8 Steps to Reverse Your PCOS

1. PCOS is a complex endocrine disorder with diverse phenotypes

PCOS is called a syndrome, rather than a disease, as there is a wide range of ways that PCOS can present and a variety of factors that characterize it.

Diverse manifestations. PCOS affects an estimated 116 million women worldwide, impacting hormones, fertility, skin, cardiovascular health, and metabolism. The Rotterdam criteria define PCOS using three main factors:

• Delayed ovulation or irregular menstrual cycles
• Excess androgens (male hormones)
• Polycystic ovaries on ultrasound

Based on these criteria, four main PCOS phenotypes exist:

• Type A: All three criteria present (classic PCOS)
• Type B: Delayed ovulation and excess androgens
• Type C: Excess androgens and polycystic ovaries
• Type D: Delayed ovulation and polycystic ovaries

Each woman's PCOS presentation is unique, influenced by factors such as age, weight, environment, genetics, and stress levels.

2. Inflammation and insulin resistance are central to PCOS pathology

Inflammation is a hallmark factor of PCOS. Evidence has mounted showing that chronic low-grade inflammation is not just a side effect of PCOS, as thought previously. It is the central factor in the condition.

Vicious cycle. Inflammation and insulin resistance are interconnected in PCOS, creating a self-perpetuating cycle:

1. Inflammation:

   • Increases androgen production
   • Promotes insulin resistance
   • Causes oxidative stress

2. Insulin resistance:

   • Leads to high insulin levels
   • Stimulates ovarian androgen production
   • Contributes to inflammation

To address these issues:

• Adopt an anti-inflammatory diet
• Increase physical activity
• Consider supplements like omega-3 fatty acids, N-acetyl cysteine, and resveratrol
• Manage stress levels

3. Addressing adrenal health and stress is crucial for managing PCOS

As PCOS has inflammation at its center, all women with this condition have increased baseline cytokines.

Stress and hormones. Women with PCOS often have higher cortisol levels and are more susceptible to stress-related symptoms. Adrenal health impacts PCOS in several ways:

• Adrenal androgens: Some women produce excess androgens from their adrenal glands
• Cortisol imbalance: Can disrupt other hormones and increase insulin resistance
• Stress response: Affects overall hormonal balance and exacerbates PCOS symptoms

Management strategies:

• Practice stress-reduction techniques like meditation, yoga, or deep breathing
• Consider adaptogenic herbs like Rhodiola or Ashwagandha
• Ensure adequate sleep and maintain a consistent sleep schedule
• Support adrenal function with nutrients like vitamin C and B-complex vitamins

4. Excess androgens cause many PCOS symptoms but can be managed

High levels of hormones known as androgens (testosterone and similar hormones) are one of the most important diagnostic factors seen in women with PCOS and are even argued by some key researchers as being required for the diagnosis of PCOS.

Androgen effects. Excess androgens in PCOS contribute to various symptoms:

1. Hirsutism (excess hair growth)
2. Acne
3. Male-pattern hair loss
4. Irregular ovulation

Management approaches:

• Diet and lifestyle changes to reduce insulin resistance
• Natural supplements like saw palmetto, spearmint tea, and licorice root
• Topical treatments for acne and hair loss
• In some cases, prescribed anti-androgen medications

It's important to note that androgens also have beneficial effects, such as maintaining bone density and muscle mass, so the goal is to achieve a balance rather than eliminate them entirely.

5. Hormonal imbalances in PCOS affect ovulation and menstrual cycles

PCOS is the cause of more than seventy-five percent of cases of anovulatory infertility and is a leading cause of infertility in general.

Disrupted cycles. PCOS often leads to irregular or absent ovulation, causing:

• Unpredictable or missed periods
• Difficulty conceiving
• Increased risk of endometrial hyperplasia

Hormonal imbalances in PCOS include:

• High luteinizing hormone (LH) to follicle-stimulating hormone (FSH) ratio
• Low progesterone levels
• Elevated estrogen relative to progesterone (estrogen dominance)

Strategies to improve hormonal balance:

• Support ovarian health with nutrients like inositol and CoQ10
• Use herbs like vitex or black cohosh to regulate cycles
• Consider bioidentical progesterone in some cases
• Track cycles using basal body temperature or ovulation predictor kits

6. Thyroid health is closely linked to PCOS and requires attention

Women with PCOS should definitely have their thyroids carefully investigated, as the symptoms of hypothyroidism can aggravate PCOS.

Thyroid-PCOS connection. Thyroid dysfunction is more common in women with PCOS and can exacerbate symptoms:

• Increased risk of autoimmune thyroiditis (Hashimoto's)
• Subclinical hypothyroidism more prevalent
• Thyroid issues can worsen insulin resistance and weight gain

Key points for thyroid health in PCOS:

• Regular thyroid function testing (TSH, free T3, free T4)
• Optimal TSH levels for PCOS may be lower (between 1-2 mIU/L)
• Consider testing for thyroid antibodies
• Support thyroid function with nutrients like selenium and iodine
• Address underlying inflammation and autoimmunity

7. Environmental factors play a significant role in PCOS development

PCOS is a rapidly growing epidemic. The increased incidence of PCOS coincides with industrialization and the introduction of a wide variety of chemicals into our environment.

Environmental impact. Endocrine-disrupting chemicals (EDCs) in our environment can influence PCOS development and progression:

1. Common EDCs affecting PCOS:

   • Bisphenol A (BPA)
   • Phthalates
   • Pesticides
   • Dioxins

2. Effects of EDCs on PCOS:

   • Disrupt normal hormone function
   • Increase androgen production
   • Contribute to insulin resistance
   • May affect future generations through epigenetic changes

To reduce exposure:

• Choose BPA-free products
• Opt for organic produce when possible
• Use natural personal care and cleaning products
• Filter drinking water
• Avoid heating food in plastic containers

8. A balanced, low-insulin diet is key to managing PCOS symptoms

It goes without saying that one of the most important factors for women with PCOS is a healthy diet. PCOS is probably the women's health condition that responds the best to dietary changes.

Nutritional approach. A PCOS-friendly diet focuses on:

1. Balancing macronutrients:

   • Moderate protein (about 25-30% of calories)
   • Healthy fats (about 30-35% of calories)
   • Complex carbohydrates (about 40% of calories)

2. Emphasizing low glycemic index foods:

   • Non-starchy vegetables
   • Berries and low-sugar fruits
   • Whole grains in moderation

3. Avoiding or limiting:

   • Refined sugars and processed foods
   • Dairy products (due to hormonal content)
   • Gluten (may increase inflammation in some women)

4. Considering the "insulin index" of foods to manage insulin levels

Meal planning tips:

• Include protein and fiber with each meal
• Eat regular, balanced meals to stabilize blood sugar
• Stay hydrated with water and herbal teas

9. Natural supplements can effectively support PCOS management

Fortunately, there are some supplements that can be exceptionally helpful for women with PCOS when it comes to getting pregnant.

Key supplements. While diet and lifestyle changes are foundational, certain supplements can provide additional support:

1. Inositol (myo-inositol and D-chiro-inositol):

   • Improves insulin sensitivity
   • Supports ovulation and egg quality

2. N-acetyl cysteine (NAC):

   • Reduces inflammation
   • Improves insulin sensitivity

3. Berberine:

   • Similar effects to metformin
   • Improves insulin resistance and lipid profiles

4. Omega-3 fatty acids:

   • Reduce inflammation
   • Support hormonal balance

5. Vitamin D:

   • Often deficient in PCOS
   • Improves insulin sensitivity and reduces inflammation

Always consult with a healthcare provider before starting any supplement regimen, as individual needs may vary.

10. PCOS impacts fertility but can be addressed with proper treatment

PCOS is associated with subfertility, rather than infertility. Stay hopeful, no matter how long you've been trying. Most women with PCOS can and do achieve pregnancy!

Fertility strategies. PCOS can affect fertility through:

• Irregular or absent ovulation
• Hormonal imbalances
• Increased risk of miscarriage

Approaches to improve fertility:

1. Regulate cycles:

   • Use of herbs like vitex or supplements like inositol
   • Tracking ovulation with basal body temperature or ovulation predictor kits

2. Improve egg quality:

   • CoQ10 supplementation
   • Antioxidant support

3. Address insulin resistance:

   • Metformin or natural alternatives like berberine
   • Diet and exercise modifications

4. Support implantation:

   • Progesterone support if needed
   • Anti-inflammatory diet and supplements

In some cases, fertility treatments like ovulation induction or IVF may be necessary, but many women with PCOS can conceive naturally with the right approach.

11. PCOS management continues through menopause and beyond

Although we often think of PCOS as a condition that women of reproductive age experience, it is in fact a complex endocrine disorder that goes well past the menopausal years.

Lifelong management. PCOS symptoms and risks evolve with age:

1. Perimenopause:

   • Cycles may become more regular as androgen levels naturally decrease
   • Insulin resistance may worsen

2. Postmenopause:

   • Androgen levels remain higher than in women without PCOS
   • Increased cardiovascular and metabolic risks

Management strategies:

• Continue focusing on insulin sensitivity and inflammation
• Monitor and support adrenal health
• Address bone health (PCOS may offer some protection against osteoporosis)
• Regular screening for cardiovascular disease and diabetes
• Consider bioidentical hormone therapy if needed

12. PCOS increases risks of certain diseases but they can be mitigated

Having PCOS is linked with an increased risk of cardiovascular disease due to metabolic risks, high LDL and low HDL cholesterol, hypertension, and insulin resistance.

Long-term health. Women with PCOS have increased risks for:

1. Cardiovascular disease:

   • Regular lipid panel screening
   • Focus on heart-healthy diet and exercise

2. Type 2 diabetes:

   • Annual glucose and HbA1c testing
   • Maintain insulin sensitivity through diet and lifestyle

3. Endometrial cancer:

   • Regular gynecological check-ups
   • Induce periods if cycles are very infrequent

4. Non-alcoholic fatty liver disease (NAFLD):

   • Liver function testing
   • Reduce sugar and refined carbohydrate intake

Preventive strategies:

• Maintain a healthy weight and body composition
• Regular exercise, emphasizing both cardio and strength training
• Anti-inflammatory diet rich in antioxidants
• Stress management and good sleep hygiene
• Regular health screenings and check-ups

By addressing the underlying factors of PCOS and maintaining a healthy lifestyle, many of these risks can be significantly reduced.

Last updated: November 19, 2024