Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. It can cause a lot of stress and heartache for people, who are typically told they won’t be able to have a baby, will go on to develop metabolic diseases such as diabetes, and will always suffer from the symptoms of acne, irregular cycles, polycystic ovaries and insulin resistance.
Diagnosis requires that you meet 2/3 of the Rotterdam criteria:
- Ovulatory problems (Irregular periods)
- Polycystic ovaries on an ultrasound
- Excessive androgens on a hormone blood test
When we are treating PCOS holistically, we first need to understand the underlying causes of the PCOS symptoms, and that helps us to classify and treat the symptoms. From that perspective, we can classify PCOS into different types depending on the main factor contributing to the symptoms.
Here are the 4 main types of PCOS according to their causes
- Insulin resistant PCOS
- Inflammatory PCOS
- Adrenal PCOS
- Post-pill PCOS or High androgen PCOS
1. Insulin-resistant PCOS
Insulin resistance is a condition in which the body’s cells, primarily in the liver, muscles, and fat tissues, do not respond properly to insulin, a hormone produced by the pancreas. Insulin plays a crucial role in regulating blood sugar (glucose) levels. When you eat, your digestive system breaks down carbohydrates into glucose, which enters the bloodstream. Insulin allows cells to take in glucose from the bloodstream to use it as energy or store it for future use.
In the case of insulin-resistant PCOS, the body’s cells, especially those in the muscles, liver, and fat tissues, don’t respond effectively to insulin. This causes the pancreas to produce more insulin to compensate for the decreased effectiveness. Elevated insulin levels can stimulate the ovaries to produce more androgens, which can disrupt the normal menstrual cycle and lead to the symptoms associated with PCOS, such as irregular periods, infertility, and the development of cysts on the ovaries.
The key to getting insulin resistance under control, is first to understand how it is impacting you, ie is it increasing your androgen levels or causing issues with ovulation, and then to treat those issues alongside the insulin resistance in a holistic way.
As Naturopaths, we have many great nutrients, herbs and dietary modifications that can help with insulin resistance such as berberine, myo-inositol and gymnema sylvestre.
2. Inflammatory PCOS
Inflammatory PCOS refers to a condition where individuals with PCOS experience elevated levels of inflammation in their bodies. Inflammation is a natural response of the immune system to protect the body against harmful stimuli, such as pathogens, damaged cells, or irritants. However, when inflammation becomes chronic and persists over time, it can contribute to various health problems, including PCOS.
In PCOS, chronic low-grade inflammation is thought to play a role in the development and progression of the condition. Elevated levels of inflammatory markers, such as C-reactive protein (CRP) and certain cytokines, have been observed in many women with PCOS. This inflammation can negatively affect insulin sensitivity, disrupt hormonal balance, and contribute to the symptoms associated with PCOS, such as insulin resistance, irregular menstrual cycles, and ovarian cysts.
The exact cause of inflammation in PCOS is not fully understood, but it is believed to involve complex interactions between genetic, hormonal, and lifestyle factors. Obesity, for example, is known to be associated with both PCOS and chronic inflammation. Adipose (fat) tissue produces pro-inflammatory substances, and excess fat can contribute to systemic inflammation.
Managing inflammatory PCOS often involves addressing the underlying inflammation through lifestyle modifications, such as:
- Healthy Diet: Adopting an anti-inflammatory diet, which includes plenty of fruits, vegetables, whole grains, and healthy fats (such as those found in fish, nuts, and olive oil) while avoiding processed foods, sugary snacks, and excessive red meat.
- Regular Exercise: Engaging in regular physical activity can help reduce inflammation and improve insulin sensitivity.
- Weight Management: For individuals who are overweight or obese, losing weight through a combination of diet and exercise can significantly reduce inflammation and improve PCOS symptoms.
- Stress Management: Chronic stress can also contribute to inflammation. Techniques such as meditation, yoga, and relaxation exercises can help manage stress levels.
- Herbs and supplements: In some cases, anti-inflammatory herbs or supplements can reduce inflammatory load on the body, such as Turmeric or Omega 3 fatty acids.
3. Adrenal PCOS
Our adrenal glands make hormones such as DHEA and cortisol, and these play an important part in regulating our reproductive hormones.
In our brains, the Hippocampus controls a feedback loop between our hypothalamus, adrenal glands and ovaries known as the HPA or HPO axis. The brain monitors how much DHEA and cortisol is being made by the brain, and it sends a message back to the ovaries about whether it is safe to make reproductive hormones. If there is a great deal of physical or emotional stress going on, we have increased levels of cortisol and DHEA which tells the body that we need to slow down our reproduction, so we don’t have a baby in times of great stress.
This stress can be long days at a stressful job or too much high-intensity exercise with low calorie intake.
This is one way that the adrenal glands can impact our hormones and lead to PCOS, because if we don’t make reproductive hormones that encourage ovulation, that can cause an increase in follicles on our ovaries.
The other way is via DHEA on its own, this is an adrenal androgen so it can have a similar effect to testosterone and other androgens. When this is the case, we need to treat it by addressing stress levels as well as hormone balance.
When treating this, I will opt for cortisol lowering herbs such as withania somnifera and rhodiola rosea, as well as herbal medicines traditionally used to balance hormones such as saw palmetto or paeony.
4. Post pill PCOS (Excess androgen PCOS)
While you are on the oral contraceptive pill, your hormones are bound up by Sex hormone bunding globulin (SHBG) to ensure that you don’t have too many hormones circulating while the artificial ones are in use. This is why some people experience temporary relief from some of their symptoms, including acne or irregular cycles, because your own hormones that may have been contributing to the issues are now silenced.
However, this Is simply a temporary fix and for most people their symptoms return once they stop the OCP. This is partly because the SHBG starts to decrease, and your own hormones ramp up as your body realises it doesn’t have the artificial ones anymore. This can even happen even to those who have never had these symptoms before, because your hormones are in overdrive while things go back to normal.
It can also be because the original issue that was causing the symptoms was only being masked temporarily while on the OCP.
This is a temporary state but can last for up to 12 months post pill.
If you have high androgens, the best way to address this is to:
- Use herbs and nutrients traditionally used to reduce androgens
- Ensure you are eating a wholefood, LOW GI diet to avoid spikes in insulin and glucose that can lead to an increase in androgens
- Support your nervous system to encourage a regular cycle
Naturopathic treatment of PCOS
In summary, if you have been diagnosed with PCOS, here are the steps you can take to reduce your symptoms:
- Test your hormones
- Check your fasting insulin and glucose
- Implement a LOW GI, wholefoods diet
- Utilise stress-reducing techniques such as journalling or meditating
Many people who are diagnosed with PCOS are told that their symptoms will be lifelong and can lead to infertility, metabolic disease and irregular cycles, but having worked with many people with PCOS I can assure you that our Naturopathic treatment helps to treat the causes of these symptoms to get people back on track. Contact us for a consultation.