Let’s Talk About PCOS: What It Is and How to Manage It

September is PCOS awareness month and I wanted to chat with you about something that between 8-13% of women deal with but don’t always talk about—Polycystic Ovary Syndrome, or PCOS. If you’ve ever heard of it or even been diagnosed with it, you know it can be a bit overwhelming. But don’t worry, I’m here to break it down in a way that’s easy to understand. Let’s dive in.

So, What Exactly is PCOS?

PCOS is a hormonal condition that affects many women, especially those in their reproductive years. It’s one of those things that can show up in a bunch of different ways, which is why it’s often hard to pin down. The name comes from the tiny cysts that can form on the ovaries, but not everyone with PCOS has these cysts, so the name can be a bit misleading.

The exact cause of PCOS is still a bit of a mystery, but we do know that there is a genetic link and a relationship with insulin resistance. If your mom or sister has PCOS, that can increase your chances of having PCOS. Unfortunately, because many women historically have not had great education in understanding normal menstruation and other symptoms, there is a good chance that your family member may have had this diagnosis and never known. You may also be more likely to have PCOS if you are obese.

PCOS is also connected to higher levels of androgens, which were historically known as male hormones, and this can throw off the balance of your endocrine or hormonal system. (A quick note, both male and females make estrogen and androgens, with testosterone being the most spoken of androgen. Women make more testosterone than they do estrogen, but just not as much testosterone as what men make. Ladies, estrogen is not our most dominant hormone and androgens based hormones are essential for our health. Using the terms male hormones when speaking of androgens is deceiving, just as using the term female hormone for estrogen. But let’s get back to PCOS.)

How Do You Know If You Have PCOS?

Diagnosing PCOS isn’t always straightforward and there’s no single test for it. It is classified as a syndrome meaning that a medical diagnosis is usually based upon a combination of factors. Here’s what they typically check for:

1. Irregular Periods: If your periods are all over the place, super heavy, or hardly show up at all, that’s a big red flag. Understanding menstrual health is crucial!. You want to keep track of how long your period lasts, how many days between each cycle, and the menses flow. Knowing this information is important when your provider is helping to find a link with your symptoms and complaints. It is also important to know this information in general as your menstrual cycle is a vital sign for your overall health. So when your provider asks questions about your menstrual health, we are being nosey. We simply want to make sure that we know how this vital sign is presenting just as when we check your blood pressure.
2. High Androgens: Hair growth that occurs in what is considered a “male pattern” may serve as a sign for higher androgen levels. This is known as hirsutism and is associated with darker and more coarse hair. If you’re noticing more hair in places you don’t want it (like your face or chest), or if you’re dealing with stubborn acne, these might be signs your androgen levels are higher than normal. In addition to the excessive hair growth in some places, some women will notice a decrease in hair on their head and experience male pattern baldness. Higher androgen levels may also result in some women having skin tags, small extra flaps of skin, around the neck or armpit region. Androgen levels are generally checked via blood tests.
3. Polycystic Ovaries: This is where an ultrasound might come into play. If your ovaries look enlarged or have lots of tiny cysts, that’s another clue. Cysts on the ovaries related to PCOS can occur when ovulation does not occur resulting in the egg not being released from the follicle. These cysts can be one factor for having elevated androgen levels. Cyst presentation in PCOS when observed on ultrasound can present like several tiny white balls and has earned the name the string of pearls.

Usually, if you tick off at least two of these boxes, doctors might diagnose you with PCOS. They’ll also want to rule out other conditions that can mimic the symptoms, like thyroid issues.

What Are the Symptoms?

PCOS can show up differently for everyone, which is why it can be so tricky. Some of the most common symptoms include:

• • Irregular Periods: This might be the most obvious sign. If your cycle is shorter than 21 days or longer than 35 days, that is outside what we consider to be the normal range.
  • Excess Hair Growth: This is called hirsutism, and it affects a lot of women with PCOS. Think hair on your face, chest, back, and even your toes.
  • Acne: Not just a few spots here and there, but more persistent, sometimes severe acne.
  • Weight Gain: Many women with PCOS find it harder to maintain a healthy weight, especially around the belly area.
  • Thinning Hair: It’s not fair, but while you might be dealing with extra hair on your body, the hair on your head might start to thin.
  • Mood Swings: Anxiety, depression, and mood swings can occur with PCOS, thanks to all those hormonal fluctuations. Regulating hormones can help, and if you are noticing these symptoms it is important that you speak with your provider to discuss management of these symptoms.

• Skin changes: Because of the hormonal changes your skin may notice changes as well. I previously mentioned that skin tags can occur in certain areas, but some women will notice darkening or thickening of their skin in areas such as the neck, armpits, and under the breast.

How Do You Manage PCOS?

There are plenty of ways to manage PCOS, both through medical treatments and lifestyle changes.

Medical Management:

1. Hormonal based medication: Birth control can help regulate your periods, lower androgen levels, and clear up your skin. If pregnancy is the current goal, then birth control pills are not the best choice at that particular time. Instead your provider may recommend hormonal based medications to assist with the ovulation process. (Ovulation is the process in which an egg is released for potential fertilization.)

If excess hair growth or acne is a big issue for you, your doctor might prescribe something to block those androgens. These can be hormonal based medications that block the impact of androgens by preventing them from binding at designated receptors in the body.

1. Metformin: Metformin is considered to be a gold standard when treating PCOS. This medication is commonly known for treating diabetes, as it can help with insulin resistance. Insulin resistance is a common issue with PCOS and this places individuals with PCOS at higher risk for developing another chronic based condition, diabetes. It is important to note that insulin resistance in relation to PCOS is not necessarily related to weight. This means that a woman may be at a healthy weight, but still be insulin resistant due to PCOS. However, it is important to reiterate that obesity can worsen insulin resistance.
2. Weight Management: Losing even a small amount of weight can make a big difference in managing your symptoms, especially if you’re dealing with insulin resistance. If you are overweight and/or noticing more fat around the abdominal region, making lifestyle changes to help with this can drastically improve your symptoms and your overall health as you navigate PCOS. Lifestyle changes for weight loss should include healthy eating, increased activity, and improved sleep habits. Lifestyle changes can take longer to notice results, but help to better equip you with managing your weight long-term. 

And that brings us directly into how a holistic approach can offer a natural way to manage symptoms of PCOS.

1. Diet: Focus on a diet rich in whole foods—think fruits, veggies, lean proteins, and healthy fats. Cutting back on sugar and processed carbs can really help, too. When eating grains, look for whole grains. If you notice the word “enriched” before the mention of the grain product, then it has been altered and is not a whole food. Please notice that when cutting back on carbs, it is recommended that you cut back on processed carbs, and that I am not indicating that you eliminate all carbs. Carbohydrates (carbs) are a main source of energy for your body and a healthy balance is needed. Here are some other words that you should look for when reading labels to determine if the food you are consuming is a good choice:
   1. High fructose corn syrup
   2. Hydrogenated oils
   3. Dyes
   4. Monosodium glutamate
   5. Sodium nitrates and nitrites
   6. Various types of sulfites
2. Exercise: Regular physical activity is your best friend here. It helps with insulin resistance, weight management, and even mood swings. The current recommendation set by the World Health Organization and Center of Disease Control for exercise is at least 150 minutes of moderate intensity activity within a week. In addition to this, there is some information that shows that high intensity interval style training (HIIT) can be beneficial with managing blood glucose level which is directly related to insulin sensitivity.
3. Stress Reduction: Easier said than done, I know, but stress can make symptoms associated with many chronic conditions worse. Try incorporating relaxation techniques like stretching and good old-fashioned deep breathing. Stress can cause an increase in various inflammatory based chemicals in the body and can make pain, especially pain associated with menstruation worse. One of these inflammatory based chemicals released by the body that can cause increased pain with menstruation is called prostaglandins. Higher levels of prostaglandins are associated with more cramping during menstruation and higher pain levels. Check out our video here for breathing techniques to help with stress management. 
4. Sleep: Never underestimate the power of a good night’s sleep. Aim for 7-9 hours and try to keep a consistent sleep schedule. Studies have indicated that poor sleep is associated with more perceived pain and increase in inflammatory factors, which can lead to additional pain. Sleep hygiene and routines can help prepare your body for sleep. Consider things like removing electronics from your room, stopping use of your phone/tablet at least an hour before bedtime, and developing a bedtime routine. I know one of the envied highlights of adulthood by children is the concept of not having a bedtime, but we need to revert back to the childlike way of sleep and have a routine to follow.
5. Supplements: Some women find that supplements like inositol, omega-3s, and vitamin D can help balance hormones and improve symptoms. Before we discuss these in more detail, we need to have “The Talk”.  So here is “The Talk”…Supplements are widely available on the market for you to purchase without a prescription. Supplements should be considered a form of medicine and can interact with your body in both positive and negative aspects. For your safety and health, it is recommended that you discuss all supplement options with your medical provider prior to using. Okay, so now let’s talk about the above mentioned supplements.

• Inositol is also known as vitamin B8, but it really is not a vitamin. It is a form of sugar that is naturally produced by your body. Inositol is suggested to help improve metabolic health including blood sugar levels. It has been shown to also have an impact on assisting with normalizing the menstrual cycle and decrease the presence of androgens. Check out this Inositol supplement.
• Omega 3’s can have an impact on inflammation within our body reducing pain associated with menstruation, and it can also help to regulate levels of androgens. Regulating androgen levels may ultimately improve regularity of menstruation. It is important to mention that Omega 3’s also may help with heart health and mood related disorders. Check out this Omega 3 supplement.
• Vitamin D is probably one of my favorite vitamins to discuss because it is too often overlooked. Vitamin D is not found in many foods, and we should be exposed to it everyday by getting it naturally from the sun. Unfortunately, most people in developed nations such as the USA live sedentary lives and do not spend much time outside. In addition to this, we use sprays and creams to help protect us from the harmful ultraviolet (UV) rays. (Sun protection is important to help protect our skin from harmful changes that can occur due to excessive UV exposure, and it can also help decrease early aging changes in the skin.)

So, what does vitamin D do for our bodies? A LOT! It does more than assist with bone health. Vitamin D can decrease prostaglandin presence, which means that it can serve in an anti-inflammatory manner and decrease associated pain with menstruation. Also, having inadequate levels of vitamin D has been noticed in women who have irregular cycles. Supplementation has been shown to improve regularity of menstruation and fertility. As previously mentioned, women with PCOS tend to have higher androgen levels and improving vitamin D levels has been shown to help decrease testosterone levels, which is a type of androgen.

Vitamin D has a much greater impact on our overall health, but for the purpose of this blog, I will solely focus on those that I have mentioned. Check out this Vitamin D supplement. 

6. Acupuncture: Some women indicate that acupuncture is what has helped to regulate their cycles, reduce their stress, and with pain management. Acupuncture has been shown in the research to have an impact on the nervous, immune, and endocrine systems. Acupuncture introduces a  needle as a mechanical stimuli to the body and can cause a physiological response that impacts the regulation of symptoms such as pain, changes in heart rate, inflammation, etc. 

7. Physical Therapy: Seeing a physical therapist can help you manage symptoms related to pain and improve your ability to participate in everday activities. A physical therapist can use various techniques such as manual therapy, massage, dry needling, electrical stimulation, and more to help manage and decreased complaints of pain. Reach out to a physical therapist who specializes in care for the pelvic region, and they can evaluate you to see what options may be best for you. Need help finding a physical therapist? Go ahead and contact us so we can help you locate someone or even help offer you care.

Whew! So what does this mean for you?

Living with PCOS can be a bit of a rollercoaster, but with the right management plan, you can definitely keep it under control. The key is finding what works best for you—whether that’s medication, lifestyle changes, or a mix of both. And remember, you’re not alone in this. Reach out to your doctor, talk to your friends, and don’t be afraid to ask for help. Feel free to use this information here as a resource as you discuss treatment options with your medical team so that you can find the best route for you. You’ve got this! 

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