Are you one of the 5-10% of women diagnosed with Polycystic Ovarian Syndrome (PCOS)? If so you are in good company, as this is by far the most common reproductive disorder I see in my practice.
So what is PCOS? First, it is not a disease but a syndrome - meaning there are several symptoms that tend to collect together to cause malfunction. With PCOS, the most common symptoms are:
Menstrual Irregularities - this ranges from long, heavy periods to irregular and scant to no periods at all (amenorrhea). This can lead to fertility trouble when trying to conceive, as ovulation is typically absent as well.
Hormonal imbalance - Elevated levels of insulin, and androgens lead to high blood sugar levels, facial hair growth and acne.
Difficulty with weight - Not that weight loss is ever easy, but PCOS ladies tend to have even more difficulty losing weight if overweight, and tend to collect fat around the belly at a faster rate.
Ovarian cysts - as the name suggests, some women have cysts on their ovaries that can be small and painless, or large and painful and potentially dangerous. Not all women with PCOS actually have cysts, in fact most of my patients do not.
Getting to the root
Insulin resistance with high blood sugar is understood to be one of the main drivers of PCOS. Put simply, higher than normal levels of insulin negatively impact the ovaries leading to irregular levels of hormonal output causing the symptoms listed above. So, to control this and improve ovarian function the typical lifestyle change is to limit carb intake, exercise and work on weight loss. Metformin is a diabetes drug that is commonly prescribed to bring down blood sugar as well.
That’s cool, but…. let’s dig a little deeper. PCOS isn’t just about carbs. Why does one become insulin resistant in the first place? There are a few likely scenarios…
Low grade inflammation is at the heart of many chronic conditions (think heart disease, diabetes, cancer, etc) and PCOS is among those. We know this because women with PCOS tend to have high levels of certain blood tests that indicate chronic inflammation. Inflammation is the set of events that are triggered by some type of injury or insult to the body, with the ultimate goal of healing. If you cut your hand while cooking, immune system “healer” cells travel to your injury to work on fixing it, and you may notice the typical signs of heat, redness, and puffiness to the affected area. Chronic / low grade inflammation is the same process, except on a less dramatic and visible scale. In chronic inflammation the injury to the body is constant but small, and the inflammatory response never turns off.
What types of injury contribute to this inflamed state? A bunch! Too much sugar and refined grains and oils, not enough colorful vegetables and omega-3 fats, smoking, excessive drinking, infections, obesity (especially around the middle), as well as the state of our digestion (see below). These habits and conditions generally lead to a state of unwell, and PCOS can start to brew.
Stress is an extremely under-appreciated element of wellness and health. When we are constantly worried, stressed, anxious we are releasing the stress hormone cortisol from our adrenal glands. This hormone is essential under acute stress (like running away from a tiger), but starts to cause havoc when elevated for too long. Longterm high cortisol output leads to high blood pressure and blood sugar, weight gain around the middle, carbohydrate cravings, decreased libido and immunity. So this stress can drive the impaired immunity and insulin resistance related to both chronic inflammation and PCOS. Full circle.
It’s important to note here that stress doesn’t just mean feeling “stressed out.” Other habits also cause the body to be in a stressed state - most noteably lack of sleep- measured in quality or quantity. When we aren’t getting enough hours (7-9 hours nightly) or those hours are very interrupted, we will also be in a state of chronic stress with the same symptoms outlined above. Similarly, excessive high volume and intensity exercise not balanced with enough restorative movement and sleep falls in this same category.
The gut microbiota (aka the “good” bacteria that reside in the large intestine) is a hot area of research and nutrition right now. Dysbiosis of the gut - too many “bad” bacteria and not enough “good” bacteria is usually caused by a low fiber diet and/or overuse of antibiotics. Not only can this lead to a lot of digestive symptoms, but also activate the immune system that regulates inflammation and contributes to the whole cycle of inflammation - insulin resistance - hormonal disruption.
Phew. That was a brain-full. Stay tuned for part 2 of PCOS where I discuss foods to include and avoid, and a bit about meal timing.