PCOS: A Functional Doctor Explains What You Really Need To Know
In my practice, Parsley Health, it seems every week I meet a patient who has been told by her gynecologist that she has PCOS.
PCOS, or polycystic ovarian syndrome, is a group of symptoms resulting from a hormonal imbalance. It's the number one cause of fertility issues in the U.S. An estimated 5 to 10 percent of women of childbearing age have PCOS, while at least 30 percent of all women have some symptoms of PCOS. And as with most chronic diseases and conditions, the prevalence of PCOS is increasing around the world.
Most of the women who come to me with PCOS have been told by their doctor that they must take a birth control pill in order to "stop it." Unfortunately, the Pill does not actually fix or “stop” PCOS. It only masks its symptoms while the syndrome continues unhindered under the surface.
No one truly knows what causes PCOS. It's also not one single disorder but at least four independent disorders all characterized by an overlapping but inconsistent set of symptoms:
- High androgen, or male hormone, levels
- Facial hair growth
- Irregular or absent menstrual cycles
- Ovarian cysts
The link between these seemingly unrelated and random set of symptoms? It's suspected that insulin, body fat, and metabolism are the underlying causes of this constellation.
So what is PCOS and what are the many myths surrounding it? Here are the top five myths I most commonly see, as well as the reality of this common hormone imbalance:
Myth #1: PCOS is one syndrome.
In fact, PCOS has four diagnostic categories. And recently a fifth “type” has been proposed, which is that PCOS is caused simply by obesity:
- Type 1: Classic PCOS: high androgen levels, irregular or absent ovulation, and a polycystic ovary
- Type 2: Hyperandrogenic anovulatory: excess androgens with irregular or absent ovulation (but no polycystic ovary)
- Type 3: Ovulatory PCOS: excess androgens with a polycystic ovary (but without ovulatory dysfunction)
- Type 4: Non-hyperandrogenic PCOS: irregular or absent ovulation and a polycystic ovary
- Type 5: Obesity, the unofficial type: obesity with insulin resistance can lead to excess testosterone production, and subsequently excess estrogen production, the combination of which result in the acne, facial hair, and irregular cycles seen in PCOS.
Myth #2: If you have PCOS, you have cysts on your ovaries.
As we can see above, this is not always the case. In type 2 PCOS, a woman presents with irregular cycles and high androgen levels but does not have ovarian cysts.
Myth #3: If you aren’t getting a regular menstrual cycle, you have PCOS.
Many women are anovulatory (they fail to ovulate) because of a variety of other factors. In today’s high-stress, high-inflammatory world, I see this frequently and it’s usually as a result of a suppressed HPG (hypothalamus, pituitary, gonadal) communication pathway.
This pathway can be suppressed by high cortisol levels, high insulin levels, or high inflammation levels, as well as by body fat that’s either too low or too high. Sometimes this pathway is suppressed for all of these reasons combined.
Myth #4: The cure for PCOS is the birth control pill.
In reality, the birth control pill does nothing to cure, prevent, or fix PCOS or any other hormone disorder. It can be helpful as a management tool for symptoms, but ultimately it just masks the problem.
OBGYNs put women with PCOS on birth control because they often lack other solutions. My approach is to help women lower inflammation and balance testosterone through nutrition, supplements, and lifestyle changes.
Myth #5: PCOS is irreversible.
I consider this to be the most "bustable" of all the myths about PCOS. I've had many women balance testosterone levels, lose body fat, resolve acne and facial hair growth, and regain their menstrual cycles through a mixture of diet, supplements, and lifestyle changes including stress reduction and better sleep.
This brings us to the deeper question on PCOS: What can we do about it?
What I often see causing PCOS is a potent mixture of chronic stress that increases testosterone levels, and a diet high in refined carbs, sugar, processed foods, and alcohol, which increases insulin, thereby increasing testosterone.
Weight gain, especially visceral fat — the kind that’s underneath the muscle of your belly, not on top of it — is also a culprit. This fat is inherently insulin resistant, inflammatory, and estrogen producing. The increased estrogen suppresses LH and FSH from the brain, the hormones you need to get a menstrual cycle.
I find that the solution for many women is therefore real stress reduction, not the kind you pay lip service to by going to yoga once a month, but real, daily stress management. (I teach this in my mindbodygreen stress course.) It also means following a very low-glycemic, plant-based, Paleo-style eating plan.
I also tell my patients that supplements can be helpful, specifically myo-inositol and d-chiro-inositol to lower testosterone and balance insulin; curcumin and other herbal compounds to lower inflammation; a combination of cinnamon, EGCG from green tea, and chromium to balance blood sugar; and long-chain omega-3 fatty acids to lower the production of inflammatory messengers.
Remember to use supplements with the support of a trusted provider, such as a functional medicine practitioner, who knows you and your life story, and who can do regular testing to be sure that the effects of these supplements are getting the results you want. After all, it’s not fun to play with your hormones and get it wrong.