Cassandra Wilder is a hormone expert and Naturopathic Doctor who specializes in cyclical health and menstruation. She aims to share a holistic perspective on naturally managing a wide range of cycle related symptoms. 

Demystifying PCOS and Holistic Options for Supporting It

In our modern world, chances are that you know someone who has been diagnosed with PCOS. Or perhaps you received this diagnosis and feel overwhelmed and confused as to where to begin in supporting your body. Are there different types of PCOS? Will losing weight cure my PCOS? Do I have to take birth control to manage PCOS? What are my long-term options?

The Prevalence of Polycystic Ovarian Syndrome

PCOS, or Polycystic Ovarian Syndrome, is estimated to affect 1 in 10 women in the United States or 5 million women across the country. With more and more women being diagnosed with this syndrome every year, it’s quickly grown to become the most common hormonal disorder among women of reproductive age. 

What’s even more shocking is that many experts agree that the numbers of PCOS are probably even higher, maybe affecting up to 1 in 5 women of reproductive age. To add to the confusion, it’s estimated that less than half of all women are diagnosed correctly, leaving a gaping hole in the numbers and more women than ever confused about their diagnosis. 

Symptoms of PCOS

• Missing or very irregular periods
• Cysts on the ovaries
• Excess body hair or facial hair (this is known as hirsutism)
• Trouble getting pregnant
• Weight gain, especially in the belly region
• Thinning of hair or androgenic alopecia
• Darkening skin
• Skin tags
• Oily skin
• Acne

Interestingly enough, you don’t need to have cysts on your ovaries to be diagnosed with PCOS. While the “Polycystic Ovarian” part of the name would make us assume that cysts are key for a PCOS diagnosis, most physicians diagnose based on the Rotterdam Criteria. Based on this criteria, you must simply present two of the following:

• Irregular menstrual cycles
• Elevated androgens like testosterone
• Confirmation of cysts on the ovaries from an ultrasound

Irregular menstrual cycles are very common because many women with PCOS experience anovulatory menstrual cycles. This means that they’re not ovulating in the middle of the month and don’t get the same hormone surges an ovulatory cycle would create. Anovulation can cause menstrual cycles to become very long, even exceeding 40+ days. Some women with PCOS may also lose their period and go months without bleeding.

If PCOS is not managed effectively, anovulatory menstrual cycles can become the norm and it may become more challenging to get pregnant. It’s important to note that a common misconception is that women with PCOS are infertile and cannot have children. However, many women with PCOS are able to get pregnant and enjoy healthy pregnancies when they intentionally support their ovulation patterns. 

What causes PCOS in the first place?

While there’s no confirmed cause, there are a number of factors that can influence PCOS. These include insulin resistance, high stress lifestyles, inflammation, genetics, and environmental toxins. Simply put, PCOS invites us to look closely at the body and apply thoughtful tools to help manage it. Through lifestyle changes, many women with PCOS live symptom free. Now more than ever, we need to be talking about PCOS and providing helpful solutions.

Getting to the Root of PCOS

Here’s where to start in supporting your body and taking intentional steps towards balance.

1.  Determine your PCOS type.

Did you know that there are actually four types of PCOS? And some women may have more than one type. The four types include:

Insulin Resistance PCOS

This is the most common type, affecting 70% of those with PCOS. Insulin is a hormone produced by the pancreas and many women with PCOS develop a resistance to it, meaning their body does not respond to insulin the way it's supposed to. Signs of insulin resistance include: fatigue, darkening of the skin around the armpits or groin, cravings for sugary or sweet foods, an increase in hunger, and frequent urination.  

Adrenal PCOS

High cortisol and stress can cause the adrenal glands to produce androgens. Chronic stress can also deplete progesterone levels and this becomes really problematic because progesterone normally helps to keep androgens in check. 

Post-pill PCOS

Post-pill PCOS is usually only temporary for 3-6 months after coming off of hormonal birth control. During this time, ovulation may not restart immediately and so menstrual cycles may be exceptionally long.

Inflammatory PCOS

This type is rooted in chronic inflammation throughout the body. Inflammation is connected to gut and thyroid dysfunction, and these are two areas that PCOS patients are more likely to struggle with.

Read more: Understanding — and Breaking — the Cycle of Chronic Inflammation

By knowing which type or types you’re experiencing, you can target your treatment plan to support your body even more. 

2.  Focus on blood sugar balance.

Women with insulin resistant PCOS may especially find great benefit in focusing on blood sugar balance throughout the day by eating quality protein, fat, and fiber at every meal and eating every couple hours. 

Studies have shown that women who ate low glycemic diets and maintained balanced blood sugar levels saw an improvement in PCOS symptoms

A helpful acronym to remember is PFF at every meal: protein, fat and fiber. Fiber refers to complex carbohydrates like brown rice, quinoa, sweet potatoes, oatmeal and vegetables. 

Read more: 4 Surprising Facts about Your Period

3.  Create a plan to mitigate stress.

Up to 50% of women with PCOS have elevated adrenal androgens (meaning stress is creating the increase in androgens like testosterone), so consciously approaching stress is key. While some level of stress is inherent, it’s empowering to look at the things that don’t contribute to balanced stress levels. Is browsing Youtube before bed causing you to feel overwhelmed? Or is there a relationship in your life that needs a boundary in place? Are you avoiding creating a quality morning routine?

This is another invitation to create small habits throughout the day that support you in lowering stress levels. Some of my favorite personal ways are  enjoying a cycle tea (a nutrient-dense herbal tea that helps mineralize the body) each day with my Elix Formula, implementing social media boundaries, and cultivating a morning routine. 

Read More: How Stress Affects Your Menstrual Cycle

4.  Supplement intentionally.

Herbal supplements can be great tools on the healing journey. Some of my favorite herbs and supplements to implement include:

• Cinnamon: may help lower androgens and support healthy blood sugar balance
• Zinc: may help blood sugar balance, support hormone production and decrease PCOS symptoms like hirsutism
• N-Acetylcysteine: clinically shown to improve fasting blood sugar and fasting blood insulin better than metformin
  

There are many excellent tools that can benefit PCOS, but these three are exceptional ones to consider adding into your daily routine. 

 5.  Consider easing up on intense exercise routines.

Unfortunately, many women with PCOS are familiar with their physicians telling them to “go lose weight” as their primary suggestion for PCOS management. This is problematic for a number of reasons, though. Women with PCOS often struggle with increased androgens and higher than normal cortisol levels — making weight loss an incredibly challenging feat! A prolonged, cardio-heavy workout will also increase stress in the body and likely keep a woman with PCOS plateaued in her weight. 

Instead of rushing off to the next HIIT workout class or preparing for a long run, women with PCOS may greatly benefit from stress-reducing exercises that are low impact. Some great options may include yoga, pilates, weight training, walking, and swimming. You can add these to your PCOS care routine as you work with a practitioner to address what’s going on hormonally. 

6.   Create opportunities for rest.

Part of the healing journey is allowing ourselves to slow down, reduce stress levels, and create moments of presence. While PCOS may be a lifelong syndrome, utilize these tools to take inspired action to support your body. 

Healing certainly isn’t linear, but there are so many opportunities to find balance once again. 

Curious if Elix can help your hormonal symptoms and re-balance your cycle? Click here to take the Health Assessment and find your recommended blend of herbs

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This article was reviewed by Dr. Elizabeth Fine.
Dr. Elizabeth Fine, DAOM, LAcDr. Fine is currently the Dean of Clinical Education at Emperor’s College and has been practicing Acupuncture and Herbal Medicine for over 25 years, with a specialization in Women’s Reproductive Health.