How You Can Overcome PCOS

Written by Stephanie Deppe, M.D.

A diagnosis of PCOS can be frustrating for women experiencing typical symptoms, such as menstrual irregularities, acne, weight gain, or unwanted body hair. For women who are trying to conceive, it can be heartbreaking. I know this first-hand having been diagnosed with PCOS during my own infertility journey. Fortunately, PCOS does not have to be a permanent illness. Understanding and correcting the underlying causes of PCOS can help you reverse your symptoms and achieve optimal hormonal health. Through intensive lifestyle and nutraceutical interventions, I was able to overcome my own PCOS and conceive a healthy daughter.

What is PCOS and why does it matter?

PCOS affects between 10-20% of women worldwide. The features of PCOS can include insulin resistance, dysfunctional estrogen signaling, higher than normal levels of androgens (testosterone and androstenedione), elevated stress hormones, and chronic low-grade inflammation (1, 2). About 80% of women with PCOS are overweight or obese, and 70% of women have insulin resistance (1). Even if you don’t have the telltale symptoms, you should consider being tested if you are struggling with irregular menstrual cycles or are dealing with infertility. I was surprised to learn of my diagnosis given that I fell within the 20% of women who are thin, and I thought that I led a fairly healthy lifestyle.

Even for women who are not trying to conceive, a diagnosis of PCOS should not be ignored. Women with PCOS are at higher risk of other diseases. Diseases associated with chronic inflammation, including obesity, heart disease, diabetes, hypertension, and fatty liver occur more often in women with PCOS (1). They also have a three times higher likelihood of autoimmune diseases, such as Hashimoto’s thyroiditis, as compared to other women (1). Women with PCOS also have a high prevalence of gut related disorders, including IBS, intestinal permeability, and gastric reflux (1). For women who become pregnant, rates of prenatal complications, including miscarriage, low or high birth weight, and gestational diabetes are higher (3).

What causes PCOS?

The etiology of PCOS is complicated, and there seems to be a variety of contributing factors. These include genetics, environmental exposures in the womb, insulin resistance and high levels of androgens (4). One major concern is environmental chemical exposures. Bisphosphenol A (BPA) is a chemical compound and potent endocrine-disruptor, and it is unfortunately ubiquitous in our everyday lives. It is found in water bottles, aluminum cans, food container linings, and much more. In animal studies, exposure to BPA in utero or early life resulted in hormonal abnormalities, including altered menstrual cycles and abnormal levels of sex hormones (6). Furthermore, women with PCOS have been found to contain higher blood concentrations of BPA than controls (5).

Why does it cause irregular cycles?

The molecular signaling that happens in PCOS is complex. In a normal ovulatory cycle, the hypothalamus (a gland in the brain) produces a signaling hormone known as GnRH, which stimulates the pituitary gland to make the hormones, FSH and LH. These hormones tell the ovaries to grow follicles (tiny fluid-filled sacs containing eggs). Specifically, LH stimulates the ovaries to make androgens (androstenedione and testosterone), which are converted into estrogen under the direction of FSH. One of these follicles will eventually mature, and a surge of LH will cause it to rupture and release an egg for fertilization (i.e. ovulation).

In PCOS, however, inadequate levels of estrogen are produced, and so the brain secretes more LH in an effort to raise estrogen levels. Unfortunately, this just results in excess levels of androgens. This also recruits more follicles to grow, which is why women with PCOS have polycystic ovaries. Levels of another hormone, anti-mullerian hormone (AMH), rise as more follicles develop. This is why women with PCOS tend to have high levels of AMH and a high ratio of LH to FSH. Ultimately, the defect in converting estrogen to testosterone prevents the brain from seeing the high levels of estrogen that are required to provoke the LH surge, which induces ovulation.

The role of insulin resistance

Most–although not all–women with PCOS have insulin resistance. Why does it matter? High levels of insulin signal the ovaries to make more androgens, testosterone and androstenedione (7). Higher levels of insulin are also associated with lower levels of sex hormone binding globulin (SHBG), which is a protein that binds testosterone in the blood (8, 9). This explains why women with PCOS and insulin resistance have higher androgen levels than they should. Research has shown that improving insulin sensitivity in women with PCOS–regardless of whether they are thin or obese or have normal of elevated levels of fasting insulin–actually actually results in lower levels of circulating androgens (10,11).

How to Reverse PCOS and Balance Your Hormones

1. Reduce your exposure to endocrine disruptors, especially BPA–found in aluminum cans, cash register receipts, airline boarding passes, water bottles, plastic food containers, amongst others. You can learn more on the Environmental Working Group (EWG) website: Dirty Dozen Endocrine Disruptors | Environmental Working Group (ewg.org). Taking specific supplements can also assist with detoxification support for existing BPA exposure.

2. Improve your insulin sensitivity. A blood test can determine if you have insulin resistance, and it can also check your levels of androgens. Reversing any insulin resistance can help reduce body levels of androgens and balance your hormones. This may help alleviate symptoms of high androgens, such as facial hair and acne. Insulin sensitivity can be improved through lifestyle changes–including a very low-carbohydrate diet, avoiding skipped meals, aerobic and high-intensity interval exercise, stress reduction, and optimizing vitamin D levels–along with supplementation of critical nutrients and prescription medications when appropriate.

3. Get your cortisol levels tested. Cortisol is a glucocorticoid (steroid hormone) made in the adrenal gland, which is released in response to stress, such as every day emotional stressors. Chronic exposure to glucocorticoids leads to insulin resistance (12). Addressing your adrenal health is an important component of treating insulin resistance by normalizing cortisol. Your adrenal health can be evaluated through a simple salivary test, and specific lifestyle and nutraceutical interventions can help correct any abnormalities.

4. Optimize your gut health. Emerging data shows a convincing association between the health of the gut microbiome and insulin sensitivity and hormonal balance. Disruption of gut flora can lead to several hormone-related conditions, including PCOS (13, 14). Preliminary research has demonstrated that a healthy gut microbiome may improve insulin resistance and prevent diabetes (15). Simple changes such as eating a diverse, plant-rich diet and taking probiotics may improve your gut health. A functional stool test can be done to uncover any issues and guide targeted treatments.

5. Consider hormone support with bioidentical hormones. In cases of inadequate hormone production or issues with ovulation timing, the use of bio-identical hormones can be helpful. A month-long hormone evaluation panel (for cycling women) can show any deficiencies or imbalances of estrogen and progesterone. Supporting the cycle with natural hormones that are identical in chemical structure to the body’s own hormones can help correct these issues. Women who are not menstruating at all due to PCOS can also benefit from bioidentical hormones.

I hope this information is as helpful for you as it has been for me in overcoming my own challenges with PCOS. Best wishes for your health and well-being.

To your health,

Dr. Deppe

Resources:

1. Klatz R, Goldman R, editors. Anti-Aging Therapeutics Volume XVII. Chicago: American Academy of Anti-Aging Medicine; 2015.

2. Tock L, Carneiro G, Pereira AZ, Tufik S, Zanella MT. Adrenocortical Production Is Associated with Higher Levels of Luteinizing Hormone in Nonobese Women with Polycystic Ovary Syndrome. International Journal of Endocrinology [Internet]. 2014;2014:1–7. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033536/

3. ‌Alshammari A, Hanley A, Ni A, Tomlinson G, Feig DS. Does the presence of polycystic ovary syndrome increase the risk of obstetrical complications in women with gestational diabetes? The Journal of Maternal-Fetal & Neonatal Medicine. 2010 May 21;23(6):545–9.

4. Goodarzi MO, Dumesic DA, Chazenbalk G, Azziz R. Polycystic ovary syndrome: etiology, pathogenesis and diagnosis. Nature Reviews Endocrinology [Internet]. 2011 Jan 25;7(4):219–31. Available from: https://www.nature.com/articles/nrendo.2010.217

5. Tarantino G, Valentino R, Somma CD, D’Esposito V, Passaretti F, Pizza G, et al. Bisphenol A in polycystic ovary syndrome and its association with liver-spleen axis. Clinical Endocrinology. 2013 Jan 25;78(3):447–53.

6. ‌Sobolewski M, Barrett E. Polycystic Ovary Syndrome: Do Endocrine-Disrupting Chemicals Play a Role? Seminars in Reproductive Medicine [Internet]. 2014 Apr 8;32(03):166–76. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4086778/

7. Micic D, Popovic V, Nesovic M, Sumarac M, Dragasevic M, Kendereski A, et al. Androgen levels during sequential insulin euglycemic clamp studies in patients with polycystic ovary disease. Journal of Steroid Biochemistry. 1988 Dec;31(6):995–9.

8. ‌Daka B, Rosen T, Jansson PA, Råstam L, Larsson CA, Lindblad U. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocrine Connections. 2013 Mar;2(1):18–22.

9. ‌Baptiste CG, Battista M-C, Trottier A, Baillargeon J-P. Insulin and hyperandrogenism in women with polycystic ovary syndrome. The Journal of Steroid Biochemistry and Molecular Biology [Internet]. 2010 Oct;122(1-3):42–52. Available from: https://www.sciencedirect.com/science/article/abs/pii/S0960076009003033

10. ‌NESTLER JE, POWERS LP, MATT DW, STEINGOLD KA, PLYMATE SR, RITTMASTER RS, et al. A Direct Effect of Hyperinsulinemia on Serum Sex Hormone-Binding Globulin Levels in Obese Women with the Polycystic Ovary Syndrome*. The Journal of Clinical Endocrinology & Metabolism. 1991 Jan;72(1):83–9.

11. NESTLER JE, BARLASCINI CO, MATT DW, STEINGOLD KA, PLYMATE SR, CLORE JN, et al. Suppression of Serum Insulin by Diazoxide Reduces Serum Testosterone Levels in Obese Women with Polycystic Ovary Syndrome*. The Journal of Clinical Endocrinology & Metabolism. 1989 Jun;68(6):1027–32.

12. ‌Geer EB, Islam J, Buettner C. Mechanisms of Glucocorticoid-Induced Insulin Resistance. Endocrinology and Metabolism Clinics of North America. 2014 Mar;43(1):75–102.

13. ‌Qi X, Yun C, Pang Y, Qiao J. The impact of the gut microbiota on the reproductive and metabolic endocrine system. Gut Microbes [Internet]. [cited 2021 Oct 6];13(1):1894070. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7971312/

14. ‌He S, Li H, Yu Z, Zhang F, Liang S, Liu H, et al. The Gut Microbiome and Sex Hormone-Related Diseases. Frontiers in Microbiology. 2021 Sep 28;12.

15. ‌Chen Z, Radjabzadeh D, Chen L, Kurilshikov A, Kavousi M, Ahmadizar F, et al. Association of Insulin Resistance and Type 2 Diabetes With Gut Microbial Diversity: A Microbiome-Wide Analysis From Population Studies. JAMA Network Open [Internet]. 2021 Jul 29 [cited 2021 Oct 27];4(7):e2118811–1. Available from: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782527