All About Polycystic Ovary Syndrome (PCOS)
Polycystic Ovary Syndrome (PCOS) is among the many conditions that are underdiagnosed and dismissed for women. The current estimate is ~10% of women have PCOS, but because it is so widely under-diagnosed and under-treated, the prevalence is likely much higher.
If you have PCOS, or think you have PCOS, you may have experienced the treatment recommendation of “just lose weight and go on birth control if you don’t want to have kids soon”. Unfortunately, this can be extremely confusing for women who don’t want to be on birth control, don’t want kids at this time, AND not to mention the harm that weight loss and restrictive diets can cause. Birth control actually masks the symptoms of PCOS, and does not treat the root of the issue (which means once the individual comes off birth control, the symptoms are still present).
The exact cause of PCOS is unknown, but we know there are several root causes of PCOS including genetic and environmental factors. Women will often present with different (but similar!) symptoms.
- absent/irregular menstrual cycles
- strong cravings
- hair thinning
- anxiety and depression
- weight gain
According to the Rotterdam criteria, you must have 2 of the following 3 criteria in order to diagnose PCOS (however this diagnostic process is currently being looked at):
- Oligo- or anovulation (irregular or absent menstruation)
- Clinical and/or biochemical signs of hyperandrogenism (acne, hirsutism, and/or blood tests showing high androgens)
- Polycystic ovaries (12 or more peripheral follicles) Did you know… they are not actually cysts, they are immature follicles!
PCOS has variable phenotypes, which we will not get into today, but it is important to know women can have different presentations. Some women with PCOS actually get regular periods, and others don’t have any cysts on their ovaries. So as you can imagine, there is not one cookie-cutter approach to treating PCOS, and it can be overwhelming.
Part of figuring out YOUR root cause and symptom management of PCOS involves analyzing your hormones…
Hormones are chemical messengers made by endocrine glands, such as the hypothalamus, pituitary gland, ovaries, adrenal glands, thyroid, and pancreas.
- Hypothalamus – dopamine, GHRH, GnRH
- Pituitary Gland – prolactin, LH, FSH, oxytocin, TSH
- Ovaries – estrogen, progesterone, testosterone, AMH
- Thyroid – T4, T3
- Adrenals – cortisol, DHEA, DHEA-S, androstenedione, testosterone, epinephrine/norepinephrine
- Pancreas – insulin, glucagon
- Liver – main producer of sex-hormone binding globulin (SHBG)
All of these hormones are interconnected in various ways. For example, in the first half of your cycle (start of period until you ovulate), estrogen should be your dominate hormone. Rising estrogen triggers the release of FSH and LH, which leads to ovulation. After ovulation, progesterone takes over as dominant hormone. Another example would be insulin, testosterone, and sex-hormone binding globulin. Insulin stimulates the ovaries to release testosterone, and furthermore can inhibit the liver from producing SHBG (which therefore results in more circulating testosterone). Elevated insulin levels can also stimulate the adrenals to produce more androgens. Elevated levels of androgens can lead to symptoms such as facial hair, acne, and male-pattern hair loss.
When working with women with PCOS, it is crucial to help them understand WHAT is happening in their body and WHY each treatment is recommended. It is so empowering to understand how each change you make is positively impacting your health and well-being.
A large component of PCOS nutrition therapy is healing your relationship with food, eating ENOUGH and regularly during the day, increasing nutrient-dense foods in your diet, improving your gut health, and adding supplements as needed. Many women are told to lose weight or go on restrictive diets – you do not need to do this! In fact, this is often MORE harmful to women with PCOS or other hormonal concerns.
There is a lot of information out there about PCOS that can unfortunately be overwhelming and confusing. Stephanie, our co-founder and registered dietitian, hears this struggle with many of her clients with PCOS and works with them to help manage symptoms through diet and lifestyle. If you want an evidence-based treatment approach to your health and nutrition, email email@example.com to find out how you can book in with Stephanie.
Questions? Comment below!