What Is Polycystic Ovarian Syndrome (PCOS)?
Polycystic ovarian syndrome (PCOS) is the most common endocrine disorder in women of reproductive age, spanning adolescence through menopause (1). It’s referred to as a syndrome, because it involves a complex interplay of various endocrine and hormone imbalances which can present differently depending on the person. At its core, PCOS is typically defined as hyperandrogenism (an excess of “male” sex hormones like testosterone), and chronic anovulation (meaning you don’t ovulate every month), which often leads to missed periods (oligomennorhea) or no period at all (amenhorrea).
Let’s get one thing clear right off the bat- the name is a little misleading. The reason for that is cysts in the ovaries aren’t always present, and in fact you don’t have to have cysts in order to be diagnosed with PCOS.
If you have cysts present, here’s why: Typically every month, a follicle will mature and be released with ovulation to be potentially fertilized. But when ovulation doesn’t occur, the follicles don’t get released. This can result in “multiple mature follicles” showing up in an ultrasound, which is where the “cyst” part comes in. Again, not all women with PCOS have these “cysts” present. Also important to note, some women have multiple follicles present in an ultrasound, and don’t have PCOS. I know, a little confusing right? Keep reading to get clearer on what PCOS is all about.
What Are the Most Common Symptoms of PCOS?
The following symptoms may be present in PCOS (However, not all need to be present to be diagnosed):
- Irregular and infrequent periods (oligomenorrhea)
- Amenorrhea (lack of menstruation)
- Hirsutism (unwanted hair growth, often on the face, chest and back)
- Obesity (seen in 65% of women with PCOS)
- Elevated cholesterol and triglyceride levels
- Insulin-resistance or blood sugar imbalance (often hyperglycemia)
- Dysfunctional uterine bleeding (heavy or excessive bleeding) or irregular bleeding
- History of ovarian cysts or ultrasound revealing multiple “cysts” on the ovaries (again, not necessarily present for all women with PCOS)
- Alopecia (hair loss), male-patterned balding or hair thinning
- Dark or thick skin patches on the back of the neck, in the armpits, and under the breasts (acanthosis nigricans)
- Weight gain, especially around the abdomen
- Mood disorders (anxiety, depression, irritability)
Ultimately, in order to be diagnosed with PCOS, two out of these three clinical presentations needs to be present (4):
(a) oligo-ovulation or anovulation (irregular ovulation or lack of ovulation)
(b) clinical and/or biochemical signs of hyperandrogenism, and
(c) polycystic ovaries by ultrasound and also the exclusion of other related disorders
While there tends to be a focus on its reproductive features, PCOS also has numerous metabolic consequences including increased risk of obesity, insulin resistance, type 2 diabetes mellitus, premature atherosclerosis, hypertension, dyslipidemia, cardiovascular disease, gestational hypertension, gestational diabetes and endometrial cancer (1)(4). There are definitely some serious potential health consequences down the line! But fret not- there’s a lot you can do to address the root causes of PCOS and support your body to come back into balance.
What Causes PCOS?
No one knows for sure what exactly causes this condition. There are several leading theories which includes genetics (it seems to run in families), elevated androgens which “contributes to hirsutism, can promote acne, creates altered feedback loops with pituitary gonadotropins (hormones produced in the ovaries such as luteinizing and follicle stimulating hormones), and frequently some degree of insulin resistance, which contributes to obesity.” (2) Because of the link to insulin-resistance, elevated lipid levels and obesity, PCOS is often referred to as a metabolic syndrome. Interestingly, and similar to the ovarian cysts discussed above, this part of the picture isn’t always present in all women who have PCOS.
In addition to elevated androgen levels, other hormones can be imbalanced. Dr. Stansbury says: “Estrogens are often elevated in tandem with the androgens, leaving women at risk of excessive estrogenic stimulation of the breasts or endometrium.” She goes on to explain that altered levels of TSH (thyroid stimulating hormone), FSH (Follicular stimulating hormone) and prolactin may be present as well (2). As you can see, PCOS is multi-faceted and there is a complex interplay of symptoms going on!
What is the Natural Approach PCOS?
So now that we know what PCOS is and how it’s affecting the body, what can we do?
A holistic approach to Polycystic Ovarian Syndrome (PCOS) involves addressing the following root causes and goals:
- Balance your blood sugar. This can be done through a whole food diet that minimizes refined sugars and decreases inflammation. Eating balanced and regular meals throughout the day will also keep your blood sugar balanced. Tip: Make sure you have adequate protein and fiber at every meal to allow the glucose in your meal to release slower into your bloodstream, which prevents large blood sugar spikes (and crashes). These strategies are the first line of defense to counter insulin-resistance. Specific herbs can also help to keep blood sugar balanced (see below).
- Minimize the impact of stress in your body. The effects of stress on the deregulation of the Hypothalamus-Pituitary- Adrenal (HPA) axis are well known. Stress can create a cascade of events that can seriously impact our hormone and endocrine levels. In fact, studies have shown that stress is a factor in the manifestation of PCOS and can contribute to insulin-resistance, which creates a loop of abdominal fat deposition and endocrine disruption (5). Looking at stress head on can be a key factor in bringing your body back into balance if you have PCOS. This includes stresses related to your job, significant relationships (partners, friends, family), living situations, trauma of any kind, busyness and any emotional/physical/mental strain. Herbs that help regulate the HPA axis are called adaptogens, and they can work wonders to support this whole process (see below).
- Support the underlying hormone imbalances. In addition to addressing stress, which can directly impact hormones, we want to be focusing on supporting the liver to properly cycle hormones, and encourage the body to eliminate excess hormones through the bowel (hello regular bowel movements!). There are also many herbs that can help the endocrine system to re-balance hormones (see below).
- Manage your weight in a healthy, wholesome way. This part of the journey needs to be focused on self-love. Super restrictive or fad diets are not welcome here! Through balanced, whole food nutrition as well as exercise, you can give your body the building blocks it needs to support healthy hormone production as well as elimination. Keeping cholesterol and lipid levels in balance, as well as giving your body wholesome nutrients is key here.
What Herbs Can Support PCOS?
Herbalists often turn to the following herbal allies in our approach for supporting PCOS:
- Hormone Regulation/Modulation (related to prolactin, FSH, LH, estrogen and progesterone): White Peony (Paeonia lactiflora) in combination with Licorice root (Glycyrrhiza glabra), Chaste Tree berry (Vitex agnus-castus), Tribulus (Tribulus terrestris)
- Decreasing testosterone: Licorice root (Glycyrrhiza glabra), Saw Palmetto (Serenoa repens), Nettle Root (Urtica dioica radix), Spearmint (Mentha spicata)
- Blood sugar balancing: Gymnema (Gymnema sylvestre), Fennel (Foeniculum vulgare), Cinnamon (Cinnamomum spp.)
- Improving and balancing lipids (cholesterol, triglycerides): Garlic (Allium sativa), Turmeric (Curcuma longa), Holy Basil/Tulsi (Ocimum sanctum)
- Modulating the stress response and regulating the HPA axis: Ashwagandha (Withania somnifera), Siberian ginseng (Eleutherococcus senticosus), Shatavari (Asparagus racemosa), Roseroot (Rhodiola rosea).
- Liver support for the clearance of estrogen, androgens and other hormone imbalances: Dandelion root (Taraxacum officinalis), Barberry (Berberis vulgaris), Oregon Grape Root (Mahonia spp.), Rosemary (Rosmarinus officinalis), Schisandra (Schisandra chinensis)
- Herbs related to specific symptoms of acne, anxiety, depression, infertility and heavy bleeding may also be used depending on what is needed for each individual.
Of course, when it comes to herbs, I always recommend seeing a trained herbalist who can create a formula that is specific to your unique body type and will address your individual set of symptoms, so you get the best results.
Estrogen Dominance: What Else Can I Do?
If you have estrogen dominance as part of the picture for you, including up to a pound of combined fresh vegetables, especially from the brassica/cruciferous vegetable family (kale, collards, broccoli, cauliflower, Brussels’s sprouts, cabbage) and fresh fruits (especially berries) each day is a great idea. The brassica family contains sulfur compounds, as well as DIM (diindolylmethane), which help the liver to clear excess estrogen out of the system.
All meat should be organic to avoid chemicals used in meat production that might be adding to your toxin burden (also known as xenoestrogens). Xenoestrogens are estrogen-like compounds that are present in the environment (chemicals added to personal care products & cleaning products, pesticides, plastics, synthetic hormones given to the animals we eat etc.). When xenoestrogens enter our bodies, they wreak havoc on our delicate hormone system and act like stronger versions of estrogen than our own. This can lead to more burden on the liver, plus a net effect of estrogen dominance in the body.
Now, with all of these strategies on your side, there’s plenty you can do to support your body naturally as you get to the root cause of your PCOS symptoms!
With all my herbal love,
READY TO GET TO THE ROOT CAUSE OF YOUR HEALTH ISSUES, NATURALLY? BOOK A CONSULTATION WITH ME SO WE CAN DO IT TOGETHER!
- Romm, A. (2018). Botanical Medicine for Women’s Health.
- Stansbury, J. (2018). Herbal Formularies for Health Professionals: Volume 3 (Endocrinology).
- John Hopkins: Polycystic Ovarian Syndrome retrieved September 7th, 2021 from https://www.hopkinsmedicine.org/health/conditions-and-diseases/polycystic-ovary-syndrome-pcos
- Basu, B. R., Chowdhury, O., & Saha, S. K. (2018). Possible Link Between Stress-related Factors and Altered Body Composition in Women with Polycystic Ovarian Syndrome. Journal of human reproductive sciences, 11(1), 10–18. https://doi.org/10.4103/jhrs.JHRS_78_17