CLEAN LIVING:

You can help support your body by limiting your exposure to endocrine disruptors. These hormone disruptors are chemicals that mimic the natural hormones in our bodies leading to confusion from within. Our hormones are messengers that when activated help send messages to different systems, letting our bodies know when to perform certain actions. For instance, ovulation is triggered by the hormone progesterone, if it doesn’t receive this message, ovulation does not occur. Less interference from endocrine disruptors means an easier job for our bodies.

Here are common places endocrine disruptors can be found and some helpful places to find alternatives that work for you -

Household Products - Cleaning products are a major source of endocrine disruptors. Find out which products and ingredients are safe at the EWG Website which has databases on Cleaning Products, Personal Care Products and more!
- Here is one of my favorite brands for household cleaning products!
  - Branch Basics

Make Up + Skin Care - Use toxin-free cosmetics from shampoo to foundation. Find out which cosmetics and ingredients are safe here:
- Here are three of my favorite brands for makeup and skin care that I use everdyay

Feminine Hygeine - Pads + Tampons are full of dioxins, furans, and fragrance chemicals that have been linked to cancer, endocrine disruption and reproductive toxicity.
- There are many brands available online and in stores that offer organic products as well as alternatives like diva cups and period underwear. Here are some great options to check out!
  - Period Underwear: Thinx, Knix
  - For Mess Free Period Sex: Flex Disc
  - Period Swimwear: Knix
  - Reusable Pads: Rael
  - Organic Cotton Tampons and Pads can be found in places like Whole Foods and Amazon!

Plastics! - Plastic food and beverage containers are full of endocrine disrupting chemicals that can leach into your food. Use glass containers when you can and pass on using a plastic water bottle. Try not to reheat any food in your microwave in plastic Tupperware or take-out containers as well!

Cookware - Non-stick pots and pans are unfortunately a major source of toxic chemicals. Try to cook using stainless steel or cast iron when you can!

SUPPLEMENTS

There are many supplements and herbs that have been researched for PCOS with positive results and I am sure there will be many more to come.

Please note that just because a supplement or herb has been shown to help, does not mean it is right for you. A certified practitioner will be able to guide you in finding a supplement regimen for your optimal health and well-being in tandem with your general practitioner.

No one needs to be taking 100 different supplements every day. Give your liver a rest! Listed below is a more focused list of supplements from vitamins to herbs that have been studied along with links to brands that are reliable and affordable.

*Disclaimer: I do not have an association nor receive any benefit from naming the specific products and brands below!

Spearmint Tea - 2 Cups of Spearmint Tea daily - Spearmint has Anti-Androgenic Properties, meaning it helps to lower testosterone levels and reduce hirsutism with PCOS.
Mushroom Coffee and/or Powder - Find one with Maitake Mushroom at 50mg/day - this has been shown to support ovulation
Vitanica OvaBlend - Includes NAC (N-Acetyl-L-Cysteine), Cinnamon, Chromium, Green Tea, Chamomile, Saw Palmetto, and Sarsaprilla. This combination was specifically formulated for those with PCOS and includes many active ingredients that have been studied to support it.
Vitanica Optinositol™ offers both Myo-inositol and D-chiro-inositol in support of normal, healthy ovulation and maintenance of healthy insulin levels.
Vitamin D - It is super helpful to get your Vitamin D levels tested first! Recommended dosage if you are struggling with PCOS is 2000 units/day. Look for Vitamin D supplements that contain Vitamin D3/K2 and Calcium. A a great option is Mary Ruth’s K2 + D3 Calcium Gummies
Peony + Licorice Root Decoction (Gan Mai Da Zao Tang) - This is a Chinese Herbal Formula that can be offered through your local acupuncturist and herbalist. It may help to reduce testosterone levels and in Chinese medicine is considered a nourishing and harmonizing formula.

This is by no means an exhaustive list of all the potential supplements that may be supportive for you. Each person has a varying presentation of PCOS, some present with polycystic ovaries, some without, some with androgen excess, some with amenorrhea. Work with your PCP and an integrative health practitioner like an acupuncturist, functional medical doc, naturopath, or nutritionist. They can work together to best support you in your health goals and progress.

*Please note! Folic Acid is often recommend for women with PCOS - if you have MTHFR, a genetic condition that affects the way you metabolize folic acid, you will need a supplement that contains METHYLATED FOLATE!

PCOS - How Lifestyle Changes from Food to Acupuncture Can Support You

In this ARTICLE

What Hormones are out of balance with PCOS?

how is pcos diagnosed?

PCOS + FERTILITY

Lifestyle Factors that Contribute to PCOS

PCOS SUPPORT

PCOS HERBS + SUPPLEMENTS

FURTHER READING

PCOS (Polycystic Ovary syndrome)

SIGNS + Symptoms of PCOS

HORMONE IMBALANCES WITH PCOS (PCO)

How is PCOS Diagnosed?

PCOS + FERTILITY

Lifestyle Factors that Contribute to PCOS

PCOS Support

Stress Management:

FOOD + EXERCISE:

CLEAN LIVING:

SUPPLEMENTS

FURTHER READING: