So, what exactly is PCOS?
PCOS stands for Polycystic Ovary Syndrome. However, it is actually a complicated disorder of the endocrine (hormone) system as well as a metabolic syndrome. And you can be diagnosed with PCOS even without having ovarian cysts.
In fact, the NIH has recommended that its name be changed to better reflect “the complex metabolic, hypothalamic, pituitary, ovarian, and adrenal interactions that characterize the syndrome.”(1)
PCOS affects up to 10% of women of childbearing age. It is the most common endocrine disorders in this group. So, if you’ve been diagnosed with PCOS, you’re not alone!
PCOS is characterized by high levels of androgens (“male” hormones), including testosterone, androstenedione, dihydrotestosterone (DHT), dehydroepiandrosteron (DHEA) and DHEA sulfate (DHEA-S).
Higher than normal levels of insulin are also common, leading to insulin resistance and type 2 diabetes over time.
What causes PCOS?
The cause of PCOS is not yet fully understood.
While the sex hormones (estrogen, progesterone, testosterone) are affected by the disorder, PCOS itself appears to be caused by insulin resistance. Insulin stimulates the ovaries to secrete testosterone and blocks the liver’s production of SHBG (sex-hormone binding globulin), which leads to an increase in circulating testosterone. This results in many of the hallmark symptoms (facial hair, acne, male-pattern hair loss). The adrenal glands also produce androgens, including all of the DHEA-S, 80% of DHEA, 50% of androstenedione, and 25% of the testosterone in the body.(2)
However, it is not yet known whether elevated insulin levels lead to increased production of androgens by the adrenal glands, or whether elevated androgens lead to insulin resistance, It’s a chicken or egg situation. But the adrenals may be involved in increased androgen production in up to 30% of women with PCOS.(3)
Research suggests that there is a strong genetic component to developing PCOS. However, you can reduce the risks from ongoing insulin resistance and chronic inflammation by modifying lifestyle factors such as diet, exercise, sleep, and stress.
What are the symptoms of PCOS?
Irregular or missed periods
- Weight gain or difficulty losing weight, especially around the abdomen
Strong cravings for carbohydrates/sugar
Unwanted facial hair
Acne, especially cystic acne
Male-pattern hair loss
Infertility—difficulty getting pregnant or miscarriages
Anxiety or depression
Elevated blood glucose and/or insulin levels
Darkening of the skin or “skin tags” around your neck or armpits
Disordered eating—especially binge eating disorder
How is PCOS diagnosed?
To be diagnosed with PCOS, according to the Rotterdam Criteria, which is the current standard, a woman must meet 2 of the following 3 criteria(4):
- Irregular or absent ovulation or menstruation
- Elevated levels of androgenic hormones (diagnosed by blood test or signs and symptoms such as facial hair, acne, or hair loss)
- Presence of ovarian cysts
If you think you may have PCOS, consult your primary physician, gynecologist, or reproductive endocrinologist.
They may order blood tests including fasting glucose, fasting insulin, HbA1C, and hormones (leutinizing hormone [LH], follicle stimulating hormone [FSH], DHEAS sulfate, testosterone, and SHBG). They may also order a pelvic ultrasound to check for the presence of ovarian cysts.
Why should I be concerned about PCOS?
Women with PCOS are more likely to experience infertility and are 20% to 40% more likely to experience miscarriage. So, if you’re trying to conceive, you should know if you’re at increased risk.
Even if you’re not trying to get pregnant, knowing whether you have PCOS or not is important, because PCOS increases the risk of heart disease and stroke due to elevated blood sugar and insulin resistance. Knowing that you have it is the first step toward taking action to reduce your risks.
So, what can I do?
Most doctors will tell you to “just lose weight.” Unfortunately, most doctors don’t understand why that is nearly impossible for women with PCOS . . . and it’s not because of a lack of willpower. Many of my clients have told me that their doctors think they’re lying about how little food they’re truly eating.
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Fortunately, there are a number of ways to manage PCOS naturally, including food, supplements, lifestyle, sleep, and stress management.
When I treat clients in my practice with PCOS, we focus on balancing blood sugar and improving insulin resistance, supporting the adrenals and thyroid, balancing sex hormones, and reducing inflammation.
Check out my book, A Balanced Approach to PCOS, for more of the best foods for PCOS!
Or sign up for our free masterclass – PCOS Period Success: 3 Simple Diet Shifts You Can Make NOW to Get Your Period Back now!
Melissa Groves, RDN, LD
IMPORTANT NOTE -> This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements.