Colleen found her way into our office because she had just been diagnosed with PCOS and was struggling to get pregnant. She had all the classic signs; irregular periods, acne, and a hard time losing weight. We figured out that in addition to her cycles being very long, she also wasn’t ovulating. It’s no wonder she couldn’t get pregnant!  

1 in 10 American women are dealing with what has been named Polycystic Ovarian Syndrome, or PCOS. The name is a little misleading, since those ovarian cysts aren’t real cysts, and you don’t even need to have them to be diagnosed with the condition. These new findings have led the medical community on a hunt to find a more fitting name.

Until then, let’s just talk a little about what PCOS really is, how it’s diagnosed, and what you can do about it if you have been diagnosed.

At its core, PCOS is a hormonal issue. If you truly do have PCOS, your blood test will show high androgens, or male hormones, without another explanation. You’ll also have a high luteinizing hormone (LH) to follicle stimulating hormone (FSH) ratio. If your FH to FSH ratio is low, there’s a good possibility that you don’t have PCOS, but instead have something called hypothalamic amenorrhea. This is frequently misdiagnosed as “lean PCOS” and caused by overexercising or undereating.

Another possibility in a small percentage of women is a genetic condition called congenital adrenal hyperplasia. This condition has many of the same symptoms of PCOS but is treated differently.

Once you’ve been properly diagnosed, the next step is to figure out what kind of PCOS you have. According in Dr. Lara Briden, author of Period Repair Manual, there are 4 types of PCOS, and each type should be treated a bit differently.

The first type, which represents about 70% of all cases, is Insulin Resistant PCOS. In addition to high androgen levels, you’ll also have high insulin. Glucose and HbA1c blood tests are good to have, but they can’t diagnose insulin resistance. For that you need to have your insulin levels checked.

If your androgens (and FH) are high but your insulin is normal, the next step on the diagnosis train is Post Pill PCOS. Some women, after going off hormonal birth control (this includes the pill, hormonal IUD’s, the patch, the shot, etc.) will get a spike of androgens as their own hormones adjust to not getting synthetic hormones anymore. This spike can last up to 6 months and can cause acne, irregular periods and body hair growth. So if you’re having symptoms of PCOS, you just went off the pill, you didn’t have these issues before you went on hormonal birth control, and you don’t have high insulin; chances are high that you’ve got a temporary condition called Post-Pill PCOS.

The third type of PCOS is called Inflammatory PCOS. Technically, all PCOS has a level of inflammation involved, but if you have PCOS, aren’t coming off hormonal birth control, and don’t have insulin resistance, then you could have underlying inflammation as the root cause of your PCOS. In this case, there’s always some other condition or symptom that is the root cause of inflammation, like IBS or SIBO, headaches, joint pain, rashes, etc.

Finally, we get to the fourth and last type of PCOS. If you’ve gotten this far, you’re a rare bird. Adrenal PCOS is only diagnosed if you don’t fit into any of the first 3 categories. This is caused by an abnormal response to stress. In this case, not all of your androgen hormones will be elevated, instead just your DHEAS will be high.

Remember Colleen, from earlier? She ended up having insulin resistant PCOS. Here are the steps we took to get her ovulating, losing weight, and eventually pregnant!

1.     Diet

A main driver of insulin resistance is a diet full of processed foods and simple sugars. So we switched Colleen to a whole foods diet full of fresh fruits and vegetables, meats and seafood, nut and seeds, and healthy fats. At the beginning of the diet she stayed away from most grains and legumes, but as she started to feel better, she was able to add whole grains, beans and lentils back into her diet with no ill effects.

 There’s quite a bit of research that shows that a whole food, Mediterranean Diet lowers both insulin resistance and androgen levels in women with PCOS.

2.     Exercise

While extra testosterone does come with negative side effects for women, like acne and unwanted hair growth (or hair loss!), one of its benefits is that it makes you stronger. I asked Colleen to start weightlifting in order to take advantage of this fact. She started out lifting comfortable amounts of weight, to avoid injury, then gradually increased her weight. It turned out to be something that she really enjoyed; it relieved stress and she was actually good at it.

Building muscle mass, especially when added to a healthy diet, not only burns more fat, making it easier to lose weight, but it also stabilizes your insulin levels.

 3.     Supplements and Herbs

With the foundation of diet and exercise, we turned our attention to other things we could add to speed the process along. Myo-inositol powder helps to regulate blood sugar, and magnesium glycinate provides some building blocks for hormones, as well as being beneficial for muscle relaxation and sleep. So we added those 2 supplements to a custom herbal formula to balance her hormones.

4.     Acupuncture

Colleen came in for acupuncture once a week for 2 months, and then every other week for another few months until she got pregnant. (She did continue monthly treatments during pregnancy to address all the lovely issues that come along with that, but that’s a whole different blog post.) Acupuncture lowers stress and allows your body to regulate and balance its own hormones. I find that this works better in most women than giving hormone replacement, since in the end, your endogenous hormones can better respond to the complex processes in the body. Insulin, cortisol, thyroid, and sex hormones all interweave and affect each other’s feedback loops. It’s a very elegant dance that our bodies do to keep us alive and healthy, and herbs and acupuncture are subtle enough to affect that without causing side effects.

Since PCOS is really just a collection of symptoms that affect your hormones, it isn’t a death sentence. By treating the root of the issue, it is possible to reverse it. And once your labs are normal, you no longer have PCOS. Of course, you’re always more susceptible to having it return if the diet and lifestyle habits you created while treating it go to the wayside. But having reversed it once, you’ll have the tools you need to do it again.

If you’re struggling with PCOS and live in the Greenville area, I’d love to help you tackle your issue.

Author:
Elizabeth Williams, LAc is an acupuncturist and herbalist in Greenville, South Carolina, specializing in women’s health, digestive issues, psycho-emotional issues and chronic illness. She’s passionate about helping people feel their best and sharing her wealth of knowledge with the community. Elizabeth is the owner of Dragonfly Acupuncture & Massage on Wade Hampton Boulevard. Appointments can be made by calling 864-451-4313 or scheduled online.