PCOS – Polycystic Ovarian Syndrome
Fertility struggles, weight gain, and poor metabolic health are only a few of the symptoms associated with this complex hormone condition. Functional medicine offers true hormone balance for those seeking to manage PCOS symptoms with or without the use of conventional hormone treatment.
PCOS Affects 1 in 10
Polycystic ovary syndrome (PCOS) is a complex hormonal disorder that affects many aspects of a woman’s health, including her reproductive, metabolic, and cardiovascular systems. It’s characterized by a range of symptoms and potential complications that can significantly impact a woman’s quality of life. PCOS is a common condition, affecting approximately 1 in 10 women of childbearing age, making it one of the most prevalent endocrine disorders.
Commonalities in PCOS
PCOS is known to vary widely from woman to woman. However, there are common hallmarks of the condition:
Irregular Menstrual Cycles
Women with PCOS often experience irregular or infrequent menstrual cycles, sometimes with long gaps between periods.
Hyperandrogenism
This refers to elevated levels of male hormones (androgens) such as testosterone. It can lead to symptoms like acne, excessive hair growth (hirsutism), and male-pattern baldness.
Polycystic Ovaries
Despite the name, not all women with PCOS have ovarian cysts. The term “polycystic” refers to the appearance of the ovaries on an ultrasound, where multiple small follicles may be seen.
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Types of PCOS
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The 4 PCOS Subtypes
Insulin-Resistant PCOS
Insulin-Resistant PCOS is the most common subtype, affecting about 70% of women with PCOS. This type is characterized by high levels of insulin in the blood, which commonly leads to weight gain, acne, and excessive hair growth. Insulin-resistant PCOS is often thought of as the “classic” presentation of PCOS, leading to misdiagnosis when symptoms don’t match this criteria.
Women with this subtype often struggle with obesity and are at increased risk for type 2 diabetes and cardiovascular diseases even after their reproductive years.
Inflammatory PCOS
Inflammatory PCOS is identified by chronic inflammation, which can cause the ovaries to produce excess androgens. Symptoms include skin conditions like acne or eczema, unexplained fatigue, and digestive issues such as irritable bowel syndrome (IBS).
Inflammation markers like CRP (C-reactive protein) are usually elevated in women with this subtype.
Adrenal PCOS
Adrenal PCOS is less common and is associated with the overproduction of androgens by the adrenal glands rather than the ovaries. This subtype often manifests during adolescence and is triggered by stress.
Symptoms include elevated DHEA-S levels (a hormone produced by the adrenal glands), anxiety, and irregular menstrual cycles.
Post-Pill PCOS
Post-Pill PCOS occurs after discontinuing birth control pills, particularly those that suppress testosterone. This subtype is usually temporary, and symptoms might resolve themselves within a few months. Women with Post-Pill PCOS often experience acne, hair loss, and irregular periods shortly after stopping oral contraceptives.
Many providers don’t strictly classify PCOS patients by these types, because so many women do not fit neatly into just one of these subtypes. More often than not, many women experience a combination of these PCOS subtypes, having symptoms that overlap one type with another.
Identifying Your PCOS Type
Recognizing your unique PCOS subtype is a helpful first step toward effective management. Here’s how you can identify your type through symptoms and diagnostic tests:
Symptom Analysis
- Insulin-Resistant PCOS: Look for signs of weight gain, skin tags, dark patches of skin (acanthosis nigricans), and irregular periods.
- Inflammatory PCOS: Be aware of chronic fatigue, skin issues, joint pain, and gut health problems.
- Adrenal PCOS: Notice if you have persistent anxiety, high stress levels, and menstrual irregularities.
- Post-Pill PCOS: Pay attention to breakouts, hair shedding, and cycle changes after stopping birth control pills.
Diagnostic Tests
Consult a healthcare provider for comprehensive diagnostic tests:
- Blood Tests: Measure insulin, fasting blood glucose, and androgen levels.
- Ultrasound: Check for the presence of cysts on the ovaries.
- Inflammation Markers: Assess CRP levels for inflammatory PCOS.
- Hormone Panels: Evaluate DHEA-S levels for adrenal PCOS.
What If Your PCOS Does Not Match a Type?
Unfortunately, misdiagnosis and delayed diagnosis are not uncommon when women experience reproductive & metabolic disorders like PCOS. There are also other health conditions that may mimic PCOS, but are not.
Hypothalamic amenorrhea (HA) causes missing periods due to low levels of GnRH, a hormone made in the hypothalamus that regulates the reproductive system. Severe under-eating, excessive exercise or stress, low body fat, and other factors that affect the hypothalamus are among the root causes for hypothalamic amenorrhea. HA symptoms may overlap with PCOS. It’s possible to have both HA and PCOS, but HA can exclude a PCOS diagnosis.
Similarly, a low or underactive thyroid (hypothyroid) can also cause irregular cycles and lack of ovulation. The bottom line: if your period is irregular or missing completely, it’s crucial to work with an integrative team who will guide you to identify and address the root cause.
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Functional Medicine Approach to PCOS
Conventional Western medicine approaches PCOS primarily through symptom management, relying on hormonal contraceptives, anti-androgen medications, and insulin-sensitizing drugs. While these treatments can provide relief from some PCOS symptoms, they may not address the underlying causes. Long-term use of hormonal contraceptives can also mask underlying hormonal imbalances, making it challenging to identify and address them if the patient decides to conceive later.
Genetics
If a woman’s mother or sister has PCOS, her risk of developing the condition is higher.
Insulin Resistance
Poor diet and sedentary lifestyle contribute to insulin resistance, which is strongly associated with PCOS.
Hormone Imbalances
Elevated androgens, along with changes in luteinizing hormone (LH) & follicle-stimulating hormone (FSH).
Lifestyle Factors
Diet, exercise, stress, and exposure to endocrine-disrupting chemicals influence the development and severity of PCOS.
The most current research supports the use of diet & lifestyle therapies as a first-line treatment to successfully treat PCOS symptoms. Functional medicine provides a patient-centered, systems-oriented approach to address PCOS from multiple angles.
PCOS Treatment & Testing
In addition to the standard hormonal panels, our integrative medicine team may investigate markers of inflammation, insulin resistance, adrenal function, and assess the gut microbiome.
A functional medicine doctor’s primary goal will be to resolve chronic fatigue by employing various tests and treatments, including:
- Supplement therapy to improve insulin sensitivity, regulate menstrual cycles, and reduce elevated androgen levels
- Gut function analysis to explore the potential influence of the microbiome on hormones and metabolic pathways
- Dietary Modifications: A low-glycemic or anti-inflammatory diet to help stabilize blood sugar levels and reduce insulin resistance
- Lifestyle modifications such as reducing stress and promoting quality sleep to normalize hormones
IV Drip Therapy to reduce oxidative damage and replenish nutrients
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For Fertility and Beyond
PCOS is a leading cause of female infertility. Irregular ovulation and anovulation are hallmarks of PCOS and both hinder conception. While hormonal treatments in conventional medicine may help induce ovulation, they may not address the underlying hormonal imbalances or insulin resistance, leading to a return of symptoms, as well as a continued risk of developing long-term metabolic diseases.
PCOS itself does not directly cause heart disease or type 2 diabetes, but it does share some of the main underlying risk factors, which is why it’s important to treat PCOS with a whole-body approach.
Women Who Have PCOS May Also:
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Have elevated cholesterol and triglyceride levels
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Be more likely to be pre-diabetic or diabetic
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Be at increased risk for cardiovascular disease