A Functional Approach to Polycystic Ovarian Syndrome (PCOS)

September is PCOS Awareness Month. 

PCOS, or Polycystic Ovary Syndrome, is a common but often misunderstood hormonal disorder that affects many women, primarily those of reproductive age. It can be a challenging condition to manage, but with the right knowledge and lifestyle changes, you can take control of your health and well-being. In this blog post, we’ll explore the different types of PCOS, abnormal lab values associated with it, the physical manifestations you might experience.

Types of PCOS

First things first, PCOS isn’t a one-size-fits-all condition. There are actually several types, each with its own unique characteristics. Understanding which type you have is crucial for proper management. Let’s dive into the three main types:

1. Insulin-Resistant PCOS:

   This is the most common type of PCOS. In this form, your body’s cells don’t respond well to insulin, leading to higher insulin levels in your bloodstream. This can result in increased production of androgens (male hormones) in your ovaries, disrupting your menstrual cycle and causing symptoms like acne and excess hair growth.

2. Adrenal PCOS:

   This type is linked to an overproduction of androgens by the adrenal glands, which are responsible for producing hormones like cortisol. Adrenal PCOS may not always present with cysts on the ovaries, making it trickier to diagnose.

3. Inflammatory PCOS:

   Inflammation plays a key role in this type of PCOS. Chronic inflammation in the body can disrupt hormone production and cause irregular periods, weight gain, and other PCOS symptoms. It’s often associated with other inflammatory conditions like Hashimoto’s thyroiditis.

Understanding your specific type of PCOS can help you and your healthcare provider tailor a treatment plan that addresses your unique needs.

Physical Manifestations of PCOS

PCOS can manifest itself in various ways, both internally and externally. Here are some common physical manifestations:

1. Irregular Periods:

   Irregular or absent menstrual cycles are a hallmark of PCOS. You might experience heavy bleeding when your period does arrive.

2. Acne and Oily Skin:

   Increased androgens can lead to acne breakouts and excessively oily skin.

3. Hirsutism:

   This is the medical term for excess hair growth, often in areas where men typically grow hair, such as the face, chest, and back.

4. Hair Thinning:

   On the flip side, some individuals with PCOS experience hair thinning on their scalp, which can be distressing.

5. Weight Gain:

   Many individuals with PCOS struggle with weight gain, particularly in the abdominal area.

6. Skin Tags:

   Small, benign growths of skin, known as skin tags, can develop in areas where skin rubs together, such as the neck and underarms.

7. Darkened Skin:

   A condition called acanthosis nigricans can cause dark, thickened patches of skin, often in body creases like the neck, armpits, and groin.

8. Infertility:

   Many women with PCOS struggle to get pregnant, though not all do. Normalizing hormones (especially progesterone and androgens is foundational to restoring fertility)

Abnormal Lab Values Associated with PCOS

There are various lab tests that can help identify PCOS. These tests can help identify hormonal imbalances and other factors contributing to your symptoms. Here are some of the abnormal lab values commonly associated with PCOS:

Elevated Androgens

High levels of androgens, such as testosterone, can lead to acne, excess facial and body hair, and hair thinning. A blood test can measure these hormone levels.

Insulin Resistance

An oral glucose tolerance test (OGTT) can determine if you have insulin resistance, a hallmark of many PCOS cases. Elevated insulin levels can lead to weight gain and disrupt your menstrual cycle.

Luteinizing Hormone (LH) to Follicle-Stimulating Hormone (FSH) Ratio

An LH/FSH ratio greater than 2:1 is often seen in PCOS. This imbalance can contribute to irregular periods and difficulty with ovulation.

Irregular Menstrual Cycle

The absence of regular menstrual cycles or prolonged periods can also be indicative of PCOS. Tracking your cycle and discussing it with your healthcare provider is essential.

Cystic Ovaries

While not all individuals with PCOS will have cystic ovaries, the presence of multiple small cysts on the ovaries is a common characteristic. An ultrasound can help identify this.

High Inflammatory Markers

Elevated C-reactive protein (CRP) or other markers of inflammation may be found in cases of inflammatory PCOS.

*It’s important to note: that not all individuals with PCOS will have all of these abnormal lab values. Diagnosis is typically based on a combination of symptoms, physical examination, and laboratory tests.

The Functional Medicine Approach to PCOS Management

Now that you have a foundational understanding PCOS, let’s delve into the practical aspects of managing this condition from a holistic perspective:

1. Comprehensive Evaluation

Functional medicine practitioners conduct in-depth assessments, including a thorough medical history, hormone testing, metabolic assessments, and evaluation of lifestyle factors. This helps create a personalized roadmap for treatment.

2. Personalized Nutrition

Nutrition is a cornerstone of PCOS management in functional medicine. Recommendations may include a low-glycemic diet, focusing on whole foods, healthy fats, and lean proteins. Nutritional plans are tailored to address insulin resistance, hormone balance, and inflammation.

3. Lifestyle Modifications

Stress management techniques, such as meditation, yoga, and deep breathing exercises, can be integral to addressing hormonal imbalances. Exercise is also encouraged, as it can help improve insulin sensitivity and promote overall well-being.

4. Supplementation

Functional medicine practitioners may recommend supplements to address specific deficiencies or imbalances. Common supplements for PCOS management may include inositol, vitamin D, omega-3 fatty acids, and N-acetylcysteine (NAC), among others. We’ll dig into this next week!

5. Gut Health

Gut health is closely linked to hormonal balance, so addressing gut issues is a priority. Probiotics, prebiotics, and dietary changes to support a healthy gut microbiome may be recommended. I often recommend a GI Map test to pinpoint areas in the gut that need support.

6. Individualized Treatment

Functional medicine is all about personalized care. Treatment plans are tailored to the individual’s unique needs and may evolve over time as progress is made.

7. Monitoring and Support

Regular follow-ups with a functional medicine practitioner are essential to monitor progress, make adjustments to the treatment plan, and provide ongoing support and education.

Foundational Support

Women suffering from PCOS have a hormonal imbalance that is rooted in inflammation, gut health and blood sugar regulation. Addressing these areas is foundational to managing PCOS.

Remember, PCOS management is a journey that requires patience and persistence. What works for one person may not work for another, so it’s essential to work closely with your healthcare team to find the best approach for you. If you’ve been diagnosed with PCOS, my team can help you develop a comprehensive plan to address it AND help you implement it. Let’s talk about it!