PCOS 101: I Was Just Diagnosed With PCOS What Do I Need To Know?
what is pcos?
PCOS is the most common hormonal condition in women of reproductive age
‘What is PCOS?’ seems like a very simple question, but the answer is actually quite complicated. This is because it presents very differently in every single woman that has it, and as a result means and is different things to different people
Medically its diagnosed when there are 2 of the 3 following criteria present:
Hyperandrogenism
Hyperandrogenism is when we our levels of androgens, better known as ‘male hormones’, are elevated
This criteria is diagnosed either through elevated androgens on blood tests, or with clinical signs and symptoms
Clinical signs and symptoms of hyperandrogenism include acne, increased hair growth on the body or face, head hair loss, oily skin or scalp
Anovulation/Oligoovulation
This is when we are not ovulating, or not ovulating consistently every month
Clinically this often shows up as irregular or absent periods
Polycystic Ovaries on Ultrasound
Polycystic ovaries has become quite controversial, and might actually be taken out of the diagnostic criteria soon
Polycystic ovaries are when there are many follicles (eggs) visible on our ovaries on ultrasound, giving it a polycystic appearance
Many women with and without PCOS have polycystic ovaries, so it’s not the greatest criteria to determine a clear diagnosis
what do these criteria look like in real lifE?
Looks different in every woman
Weight disturbances
Period irregularities
Acne/oily skin
Hirsutism - increased hair growth on the body & face
Head hair loss
Issues with blood sugar regulation - if you get really hungry soon after eating, or insatiable appetite, this is something to consider
what is insulin resistance and why does everyone talk about it in pcos?
What Is Insulin Resistance?
Sugar is our body’s primary fuel source, and when we eat, our cells need to absorb that sugar to utilize it for energy production. The only way sugar is able to get absorbed into the cell is when our hormone insulin binds to a receptor on the surface of our cells, allowing sugar to enter the cell.
If there’s a situation where insulin is always being released, our body starts to tune out that signal and becomes desensitized or resistant to it. So instead of sugar being absorbed into the cell, it remains in the bloodstream causing high blood sugar - this whole process is called ‘insulin resistance’.
Why Is Insulin High in PCOS?
There are a number of factors that contribute to high insulin in PCOS, and insulin resistance has been found to be one of the central factors of the condition. Part of effective PCOS treatment is teasing apart which of these factors is most prevalent for you, and regulating them effectively. There are 4 major components that play into insulin resistance in PCOS:
Hyperandrogenism: This can cause or worsen insulin resistance. Insulin resistance and hyperandrogenism tend to interact with one another in a vicious cycle, each worsening the other.
Chronic Low Grade Inflammation: There is chronic low grade inflammation in PCOS, and our body responds to inflammation with insulin dysregulation unfortunately.
Chronic Stress: When we’re chronically stressed, our stress hormone cortisol is secreted which mobilizes stored sugar into our bloodstream. Obviously when there’s sugar in the bloodstream, insulin is also released so sugar can be absorbed. When we’re in constant stress mode, this does lead to insulin resistance over time. Unfortunately in women with PCOS, we are far more sensitive to cortisol signaling compared to the average woman.
Gut Dysbiosis: Last, poor quality and diversity of our microbiome - which is our gut bacteria- contributes to a high insulin state. Our microbiome is one of the most important regulators of insulin in the body, and unfortunately in PCOS there isn’t great quality or diversity of the microbiome.
what are the long-term health considerations in pcos?
There are 5 big considerations to think about when it comes to your long-term health with PCOS:
Metabolic Disturbances: There are higher rates of diabetes, cardiovascular disease, fatty liver, etc. There’s a lot we can do here to help manage these risks.
Reproductive Health & Fertility: PCOS is a hormone condition, and as a result fertility is definitely impacted. It doesn’t mean you can’t have children, it just means it will likely be more difficult for you. It may take longer to get pregnant, and may require more nuanced care compared to someone without PCOS. That said, this doesn’t mean pregnancy is impossible, and there are a lot of things that can be done to optimize fertility. We just recommend starting preconception preparation 6 months to one year in advance.
Gastrointestinal Disturbances: We do see a lot of gastrointestinal and microbiome disturbances in PCOS. In particular we see a lot of unwanted digestive symptoms, and in particular issues digesting fats. This plays into issues with bile acids, which we won’t discuss in detail here, but definitely something to be mindful of.
Higher Risk of Reproductive Cancers: Women with PCOS are at a higher risk of reproductive cancers, and in particular ovarian and endometrial cancer. This is likely due to a variety of factors including irregular periods and unopposed estrogen exposure. It’s important to note that the overall rates of ovarian and endometrial cancers are low. With PCOS care, we do always consider prevention strategies in your treatment.
This is a lifelong condition - consider that during life’s transitions: PCOS is a lifelong condition - and although it can be well managed, there’s no cure. As you go through life transitions such as preconception, postpartum, and menopause, you will likely have to manage things differently compared to someone who doesn’t have PCOS.
what should i look for in a naturopathic doctor if i have pcos?
Do your research and try to find an ND that really only focuses on PCOS, and that their practice consists primarily of PCOS patients. The reason being is as you can hear, it’s incredibly complicated and there’s no way you can know everything about the condition, unless it’s one of the only things you’re treating.
Ask if they’ve done additional training in PCOS, fertility, acne, or weight loss resistance - whichever factors are most prevalent in your presentation, make sure that the naturopath you’re seeing has additional training in those areas.
how i support pcos with my patients
The first thing we do is really figure out your unique factors when it comes to PCOS. As I mentioned every woman presents with different symptoms, different contributing factors, and very different goals.
We then go through your goals, as these can vary greatly. Maybe you want to clear your skin, maybe you want to lose weight, or maybe you want to start a family. Your primary goals really determine the course of treatment, and helps us narrow down to support you as best as possible.
This is achieved by going through a very extensive intake - we spend about 1.5-2 hours just talking, and trying to work through what’s going on with you specifically.
At the end of that visit, we often do requisition blood work, and in particular I like to look at hormones and metabolic markers, so we can get a baseline of where you’re at, as well as determine where things are going wrong specifically.
Once we’ve received your lab results, we really customize treatment from there. There’s really no one size fits all approach - I’ve never given the same treatment plan to two different women, that just doesn’t work for me.
In terms of the treatment itself we go through some minor dietary tweaks - nothing too crazy and I’ll always meet you where you’re at with this. I’m very against restrictive diets and truthfully they’re just not sustainable long-term.
I do tend to go quite supplement & botanical heavy. The reason for this is that there’s actually a ton of research out there on PCOS and natural health products, and the research is extremely promising. I do follow an evidence informed model of care with my patients, and I find supplementation along with balanced lifestyle choices really provides the strongest clinical results.
will my pcos get better?
It is a lifelong condition, but the symptoms of PCOS and the long-term health concerns can get a lot better!
I am very honest about expected outcomes - this is not an overnight fix. For some women they feel better pretty quickly, within 1-3 months, for other women it’s closer to 9 months to a year. As I said, every woman is different, so there are varying lengths of time in terms of finding what works for you specifically.
what is the pcos series?
I’m so excited to be offering this educational series to my patients and community soon!
I built this program to help educate you on PCOS - why the condition occurs, how it manifests, as well as the latest research for natural treatments. The ultimate goal is to help you understand your condition, because through understanding comes healing. This series really aims to guide you on how to live your life optimally with PCOS.
To learn more about this program, click here.
If you want to learn more about how Naturopathic Medicine can help support PCOS, click here.
Want to learn more?
Like what you’ve heard today? If you’ve enjoyed this episode and want to know more, we’re always here to answer your questions. Contact us to find out more.
In support of your health,
Dr. Hayhlee Clarence & Dr. Alessia Milano