Polycystic ovarian syndrome (PCOS) is one of the most common endocrine conditions in women affecting around 20% of Australian women. PCOS is an extremely complex disorder and can present in many ways and varies from case to case. The name polycystic ovarian syndrome is a little misleading as it implies the presence of small cysts on the ovaries is the main feature of the condition. However, not all women with PCOS have ovarian cysts. This is just one of the possible symptoms that makes up the condition.

PCOS is more of a collection of symptoms, with high androgens and insulin resistance being the main drivers. The list of symptoms of PCOS is long and is why so many women do not know why they have the symptoms they do.

Typical Symptoms of PCOS

• Irregular periods or absent periods
• Weight gain
• Acne or oily skin (particularly on the jaw line)
• Excess body hair (particularly on the face, abdomen, and breasts)
• High cholesterol and triglycerides
• High blood pressure
• Difficulty conceiving and infertility
• Sugar cravings

It is important to note, you do not have to have ALL these symptoms or problems to be diagnosed with PCOS. The condition is typically diagnosed by the presence of 2 of the 3 factors from the following criteria:

• Irregular or absent ovulation/periods
• High androgen levels in blood tests or having symptoms of high androgens including acne, excess hair and/or hair loss
• Exclusion of other potential causes (thyroid disease, Cushing’s syndrome, hyperprolactinemia)

Causes of PCOS

There are several main ways PCOS can present, and for these subtypes, there are different causes. There are often overlaps between these types as well.

Insulin Resistant PCOS

This is the classic type of PCOS and by far the most common, which causes androgen levels to become too high. High insulin can impair ovulation and cause the ovaries to stimulate excess testosterone. Insulin also lowers the amount of SHBG (sex hormone-binding globulin) which means the body cannot bind up excess testosterone effectively, and so more is circulating in the body and in turn worsens symptoms such as excess hair, acne and hair loss. High sugar diets, smoking, trans fats and environmental toxins are the main culprits for driving insulin resistance by causing our blood sugar levels to be elevated over a long period of time.

Pill induced PCOS

Hormonal birth control supresses ovulation. For some women this can carry on for months or even years once coming off the pill. If you have come off the pill and have failed to establish a regular cycle within 4 months, and you had a regular cycle before the pill, you may have pill induced PCOS.

Inflammatory PCOS

When chronic inflammation is the driver of PCOS, it is known as inflammatory PCOS. Inflammation is a problem for PCOS as it can prevent ovulation, disrupt hormonal balance, and stimulate adrenal androgens such as DHEA and androstenedione. Inflammation is caused due to stress, environmental toxins and inflammatory foods like gluten. You may have inflammatory PCOS if you meet the criteria of PCOS. Plus, you do not have insulin resistance – Plus you’re not in a temporary post-pill phase – Plus you do have signs and symptoms of inflammation including headaches, joint pain, bowel problems, unexplained fatigue or chronic skin conditions.

How to manage PCOS

As PCOS is such a complex condition involving multiple systems, it is best you speak with your Naturopath or health practitioner to get the best treatment plan that is specific to your individual case. The following is a great starting point and provides the common tools used to improve PCOS symptoms naturally.

Dietary Modification

Modifying your diet is the first and one of the most important steps to managing PCOS. My top recommendations include:

• Switch refined carbohydrates for wholegrains or other vegetable alternatives. Refined carbohydrates act like sugar in the blood and spike blood sugar and insulin levels. Excess sugar and insulin can drive excess testosterone levels and worsen PCOS symptoms.
• Consume 25g of fibre each day. Adequate fibre intake has been associated with improved insulin sensitivity, weight loss and lower levels of androgens.
• Include a serving of protein in every meal (animal or plant protein). Protein helps to increase feelings of satiety and helps to stabilise your blood sugar.
• Increase intake of Omega 3 Fatty acids with foods such as hemp seeds, flaxseeds, chia and fish. Omega 3’s are especially important for PCOS as they can help improve insulin resistance, lower inflammation, reduce androgens, regulate menstrual cycles and improve acne and hair loss.

Lifestyle Modification

• Aim to achieve of at least 30 minutes of exercise each day. Exercise not only helps you lose weight, but it can also improve insulin levels and regulate hormone levels which in turn helps to improve symptoms such as acne, excess hair, cycle regularity, and fertility.
• Women with PCOS are often overly sensitive to the effects of stress. High cortisol can drive insulin production and can worsen PCOS symptoms.It is important to find a stress management technique that works for you, whether it’s meditation, journaling, yoga, breathing exercises, or reading. Set aside time each day to complete this practice.
• Try to avoid alcohol and smoking as they can drive inflammation and worsen symptoms.
• Limit caffeine consumption as caffeine can increase cortisol levels which drives elevated insulin levels and further disrupts blood sugar levels and can contribute to increased androgens.

Herbal & Nutraceutical Support

• The combination of Peony & Licorice works beautifully to reduce elevated testosterone levels. Pairing Peony with Licorice makes a great combination of herbs for PCOS as it helps to boost ovulation due to its lowering testosterone effects.
• Nutrients such as magnesium, chromium and inositol can help improve insulin sensitivity and improve blood sugar levels.
• Two cups of spearmint tea each day has shown to be beneficial in PCOS by lowering androgens and resulting hirsutism.
• Zinc is particularly helpful for symptoms such as acne, hirsutism, and thinning hair. Zinc can also help lower testosterone levels, regulate insulin levels, and support hormone production.
• Reishi mushroom is a known adaptogen that helps the body adapt to stress. Reishi has shown to have anti-androgenic effects, meaning it can help lower androgens, making it a great choice for PCOS women.
• Berberine containing herbs have shown to be just as effective as Metformin in lowering insulin levels and also improving other metabolic markers.