While there are more than 38 million Google searches for what is PCOS, Polycystic Ovary Syndrome is an underdiagnosed condition that is estimated to affect about 10% of people who menstruate.
A 2016 survey found that it frequently took two years and about three practitioners before a diagnosis was made. More recently, PCOS is being readily recognized, however, there is still a lot unknown about the syndrome. This can lead people to feeling frustrated and unsure of what PCOS entails. As a naturopathic doctor, I hope to expand, educate and shed light on this complex syndrome and provide some insight into how a holistic approach may benefit.
What is PCOS?
PCOS is a hormonal, metabolic and reproductive condition in people with ovaries, and is the leading cause of anovulatory infertility. While the cause is unknown, PCOS is related to unbalanced hormones, particularly high insulin levels, and tends to have a connection to both environmental and genetic factors. While there are some common symptoms, it can look different for each person as there are four main categories or phenotypes (see below).
What are the symptoms of PCOS?
Physicians most commonly use the Rotterdam Criteria to diagnose Polycystic Ovary Syndrome whereby two of the following symptoms are present:
Ovulatory dysfunction: May appear as irregular periods or a lack of a period.
Hyperandrogenism: May appear as excess hair on the face/chest/ back, cystic acne, and thinning hair on the scalp.
Polycystic ovaries: Using an ultrasound, polycystic ovaries are identified by a set of criteria, namely the presence and characteristics of follicles.
* plus the exclusion of anything else that could cause the signs and symptoms listed above!
What are the main types of PCOS?
There are four main categories (also known as a phenotype) of PCOS that present in different combinations of the Rotterdam Criteria symptoms:
A: ovulatory dysfunction, hyperandrogenism, and polycystic ovaries found on ultrasound.
B: hyperandrogenism and ovulatory dysfunction.
C: ovulatory dysfunction and polycystic ovaries.
D: hyperandrogenism and polycystic ovaries.
Due to the different phenotypes, not every person with PCOS will experience it the same way. For example, you could assume that you would need polycystic ovaries to be diagnosed with poly-cystic-ovarian syndrome, however, that is not the case for subtype B. Also, not every person with PCOS will experience cystic acne and facial hair growth (hirsutism).
How do I know if I have PCOS?
Diagnosis of PCOS can include a thorough medical history intake, lab work and imaging. So how do you know if you have PCOS? Aside from the symptoms listed above, there are other PCOS signs and symptoms to watch for:
Infrequent periods or a lack of a period
Excess hair growth
Hair loss on the scalp or hair thinning
Weight gain or troubles managing weight
Changes in mood
Troubles with fertility
How do you treat PCOS?
Sadly, many people are still told that the only thing they can do is to go on the pill and that they are infertile. This is not true and I’ve seen many PCOS patients who were able to get pregnant. While we may not know exactly what causes PCOS, there are ways to minimize contributing factors, and treatment will depend on which subtype of PCOS the patient has.
A Holistic Approach to PCOS
As an ND, I see many patients with PCOS who are looking for more answers beyond the pill.
The birth control pill can be helpful in managing some of the symptoms associated with PCOS, but it doesn’t always get to the root of the problem.
Associated with hormonal imbalances, PCOS treatment can sometimes involve:
Improving insulin resistance
Improving the gut microbiome
Supporting the adrenal glands, which are also responsible for producing androgens (hormones such as testosterone, DHT, DHEA, etc.). High androgens lead to symptoms of cystic acne, facial hair growth.
Reducing androgen symptoms
Improve ovulation/ progesterone
Naturopathic Medicine can support PCOS through a holistic approach by focusing on nutrition and nutritional supplements, stress management, mental health, sleep quality, acupuncture and sometimes medications.
PCOS Lifestyle Changes
It is also so important that dietary and lifestyle changes are a part of the treatment plan. For example, exercise (the literature in the link specifically looked at the importance of aerobic exercise) has shown to help with menstrual irregularity, hormone imbalances, insulin sensitivity and more! But also keep in mind that a well-rounded exercise plan beyond just aerobic exercise has its benefits. Excessive exercise can be a stress on the body, so incorporating movement of all different kinds is the best approach.
Finding a PCOS-Supportive Practitioner
I always recommend finding a practitioner who is familiar with the condition and who is up to date with current research if you have PCOS or if this is something you would like to have investigated. Treatment of PCOS should have a well-rounded approach so that many different factors can be considered and addressed!
Centers for Disease Control and Prevention. (2015). Infertility FAQs:What is infertility? Retrieved January 7, 2016, from http://www.cdc.gov/reproductivehealth/infertility/
Endocrine society (2016): Women dissatisfied with the long process to diagnose polycystic ovarian syndrome. Retrieved from: https://www.endocrine.org/news-and-advocacy/news-room/2016/women-dissatisfied-with-long-process-to-diagnose-polycystic-ovary-syndrome
Liang Z, Di N, Li L, Yang D. Gut microbiota alterations reveal potential gut-brain axis changes in polycystic ovary syndrome. J Endocrinol Invest. 2021 Jan 2. doi: 10.1007/s40618-020-01481-5. Epub ahead of print. PMID: 33387350.
Monastra G, Unfer V, Harrath AH, Bizzarri M. Combining treatment with myo-inositol and D-chiro-inositol (40:1) is effective in restoring ovary function and metabolic balance in PCOS patients. Gynecol Endocrinol. 2017 Jan;33(1):1-9. doi: 10.1080/09513590.2016.1247797. Epub 2016 Nov 29. PMID: 27898267.
OASH (2019) Polycystic ovarian syndrome. Retrieved from: https://www.womenshealth.gov/a-z-topics/polycystic-ovary-syndrome#9
Ricardo Azziz, Diagnosis of Polycystic Ovarian Syndrome: The Rotterdam Criteria Are Premature, The Journal of Clinical Endocrinology & Metabolism, Volume 91, Issue 3, 1 March 2006, Pages 781–785, https://doi.org/10.1210/jc.2005-2153
Shetty, Disha & Chandrasekaran, Baskaran & Singh, ArulWatson & Oliverraj, Joseph. (2017). Exercise in polycystic ovarian syndrome: An evidence-based review. Saudi Journal of Sports Medicine. 17. 123. 10.4103/sjsm.sjsm_10_17.