Many women who have irregular cycles are diagnosed with Polycystic Ovarian Syndrome (PCOS) but this is really a blanket diagnosis for what could possibly be one or more of four root causes. Really the phrase “irregular cycle” is also a blanket phrase for many different issues. It could used for someone who experiences cycles that change in length drastically, or someone who consistently has cycles that are outside of optimal length (greater than 35 days), or someone who doesn’t get a cycle all together. If any of these cycle issues fit you, you may have PCOS. The question then becomes which type or combination of types of PCOS do you have and how do you best support your body so it can work optimally and be the amazing and fertile body it was meant to be.
Lets talk about the different underlying causes of PCOS. There are many factors that contribute to the symptoms of PCOS (primarily irregular cycles/ovulation) but the main ones are inflammation, insulin resistance, hormonal birth control, and adrenal.
Inflammation
Systemic inflammation causes so many problems in the body and is very stressful to the system which shuts down ovulation and increases the release of testosterone from the ovaries. If you have any of the following symptoms inflammation may be a contributing factor to your PCOS: allergies or runny/stuffed nose, unexplained fatigue, gut issues, headaches, joint or muscle pain, and/or chronic skin conditions like eczema or hives. If inflammation is one of your contributing causes of PCOS then you want to make sure that you are figuring out the root cause of your inflammation. Possible root causes are food sensitivities, leaky gut, dysbiosis or SIBO, and autoimmune issues. These all however mean that your gut needs healing and to heal it you need to be feeding it the right foods and avoiding inflammatory foods. A great place to start if you don’t know what may be upsetting your gut is by doing an elimination diet like the Whole 30. There are also some supplements that are great for helping ease inflammation while you heal the root cause. Some of my favorites are NAC, turmeric, and zinc. There is also some research that suggests that exercise can improve gut health it is thought that it can help increase the strength of your good gut bugs. This particularly applies to moderate cardio exercise like jogging, hiking, and walking. So make sure your are getting outside in nature and moving in the sunshine it’s good for your gut!
Insulin Resistance
Insulin resistant PCOS is what most people associate with PCOS. It is in fact the most common contributing factor to PCOS with about ~70% of cases being insulin resistant. Insulin resistance affects ovulation on several levels. First it causes the body to release excess cortisol which shuts down ovulation and also it prevents our ovaries from getting the nutrients they need. Signs of insulin resistance are craving sugary foods or caffeine to get through the day, feeling hangry or shaky before meals, feeling tired after meals, issues with concentration and waking in the night (around 2 or 3 am) and having difficulty falling back to sleep. If you have any of the previous symptoms then you definitely want to change up your diet. The best diet for insulin resistance is lower in carbs and higher in fats. I’m not talking KETO though because that may be to low in carbs, your body needs carbs but just not too many and the right kinds. I would keep breakfast very low carb to start the day off on the right path and then include complex carbs with your lunch and dinner. Complex carbs are things like sweet potatoes, winter squashes, whole fruit whole grains, and legumes. These digest more slowly which means a slower and steadier release of sugar into your bloodstream instead of an all at once spike that you get from refined carbs like sugar, white flour, and fruit juices. Along with diet you also want to include some supplements that will help your cells be more receptive to insulin including: inositol, cinnamon, chromium, and magnesium. The final important factor for this type of PCOS is exercise. Insulin resistance is most affected by resistance training. Think body weight and weighted exercises. So if you have insulin resistant PCOS make sure you hit the gym!
HPA-axis Dysfunction
The Hypothalamic-Pituitary-Adrenal Axis (HPA-axis) is what controls your stress response and is one of the most abused aspects of our endocrine system in modern life. There are so many stressors in our day to day lives between expectations at work, the struggle to keep up with appearances on social media, and our lack of self-care (not getting enough: rest and sleep, exercise, and/or eating right). Issues with your HPA-axis can affect many aspects of your cycle but we are focusing on the main event of ovulation. As mentioned earlier when excess cortisol is present, we see that ovulation is shut down and chronic stress causes cortisol to be released in excess. If you feel that your adrenals are contributing to your PCOS then you need to make self-care a priority. Make sure that you are getting plenty of sleep each night at least 7.5 hours and make sure you have time in your day to just sit and be this could mean meditation, journaling, or prayer. You’ll also want to scale back your exercise if you have been exercising a lot keep your exercise to things like walking, restorative yoga, and tai chi. When it comes to diet, you’ll want to make sure that you are eating enough (undereating is also stressful) and that you are avoiding things like processed foods and simple carbs as these foods can be stressful on the body. Finally, there are so many amazing supplements out there for supporting our stress response. Adaptogens may be the latest health craze but I’m here to tell you they are the real deal! I love adaptogens and have used them myself to help with stress but many of them are contraindicated for pregnancy. If you are actively trying to conceive a couple of safe adaptogens are reishi and licorice. If you aren’t trying to conceive right now then definitely adaptogen it up: some of my favorites are tulsi, ashwaghanda, and astragulus. Some other great stress helpers are magnesium, vitamin B5 and CBD.
Hormonal Birth Control
If you have recently (within the last year) gone off of hormonal birth control (HBC) then your PCOS may be due to the hormonal imbalances and deficiencies caused by suppressing your hormones over time. To help in this situation I would first strongly advise you get your hormone levels checked with a doctor so you can take a more targeted approach to balancing your hormones. The basic foundation of healing after HBC is to eat a diet rich in veggies, healthy fats, complex carbs, and well sourced protein and getting moderate exercise. You are also going to want to make sure that you are supplementing some of the nutrients the HBC depletes. These include zinc, b vitamins, magnesium, vitamin c, and selenium. The good news with post pill PCOS is that it is most likely temporary and within a few months you should be back to normal. If you are still struggling with PCOS in a year then you may want to revisit some of the other causes.
PCOS is a complicated and multifaceted issue and this post just begins to touch on how to support your body with PCOS. If you want more information on PCOS I would check out Dr. Lara Briden and Dr. Fiona McCulloch. They have a lot of free resources regarding PCOS and how to deal with it. However, I would also encourage you to work with a practitioner as it can be very complicated and outside eyes often see what we don’t. If you would like to work with me head on over to my services page and sign up for a free consultation!