You’ve just left your doctor appointment, where your doctor has told you that you have Polycystic Ovarian Syndrome, or PCOS. If you’re like most women in the Western world, your doctor may have handed you a prescription for Metformin, possibly a form of hormonal birth control, and an order to "lose weight," with little (if any) other information, if you’re lucky to get that much. If you were really lucky, your doctor may have explained a little about one or all of those things.
It’s Going To Be Okay
A lot of doctors basically tell women when they’re diagnosed with PCOS to kiss any dreams of having kids goodbye, because having PCOS means being infertile.
If your doctor did that, or prescribed you any medication without running or going over blood tests, start looking for a new doctor, pronto. When it comes to PCOS, knowledge is power, and here’s your first tidbit of knowledge:
You’re Probably Not Infertile.
Yes, getting pregnant with PCOS probably won’t be easy, or quick. You may also have trouble staying pregnant, but neither getting pregnant nor staying pregnant are impossible with PCOS, if you are armed with knowledge.
Likewise, you’re not alone, and yes, you can lose weight without starving yourself.
The key to both of these issues (fertility and weight control) is in our hormones.
Our Hormones Are F-ed Up
There’s no nice way to put that, really. Our genes, combined with our environment, have done a number on the delicate internal balance of our endocrine system. This is the core of PCOS. It’s not the cysts that are (or aren’t) on your ovaries. It’s not the elevated insulin, or the low progesterone or high testosterone. It’s that the balance of the whole damned thing is out of whack.
What makes them that way?
Well, the exact mechanism varies from person to person, but in general, there’s something (or several somethings) that’s throwing off the balance -- usually something you’re being exposed to, but sometimes an innate deficiency. In most cases, it is something that causes insulin levels to rise and eventually stay high. In some cases, it’s something that is causing estrogen to run high or progesterone to run low. Regardless of the initial cause, the end result is pretty much the same.
So what can we do about it?
It turns out there are quite a few things that we can do, the efficacy of which will depend on the underlying cause of the imbalance, and where your numbers are starting at.
The obvious thing most doctors do is prescribe Metformin. I’ve written about the mechanisms of Metformin already, but the short of it is that Metformin’s purpose is to increase insulin sensitivity in the liver, thereby reducing overall insulin levels in the blood. It is not a PCOS treatment. In fact, using it “to treat PCOS” is considered off-label usage. It works for a large portion of women with PCOS, because of the large percentage with PCOS who are also insulin resistant.
The key to effectively using Metformin as a treatment (assuming that you are a) insulin resistant, with elevated insulin levels, and b) responsive to Metformin), is to monitor your fasting insulin.
The fasting insulin measure is different from fasting glucose. While the two are related, it’s possible to have elevated insulin and normal (or even low) glucose, so it’s imperative that you get insulin measured directly.
Unfortunately, there’s currently no at-home test for insulin like there is for glucose, so you need to make sure you get it from your doctor, and get it on a regular basis. Do not let them tell you that the glucose and insulin tests are the same. They are not. They are completely different groups of tests with completely different test codes. Without that number, you really have no idea if any of your efforts to lower insulin are having any effect -- or if you even need to put effort into lowering it!
Metformin (and similar drugs) also isn’t the only thing that can lower insulin. You also have two other options -- diet and Inositol supplementation.
Inositol is a pseudo-vitamin, once considered part of the B-complex of vitamins, until it was found that we can make this substance ourselves. There’s a fairly large body of evidence that Inositol supplementation is useful for treating PCOS in several different ways. The primary action is reducing insulin resistance, but it works in a different way than Metformin. Inositol actually works in the full body, supporting not just the liver, but also the entire communication network. It basically helps the body heal itself, instead of commandeering the controls, like Metformin does. This can be useful even for women without insulin resistance, as it can restore the communication channels involved in proper menstrual cycles and the regulation of other hormones, independent of its insulin-lowering effect (at higher doses, it has even shown efficacy in treating a number of neurological disorders, including Depression, OCD, and Bipolar).
For either support item, it helps to work with them, instead of against them, by also ensuring a supportive diet. You don’t need to be on either, though, to control PCOS with diet, but if you’re taking either, diet can help. You also don’t need to be insulin resistant to be able to use diet to control PCOS, though the presence or absence of insulin resistance might change some of the details.
I’ll be going into details of the basic diet that I generally recommend in a dedicated post, but the most important part is eating a whole foods based diet. That alone will go a long way towards getting your hormones balanced. Processed foods have a laundry list of crap that can screw with our hormones, both in the ingredients and in the packaging itself. I personally prefer a low carb, high fat Primal approach, though there is some evidence of success with a vegetarian-leaning, higher-carb (mostly from non-starchy vegetables) approach, as well.
Estrogen and Progesterone
One of the other issues that women with PCOS may deal with is Estrogen dominance. This can happen one of two ways -- too much Estrogen, period; or a deficiency in Progesterone that puts Estrogen too high in comparison. Either way, the natural way to bring these back into balance is largely through diet, though low raw levels of progesterone may be helped with supplementation.
The big keys here are to avoid xenoestrogens -- sources of estrogen from outside the body -- and other endocrine disruptors, and get plenty of key nutrients. Endocrine disruptors include soy (particularly unfermented), red clover, and other high-phytoestrogen foods, BPA (found in plastics), pthalates (found in numerous things, including cosmetics, flooring, and air fresheners), and most commercial herbicides.
The key nutrients are Vitamins A, C, D, and B6 (and the B-complex in general), as well as magnesium, zinc, and good fats such as Omega-3s and naturally-occurring saturated fats. (Side note - through my son's recent visits with his new integrative pediatrician, I've learned that abnormalities in the above nutrients seem to be fairly common and cause a number of issues in males and females alike. It's fairly easy to conclude that such deficiencies are a major contributor to a significant portion of our society's ills.)
Additionally, it helps to reduce stress where you can and find ways that work for you to de-stress. The production of cortisol competes with the production of progesterone, so the more you can de-stress, the easier it will be to balance your hormone levels. Good ways to do this include things like meditation and yoga, but what counts here is being able to relax, so anything that does that is a winner.
Finally, losing weight, itself, will help reduce estrogen dominance (if you're overweight), because fat actually secretes estrogen. Less fat means less estrogen secretion.
Testosterone (And The Other Androgens)
Yep, we have the "male" hormones, as well (and for what it's worth, men have estrogen and progesterone, too), and when they're in proper balance, they help with things like muscle growth/retention, bone strength, energy, libido, and more. When out of balance, testosterone is the cause of male patterned baldness, acne, and hirsutism (body hair) when elevated, or loss of libido, depression, bone deterioration, and more when deficient.
We also have a stress hormone known as DHEAS, which acts like testosterone in women and has similar symptoms. It can also be a big factor in difficulty losing weight.
For the most part, bringing the androgens back into balance comes from correcting insulin resistance and losing weight, as androgen excess is often a secondary symptom in PCOS. However, not all cases of high androgens is caused by insulin resistance. In either case, a whole-foods diet that at least doesn't try to shun fats (Omega-3 fats, at least, are a big one in balancing hormones). It's also important to eat enough food and not over-exercise, especially if you know you're not insulin resistant. Starving yourself increases the stress hormones in the body, which can lead to or exacerbate PCOS.
Again, It's Going To Be Okay
One of the biggest steps in...well...everything regarding PCOS, is knowing what's going on. From there, acquiring more knowledge -- both about PCOS in general and how it manifests in you -- just takes some time.