Polycystic Ovary Syndrome (PCOS) is a condition affecting the ovaries where the ovaries produce more androgens (male hormones) than they typically should. While there are different statistics available, it appears that anywhere from 15% to 20% of female patients may have PCOS. This makes it one of the most common hormonal disorders among women of reproductive age.
Even though this condition is so common, it is unfortunately underdiagnosed. This means that many women may experience symptoms without receiving help or even knowing that their symptoms could potentially be managed with a functional medicine approach.
When PCOS is addressed with a functional medicine approach, it may help reduce the chance of developing some of the other health issues associated with it. These include challenges with fertility, digestive concerns, blood sugar imbalances, mood fluctuations, and cardiovascular health.
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PCOS Signs & Symptoms
As the name of the syndrome suggests, polycystic ovaries (having many cysts on the ovaries) are a common sign of PCOS. However, PCOS can be identified without evidence of cysts on the ovaries. Having the combination of high androgens (testosterone) and irregular ovulation may be enough to consider a diagnosis. So, the name of this syndrome only speaks to one aspect of what is going on.
Because this syndrome is more complex than the name suggests, other common signs and symptoms of PCOS should be considered. They include metabolic and hormonal symptoms.
Metabolic symptoms may occur due to insulin resistance associated with this condition. Some of these symptoms include high blood sugar, cholesterol and triglyceride levels, blood pressure, skin changes, and changes in body weight.
Hormonal symptoms may occur due to the excess androgens produced by the ovaries during PCOS. These symptoms include irregular or missed periods, lack of ovulation during a cycle, challenges with fertility, hair thinning, excess facial and body hair, skin changes, and changes in menstrual bleeding.
PCOS Possible Causes
PCOS might have a genetic component since it is frequently observed in families. Patients with a mother or sister with PCOS seem to have a higher chance of having it themselves.
However, there is much more to the story. While technically there is currently no known cause for PCOS, there is a strong connection with insulin resistance. When the body experiences insulin resistance, it may influence the ovaries to produce more testosterone. This can affect hormonal balance and is the reason women with PCOS may experience common symptoms, such as facial hair, skin changes, and hair thinning.
But what about the causes of insulin resistance? Factors such as dietary choices and stress levels may play a role. This is why diet and lifestyle are important considerations in addressing this condition.
Considering dietary changes by reducing processed foods and sugar may be a helpful start to managing these symptoms. And even though a truly stress-free lifestyle is nearly impossible these days, incorporating stress-reducing practices such as yoga, reading, meditating, taking a bath, or a long walk can be beneficial in supporting overall well-being.
Functional Medicine Labs to Test for PCOS
A thorough medical history and routine physical exam are essential for ruling out other disorders and conditions. But, using functional medicine labs can also be a useful step for exploring PCOS and understanding potential underlying factors.
Comprehensive Lipid Panel
A comprehensive lipid panel analyzes factors related to cardiovascular health, which may be relevant for those with long-term PCOS. Tracking these results over time can provide useful insights.
Insulin Resistance Testing
Since there is a strong connection between PCOS, insulin resistance, and blood sugar management, it is important to measure glucose, insulin, and HbA1C to explore metabolic health.
Homocysteine Test
Vitamin levels are commonly associated with PCOS. Homocysteine is a marker that can help assess levels of certain B vitamins and provide insights into inflammation in the body.
Vitamin D Test
Vitamin D levels are associated with both insulin resistance and inflammation, which is why this is often explored as well.
Comprehensive Female Hormones Panel
Assessing reproductive hormones is important in understanding how PCOS may affect the body. For example, testing hormones can help explore other hormonal conditions that may be present alongside PCOS symptoms. It can also provide insights into hormonal balance to guide potential management strategies.
Serum values are a common way to test for hormones. However, the downside of a serum test is that it provides a snapshot in time - meaning that the value you get only represents the value of the hormone the day and time that the lab was drawn.
On the other hand, a dried urine test is more comprehensive in testing these hormones because it can assess the hormone values throughout the entire cycle. DUTCH Cycle Mapping Plus is a comprehensive way of evaluating these hormones with the complete picture in mind.
Comprehensive Stool Test
Lastly, assessing gut health is something that should not be overlooked. It might seem unrelated to a hormonal condition, but gut health can impact inflammation, hormonal balance, and insulin resistance.
One study found that a disrupted gut microbiome may influence insulin levels and ovarian function.
Functional Medicine Considerations for PCOS
The goals for managing PCOS may include supporting inflammation balance, addressing insulin resistance, and promoting hormonal balance to support regular ovulation.
Nutrition for PCOS
Dietary guidelines and supplementation may be centered on the evidence that individuals with PCOS may have different needs for certain vitamins and nutrients such as B vitamins, vitamins D, K, E, and minerals like zinc, selenium, and chromium. Including foods containing these nutrients in the diet may help support overall health.
Individuals may consider focusing on organic food as much as possible and being mindful of other chemicals in the home. Non-organic foods, cleaning supplies, and personal care products may contain endocrine-disrupting substances. This means that these chemicals can behave like hormones in your body and potentially affect hormone balance.
Supplements for PCOS
Additional supplements that may be helpful for PCOS include Inositol, N-Acetyl-Cysteine (NAC), Vitamin D3, and Berberine. Inositol may support metabolic health and regular ovulation. NAC may help support insulin sensitivity. Proper vitamin D levels are important for inflammation regulation. Berberine has been shown to support testosterone, glucose, and insulin levels.
Exercise for PCOS
Research suggests that exercise is an integral part of managing PCOS. Specifically, high-intensity interval training (HIIT) has been shown to support metabolic health and may help with some PCOS symptoms.
Follow-up Considerations
Labs can be repeated as early as three months after beginning a management plan. This allows the body time to incorporate changes and support metabolic and hormonal health. Although, waiting a full six months may provide a clearer picture of how well the management plan is working.
With functional medicine approaches, some individuals may find they need fewer medications associated with PCOS, such as those for blood sugar, cholesterol, and blood pressure. This type of approach aims to support the body's natural balance rather than only addressing symptoms. However, it is important to know these approaches take time. A period of 6-9 months is a typical timeframe for observing changes when an individual is fully engaged with diet, lifestyle, and supplements.
Summary
PCOS is a common and complex condition affecting many women of reproductive age. It is commonly underdiagnosed and may be poorly managed, leading to many women experiencing symptoms without a clear plan of action.
Functional medicine offers tools to explore and address potential underlying factors, utilizing nutrition, supplementation, and lifestyle adjustments.
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