Alright loves, this is going to be a long one. So grab a cup of *insert warm beverage of choice here*, sit down and embrace this moment since chances are, your symptoms are what brought you to this page, and your body deserves this information. 

Whether you have already been diagnosed with PCOS, or you have Googled your way to suspecting you have PCOS, I hope this post gives you clarification around the topic at hand - since I know there is a lot of misinformation. 

PCOS is an acronym that stands for “polycystic ovarian syndrome” - the phrase itself shedding light on one (potential) symptom: polycystic (multiple cysts on the) ovaries. To get the diagnosis is scary, since it’s “considered” to be the number one cause of “infertility” (*stomach sinks*) - but fear not, in my expert hormone and professional opinion, PCOS is not an infertility diagnosis. (P.S. can we stop using the word ‘infertility’ - it’s painful and unnecessary.) Either way, the fertility piece is something that happens as a byproduct of bringing our hormones and metabolism back into harmony, and most importantly, creating a safe enough body to do so. 

PCOS manifests as a result of the body not feeling safe enough. The reason for irregular or absent cycles, and cysts on the ovaries, is because your body does not feel safe enough to ovulate (release an egg). Afterall, biologically speaking, the body was designed to procreate. It is in your favour that it prevents itself from doing that when it does not feel safe. Your body feels safe when it is free--or limited of--stressors, nutriently and emotionally fulfilled, and void of toxins. 

In upcoming blog posts, I will uncover the root causes of why your PCOS may have developed in detail, but there are 4 main reasons why it occurs: 

1. Insulin resistance (the most common, and almost all individuals with PCOS have some level of insulin resistance)

2. Inflammation: driven from diet, poor gut health, toxins 

3. Hypothalamic-Pituitary-Adrenal (HPA) axis dysfunction: chronic stress can disrupt our ovarian hormones

4. Birth control use 

In these instances, there is a protective mechanism of your body at play. So while you may be angry with your symptoms and/or diagnosis, perhaps consider shifting the perspective, and thanking your body, give yourself a hug, and ask it for grace for all you’ve endured in your life so far. You are amazing, and your body is truly helping you through. 

HOW IS IT DIAGNOSED?

The current diagnostic criteria for PCOS is based on the Rotterdam Criteria. If you hang out with me on Instagram, you’ve seen me post about this before. The Rotterdam Criteria is a set of 3 criteria, of which you must have 2 of the 3 in order to be formally diagnosed with PCOS by your naturopathic or medical doctor. They are: 

• Multiple cysts on the ovaries as seen on ultrasound 

• Absent or irregular (consistently shorter than 28 days or longer than 40 days) menstrual cycles 

• Clinical or laboratory findings of elevated androgens (evident through symptoms such as acne, hair loss, and coarse hair growth on jawline, breasts, linea alba, or simply elevated DHEA/DHEA-S, DHT and/or testosterone on blood work)

Check point: if you haven’t been diagnosed with PCOS but suspect you have it, check-in with yourself right now and ask yourself if you have any of the above findings? Here’s a tip, if you have either absent or irregular periods, OR symptoms of elevated androgens, tell your doctor and ask about getting a transvaginal ultrasound. If you have both of the aforementioned symptoms, it’s time to book an appointment with me or another holistic practitioner. 

The reason we care about getting a proper diagnosis is because diagnoses usually lead to treatment. Treatment, especially that of the holistic nature, is extremely important since untreated or poorly managed PCOS can have long-term consequences, like increasing your risk for endometrial cancer, type II diabetes, heart disease and cardiovascular disorder, breast and ovarian cancer. This isn't fear-mongering, this is fact; and my purpose for this post is to empower you now to make changes to prevent chronic disease from happening to you later. So what is the treatment?

CONVENTIONAL PCOS TREATMENT

Given that insulin resistance is a key driving factor in PCOS, I believe that lifestyle medicine is the best approach to take to improve and even reverse PCOS symptoms long-term, especially if you want to prevent its associated risk factors. But let’s first dive into the conventional medical approaches that you’ve likely already been offered, or will be offered if you receive a diagnosis from a medical doctor:

1. Since individuals with PCOS are at a 4x greater likelihood to have metabolic syndrome, if you have excess fat tissue and are considered “overweight”, MDs will prescribe weight loss. While I believe there is more that must be addressed with this approach, research does show that a 5% weight loss reduction improves symptoms and enhances fertility if the body is holding on to excess weight.

2. For individuals experiencing fertility difficulties, clomiphene and letrozole are often used as first-line treatments to stimulate ovulation. 

3. If bloodwork is run and HbA1C and/or glucose is elevated, MDs will prescribe metformin. 

4. Lastly, for individuals experiencing irregular or absent menstrual cycles, and/or those with PCOS-related acne who are not looking to conceive, birth control is prescribed. 

Unfortunately, these options do not address the underlying root cause of PCOS, nor do they address what initially triggered your PCOS to manifest. Despite it having a genetic origin, PCOS will be brought on by diet, lifestyle, and environmental factors. Here is how I approach PCOS management from a holistic perspective. 

APPROACHING PCOS FROM A HOLISTIC PERSPECTIVE: 

Diet, lifestyle, and environmental factors are key players in driving insulin resistance and ultimately the diagnosis of PCOS. These are general recommendations, though; and, your treatment should reflect the root cause of your PCOS. 

Diet: 

Diet is the most fundamental change you can make if you have been diagnosed with PCOS. Given that insulin resistance is at the core of a PCOS diagnosis, it becomes imperative to improve insulin sensitivity, and diet is the best way to make that change. Check out my Kickstart Guide to Overcoming PCOS Insulin Resistance EBook for actionable tips, tools, and recipes to support you on this journey.

Contrary to popular Google belief, not every individual with PCOS needs to take a low-carb approach, though there are scenarios where this may be therapeutic. Generally speaking, I recommend focusing on including nourishing, unprocessed foods and limiting refined carbohydrates which are quickly broken down into glucose. Here’s what I mean: 

• At every meal, include at least one to two sources of watery, non-starchy vegetables, which are excellent sources of fibre required for healthy hormone function. I recommend filling half your plate with vegetables, like: asparagus, bell peppers, broccoli, Brussels sprouts, cabbage, carrots (raw), cauliflower, celery, cucumber, eggplant, green beans, greens (beet greens, chicory greens, dandelion greens, mustard greens, etc.), jicama (raw), jalapeno peppers, kale, lettuce, mushrooms, onions, parsley, radishes, snap beans, snow peas, spinach, spaghetti squash, summer squash (crookneck, scallop, zucchini), Swiss chard, tomatoes, watercress. Daily, 6-8 servings of fruits and vegetables are recommended. 

• Include one piece of fruit after each meal or in a smoothie, up to 3x per day. By eating this after your meal, this slows the glucose response of the fruit down. Fruit should be included in the PCOS care plan since it is high in fibre, water, and above all else, minerals. We need these minerals to create a safe environment for our body to thrive. 

• Every meal should include protein and some fat. Protein slows the glucose response down, which inevitably helps our bodies become more sensitive to insulin. You can calculate your daily protein requirement by taking your weight in kg and multiplying it by 0.8g. Divide this amount by the amount of meals you have per day to get an idea of how much protein you should have at each meal. I do recommend animal and non-animal based forms of protein. For high quality animal products in Canada, check out TruLocal.

• Ensure your fat content comes from non-damaged or highly oxidized fats. Avoid fats like canola, grapeseed, sunflower, safflower, peanut, cottonseed, and vegetable oils. Instead, only include olive, avocado, coconut, butter, and ghee, and of course nuts and seeds. 

• Carbohydrates are best consumed in the form of root vegetables like beets, potatoes/sweet potatoes, and squashes, since these are high in fibre and minerals. Grains can occasionally be consumed, but focus on non-enriched whole grain products like quinoa, gluten-free oats, buckwheat, and brown or wild rice and minimize your intake to 1-3x per week.

If you eat this way 80% of the time, you will help your body to become more responsive to insulin. By the contrary, eating highly refined foods including white flours and inflammatory oils creates an environment of insulin resistance. This is a problem because when insulin is high, this signals to the ovaries to produce more testosterone. Elevated testosterone will “shut off” ovulation--hence the symptoms of irregular cycles & fertility issues.

Lifestyle:

• Exercise: 150 minutes of movement each week is recommended to improve insulin sensitivity. For some, this may look like 30 minutes of walking each day. For others, this may look like HIIT training, swimming, or yoga! If you’re currently sedentary, any movement will improve insulin sensitivity. Just get started! If you have been dealing with chronic stress, I recommend you steer away from HIIT training and focus on yoga, walking, and other calming activities that honour bodily movement without increasing your cortisol (a hormone that can wreck havoc on our insulin levels).  I recommend weight training 3x per week as well. 

• Sleep: Good quality, lengthy (8-10 hours) of sleep is essential to improve insulin sensitivity. It is often one of the most overlooked therapeutics interventions, likely because of our Western culture and desire for productivity. Unfortunately though, lack of sleep can make us more insulin resistant and cause us to crave more carbohydrate foods the next day, further exacerbating the insulin resistance we are dealing with. Sleep should also align with the circadian rhythm, so try to get to bed just after the sun goes down, and wake up when the sun comes up. In addition to that, early morning exposure to light or the sun can be extremely helpful to support deep sleep at night. 

• Avoid Endocrine Disrupting Chemicals (EDCs). ECDs have been shown to turn on PCOS genes in utero, which suggests that PCOS may develop while people are in the womb. EDCs are found in many places, but the biggest culprits are the ones we expose ourselves to daily. These are those in our personal care and household products. Your makeup bag and bathroom are two of the biggest houses of EDCs! Make-up, nailpolish, shampoos/conditioners, body washes, and all of those conventional cleaning products contain endocrine disrupting chemicals that worsen PCOS symptoms, and impair fertility. Making the switch to products that are void of EDCs is one of the easiest things we can do to improve our PCOS outcomes. For makeup and personal care products, I recommend Beautycounter, which has banned over 1500 chemicals in their products and is rated highly on the Environmental Working Group’s Skin Deep Database. Full transparency, I am a Beautycounter consultant and I will receive commissions on your purchases--but know that I would recommend Beautycounter as a result of their high standards regardless of whether or not I earned a commission. 

Your PCOS symptoms may improve or resolve once you have these diet and lifestyle changes fully implemented. These suggestions are foundational to your success. However, some individuals may need deeper support, which can be achieved through other measures like supplementation or other interventions, which we will discuss. In addition to supplement support, I always recommend working with a practitioner like myself who can serve as a coach to keep you motivated to make sustainable, lifelong change. 

Supplementation: 

Supplementation should focus on improving insulin sensitivity, releasing the body burnden of stress, and improving nutrient status. Foundational supplements for my clients and those patients with PCOS include the following: 

• Inositol: Inositol is considered a B vitamin. It improves insulin sensitivity, egg quality, and thyroid function (hypothyroidism is a common co-morbidity in those with PCOS). I recommend a combination of 40:1 myoinositol to d-chiro-inositol ratio. This is the ratio of inositol which is observed in the ovarian tissue and I have seen the greatest impact clinically. Therapeutic dosages begin at 4g per day in divided doses. Most notably, inositol has been shown to be as effective as metformin at regulating glucose and insulin levels in clinical trials.

• Magnesium: there are a variety of forms of magnesium, and many have a place in the PCOS plan. If you are dealing with constipation, we need to regulate bowel movements first since a daily bowel movement is essential for hormone balance. One way we can support this is with magnesium citrate. I also love magnesium bisglycinate, however, for its calming effect on the nervous system, since stress is often a large piece of the PCOS puzzle that I see in my practice. 

• Vitamin D: A deficiency in vitamin D has been shown to contribute to insulin resistance. Especially for those living in the northern hemisphere, I recommend getting your vitamin D levels tested to get a baseline of your levels. This can dictate what dosage of vitamin D we recommend for you to help improve insulin sensitivity.

• N-Acetyl-Cysteine (NAC): this compound is a precursor to glutathione, your body’s “master” antioxidant. It has been shown to improve ovulation and egg quality. 

• Multi-vitamin, prenatal or B complex: for those especially coming off the pill, or who are looking to conceive, a multi-vitamin that includes the B vitamins is essential to rebuild nutrient status. 

• Berberine: this is a herb that has been shown to improve glycemic control as effectively as metformin at a dose of 500mg 3x per day. By controlling our body’s response to glucose, we manage insulin. 

• Other herbs and nutrients to consider are: zinc, licorice & peony combination, omega-3 fatty acids, vitex, maca, ashwagandha, dong quai.

As you can see, a holistic approach is powerful, and necessary, in order to improve and manage PCOS symptoms. PCOS is a complex, chronic disorder that not only impacts our reproduction, but also impacts our metabolism, mood, menstruation, and so much more. I am passionate about helping you to learn more about the why and how of your body and PCOS symptoms so that you can feel empowered to make these changes and feel like yourself again. 

While I feel like this blog post has inspired me to write a book on this topic (because as long as this blog post is, I have really only addressed the tip of the PCOS iceberg), I hope that I’ve provided you with enough valuable information to--at the very least--feel inspired to opt for a holistic and natural approach to healing your hormones. If you have any questions or feel compelled to let me know your thoughts on this post, please drop a comment below for me--and all of us in this community--to see. Know that you are not alone on this journey! 

With love & in health —

Samantha