Understanding & Managing PCOS Through a HAES Lens
I’m back and ready to talk more things women’s hormone health!
Polycystic Ovarian Syndrome (PCOS) is the most common hormonal disorder, impacting 5-15% of reproductive-aged females. It is a disorder rooted in inflammation, and many unknowns. PCOS consists of multiple symptoms, yet not all people with PCOS experience the same ones. And not all who struggle with PCOS have the same body type.
Similar to hypothalamic amenorrhea (check out this blog post), PCOS is also a diagnosis of exclusion. A provider will look at your history and symptoms (such as menstrual cycle irregularities, weight changes), conduct a physical exam, order blood tests, and perhaps conduct a transvaginal ultrasound to look for the presence of excess cysts. These tests, in combination with the Rotterdam Criteria, are used to diagnose PCOS.
Rotterdam Criteria (must meet 2+)
o Irregular period (long/absent/infrequent)
o Increased androgens
o Presence of (many) ovarian cysts
Within these criteria, three types of PCOS exist.
1. Classic: all of the above criteria
2. Non-polycystic ovary: irregular period + increased androgens
3. Mild: irregular period + cysts
Hormones Involved in PCOS
Androgens:
Male hormones. Think: testosterone, DHEA, DHEAS and androstenedione. Increased androgens in the body can potentially lead to facial hair growth, acne on the chest and back, and thinning of hair on the scalp. Hirsutism is a common symptom of PCOS and can manifest in excess hair growth on the face, chest and back,
LH and FSH:
Luteinizing hormone (LH) and follicle stimulating hormone (FSH) can also be altered in PCOS. These hormones are responsible for cell growth and ovulation. In PCOS, the ratio of LH to FSH is high, meaning that there are increased levels of LH and decreased levels of FSH. With decreased FSH, fewer eggs are released and thus ovulation is altered. Increased LH can lead to increased production of androgens. Increased LH then triggers the production of excess androgens, which can create a complicated cycle.
Insulin:
Insulin is a hormone produced by the beta cells of the pancreas. Its job is to signal the liver, which is one of the places our bodies store glucose for blood sugar regulation, that there is glucose in the blood that needs to be stored for later energy. Insulin acts as the hall monitor of our blood glucose—preventing the concentration of glucose (our body’s preferred energy source) from getting too high or dropping too low.
In insulin resistance, which is seen in many cases of PCOS, cells don’t listen to insulin’s suggestion to let in glucose, and the pancreas works harder to increase the amount of insulin it produces. Instead of being let into cells and being stored, glucose can collect in the bloodstream, leading to high blood sugar, hyperglycemia. Overtime, this can lead to the development of diabetes, heart problems, and/or weight gain.
So what about all these hormones?!
With increased amounts of insulin and LH, unbound androgens accumulate. This increased level of androgens leads to a buildup of immature follicles. Mature follicles release during ovulation, but when ovulation is altered by varying hormone levels, these follicles build up and become cystic, which can lead to the presentation of “many cysts”, appearing on an ultrasound as something like a string of pearls. It is the combination of the altered hormone levels that creates the ovulation abnormalities that are so well known to PCOS.
Why me?
Well, we don’t really know. There is no clear cause for PCOS, although it is hypothesized to be rooted in a combination of genetics and environmental factors. PCOS often appears in females with irregularities in their insulin, progesterone, and testosterone levels, but why those levels are altered could be due to a whole slew of things.
Notice that I didn’t list weight as a causal factor. That was on purpose. A common misconception is that a person needs to be overweight to have PCOS, as if it is a cause and effect scenario. This is not the case. PCOS can appear in women of all shapes and sizes and is so much more complex than what the number on the scale says. And of course, correlation does not equal causation.
So how do I work with this?
Often from a medical perspective, people are told to lose weight, cut out food groups like carbohydrates and sugar, and add medication to the mix. This method is not individualized, is probably rooted in weight bias and it absolutely creates fear, confusion, shame, and increases chances of developing disordered eating, or an eating disorder. Lazy medicine!! Chances are, a person struggling with PCOS has tried all of the things, has followed the latest diet “advice”, and has attempted to lose weight already. Diets don’t work period, and for folks with PCOS this is no exception, and can even exacerbate symptoms.
Pushing people to lose weight for PCOS management is not supported by scientific evidence, and in fact, weight stigma and calorie restriction can cause stress and thus, further increase levels of inflammation. I bet you can guess what I will say to that…
A person is not their condition. A person is not the number that appears on the scale. There is no one solution that will work for everyone.
(and counting calories will never be a productive, viable solution)
Some of the best ways to work with your PCOS are to listen to your body, to avoid pushing it in ways that may cause discomfort or stress, and to get adequate sleep of 7-9 hours each night (hard, I know). Below are some nutrition management suggestions (which of course is not a universal prescription, nor a replacement for medical advice from your provider and should be discussed with your dietitian or health care provider).
Why do you keep talking about stress causing inflammation?
When the body experiences stress, there is a rise in cortisol, the flight-or-flight hormone. Cortisol itself isn’t necessarily harmful, as we need it for day to day survival, though chronically elevated cortisol in the body can lead to inflammation over time. Inflammation is our body’s response to stress, which is OK until there is a more global, persistent inflammatory response.
When people are told to diet, or restrict, or count calories, or exercise a certain way that is not comfortable for them, they experience stress, and subsequently increased inflammation. So then add this inflammation with the existing inflammation from PCOS and that is a LOT for your body to handle.
Allowing our bodies time to rest is essential for stress management. Some people find that meditation, limiting screen time for at least an hour before bed, and taking melatonin help to increase sleep and decrease stress-induced discomfort the next day. (Check out my blog post on stress and hormones here).
Overall, the goal is to decrease inflammation through reducing stressors, real or perceived. That means focusing on creating a healthy relationship between food and exercise that does not cause stress. It means finding ways to move your body multiple times throughout the week that cultivates joy or feels good/tolerable. Exercise can help to reduce and control insulin resistance, a great benefit when stress isn’t involved. It also may mean careful, intentional supplementation, if that’s something you’re willing to try.
Supplementation
*By no means am I suggesting a magic pill that will fix everything. By no means is supplementation the only intervention that I recommend. Supplementation, in combination with lifestyle choices and awareness, can lead to decreased PCOS symptoms.*
Inositol: combination of myo and d-chiro inositol
Inositols fight against insulin resistance, as well as help to improve ovulation and decrease androgens. Many people with PCOS are found to have decreased or altered metabolism of inositols, potentially explaining the presence of insulin resistance. Inositols help glucose’s signaling function, acting as back-ups to tell cells to open and let glucose in, instead of letting it sit out in the blood for extra time. Though naturally found in beans and fruit, supplementation of 2,000-4,000mg is shown to help increase efficiency and improve PCOS symptoms.
Omega-3 Fatty Acids
Omega-3’s are a big buzz word nowadays. They’re known for being a “heart healthy fat,” meaning that they help to increase HDL, our “good” cholesterol that works to move cholesterol from parts of our body to the liver for removal. For PCOS specifically, omega-3’s can help to reduce triglycerides, improve mood, reduce inflammation, aid in ovulation improvement, and lower androgens.
Some food sources to try and eat 2-3x weekly: avocado, walnuts, almonds, flax, chia seeds, fatty fish (salmon, tuna, trout), eggs (specifically the yolks, but not to say that the rest of the egg isn’t full of great protein—eat the whole dang egg!)
For vegetarians/people who don’t eat fish: consider a 1,000-4,000 mg fish oil supplement containing both ALA and EPA (2 types of Omega 3’s that are readily available in food form)
Vitamin D 2000-4000 IU
Vitamin D is a vitamin (duh), but also a hormone. Vitamin D can play a role in controlling the follicle cells and LH that impact ovulation and therefore, fertility. With Vitamin D supplementation, egg cells are better able to grow to maturity, causing a more regular ovulation cycle. Another benefit is the reduction of androgens, leading to lower testosterone levels.
And one more benefit: reduced inflammation. Remember that inflammation from cortisol? And insulin resistance? And the potentially stressful and traumatic past dieting? Vitamin D helps to reduce their impact. Besides, many people, especially us here in New England, tend to be vitamin D deficient.
As always, ask your doctor, RD, or medical professional before starting a new supplement!! If you have any questions about where and how to begin your PCOS healing journey, feel free to reach out so we can help get you started!
No one food can make or break your health. That spirulina smoothie isn’t going to cure every health problem you’ve ever had, just like one candy bar isn’t going to instantly destroy your blood lipid panel or cause a heart attack.
(And if somebody tells you otherwise….unfollow them)
There are enough things to stress about in the world. Let’s leave our food choices out of it.
Resources Cited
https://ghr.nlm.nih.gov/condition/polycystic-ovary-syndrome
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5045492/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5870911/
https://www.pcosnutrition.com/vitamind-pcos/
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5040057/
https://www.thereallife-rd.com/2018/06/pcos-supplements/
https://www.pcosnutrition.com/testosterone/
https://www.pcosnutrition.com/vitamind-pcos/
https://www.pcosnutrition.com/fishoil/
