PCOS, short for Polycystic Ovary Syndrome, is one of the more common reasons women come to see me in my naturopathic practice, and it’s also one of the most common red herrings I see! I’ve always been a big reader of detective novels, and if PCOS were a character, it’s one that you always need to get the back story on, because it’s an easy one to blame while the true causes fly under the radar. If you’ve been diagnosed with PCOS, please read on to see if you have some extra detective work to do…
The definition of Polycystic Ovary Syndrome (PCOS) has changed significantly in recent years. PCOS is a group of symptoms related to ovulation and high androgen levels. The most common symptoms are excessive facial and body hair, acne, hair loss and weight gain, especially around the belly. Dr Jerilynn C Prior, an endocrinologist and founder of the Center for Menstrual Cycle and Ovulation Research (whose work I greatly admire) is one of the pioneers for exchanging the term “Polycystic Ovary Syndrome” for “Anovulatory Androgen Excess” or AAE – is a more accurate term. And I’m taking her lead.
AAE is one of the most commonly misdiagnosed conditions. I see a number of women in my naturopathic practice who’ve been given the diagnosis of Polycystic Ovary Syndrome and are, very understandably, distressed being told that will likely have issues with fertility and have a higher risk of developing certain cancers. I’ve seen instances of women forgoing birth control, believing that she’s infertile, only to be surprised that she wasn’t that infertile after all!
More often than not, when we’ve investigated and gathered more information many women don’t, in fact, have PCOS at all. The reason for the cystic appearance on their ovaries is due to other factors that had not been considered by their general practitioner.
In this blog, I’ll walk you through the 6 healing stages that I outlined in a previous post called “The Manifold Way of Healing”, how to get an accurate diagnosis and how to support your body have a regular cycle based on root causes.
Step 1 – Investigate options, gather and organise information.
There are multiple potential drivers of AAE/PCOS.
Potential Root Causes of AAE/PCOS:
- Food triggers and nutrient insufficiencies – Blood sugar imbalances & Insulin resistance. Diet missing key ovulation nutrients, included vitamin D, zinc, iodine and magnesium.
- Gut Imbalances – and their effect on inflammation and hormone handling (our resident bacteria play a big part in our overall hormone health)
- Chronic inflammation
- Environmental factors – including effects of post-pill, exposure of environmental toxins is overburdening your body’s ability to clear them
- Chronic stress – can interfere with estrogen, androgen and progesterone balance. It’s well documented that women who have been given the diagnosis of “PCOS” experience higher levels on depression and anxiety (documented in the literature to be between 26-64% higher prevalence). Stress itself will delay ovulation.
The key to effectively creating a self-care regime for yourself is to understand which factors are at play for you. The #1 place to begin is to get a clear diagnosis because it’s going to be different from woman to woman. It’s not enough to only have an ultrasound!!
You cannot diagnose PCOS from ultrasound alone.
The appearance of ovarian cysts indicates that an egg was not ovulated, which can occur in many women for many different reasons that may have nothing to do with androgen excess. For example, it may be due to stress, low thyroid function, nutrient deficiencies or a chronic health issue that is signalling to the body that it’s not the time to be reproducing.
The AE-PCOS Society (Androgen Excess PCOS Society) have created diagnostic criteria that I find most useful. The diagnostic criteria state that if a woman is experiencing all three of the following symptoms a true PCOS diagnosis is warranted:
1. Irregular periods and/or polycystic ovaries on ultrasound
2. High androgens from a blood test and/or symptoms of high androgens such as hirsutism, acne and hair loss. A blood test that qualifies for high androgens are:
- High free androgen index
- High free testosterone
- High DHEAS
- Low sex hormone binding globulin (SHBG)
3. Other reasons for high androgens have been excluded, such as:
- High prolactin
- Low thyroid function
- Pituitary, hypothalamus or adrenal disorders (however these are rare)
- Congenital adrenal hyperplasia (again, this is very rare)
If you’ve been given a diagnosis for PCOS, but you don’t meet this criteria, I highly recommend reading the AE-PCOS Society’s task force report and discussing it with your primary healthcare provider to be re-evaluated.
Questions for your doctor:
- Has my vitamin D And zinc been checked?
- (If you’ve been given a diagnosis based on ultrasound alone) Have I been tested for high luteinizing hormone, high androgens and prolactin?
- Has my thyroid been tested including thyroid antibodies?
- Have I been assessed for insulin resistance? If not can you please test me for fasting insulin or a glucose tolerance test with insulin? (a glucose test is not an accurate diagnosis).
- (If your doctors told you have high androgens or high testosterone) have other tests been done to rule out the high androgens are coming from a different source?
- Could any of the medications I’m taking the contributing to the problem?
Step 2 – Engaging the energy and restoring connection
△ My biggest piece of advice is that reversing true PCOS/AAE is a long game. It’s important to stay calm and patient. Be consistent with your fertility charting and be consistent with your self-care.
△ Get regular exercise and dedicate two to three sessions to vigorous exercise! This means anything that gets you sweaty and breathless and maintaining this intensity for up to 30 – 40 minutes. If you’re out of practice, start small with 5 minutes and increase at every session. This is especially helpful if you’re holding extra weight around your middle.
△ Cultivate a love and positive anticipation for menstruation.
△ Map your cycle including cervical mucus and basal body temperature. This will provide you with in-depth information as to what’s going on in your body. Then tune in to signatures of the inner seasons and work with these as much as you can. If you’re feeling completely lost, use the lunar cycles as an anchor: The new moon can be treated as menstruation and the full moon is treated as ovulation. When the moon is waxing your transition through you in a string and as it wanes you’ll move through your in late summer and Autumn.
△ Bring as much regularity and groundedness in your life as possible. Regular bedtime, meals and regular practice of a chosen form of movement or spiritual practice.
△ As soon as you wake up in the morning get outside and expose your skin to natural sunlight. At night use only warm (non-blue) light. The Himalayan salt lamp is perfect and makes your bedroom as dark as possible when you sleep.
△ If you’re a driven and ambitious woman schedule in rest time as non-negotiable.
Step 3 – Strengthen and feed health with nourishment & life design.
△ Eliminate sugar, gluten and dairy from your diet. and follow a replenishing food plan with a macronutrient split of 30% protein 30% fats and 30% carbohydrates
△ Intermittent fasting can improve blood sugar balance: a very simple version is to have a window where you eat at 8 hours. This could mean having your first meal at 10 a.m. and ensuring that you have finished your dinner by 6 p.m. . for women I work with my practice who have full-time jobs, practising an eating window of 12 p.m. to 8 p.m. works well. Make sure that you’re eating enough in your 8-hour window as not eating enough can itself be a reason for your body being unable to ovulate. I also don’t recommend intermittent fasting if you’re under stress or if you’re depleted.
△ Herbs that are especially helpful for PCOS related acne are nettle root, nettle leaf, spearmint and red clover.
△ Herbs can be very helpful at addressing root causes and supporting your body come back into alignment. Working with a naturopath or herbalist to create a personalised protocol with you can be highly valuable.
△ Key ovulation nutrients to consider supplementing with are:
- Magnesium: choose a magnesium that also contains the amino acid taurine. Taurine supports the liver process hormones and improves insulin sensitivity – two common root causes of ovulation. Take magnesium glycinate or citrate combined with 500 mg of taurine three times a day.
- Zinc as citrate or glycinate, 30mg a day with food.
- Vitamin D, 2000 IU a day
- If you have a busy or demanding lifestyle and stress is a significant feature, vitamin B6 15 mg x2 times a day.
The Healing Divide
The first three steps come with almost no capacity to harm, they build health and are to be engaged with daily. The next two if not applied correctly can cause harm They are therapeutic interventions and are only supposed to be used for a short period of time. I am not a medical doctor, so the purpose of including these is to place them on your radar so that you have context as to where the may fit in with your own healing plan.
Step 4 & 5 – Stimulate and sedate with drugs and pills
Typical conventional treatment:
- Biguanides: e.g., metformin. These drugs are considered to be insulin sensitisers — they improve insulin action at target cells and reduce insulin resistance.
- Spironolactone: an antiandrogen medication used to treat hirsutism.
- The oral contraceptive pill: with ethinyloestradiol that are particularly of low androgenic potential includes, for example, those with gestodene, desogestrel or cyproterone.
- Eflornithine (Vaniqa): A cream to slow facial hair growth.
Step 6 – Break and enter
Electrolysis – A tiny needle is inserted into each hair follicle. The needle emits a puls e of electric current to damage and eventually destroy the follicle.
Writer’s note: This post was originally published in August 2020 and has been revamped and updated for accuracy and comprehensiveness in May 2021.
Pin “How to Calmly Navigate PCOS and Support Your Fertility” for Later:
If you enjoyed this article, you may also like:
- We Need to Talk About Hormone Imbalance and Why They’re so Tricky to Test
- Endometriosis: A Holistic Perspective and Healing Paths
- What Do We Know of Men and Preconception Care?
- Knowing When You Can Conceive, with Fertility Awareness
- Gathering the Building Blocks: The Importance of Preconception Nutrition
- The Good, the Bad and the Ugly of Fertility Apps & Devices
- Hormone Harmonise-Me Bliss Balls
- How to determine the best time to get pregnant (without apps, test kits, calculators or specialists)
The Period Repair Manual – Lara Briden. Lara writes a wonderful chapter on PCOS in her latest edition.
Azziz R, Carmina E, Dewailly D, Diamanti-Kandarakis E, Escobar-Morreale HF, Futterweit W, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report. Fertil Steril 2009 Feb;91(2):456-88.