Healing PCOS

What Is Polycystic Ovary Syndrome (PCOS)?

You are not alone. Polycystic ovary syndrome (PCOS) is one of the most common endocrine system disorders found in women and the most common cause of infertility in women. As calculated employing the widely used Rotterdam Criteria, PCOS affects approximately 15 to 20 percent of women worldwide, of whom less than 50 percent are diagnosed. It is present throughout a woman’s life from puberty through postmenopause and affects women of all races and ethnic groups.

As an endocrine disorder, PCOS disrupts hormone balance, negatively impacting many bodily functions including insulin levels, cell and tissue growth and development, metabolism, fertility, and cognition. A diagnosis is often difficult to obtain because PCOS is a syndrome, a collection of symptoms. It affects many different hormones, resulting in an array of symptoms that may seem unrelated and vary from woman to woman. Some symptoms include obesity, irregular menstrual cycles, insulin resistance, infertility, depression, male-pattern hair growth, acne, and hair loss.

In addition, women with PCOS have a four to seven times higher risk of heart attack, and 50 percent will develop prediabetes or diabetes before age forty. They are also more likely to develop endometrial cancer. The increased risk of these serious health issues makes managing symptoms even more imperative—and stressful.

You may have one or two of these symptoms or a dozen. Although some symptoms are more common than others, there is no single model for PCOS.

● Oligoovulation (irregular ovulation) or anovulation (absent ovulation)

● Polycystic ovaries (20–39 percent)

● High levels of insulin, insulin resistance (30–50 percent)

● Easy weight gain and/or obesity (55–80 percent)

● Fertility issues

● Acne (40–60 percent)

● Cardiovascular issues

● Type 2 diabetes

● Depression (28–64 percent)

● Anxiety (34–57 percent)

● Poor body image, eating disorders (21 percent)

● Sexual dysfunction

● Thyroid disorders

● High levels of androgens (60–80 percent)

● Irregular menstruation (75–80 percent)

● Male-pattern hair growth (70 percent)

● Skin tags

● Sleep apnea (8 percent)

● Gray-white breast discharge (8–10 percent)

● Scalp hair loss (40–70 percent)

● Darkening skin areas (acanthosis nigricans), particularly on the nape of the neck (10 percent)

● Pelvic pain

● Hidradenitis suppurativa (painful boil-like abscesses in the groin)

The most common symptoms of PCOS are insulin resistance and hyperinsulinemia, hormone imbalances, and chronic inflammation.

Insulin resistance, when cells fail to respond normally to the hormone insulin, and hyperinsulinemia, chronically high levels of insulin in the blood, are both symptoms with which I struggled all my life. Unfortunately, as is probably the case with many of you, they went undiagnosed for many years.

I remember fainting multiple times in sixth grade. The nurse didn’t know what was wrong. My mom took me to doctors, who also found nothing and finally referred me for psychiatric evaluation. Imagine being twelve years old, feeling horrible, and being told it is all in your head. Many years later, still undiagnosed, I remember feeling baffled when every Sunday morning, after my fiancé and I had our traditional waffle breakfast complete with syrup and orange juice, I would get woozy in church. Little did I know, it was the waffle breakfast throwing my blood sugar out of whack and giving me hypoglycemia! Since then, I have learned to interpret my body’s signals. Now when I feel that way, I know exactly what to do.

Insulin resistance and hyperinsulinemia are conditions in which the body becomes less and less efficient at processing and managing levels of sugar (glucose) in the bloodstream. This has serious overall health consequences. In the short term, insulin resistance is at the heart of most PCOS symptoms, including infertility, obesity, hirsutism, hyperandrogenism (elevated androgen levels), chronic fatigue syndrome, immune system defects, eating disorders, hypoglycemia, gastrointestinal disorders, depression, and anxiety. In the long term, when insulin levels rise too high, type 2 diabetes may result. Hardening of the arteries (atherosclerosis) is a common result of insulin dysfunction and may lead to an increased risk of high blood pressure and stroke.

● Weight gain

● Sugar cravings

● Skin tags

● Hypoglycemia

● Rough or red bumps on upper arms

● Dark skin patches on neck, knees, elbows, knuckles, chest, or groin

In a healthy system, insulin plays an important role in metabolism. This powerful hormone is produced by the pancreas and enters the bloodstream after a meal. Its main function is to transport glucose to cells throughout the body to be used for energy. When there is excess glucose, insulin delivers the glucose to muscles, fat, and the liver, which helps to lower the blood glucose levels by storing it and signaling the body to slow production of insulin. But in an unhealthy system, insulin resistance and hyperinsulinemia may result.

Between 50 and 70 percent of women with PCOS have some degree of insulin resistance. Insulin resistance may be caused by poor diet, ethnicity, certain diseases, hormones, steroid use, some medications, older age, sleep problems, and cigarette smoking. Although insulin resistance is often associated with obesity, research indicates that lean PCOS patients are also prone to insulin resistance. Research also indicates that the birth control pill may cause insulin resistance in all women, particularly those with PCOS.

Insulin resistance occurs when a person’s body does not react properly to the amount of insulin in the bloodstream. In a healthy system, after a meal, the pancreas creates insulin to balance the glucose in the blood. Ideally, the body detects if the level of glucose in the blood is still too high and signals the pancreas to create more insulin. The hope is that since there is more insulin, more glucose will be picked up.

Insulin in large quantities can be toxic to cells, so when there is too much insulin in the body over time, cells become insulin resistant in order to protect themselves. Alternatively, the hypothalamus may become insulin resistant and continue to send signals to the pancreas to create more insulin unnecessarily. When insulin resistance occurs, the insulin does not pick up or cannot deliver the glucose to the cells that need it. Glucose levels in the blood remain high, and diabetes and other serious health disorders may result.

Hyperinsulinemia results when more insulin is present in the bloodstream than is considered normal, usually as a result of insulin resistance. Although it is associated with diabetes, someone with hyperinsulinemia does not necessarily have diabetes.

Insulin resistance and hyperinsulinemia create a self-perpetuating and destructive cycle called the insulin resistance cycle. Insulin resistance creates chronically high levels of insulin, and those chronically high levels bombard cells, forcing them to protect themselves, thus perpetuating insulin resistance. Eventually, your pancreas can no longer keep up with the insulin demand. This means there is less insulin in the body to store and regulate glucose levels, and the result is diabetes.

In addition, high levels of insulin and insulin resistance sometimes pave the way for hyperandrogenism, excessive levels of male hormones. This may be the cause of missed periods and infertility in some women with PCOS. The relationship between hyperandrogenism and hyperinsulinemia in women with PCOS is unclear. Researchers disagree about whether hyperinsulinemia causes hyperandrogenism, hyperandrogenism causes hyperinsulinemia, or a third cause is responsible for both. One way or the other, we have a destructive cycle: insulin resistance leads to hyperandrogenism, which increases insulin levels.

A top priority of the Healing PCOS 21-Day Plan is to get your insulin under control.

When my hair started falling out during high school, my mom took me to a dermatologist who did a scalp biopsy. When it came back negative, the hair loss as well as other symptoms such as fatigue, acne, and sporadic periods were written off as a result of stress. Things got worse as I grew older. I began gaining weight, growing facial hair, experiencing anxiety and depression, and still fighting the symptoms I had since puberty. The birth control pill that was supposed to be my “quick fix” manipulated my hormones, leaving me feeling moody and dull. I wish that I had had a better understanding then of how my hormones work and how hormone imbalances caused by diet and lifestyle choices could be the source of my symptoms.

Hormones are responsible for keeping your major bodily functions running smoothly, so when hormone levels become imbalanced, you’ll feel the effects in many ways. Hirsutism, acne, hair loss, higher stress levels, mood disorders, depression, anxiety, and infertility can all result.

The most common hormones that become imbalanced and the ones that you will learn to manage with the Healing PCOS 21-Day Plan are androgens, cortisol, progesterone, estrogen, and thyroid hormones.

Androgens: Androgens are male hormones, such as testosterone, dihydrotestosterone (DHT), dehydroepiandrosterone (DHEA), and DHEA sulfate (DHEA-S). In males, these steroid hormones are responsible for sexual development and muscle mass. In women, they play a much subtler, though no less important role. Among other things, they help us maintain muscle mass, regulate our weight, and keep our libidos humming. They are produced in the ovaries, adrenal glands, and fat cells. The problem isn’t that women with PCOS have androgens; it is that we typically have an excess. This androgen excess, or hyperandrogenism, affects about 25 percent of women with PCOS and is often the root cause of common symptoms such as hirsutism, acne, hair loss, and infertility.

Androgen excess may be caused by:

● Ovarian dysfunction, which causes the ovaries to produce excess testosterone.

● Insulin resistance, which signals the ovaries to produce excess testosterone.

● Stress, which taxes the adrenal glands and stimulates the production of androgen hormones. For this reason, women with PCOS should practice stress relief from an early age.

● Early adrenal activation, which initiates early puberty and correlates with increased lifelong androgen formation. Girls who experience early puberty may have an increased risk of developing PCOS.

● Obesity.

● Genetics.

● Taking artificial hormones in birth control.

● Individual hypersensitivity to a normal amount of androgen.

● A defect in the hypothalamus, a part of the brain responsible for regulating the production of many hormones, including androgens.

Cortisol: Women with PCOS often make too much cortisol, the “stress hormone” produced in the adrenal glands. In fact, research indicates that many women with PCOS may naturally have higher cortisol levels. Being overweight also increases cortisol production.

Raised levels of cortisol change the way your body manages other critical hormones, putting you at risk for insulin resistance, anxiety, depression, and thyroid dysfunction. In addition, the overproduction of cortisol can overwork the adrenals to the point of adrenal fatigue. For this reason, stress—emotional or physical—takes more of a toll on women with PCOS than on those without it.

Progesterone: Progesterone is a hormone, produced mainly in the ovaries, that plays an important role in the menstrual cycle and maintaining and nourishing the body during pregnancy. After ovulation each month, progesterone helps thicken the uterine lining in preparation for a fertilized egg. This is called the luteal phase of the menstrual cycle. Women with PCOS almost always have low progesterone and thus a luteal-phase defect. This makes it nearly impossible to maintain a pregnancy even if ovulation and implantation do occur and is often the cause of miscarriage and unsuccessful assisted reproduction. Some doctors recommend supplemental progesterone for women with PCOS in order to support early pregnancy if they have suffered multiple miscarriages.

● Anxiety

● Waking at night

● Fibrocystic breasts

● PMS

● Bone loss

● Low libido

● Infertility or irregular periods

If you have a progesterone deficiency and your doctor suggests hormone replacement, you may be prescribed a bioidentical progesterone. Bioidentical, or natural, progesterone is a combination of elements derived from natural plant sources that identically matches the progesterone we naturally make in our bodies. Prometrium is a micronized (reduced to tiny particles and mixed with peanut oil) natural progesterone in the form of a pill. It is approved by the Food and Drug Administration (FDA) as a natural hormone-replacement therapy medication. Because natural progesterone is molecularly identical to the hormone produced by the body, it causes few side effects.

Alternatively, your doctor may suggest a synthetic progestin such as Provera, since it was the standard before good natural alternatives were developed. Provera is also a constructed compound, but its chemical structure is not identical to natural progesterone. As a result, it can cause changes in vaginal bleeding, blood sugar issues, blood clots, and depression. Unfortunately, many women are told that synthetic progestin is the same as natural progesterone. Be a PCOS Diva at the doctor’s office and discuss the differences between these two hormone-replacement options to find one that is best for you.

Estrogen: Estrogen, the primary female sex hormone, is produced in the ovaries, adrenal glands, and fat tissues. Many women with PCOS experience estrogen dominance, that is, too much estrogen and not enough progesterone to balance its effects. Symptoms such as heavy or painful periods, infertility/miscarriage, and hypothyroidism (an underactive thyroid gland) may result.

● PMS

● Headaches and/or migraines

● Fluid retention

● Heavy or painful periods

● Endometriosis

● Moodiness, anxiety, or depression

● Hypothyroidism

● Infertility or miscarriage

● Breast pain or tenderness

Thyroid hormones: Many women with PCOS have a dysfunctional thyroid. It may be overactive (hyperthyroidism) or, more commonly, underactive (hypothyroidism). Hashimoto’s disease, an autoimmune disease and the most common cause of hypothyroidism, is prevalent in women with PCOS.

If the thyroid is not functioning properly, the balance of thyroid hormones and every other hormone in the body will be disrupted, causing abnormal sexual development, menstrual irregularities, and possibly infertility. I encourage all women with PCOS symptoms to have a complete set of thyroid labs to rule out thyroid dysfunction.

“Think of PCOS as being in an extended state of puberty, where androgens, luteinizing hormone (LH), and insulin resistance dominate and follicle-stimulating hormone (FSH), estrogen, and progesterone haven’t established their rhythm.”

Signs of Hypothyroidism (Underactive Thyroid)

● Unexplained weight gain or trouble losing weight

● Fatigue

● Depression

● Hair loss and dry hair

● Muscle cramps

● Dry skin

● Swelling of the thyroid gland

● Brittle nails

● Slow heart rate

● Irregular period

● Sensitivity to cold

● Constipation

Signs of Hyperthyroidism (Overactive Thyroid)

● Unexplained weight loss

● Palpitations

● Feeling wired or anxious

● Shakiness

● Sweating spells

● Feeling hot frequently

● Tremors

● Shortness of breath

● Itchy red skin

● More frequent bowel movements than usual

● Fine hair and hair loss

I should be a dentist’s dream patient. My brushing and flossing habits are impeccable. I have my teeth cleaned every six months. I don’t poke around in my mouth with pointy objects. Then why did my gums bleed every time I went to the dentist? For years, no matter what I tried, from my dentist I would get that face and “the talk.” You know the one I mean, about brushing and flossing regularly? As it turns out, it wasn’t my oral hygiene that was the problem. It was my systemic inflammation.

Inflammation isn’t necessarily bad. Our bodies use inflammation to fight off microbial, autoimmune, metabolic, or physical attacks. For example, it’s what causes our knees to puff up and bleed when we fall and scrape them. It’s a sign the body is deploying white blood cells, which help heal injuries, fend off disease, and replace aging cells. The problem is chronic inflammation, inflammation lasting from a few months to several years. That type of inflammation takes a tremendous toll on every system of the body.

● Weight gain

● Allergies

● Brain fog

● Joint pain

● Irritable bowel syndrome

● GI issues (bloating, gas, diarrhea)

● Acne

● Asthma

● Gum disease

● Chronic sinusitis

● High blood sugar

● Depression

● Belly fat

● Fatigue

● Eczema

● Psoriasis

According to integrative physician Felice Gersh, chronic inflammation is the root cause of many of the conditions women with PCOS experience, such as obesity and weight-loss resistance, infertility, hirsutism, mood swings, and acne. And recent research suggests that women with PCOS have higher levels of circulating C-reactive protein (CRP), an indicator of general inflammation independent even of obesity.

Inflammation is widely recognized as the root of many of the major diseases that plague the Western world. Cardiovascular disease, metabolic syndrome, hypertension, some cancers, diabetes, and PCOS all share the common root of inflammation.

Chronic inflammation may be caused by obesity, food sensitivities and allergies, and stress. It may also result from environmental and lifestyle factors such as pollution, poor diet, smoking, lack of exercise, and poor dental health. Getting to the root of these problems through a proper inflammation-reducing diet and lifestyle is critical for women with PCOS.

Why Do I Have PCOS?

Although the exact cause of PCOS is unknown, it is generally agreed that genetics, hyperinsulinemia (high levels of insulin) and insulin resistance, and/or a defect in a hormone-producing organ play a role. I have already discussed the chicken-and-egg debate about insulin and PCOS, whether chronically high levels of insulin cause excess androgens or vice versa. With regard to genetics, studies show that a woman with PCOS has a 40 percent likelihood of having a sister with the syndrome and a 35 percent chance of having a mother with the disorder. It is possible that a mother’s obesity, insulin resistance, or exposure to food high in advanced glycation end products (AGEs) or industrial toxins such as bisphenol A (BPA) may be the root cause. If PCOS is genetic, the genes involved in its expression may be triggered by environmental stimuli such as poor diet or rapid weight gain.

Some women with PCOS first experience symptoms when they stop taking the birth control pill. Typically, there was a predisposition before taking the pill, but only when they stopped taking it did symptoms emerge as a result of the disruption in communication between the pituitary gland and ovaries. In this case, symptoms should clear as soon as communication is reestablished.