PCOS has become a hot topic in online communities lately, and chances are you’ve come across the term in social circles, on social media, or maybe you or someone who is close to you has been diagnosed with the condition. With all of the information out there, it can be tough to decipher fact from fiction – our Dr. Bronwyn Storoschuck breaks it down for you and answers to the most frequently asked questions about PCOS and its impact on your fertility.

What is PCOS?

PCOS stands for Polycystic Ovarian Syndrome. PCOS is a common hormonal condition that affects between 12-21% of reproductive age women. When something is classified as a “syndrome” it means that the signs and symptoms can vary from person to person. When it comes to PCOS, common signs and symptoms include infertility, facial hair growth (hirsutism), acne, irregular periods or no periods at all, hair loss, and/or obesity.

What causes PCOS?

The exact cause is still questioned, but it is well known that there are disturbances in several hormones in women with PCOS including increased androgens or male sex hormones, and insulin resistance where the cells do not respond to the normal actions of insulin. Early identification and treatment are critical since PCOS and the underlying hormonal disturbances put women at risk for developing conditions like Diabetes and Metabolic Syndrome.

What Does PCOS do to the Body?  

It is known that 65-70% of women with PCOS are found to be insulin resistant. When our cells stop responding to insulin, higher levels circulating in the blood. This stimulates the ovaries to secrete more testosterone and inhibits sex-hormone binding globulin production, which leads to high levels of testosterone.

This explains the acne, facial hair growth and hair loss in many women. Insulin resistance can be genetic, but it also is strongly associated with lifestyle factors like diet, exercise and stress. This means that it is treatable – so let’s dive in!

How is PCOS diagnosed?

As discussed above, the most common symptoms of PCOS include facial hair (hirsutism), acne, weight gain and irregular cycles, but women experience these symptoms to varying degrees. In practice, we use something called the “Rotterdam Criteria” to diagnose women with PCOS.

A diagnosis of PCOS requires two out of three of the following:

  1. Ovulatory dysfunction – leading to irregular periods or no periods at all  
  2. Signs of androgen excess like acne and hirsutism; or elevated total or free testosterone on blood work
  3. Polycystic ovaries as seen on an ultrasound

When working with a naturopathic doctor, these are some of the recommended lab tests to get a better understanding of what is going on:

  • Free and total testosterone, or free androgen index
  • Fasting blood glucose
  • Fasting insulin
  • Day 3 FSH and LH
  • Vitamin D

A pelvic ultrasound can also be done to evaluate the amount of follicles in the ovaries.

How is PCOS Treated?

There are a number of factors to consider to effectively treat PCOS.

Since PCOS is a collection of symptoms, each woman should be assessed and treated according to her individual presentation of signs, symptoms, and hormone levels while considering her desire for future fertility. The goals of naturopathic treatment ultimately should include weight loss (when necessary), managing blood sugar and balancing hormones.

  • BALANCING BLOOD SUGAR

When it comes to blood sugar, the foundation of treatment must include dietary modification, exercise and stress reduction. We also have many supplements that can be incorporated to sensitize the cells to insulin, to get to the root of PCOS. Here are some tips:

Diet:

  • I recommend a Paleo-style diet that includes an abundance of fresh vegetables, high-quality fats and proteins
  • This means cutting out sugar, most grains and ditching dairy

Exercise:

  • Exercise is beneficial for all women with PCOS, but in those who are overweight it is clear that a reduction in body weight of 5-10% can restore ovulation
  • The goal of exercise will be to build lean body tissue (muscle) to improve insulin sensitivity and increase basal metabolic rate

Sleep:

  • Prioritize sleep: get at least 7-8 hours of uninterrupted sleep each night
  • Insulin sensitivity is significantly reduced after only 1 week of sleeping 5 hours per night
  • One study even showed that one night of sleep deprivation reduced insulin sensitivity by 33%

Stress:

  • Slow down!
  • Find a mindfulness practice that works for you and practice it every day, even if it’s just for 5 minutes. This can include meditation, yin yoga, breathing or journaling.
  • Recognize the things in your life that no longer serve you and make more time for fun

My Go-To Supplements to address Insulin Sensitivity:

  • Vitamin D is essential for improving insulin sensitivity. Patients with PCOS commonly have lower levels of vitamin D which can compound the metabolic and endocrine disturbances. I recommend testing your levels before supplementing to understand how much you need
  • Myo-Inositol has been shown to increase insulin sensitivity and promote ovulation in women with PCOS
  • Berberine is a compound that has been effective at improving blood sugar levels by increasing insulin sensitivity, similar to the drug Metformin.

*This supplement is not safe in pregnancy and should be stopped upon a positive pregnancy test

  1. REGULATING HORMONES

Since insulin resistance plays such a critical role in the pathogenesis of PCOS, improving insulin sensitivity often results in hormone balancing. However, it can be a few months before many women see these results, so they look for strategies to reduce the unpleasant symptoms of PCOS at the same time. Here are a few of the supplements I like to use in practice:

  • Spearmint tea has been shown to significantly reduce free and total testosterone
  • Licorice (the botanical herb, not the candy!) can significantly reduce serum testosterone and has been used as adjunctive therapy in women with PCOS
  • In addition to licorice, White Peony has been used alongside to increase sex-hormone binding globulin and reduce free and total testosterone
  • Omega-3 supplementation can also be used to decrease free androgen levels and has been shown to reduce facial hair (hirsutism). Omega-3s may also help in increasing insulin sensitivity.

Whether you are trying to conceive, or are just hoping to have clear skin and regular periods, there are many available treatments to help manage your PCOS. If you suffer from any of these symptoms of PCOS, I recommend that you work with your healthcare provider to ensure you are receiving the appropriate diagnosis, so that you can receive the best possible treatment I always recommend working with a naturopathic doctor to determine the best laboratory testing and treatment plan for your unique concerns.

To learn more about PCOS or to book an appointment with Conceive Health, visit conceivehealth.com

Dr. Bronwyn Storoschuk is a board-certified naturopathic doctor and health advocate. She offers personalized care, appreciating the uniqueness of every individual. Dr. Storoschuk is passionate about working with intended parents to not only improve the chance of conceiving but to give a child the best start to a healthy life. Dr. Storoschuk received her Doctor of Naturopathy degree from the Canadian College of Naturopathic Medicine (CCNM). During her clinical internship, she received additional training in preconception care and fertility support. As your partner in fertility, Dr. Storoschuk will dig deep to understand the root causes of any fertility challenges. Her ultimate goal is to provide you with the tools that you need to live your healthiest life and create the healthiest offspring.

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