No. 1 Cause of Infertility? Polycystic Ovarian Syndrome

December 4, 2017
Polycystic Ovarian Syndrome - Dr.Axe

Often referred to as a “silent disorder,” it’s one of the most common hormonal disorders in women. I’m talking about polycystic ovarian syndrome, aka polycystic ovary syndrome (PCOS), which affects anywhere from 5 percent to 20 percent of women of childbearing age. (1)

While few women are aware of this disorder or what PCOS symptoms look like, PCOS is believed to be responsible for as much as 70 percent of infertility issues in women! Meanwhile, it’s associated with an increased risk for developing several medical risks. These include insulin resistance, type 2 diabetes, high cholesterol, high blood pressure and heart disease.

And if it runs in your family, then you may be at a higher risk of developing this condition. The good news is there are many natural ways to treat PCOS symptoms, and it starts with doing everything you can to balance hormones naturally. Read on to raise your PCOS awareness. Learn about my recommendations on how to treat the symptoms of PCOS if you are one of the estimated 5 million women in the U.S. dealing with this condition.

What Is Polycystic Ovarian Syndrome (PCOS)?

PCOS is one of the most common hormonal imbalances affecting women today and is often characterized by insulin resistance. The endocrine system is very complex; while PCOS has been recognized and diagnosed for over 75 years and is now considered the leading form of endocrine disruption in women of reproductive age, there’s still a lot to learn about how exactly this hormonal imbalance occurs in different women and how it can most effectively be reversed.

Alarmingly, estimates show that somewhere between 5 percent to 20 percent of women of childbearing age are affected by PCOS! However, less than 50 percent of women are properly diagnosed. This means millions have no idea what’s causing their underlying symptoms. (2) Common symptoms of polycystic ovarian syndrome include weight gain, changes in mood, low libido, irregular periods, irregular hair loss and growth, and acne — plus, it’s considered to be the major cause of infertility issues in women. (3)

PCOS can develop for a number of different reasons, and symptoms can vary a lot from woman to woman, although it is generally accepted that insulin resistance plays a large part in the development of the disease. (4) Currently, there is no known “cure” for PCOS, although the underlying hormonal causes are believed to be mostly reversible, and many women find effective ways to lower their symptoms without the use of medications.

For doctors, one of the challenges of identifying and treating polycystic ovarian syndrome is that it cannot be diagnosed with one test alone. Plus, PCOS symptoms closely mimic those of other hormonal disorders, like adrenal fatigue, chronic fatigue and thyroid disorders.

While PCOS symptoms can come and go depending on fluctuations in someone’s lifestyle, insulin resistance affects 50 percent–70 percent of all women with polycystic ovarian syndrome. And when left untreated, this can increase the risk for metabolic syndrome, hypertension, dyslipidemia (high cholesterol and/or triglycerides) and diabetes down the road.

PCOS Symptoms 

There are several PCOS symptoms common among woman dealing with hormonal issues. Sometimes, the ovaries will form what’s called a “functional ovarian cyst.” A sac forms on the surface of an ovary around a maturing egg. Usually, the sac goes away once the egg is released. If the egg isn’t released or the sac closes around the egg and fills with fluid, it becomes a functional cyst.The term “polycystic” literally means that a woman’s ovaries have multiple small cysts on them.

Normally, the ovaries release a small amount of male sex hormones (called androgens), but in women with PCOS, the ovaries start making slightly more androgens, which is the reason for masculine symptoms like extra facial and body hair and male pattern baldness.

Classically, physicians have looked for multiple cysts on the ovaries (described as looking like a “string of pearls” when performing an ultrasound), but not every woman diagnosed with polycystic ovarian syndrome has visible cysts on her ovaries. Polycystic ovarian syndrome can still be diagnosed if the majority of other common symptoms are experienced. (5)

The most frequent PCOS symptoms include:

  • irregular periods, including amenorrhea (missing periods)
  • trouble conceiving or infertility
  • changes in weight, especially weight gain and trouble losing weight
  • acne
  • insulin resistance (related to an increased risk for diabetes)
  • high testosterone levels
  • Hirsutism (excessive hair growth, including in places women don’t usually grow hair, such as on the face and abdomen)
  • male pattern baldness, thinning hair
  • fatigue
  • changes in mood
  • low sex drive
Common PCOS symptoms - Dr. Axe

Natural Remedies for PCOS Symptoms

1. Eat a Nutrient-Dense Diet

As you’ve learned, an “appropriate diet” is a bit different for everybody. In women who are overweight, mostly sedentary and battling insulin resistance, following a diet aimed at healthy weight loss that’s low-glycemic, low-sugar and nutrient-dense helps. On the other hand, in women who are battling adrenal or thyroid “burnout,” who are underfed, overly stressed and fatigued, resting and focusing on eating more nutrient-dense calories is likely the best approach. (6)

No matter the cause of hormonal imbalance, nutrient density and eliminating exposure to toxins are important. It’s crucial for everybody, whether hormonally balanced or not, to boost metabolism and therefore help with hormone production by eliminating various toxins that enter our bodies through modern and processed foods. Hormones can easily go awry when the body’s bombarded by things like artificial sweeteners, pesticides, preservatives and so on.

Rather than focusing on what needs to be eliminated from the diet, think about “nourishment” being the goal, especially eating a variety of natural anti-inflammatory foods like vegetables, fruits, grass-fed/pasture-raised meat, wild-caught fish (like salmon), nuts/seeds (like chia, flax, hemp, almonds and walnuts) and unrefined oils/fats (including coconut oil, olive oil and avocado). (7) Something positive to remember is that the same dietary treatment used to fight PCOS also helps treat a whole host of other common diseases, including obesity, heart disease, autoimmune diseases and diabetes.

Anything that does not come in a bag or a box is more supportive than packaged, processed foods. Support your thyroid and adrenal glands by reducing stress placed on them caused by a poor diet. This means experimenting with removing common allergens or sensitivities, toxins, and chemicals, including:

  • too much alcohol or caffeine
  • most sources of sugar and sweeteners (including high-fructose corn syrup, packaged sweet products and refined grains that trigger insulin spikes and are inflammatory and irritating to the gut)
  • as many packaged and processed foods as possible, since these are filled with many types of artificial ingredients, preservatives, sugars, sodium and potential endocrine disruptors
  • hydrogenated and refined vegetable oils (soybean, canola, safflower, sunflower and corn), which are highly inflammatory
  • common sensitivities, including conventional dairy products and gluten

2. Reduce Stress (Both Physical and Psychological)

One of the keys to solving any hormonal problem is to take a close look at the “mind-body connection.” That’s because stress can have drastic impacts on the endocrine system and therefore on hormone production.

Different things work for different people when it comes to combatting chronic stress, whether it’s spending more time in nature, yoga, meditation, prayer, journaling and so on. Try to address which areas of your life cause the most stress and how you can handle them appropriately. Remember that stress can show up in the body in many different ways. Even lack of sleep, your diet, and exercise routine all can be perceived as stressful if they aren’t quite what your body needs.

Adaptogen herbs are a unique class of healing plants that can help promote hormone balance and protect the body from the effects of cortisol caused by chronic stress. They also can be used to treat polycystic ovarian syndrome, along with tonic herbs. (8) These herbs include ashwagandha, holy basil and maca root. While they won’t take the place of a healthy diet and dealing with stressful circumstances in your life at their root, they can help the body improve thyroid function, lower cholesterol, reduce anxiety and depression and offer support against PCOS symptoms.

3. Get Enough Rest 

Sleep is crucial for cell regeneration, hormone production, stress control and even weight management. In fact, sleep deprivation can have the same negative effects on health and hormones as a lack of activity and a poor diet can.

In a review published in Human Reproduction, researchers looked at a cross-sectional study of women with and without PCOS. They found that “sleep disturbances were twice as common in women with PCOS compared with those without,” and women with PCOS especially had difficulty falling asleep. (9)

According to a large cross-sectional study, PCOS sufferers who get less sleep are at more risk for mental issues and insulin resistance. (10)

Consistently going without enough sleep increases stress hormones in the body, including cortisol, and changes levels of hormones that control your weight and appetite, including insulin and ghrelin. The more stressed you are, the more sleep you likely need — but the general recommendation that works well for most people is aiming for seven to nine hours each night.

4. Exercise in an Appropriate Way

If you have a predisposition to developing hormonal imbalances, keep in mind there’s a fine line between too little activity and too much. Generally speaking, women’s bodies are more susceptible to hormonal changes when exercise is increased beyond healthy levels. For example, “female athlete triad” is a condition that can contribute to PCOS. It’s caused by too much exercise coupled with a restrictive diet and too few calories. Female athletes also can be more susceptible to irregular periods, according to multiple studies. (11)

Of course, this doesn’t mean you need to cut out exercise altogether, since there are many benefits of exercise that can help with hormonal balance. It’s just a matter of finding which amount works best for you. If you’re someone who battles high levels of cortisol and chronically unstable blood sugar levels, you might be dealing with some extra body weight and turning to exercise to help shed unwanted pounds. This is still a good approach, but more isn’t always better. And pushing yourself too hard when you’re struggling with exhaustion can cause even more hormonal stress. (12)

Take a close look at all of the types of stress that are being placed on your body, and consider if doing gentler exercise, or intense exercise but for shorter periods of time (such as high intensity interval raining), will help you. Focus on getting enough activity to help with insulin sensitivity and burning excess fat, without causing the adrenals to become overstimulated.

5. Avoid Exposure to Endocrine Disruptors

Endocrine disruptors are chemicals that interfere with the production, release, transport, metabolism or elimination of the body’s natural hormones. In today’s industrialized society, we come across these more than ever before: in the air we breathe, water we drink, soil we use to grow food, and in the beauty or household products we buy. These disruptors can mimic naturally occurring hormones, especially estrogen, which can result in either overproduction or underproduction of actual hormones. (13)

While it doesn’t pay to stress over air pollution, you can do your best to avoid chemical products, including:

  • dry-cleaning chemicals
  • skin care products loaded with artificial ingredients
  • non-organic produce sprayed with pesticides and chemical compounds known as xenoestrogens — including industrial compounds such as polychlorinated biphenyl, bisphenol A and phthalates used in plastic and aluminum cans

6. Try Healthy Ways to Lose Weight

Most traditional health practitioners begin treatment plans for PCOS by advising women to lose weight. (14, 15) While this blanket statement is often unhelpful due to its broad nature, it’s true that by altering your lifestyle and losing weight, you can likely decrease symptoms of insulin resistance and irregular periods. (16, 17)

In a randomized, controlled trial of women with PCOS conducted by the Penn State College of Medicine, women who underwent lifestyle adjustments including restricted caloric intake and a regular exercise regimen experienced significant weight loss without the metabolic syndrome occurrence found in the group who used only birth control to manage the condition. Ovulation increased by 60 percent in the “lifestyle” group (with a 67 percent increase in the “combined” group who underwent lifestyle changes as well as took birth control pills) and 26 percent of the women in the “lifestyle” group achieved live births during the duration of the study. (18)

This method of treating PCOS symptoms is also important because PCOS increases the risk of high cholesterol, diabetes, sleep apnea and high blood pressure. A smaller risk for all of these conditions can be achieved by healthy weight loss.

In general, obesity exacerbates symptoms of PCOS. While weight loss can be challenging with this condition, it can greatly reduce the severity of symptoms and promote fertility, improve glucose tolerance and regulate menstruation. (19)

7. Supplement with Inositol

One particularly significant natural method of treating PCOS is inositol, a sugar alcohol chemical compound found in fruits, beans, grains and nuts (although it is not always bioavailable in these foods if presented with phytates). In nutrition, inositol is present in the highest levels in cantaloupe and oranges.

Most sources investigate inositol in supplement form, although the specifics can get a little tricky as there are two types of inositol: myo-inositol and D-chiro-inositol. However, the research seems to support that, at doses somewhere between 1,200-2,400 milligrams per day, inositol can greatly improve PCOS symptoms. Multiple studies have shown that supplementation may improve insulin resistance, decrease male hormones in the bloodstream, and lower blood pressure and high triglycerides.

Most notably, inositol seems to promote ovulation, which, in turn, may support fertility. In one study, only 6 percent of control group participants experienced menstrual cycles versus 86 percent in the inositol group, results that seem to be supported by follow-up research. (20)

8. Support Your Body Using Alternative/Complimentary Treatments

Some women with PCOS find relief from symptoms when turning to complimentary practices like chiropractic care, acupuncture, massage therapy and herbalism. These can help relieve stress and restore proper “energy” to the body, likely by lowering stress hormones and improving a sense of well-being.

For example, according to the Journal of the International Society of Gynecological Endocrinology:

Acupuncture therapy may have a role in PCOS by increasing blood flow to the ovaries, reducing of ovarian volume and the number of ovarian cysts, controlling hyperglycaemia through increasing insulin sensitivity and decreasing blood glucose and insulin levels. (21)

Experiment with different options to see which ones work best for you, whether it’s receiving adjustments from a chiropractor who can help with managing chronic pain and getting you back on your feet, or trying herbs to help you sleep and unwind more easily.

What Causes PCOS?

The underlying cause of PCOS symptoms is an abnormally high level of male sex hormones compared to female hormones. Male sex hormones, or androgens, include testosterone, DHEA-S and others. A 2017 study led by the University of Birmingham revealed that a class of androgens, known as 11-oxygenated C19 steroids, contributes significantly to androgen excess in women with PCOS, while previous research has primarily focused on the androgen testosterone. (22)

The vast majority of the time, male sex hormones are high in PCOS patients (this is called hyperandrogenism). High levels of testosterone can prevent the ovaries from releasing an egg each month like they normally do in women without hormone imbalances. This is why irregular or skipped periods and trouble getting pregnant are common among women with polycystic ovary syndrome.

Sometimes these male sex hormones aren’t so high that they are considered abnormal levels. (23) However, this can still cause problems when female sex hormones aren’t proportionate to male sex hormones. In fact, it’s the ratio of hormones that seems to be the critical factor. For example, estrogen might be low, or testosterone might be very high, even compared to estrogen that’s also high. Female sex hormones can drop for one reason or another, and male sex hormones can rise. This is why there’s an “imbalance,” although women get to this point for different reasons.

As of 2017, there are over 5,000 research articles about PCOS available on PubMed Central (PMC). Research continues to reveal more information about the root causes of polycystic ovarian syndrome and other hormonal imbalances, which sheds light on how complex this type of disorder can be. Like most other disorders, there also seems to be genetic factors involved in the development of PCOS, coupled with lifestyle and environmental factors.

Some of the common causes of polycystic ovary syndrome include:

  • genetic predisposition
  • poor diet (especially a high-glycemic diet that’s high in sugar and refined carbohydrates)
  • chronic stress
  • inappropriate level of physical activity, whether too high or too low depending on the woman
  • thyroid disorders or imbalances, such as hypothyroidism
  • exposure to high amounts of endocrine-disrupting chemicals
  • for some women, having a high percentage of body fat, being overweight or obese
  • for some women, having a low percentage of body fat (usually from following a restricted diet that’s too low in calories)
  • high insulin levels
  • high levels of inflammation

PCOS is commonly regarded as a condition that runs in families, but this doesn’t mean someone is doomed to experience it if she is genetically predisposed. Having a family history of PCOS just means a woman needs to be careful how she manages her stress level, diet and lifestyle.

Insulin and inflammation can also play a role in polycystic ovarian syndrome. Excess insulin — the hormone produced in the pancreas that allows cells to use glucose — can cause the ovaries to increase male sex hormone production, which throws off the ovaries’ normal ability to ovulate. Low-grade chronic inflammation can also stimulate polycystic ovaries to produce more androgens. In fact, a 2016 study, “Type 1 Diabetes and Polycystic Ovarian Syndrome: Systematic Review and Meta-analysis,” concluded with the recommendation that screening for PCOS and androgen excess should be part of the management guidelines for women with type 1 diabetes given that they are frequently seen in women with this condition. (24)

Many people think of the typical PCOS patient as someone who is overweight or obese and struggling with insulin resistance. A high percentage of PCOS patients d0 deal with weight gain at some point; however, we now know that there are plenty of women who are normal weight, or even underweight, who also develop hormonal disruptions that lead to polycystic ovarian syndrome. PCOS patients come in all shapes and sizes, and their histories can be very diverse, which makes treating this condition even more complicated.

A woman’s diet and body weight is highly correlated with her level of hormonal health. For example, according to the PCOS Foundation, studies show that approximately a whopping 40 percent of all women with diabetes and/or glucose intolerance between the ages of 20–50 have polycystic ovarian syndrome! Despite the variety of PCOS patients, being overweight seems to complicate hormonal issues and PCOS symptoms, and weight loss improves the endocrine profile and increases the likelihood of ovulation and pregnancy in women with PCOS.

Studies have found that in women who are are overweight, menstrual cycles and ovulation can both improve with as little weight loss as dropping 5 percent of initial body weight. (25)

In overweight women, it’s still debated as to which comes first and affects the other: weight gain or hormonal imbalance. And in women who are normal weight or very lean, excess body fat obviously isn’t the underlying cause of the problem; in fact, in this case the opposite might be to blame — restricted diets that are too low in calories, high amounts of stress and overexertion through very high levels of physical activity can also throw off a woman’s delicate hormonal balance (a condition referred to as hypothalamic amenorrhea).

Causes of PCOS symptoms - Dr. Axe

The Female Reproductive System and PCOS

To further understand how polycystic ovary syndrome manifests in different women, plus how it should be treated, it helps to have some background on the female reproductive system.

Hormones are created from glands that receive signals from organs throughout your entire body. Your adrenal, thyroid and pituitary glands are so important that they control nearly every aspect of life, including your internal thermostat, ability to metabolize food, heart rate, digestion, mood, fertility and so much more. When your body picks up on stressors of any kind, hormone production can be stalled before reproductive hormones like estrogen or progesterone can be produced.

The “control center” of your endocrine system is considered your hypothalamus, which is an almond-size part of the brain that acts as your endocrine system’s main point of contact. The hypothalamus constantly receives information from various hormones throughout your body that travel through the bloodstream up to the brain. The hypothalamus signals the release of one of two hormones depending on the information it gets: either a releasing hormone or inhibiting hormone (called follicle-stimulating hormone and luteinizing hormone, respectively, both of which control the menstrual cycle and fertility).
Your pituitary gland can basically overcompensate when the body’s under stress and starts creating imbalances. This impacts how much estrogen and testosterone, growth hormones, hunger hormones, and stress hormones are ultimately released. Under stress, the pituitary gland secretes adrenocorticotropic hormone, which tells your adrenal glands to release a cascade of stress-related hormones, including cortisol and adrenaline. These kick off your body’s “fight or flight” response — for example, adrenaline boosts your blood pressure and heart rate, while cortisol releases glucose to your muscles so you have the energy to escape scary situations. (26)

Not recognizing that modern-day stress in your life isn’t actually life-threatening, your HPA axis (which stands for hypothalamic–pituitary–adrenal axisa complex set of feedback interactions between your endocrine glands) responds the same exact way to all types of stress, and this wreaks havoc on your entire endocrine system, resulting in abnormal levels of female sex hormones. (27) The result? PCOS symptoms, including experiencing no ovulation, no egg released, no menstrual cycle and various signs of male hormones dominating.

What the Experts Say about PCOS

There’s actually some controversy surrounding the criteria used to determine a PCOS diagnosis and even how to label the condition. In fact, some polycystic ovarian syndrome experts have questioned whether or not changes to polycystic ovarian syndrome criteria have led to an over-diagnosis of the condition among reproductive-age women. (28) In addition, as noted previously, treatment options can vary.

Richard Legro, M.D., is a leading researcher on PCOS based at Penn State University. He is also the first author on the “2013 Endocrine Society Clinical Practice Guidelines on PCOS,” published in The Journal of Clinical Endocrinology & Metabolism. (29) The evidence-based guidelines recommend following the Rotterdam criteria for diagnosing polycystic ovarian syndrome, which states that two of the following criteria must be present to qualify for a PCOS diagnosis:

  • androgen excess
  • ovulatory dysfunction
  • polycystic ovaries

The guidelines note that excess androgen is a key factor in presentation of the condition in adolescents. Recommended treatment options include clomiphene for infertility and, in adolescents, prescribing hormonal contraceptives and metformin to treat metabolic and glycemic issues and improve menstrual irregularity.

Other experts also note the importance of natural medicine therapies in treating PCOS. In an interview with the PCOS Awareness Association, Fiona McCulloch, N.D., founder and owner of White Lotus Integrative Medicine and author of “8 Steps to Reverse Your PCOS” lists natural medicine therapies including acupuncture, supplements, botanical medicines and mind-body approaches, in addition to diet and exercise, as important ways to address polycystic ovarian syndrome. (30)

Whether you approach treating PCOS from a conventional, natural or integrative medicine perspective, there are different solutions for different women.

Different PCOS Solutions for Different Women

PCOS is a complex condition, and the road to resolving the hormonal imbalances that cause it are not the same for every woman. Practitioners, and women with polycystic ovarian syndrome, both agree that there isn’t a “one size fits all” approach that balances hormones best.

For many years, the most common advice for battling PCOS symptoms was to follow a low-glycemic diet and work on losing weight and managing blood sugar in a healthy way. However, just cutting carbs won’t work to solve polycystic ovarian syndrome for women who are underweight or even normal weight, so usually another approach needs to be considered for these types of patients.

Diet isn’t everything, and other lifestyle factors — especially stress, but also things like meal timing and level of exercise — all play an important role in a woman’s reproductive system. The body is able to detect different kinds of stressors, both internal and external. Internal stressors are those that disrupt your body’s healthy patterns, such as mismanaged blood sugar, inadequate sleep or lack of physical activity. External stressors are those that cause chronic, underlying stress outside of your body and reduce a sense of general well-being.

When visiting your doctor or an endocrinologist, he or she might prescribe birth control pills to help you have regular menstrual cycles. Metabolic issues are also seen as a key part of polycystic ovarian syndrome and insulin resistance in particular is often a factor. Because of this, the diabetes drug metformin also is often prescribed to reduce insulin resistance as part of an overall PCOS treatment plan. It also can help regulate a woman’s menstrual cycle, potentially increasing fertility.

Research has shown that metformin is most effective when prescribed in conjunction with lifestyle changes, such as dietary changes and weight management. (31) However, there is controversy around using metformin to treat PCOS and a lack of long-term studies to prove its efficacy. In addition, it can cause many side effects. If your doctor prescribes metformin, it’s important to have a conversation to make sure you understand the risks vs. benefits to determine if this is the right treatment method for you. (32) Keep in mind that it’s still possible to have problems with fertility and getting pregnant once either birth control pills or metformin is stopped because a woman’s diet, stress and exercise patterns aren’t addressed by these medications.

While it might seem complicated, fortunately the best options for moving forward for women with different types of polycystic ovarian syndrome all fall within the same general categories, focusing on all aspects of health: mainly eating a balanced diet, maintaining an appropriate body weight, and eliminating as much physical and psychological stress as possible.

Read Next: Get Your Cortisol Levels Under Control & Turn Down Stress

From the sound of it, you might think leaky gut only affects the digestive system, but in reality it can affect more. Because Leaky Gut is so common, and such an enigma, I’m offering a free webinar on all things leaky gut. Click here to learn more about the webinar.

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