What to know if you've just been diagnosed with PCOS and want to avoid medication

If you've just been diagnosed with polycystic ovary syndrome, or PCOS, chances are you may be a bit confused.

Despite PCOS impacting a whopping 10% of women, awareness about this condition remains low - even within the medical community - and it can be overwhelming diagnosis to receive.

While PCOS can lead to future health complications such as infertility, diabetes, heart disease, and even certain types of cancers, many of these risks can be mitigated by learning how to manage your symptoms early on. But before jumping into symptom management, it can be helpful to learn the basics of PCOS.

Keep reading for an overview of what we've found to be helpful lifestyle habits for those new to the world of PCOS. If you are curious about options for managing PCOS with conventional medication, be sure to check out this article.

What is PCOS?

PCOS is a common hormone imbalance that can also be a metabolic and inflammatory issue for some (more on that below!).

In order to have been diagnosed with PCOS, you have fulfilled 2 of 3 of the Rotterdam criteria:

• Elevated androgen levels such as testosterone, DHEA-S, or SHBG. This is diagnosed with blood work.
• Anovulatory cycles or irregular ovulation. You likely reported this yourself to your doctor; if you have not been tracking your ovulation specifically, irregular menstrual cycles (i.e., a cycle that is not within a 21 - 35 day window) is used as a proxy.
• Polycystic ovaries are identified by your doctor with an internal ultrasound.

Since those with PCOS typically produce more of the male sex hormones which can lead to a range of symptoms and disrupt our monthly cycles. This can include symptoms like irregular or absent cycles, adult acne, hair loss, weight gain, hirsutism, or more.

Different types of PCOS

There are four main types of PCOS that we commonly see.

⁠1. Insulin resistant PCOS⁠

⁠This is the most common type of PCOS. We can determine that you have insulin resistant PCOS by looking at your circulating insulin levels.⁠

2️. Pill-induced PCOS⁠

⁠Unfortunately, birth control can mask PCOS and may cause symptoms once we stop taking it. When we cease birth control, there is a flood of androgens which while temporary which can cause a range of symptoms associated with PCOS.⁠

3️. Inflammatory PCOS⁠

⁠Chronic inflammation in our body can see our ovaries produce too much testosterone, which we know is a common issue in PCOS!⁠

⁠4. Adrenal PCOS⁠

⁠If our bodies respond to stress in an abnormal way, we can see adrenal PCOS as a result. It is not as common, only making up around 10% of all PCOS cases. This diagnosis will see high levels of DHEAS (an androgen produced in the adrenal glands) and normal levels of other androgens.⁠

Helpful PCOS labs to request

In your quest to learn everything you've wanted to know about your PCOS, it's important to consider labs! There are several helpful labs that you can ask your doctor to request if you suspect you have PCOS or if you want to gain a clearer picture of how well you are currently managing your PCOS.

There are several hormones which may be contributing to your PCOS and are responsible for your symptoms including:

• Testosterone
• DHEA-S
• Estrogen
• Progesterone
• LH
• FSH
• Prolactin

It’s also helpful to understand your blood sugar levels and whether insulin resistance is an issue for you. You can ask your doctor to check your:

• Fasting glucose
• HbA1c
• Fasting insulin

Inflammation can be common in those with PCOS and thankfully with dietary and lifestyle changes, we can reduce this if we know it is an issue. As your doctor to check your:

• CRP
• Homocysteine

Metformin (a commonly-prescribed PCOS medication) can cause B12 deficiencies, so ensure that you doctor screens for this in your bloods also!

How does PCOS impact your menstrual cycle?

There are two main ways in which PCOS impacts upon your menstrual cycle.

Firstly, people with PCOS typically don’t ovulate or ovulate infrequently. This prevents the uterine lining from shedding each month like we would typically expect. As a result, this can cause irregular menstrual cycles. 

Second, as a result of the above, the uterine lining doesn’t shed as often, becomes thicker and can cause heavier bleeding than normal when you do get a menstrual bleed.

Over time the buildup of uterine lining that occurs with lack of menstruation can also increase risk for endometrial cancer, so be sure to talk with your doctor about ways to prevent this through either lifestyle (e.g., nutrition and exercise changes to regulate your cycle) or pharmaceutical (e.g., hormonal birth control) means.

What does PCOS mean in terms of fertility?

Given that PCOS disrupts your ability to have a normal menstrual cycle, it can also potentially impact upon your ability to get pregnant. It is estimated that between 70-80% of women diagnosed with PCOS struggle with infertility at some point.

The changes in hormone levels can also increase your risk of complications arising during your pregnancy including:

• Premature birth
• Miscarriage
• Gestational diabetes
• Pre-eclampsia

Thankfully dietary and lifestyle changes - which require much lower financial resources than costly fertility treatments - considerably improve your chances of conception and having a healthy pregnancy and healthy baby. If you have PCOS and are able to regulate your ovulation and menstrual cycle, your chances of conceiving naturally are greatly improved.

Things that can make your PCOS worse

There are many things in our day-to-day that may unknowingly be making our PCOS symptoms worse.

While balance is key, it is important to know what should be avoided most of the time. Some examples include:

• Working long hours and not taking regular breaks
• Inadequate water intake
• Inadequate daily movement or exercise
• Not eating enough fiber
• Poor sleep duration and quality
• Drinking too many caffeinated beverages
• Not eating enough healthy fats in your diet
• Not eating regularly (skipping meals and snacks can wreak havoc on your blood sugar and insulin levels)
• Exposure to endocrine disrupting chemicals
• Not eating balanced meals
• Consuming too many processed foods

How to support your PCOS with lifestyle changes

The good news is that there are many aspects of your lifestyle that can be altered that can significantly improve the free androgen index (FAI), in addition to your weight and BMI. What are areas you should be focused on?

Optimize nutrition

Aiming to balance your blood sugar levels and manage your insulin resistance is key, particularly if you are one of the 70 - 90% of people with PCOS who are also insulin resistant. Consuming low-glycemic index foods (see guide here for more info) is a helpful place to start, as is making sure you are eating regularly-timed meals and snacks every 3-4 hours. Lastly, consuming balanced meals and snacks that incorporate protein, healthy fats, and fiber-filled carbohydrates is always a win.

Manage stress and get enough rest

Adopting strategies to better manage your stress can be vital when it comes to lowering inflammation, androgens, and stress hormones. Moving your body, meditating, and journaling are all common stress management strategies, but experiment and find what works for you.

Sleep is also key. It's recommend you get at least 7-8 hours of sleep each night, and it can also be helpful to avoid screens before bed and get some time in the sun upon waking to support your circadian rhythm.

Supplement if necessary

Talk to your healthcare profession about how dietary supplements may be able to assist in the management of your PCOS. Common PCOS supplements include: 

• Magnesium: The research on magnesium supplementation is not concrete at present. Some studies suggest that magnesium may play a role in improving insulin resistance due to its links to glucose metabolism..
• Inositol: Inositol is often combined with metformin and can help to enhance insulin function. It has also been shown to move glucose into our cells faster, helping to keep our blood sugar levels more stable.
• Berberine: Berberine is known for having several functions including helping to reduce inflammatio, increasing insulin sensitivity, and encouraging ovulation each cycle (in turn improving fertility).
• N-Acetyl Cysteine (NAC): NAC is an antioxidant compound which reduces the number of free radicals that can damage cells in our body. NAC is associated with improved chances of conceiving and more regular ovulation.

Drink enough water

Aim for at least 8 glasses of water each day! 

Avoid endocrine disrupting chemicals

Avoid BPA, phthalates, dioxins, copper and chromium. These are just some of the many endocrine disrupting chemicals we are exposed to each day, and as someone with PCOS, your body is likely more sensitive to these harmful substances already. Endocrine-disrupting chemicals are found in:

• Food (aim for organic produce, particularly for the Dirty Dozen!)
• Personal care products
• Cosmetics
• Pharmaceuticals
• Pesticides
• Plastics
• Water
• Soil

You can learn more about endocrine disruptors here.

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Enjoyed learning about managing PCOS through lifestyle changes and keen to learn more?

Check out Pollie's PCOS Program to learn more about how we can help with our lab packages, care teams, personalized PCOS Plan, and more. If you would like to work 1-1 with a provider, you can learn more about working with Anabelle through her private practice here.

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References

1. Treatment of infertility in women with polycystic ovary syndrome: approach to clinical practice (nih.gov)
2. Pregnancy complications in women with polycystic ovary syndrome | Human Reproduction Update | Oxford Academic (oup.com)
3. Polycystic Ovary Syndrome (PCOS): Symptoms, Causes, and Treatment (healthline.com)

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