Polycystic ovary syndrome (PCOS), also known as polycystic ovarian syndrome, is the most common endocrine disorder in women. It is estimated that PCOS impacts 1 in 10 women between the ages of 15 and 44, with most women being diagnosed in their 20’s or early 30’s. As much as 70 percent of infertility challenges women face are due to PCOS.

How do I know I have PCOS?

PCOS is a condition that impacts women of reproductive age with irregular menstrual cycles and a wide variety of symptoms such as infertility, acne, excess facial hair, and weight gain. Polycystic ovary syndrome gets its name from the tiny cysts that form around the rim or outside rim of the ovary.

Additionally, women with PCOS have elevated androgens, which are a group of sex hormones that give men their male characteristics such as testosterone or the adrenal androgen DHEA.

PCOS is a problem with the production and function of estrogen where metabolic problems manifest alongside reproductive problems.

The form of estrogen that’s made from the ovaries, called estradiol, works on every organ system because we have estrogen receptors everywhere throughout the body. If a woman doesn’t have proper function of those receptors or enough estrogen to fit into those receptors, she will have issues with virtually every organ system, which is what we see in women with PCOS.

To learn more about PCOS, check out my podcast episode 52 below with Dr. Felice Gersh, founder and director of the Integrative Medical Group of Irvine. You can also find the Eat For Life podcast on Apple Podcasts, Spotify, Google Podcasts, or wherever you listen to podcasts!

What are the first signs of PCOS?

PCOS manifests differently for each woman, but for many, the first signs of PCOS are irregular and infrequent periods, often with heavy bleeding, clots, and severe pain. Many of the women I’ve worked with in my clinic also experience anger, irritability, anxiety, panic attacks, depression, difficulty concentrating, fatigue, food cravings with a desire to binge eat, along with headaches and insomnia.

You may not have all of these symptoms or they may be milder. For example, not every woman with PCOS experiences severe period pain. Every woman is different and will therefore have different symptomatology.

PCOS Symptoms

• Abnormally heavy periods
• Acne
• Anxiety
• Dark or thick skin patches
• Depression
• Digestive problems
• Disordered eating
• Elevated copper levels
• Excess facial and/or body hair (hirsutism)
• Headaches
• Infertility
• Insomnia
• Insulin resistance
• Irregular/infrequent periods
• Male-pattern baldness or thinning hair
• Metabolic syndrome (high cholesterol, blood pressure, blood sugar)
• Miscarriage
• Ovarian cysts
• PMS and PMDD
• Skin tags
• Sleep apnea
• Weight gain

Irregular periods are a red flag something is wrong.

I was briefly on the birth control pill in my 20s. My doctor told me I could cycle it to have a period only four times a year. I was told this was safe and healthy. Back then I thought it was a great idea and so much less of a burden than dealing with a monthly cycle but the long-term repercussions were tremendous.

It would take years to achieve normalcy with my cycle. Understanding my unique biochemistry (with lab testing) along with diet and lifestyle changes was the key to my transformation and so many women I’ve been blessed to work with.

Hormones are not just about maintaining a menstrual cycle. They are integral to every function in every part of your body. The menstrual cycle is a vital sign of female well-being. When menstruation is dysregulated, this is a serious sign something is wrong.

If the right hormones aren’t being produced in the right rhythms, not only are you going to have fertility and period problems but you’re also going to have problems with other parts of your body because all of these hormones are involved in brain function. So you’re more likely to have a mood disorder and even brain fog.

Dysregulated hormones also impact your cardiovascular and immune systems, therefore creating a state of low-grade chronic inflammation. Keep in mind blood clotting is an inflammatory response.

So in essence, your blood vessels, heart, brain, skin, vagina, and bladder are all impacted by this inflammation.

What happens when you have polycystic ovaries?

Women with PCOS are not adept at converting testosterone into estradiol. Estradiol comes from testosterone and it’s converted in the ovaries using an enzyme called aromatase, so essentially you end up with a surplus of testosterone and a deficiency of estradiol. This causes the brain to put out a signal through the pituitary gland to make more luteinizing hormone (LH), which is the hormone from the pituitary gland that tells the ovary to make more testosterone.

So the ovaries make more testosterone and not enough estrogen in the form of estradiol, which causes the brain to keep pushing out more testosterone and less estrogen. Then you end up with too much testosterone in your body leading to cystic acne, facial hair, and androgenic alopecia, which is the female version of male pattern baldness. 

This process creates hormone receptors (specifically estrogen receptors) that don’t work well. Estrogen also regulates metabolism, which is the creation, distribution, utilization, and storage of energy. Because estrogen is dysregulated, women with PCOS are not as good at creating energy, including burning fat and transporting glucose into cells.

Then you end up having dysregulation of the immune system, which also has estrogen receptors. Inflammation occurs because the immune cells are not well regulated. The gut, which has a special, complex microbiome, is also dependent on having proper estrogen to maintain the healthy cells that line it. Women with PCOS have leaky gut because the wrong cells are living among the microbes, which creates another cascade of inflammation and insulin resistance.

Syndrome simply means there is a spectrum of symptoms. Now that we understand PCOS better, we know that there are two different types and variations within those types.

The Adrenal Type of PCOS

The adrenal type is called acquired adrenal hyperplasia or Cushing syndrome, which involves the adrenal glands. You have two adrenal glands and each one sits on top of your kidneys. They’re small but do a lot to produce hormones that help regulate stress, blood pressure, metabolism, and your immune system.

In a healthy woman of reproductive age, half of her body’s testosterone comes from the ovaries and half comes from each adrenal gland, which is controlled by the brain through the pituitary gland.

In PCOS, the adrenal glands are not producing the proper amounts of certain types of hormones such as cortisol and DHEA. When this occurs, side effects include problems with sleeping, loss of muscle mass (usually in the arms and legs with a heavier middle), facial hair, and acne.

The Ovarian Type of PCOS

80% of women with PCOS fall under the ovarian type that I described previously where there’s a problem converting testosterone into estrogen in the ovaries, so you end up with a surplus of testosterone and a deficiency of estrogen. PCOS is not a problem of estrogen dominance. It is a problem of androgen excess.

I am often asked what is the “main” cause of PCOS but in truth, there are multiple underlying causes that contribute to PCOS. In my opinion, PCOS is an autoimmune condition that targets sex hormones but actually impacts the entire body.

PCOS and Gut Dysbiosis

A major underlying factor is dysbiosis of the gut microbiome. Dysbiosis simply means abnormal life forms and the wrong balance of microbial populations (more opportunistic and pathogenic microbes that create inflammation along with low keystone species).

Dysbiosis also causes loss of the protective mucus coating in the GI tract. This coating helps to protect lining cells called enterocytes that line the small and large intestine. These lining cells are very close to one another, but with just enough space for important nutrients to pass through into the body for nourishment.

Additionally, immune cells have little fingers called dendritic cells that link your innate and adaptive immunity and are critical for protection against pathogens. They poke their little fingers between cells to actually check what’s going on, much like a human antenna. They assess what’s going on inside the gut and communicate that information with the rest of the immune system, which in turn communicates with the brain.

Women with PCOS lose the protective mucus coating, which allows toxins in the gut (along with the wrong bacteria) that in turn create system-wide inflammation and an impaired gut barrier, also known as leaky gut.

If you were given lots of antibiotics and inoculations as a baby, toddler, and teen, you are more susceptible to developing PCOS and autoimmunity. Any woman can have an impaired gut barrier, but women with PCOS are more prone to it because they don’t make enough estrogen. Balanced estrogen is critical to a healthy gut microbiome.

To learn more about the gut-brain connection, click here.

PCOS and Hashimoto’s

As I shared previously, I believe PCOS is an autoimmune condition. And women with PCOS have been shown in the medical literature to have higher rates of Hashimoto’s thyroiditis, also called autoimmune thyroid disease. Unless treated, autoimmunity can impact other body systems, thus leading to other autoimmune diseases.

It’s fascinating how leaky gut is related to increasing the inflammation that underlies so many of the problems that women with PCOS and Hashimoto’s have. This chronic state of inflammation has everything to do with a dysbiotic gut microbiome and the increased risk of autoimmunity that results.

Additionally, women with thyroid autoimmunity have more problems with fertility and pregnancy, yet still, today, most gynecologists and obstetricians are not testing for thyroid antibodies. A full thyroid panel should be routine for every woman, but especially those with PCOS because your risk of having Hashimoto’s is so much higher.

Doctors tell women all the time once they have an autoimmune disease they can never reverse it, but that is simply not true. If you are proactive and test at the first sign of symptoms, there is so much you can do to reverse it but you must be on top of it before the disease progresses.

PCOS and Copper Toxicity

I’ve been writing and advising women for over a decade about the role copper toxicity plays in women with hormonal dysregulation. This is because when copper is elevated, it becomes a pro-inflammatory agent.

While it’s true that copper and estrogen share an intimate relationship with one another, not all women with copper overload are estrogen dominant, and this is what I see in women with PCOS. Elevated copper raises the sympathetic nervous system leading to panic, anxiety, and sometimes paranoia. Falling blood sugars during these times lead to an increased risk for psychotic episodes (dysregulated sensory processing and confusion).

Copper overload lowers dopamine and increases norepinephrine in the brain, and also has a profound effect on the adrenal glands and endocrine system.

Imbalances in these important neurotransmitters are associated with depression (especially postpartum depression), headaches, temper control problems, anger and rage, hyperactivity (especially in children), and ADHD.

Additionally, copper is needed to make blood vessels, which is why copper naturally increases with pregnancy. It’s an important metal needed for the body to function optimally, but when it gets out of control, fibroids, cysts, and polyps can grow, all of which are made out of blood vessels.

Many doctors tell women the copper IUD is a safe, non-hormonal birth control option. This couldn’t be further from the truth. Get the facts here.

To learn more about copper toxicity, click here.

PCOS and Methylation

Methylation is a chemical reaction that occurs in every cell and tissue in the body, except for red blood cells. It regulates many substances that are necessary for the body to function. Our bodies possess an on-off switch for certain hormones, neurotransmitters, enzymes, and various chemicals known as methyl groups (Me).

A Me is made up of one carbon atom bonded with three hydrogen atoms. These methyl groups can drastically alter how you think, feel, and act.

If you don’t make enough methyl groups to attach to hormones and neurotransmitters (called undermethylation), they won’t function properly. The result is low levels of dopamine, serotonin, and norepinephrine. Sex and stress hormones also become dysregulated.

We get our methylation status in-utero from one or both parents, which is why I always test it in my clinic. Keep in mind genetic tests such as MTHFR (which is a backup pathway and at best only 30% expressive) are not accurate markers for methylation status.

PCOS Treatment

Unfortunately, the conventional treatment for PCOS is to put women on birth control pills and metformin to regulate blood sugar levels, but this is merely a bandaid approach and doesn’t get to the root cause of the problem. The long-term side effects just aren’t worth it such as fertility, digestive, immune system, and cardiovascular problems that can lead to further autoimmunity.

Additionally, the birth control pill is made from synthetic equine (horse) hormones your body does not recognize and is an endocrine disrupter that suppresses all hormones by shutting down the ovaries. Hormone suppression, especially over a period of several years, leads to the aforementioned problems. Plus the birth control pill contains a mild antibiotic, which dysregulates the gut microbiome leading to bacterial and/or yeast overgrowth and leaky gut.

Long-term downstream effects of the birth control pill include hypertension, blood clots, bone loss, depression, recurrent bladder and yeast infections, and cardiovascular events such as heart attack and stroke.

In addition to depleting important nutrients such has vitamin B12, Metformin stresses the liver, making it difficult for your body to detox properly. More troubling is that it comes with a black box warning because it could cause lactic acidosis, a condition that occurs when too much lactic acid builds up in the bloodstream.

If you are currently taking Metformin, you should know that the FDA recalled extended-release options in May 2020 due to high levels of N-nitrosodimethylamine (NDMA), a known carcinogen (cancer-causing agent) used in the formulation.

Most doctors don’t give informed consent about the possible side effects of medications. Please don’t be afraid to ask questions. If your doctor gaslights you, or becomes defensive and makes you feel uncomfortable, find another doctor.

How to Reverse PCOS

In my clinic, I run lab tests to ascertain a woman’s biochemical status in addition to gut testing. These include stool (GI Map and/or BiomeFx), functional thyroid markers including antibodies, hormone panel, CBC, metabolic panel, lipids, copper panel, zinc, urine kryptopyrrole, and methylation. Other helpful markers include homocysteine, HR CRP, 25-hydroxy vitamin D, and fasting insulin. This is not an exhaustive list and every woman is unique, but I find these to be very helpful.

The next step is to take a good inventory of what you are eating. You can get a dysbiotic gut microbiome just by eating processed and chemically-laden foods that add more fire to an already chronic state of low-level inflammation, which in turn exacerbates insulin resistance. Increased circulating blood sugar creates more obesity, which is why I always start every one of my PCOS clients on a gut rehab program.

Most foods today are sprayed with glyphosate, even those beloved gluten-free oats and oat milk many women have for breakfast, which also spikes insulin precipitously. Gluten-free is merely a marketing term as most gluten-free products still contain gluten, including restaurant menus, so a grain-free diet is encouraged.

Next, consider personal care and cleaning products including skincare, cosmetics, shampoo, laundry detergent, and spray cleaners. Like the birth control pill, it’s been proven that many of these products contain endocrine-disrupting chemicals that have a detrimental effect on the brain and body. I personally love Ayla skincare but there are many other brands that don’t use harsh chemicals.

Strength and resistance training, even for 20 minutes a day, has been shown to be effective for PCOS sufferers in balancing hormones and reducing insulin resistance. Be careful with heavy cardio as that can spike cortisol and insulin. I find gentle yoga, walking, and cycling to be safe.

PCOS and Fertility

If you have PCOS and are trying to conceive, the very best thing you can do is optimize your diet and correct any biochemical imbalances, including cleaning up your gut microbiome. I have seen dramatic shifts in the ability to conceive when these healing practices are put into place.

Statistically, women with PCOS have very low rates of success with IVF because of the underlying problems discussed in this post and because they don’t have good-quality embryos. It’s difficult to conceive with an inflamed body. I have found dramatically higher success rates and a dramatically lower rate of pregnancy complications such as gestational diabetes, hypertension, preeclampsia, and preterm delivery when health is optimized prior to conception.

Nutrition Therapy To Help You Thrive

If you’d like to understand how PCOS may be impacting you, let’s look at identifying and addressing the root biochemical causes and imbalances of your symptoms, which includes testing and analysis.

I offer a free 1:1 consultation to help you disconnect from the hype and the marketing jargon, and address the true source(s) of your discomfort.

I encourage you to consider how diet, environment, and your gut microbiome are playing into your struggle with PCOS. If you have a loved one that is suffering from PCOS, please share this post.

References

Singla R, Gupta Y, Khemani M, Aggarwal S. Thyroid disorders and polycystic ovary syndrome: An emerging relationship. Indian J Endocrinol Metab. 2015;19(1):25-29. doi:10.4103/2230-8210.146860.

Ricardo Azziz, et al. The Androgen Excess and PCOS Society criteria for the polycystic ovary syndrome: the complete task force report, Fertility and Sterility, Volume 91, Issue 2, 2009, Pages 456-488, ISSN 0015-0282.

Salvatore Benvenga, et al. Endocrine disruptors and thyroid autoimmunity, Best Practice & Research Clinical Endocrinology & Metabolism, Volume 34, Issue 1, 2020,101377, ISSN 1521-690X, https://doi.org/10.1016/j.beem.2020.101377.

J.J. Amaral Mendes, The endocrine disrupters: a major medical challenge, Food and Chemical Toxicology, Volume 40, Issue 6, 2002, Pages 781-788, ISSN 0278-6915.

Khan M. Firoze, Wang Hui, Environmental Exposures and Autoimmune Diseases: Contribution of Gut Microbiome, Frontiers in Immunology, Volume 10, 2020, ISSN=1664-3224, DOI=10.3389/fimmu.2019.03094.

Dunaif, Andrea, Insulin Resistance and the Polycystic Ovary Syndrome, Mechanism Endocrine Reviews, Volume 18, Issue 6, 1 December 1997, Pages 774–800.

Nidhi R, Padmalatha V, Nagarathna R, Ram A. Effect of a yoga program on glucose metabolism and blood lipid levels in adolescent girls with polycystic ovary syndrome. Int J Gynaecol Obstet. 2012 Jul;118(1):37-41. doi: 10.1016/j.ijgo.2012.01.027. Epub 2012 Apr 14. PMID: 22507264.

Lisa J. Moran, et al. Dietary Composition in the Treatment of Polycystic Ovary Syndrome: A Systematic Review to Inform Evidence-Based Guidelines, Journal of the Academy of Nutrition and Dietetics, Volume 113, Issue 4, 2013, Pages 520-545, ISSN 2212-2672.

Balen, Adam H. Polycystic ovary syndrome (PCOS). The Obstetrician & Gynaecologist 19.2 (2017): 119-129.

John W. Crayton, William J. Walsh, Elevated serum copper levels in women with a history of post-partum depression, Journal of Trace Elements in Medicine and Biology, Volume 21, Issue 1, 2007, Pages 17-21, ISSN 0946-672X.