I’ve had a number of clients come to the clinic lately who are struggling with Polycystic Ovarian Syndrome (PCOS).
The common thread woven into their experience has been confusion, frustration and disappointment at the lack of medical care available.
Aside from being offered the pill to regulate their cycles (it doesn't) or drugs that force ovulation, there isn't a lot medically available to support folks with PCOS or to help them heal the underlying causes.
PCOS is a notoriously puzzling condition - so let's shed some light on what PCOS is, how getting the right diagnosis can be a game changer and how holistic support can help.
First things first.
What is PCOS?
PCOS is complex condition that can be best thought of as a “group of symptoms” that effect ovulation and involve a high level of androgens.
Having PCOS doesn't mean you can't have kids, or that you can't use Fertility Awareness for natural contraception.
When is it PCOS and when is it not?
PCOS is tricky to diagnose correctly, now I’m a herbalist and not a doctor so diagnosing is not in my wheel house - but here’s a few things you oughta know.
As PCOS is more deeply studied and understood, the diagnostic criteria is being revised.
At present, according to the Androgen Excess Society in order to get a PCOS diagnosis you have to meet all three of the following:
1. Ovarian dysfunction or polycystic ovaries
(Looks like: the inability to ovulate / irregular cycles or polycystic ovaries on ultrasound.)
2. High androgens on blood tests and / or hyperandrogenism aka: Hirsutism.
(Sometimes termed “male-pattern” hair growth.)
3. Exclusion of other conditions that would cause elevated androgens.
This brings us to the PCOS myth bust: you can’t diagnose PCOS by ultrasound alone!
It’s normal for between six-twelve ovarian follicles to develop under the influence of estrogen and follicle stimulating hormone (FSH) each cycle.
During a healthy cycle, one dominant follicle will eventually mature, suppressing the growth of the others and go on to ovulation.
This means that benign ovarian cysts or follicles are a normal part of ovarian function and an ultrasound can observe multiple cysts on perfectly healthy ovaries.
Therefore an ultrasound, alone, is not an effective diagnostic tool for PCOS diagnosis.
In cases of PCOS, the inability to ovulate means the dominant follicle never develops, instead all the follicles continue to develop until multiple cysts are present.
Which means you can have poly-cystic ovaries and not have PCOS.
Digging deep by Annie Spratt.
“PCOS is essentially a problem with ovulation, which results in an overproduction of androgens such as testosterone. “ - Lara Briden, N.D.
OK, how does PCOS show up in my body?
If you have PCOS you will have late, delayed or erratic periods.
You'll possibly experience some form of hirsutism and / or struggle with acne, hair loss, weight gain and difficulty conceiving.
You might also notice shifts in your libido and mood.
Many, but not all people with PCOS will also have insulin resistance, or diabetes may run in their family.
A side note on Hirsutism:
Hirsutism does not mean a few dark chin or upper lip hairs it is a condition where dark or coarse hair appears on the face, chest and back and is driven by androgen excess.
The two key criteria for PCOS are: inability to ovulate regularly and androgen excess.
So why aren’t you ovulating regularly?
In order to answer this question it’s important to take a holistic approach to your body.
So much impacts and influences ovulation.
Your hormonal (endocrine) system is connected to every other system of your body, it’s influenced by your thyroid function, adrenal hormones, blood sugar regulation, stress, exercise, weight loss and nutrition.
To understand what’s driving your irregular cycles it’s important to take a whole-body picture.
If you’re having irregular cycles and your doctor suspects PCOS, you can ask for the following investigations:
Hormone panel - FSH, LH, estrogen, progesterone, prolactin.
Thyroid panel- TSH, T3, T4 and antibodies.
Adrenal hormones - DHEA, SHBG.
Androgens -free testosterone and androstenedione.
This will help shed light on what’s preventing your body from ovulating - And help you get the right support.
Other factors to consider are;
Sudden weight loss.
High intensity athletic training.
Transitioning off hormonal birth control.
Inflammation - digestive issues, psoriasis, eczema.
Mental and emotional health, grief and trauma.
Your body needs to feel relatively safe and well in order to ovulate regularly. That means low stress with healthy ways to manage stress, adequate nutrition and a stable weight for your body.
Natural support for PCOS
Holistic herbal and nutritional support will vary depending on the underlying causes of PCOS, your constitution, lifestyle and genetic factors.
Working 1:1 with your herbalist, Traditional Chinese Medicine practitioner, Naturopath or other holistic practitioner will give you the most effective support.
With that in mind, here are some guidelines for you to consider.
Ornamental or pink Peony in the garden, Appleton, Maine.
1. CHART YOUR CYCLE
This will give you day-to-day insight on your hormonal health , allow you to confirm if you are ovulating so you know when your cycle is returning.
These can drive inflammation and exacerbate some forms of PCOS.
3. REPRODUCTIVE HERBAL TONICS
Peony + Licorice
Peony Paeonia lactiflora has long been used as a reproductive tonic that helps supports an excess estrogen picture. Heavy periods with dark red blood flow and cyclical acne that appears on the chin are common constitutional pictures of estrogen excess.
Peony and Licorice Glycyrrhiza glabra is a Traditional Chinese Medicine formula that's become increasingly popular as more and more research indicates it's ability to balance hormones and nourish fertility. (Links below).
By itself, Peony is well-indicated for hormonal and reproductive health as an anti-spasmodic and a hormonal modulator.
Alone, Licorice has a calming and nourishing effect on adrenal function.
Together, these herbs act synergistically, and are far more effective than either alone for balancing androgens and normalizing testosterone levels.
Note - Licorice is not recommended if you have a history of high blood pressure.
Be mindful about Vitex.
Often people look up hormonal regulators and Chaste tree - Vitex agnus-castus comes up.
Vitex is a popular and very useful herb for supporting cycle regularity - but only in some instances.
If your PCOS or cycle irregularity is caused by elevated Luteinising Hormone (as can be the case where there is excess insulin) Vitex can exacerbate the situation by further increasing LH.
Herbal medicines are most effective when a person’s whole health, lifestyle and constitution are considered.
To get the right herbal support for your body - consult with your local herbalist, Traditional Chinese Medicine Practitioner or Naturopath.
Bitters like kale, rocket and dandelion support the liver and hormone excretion.
Vinegars - slow glucose entry into the body, use apple cider vinegar or balsamic (without sugar) as a dressing.
Go Organic - conventionally grown foods with pesticides contain endocrine disrupters which impact your hormonal health.
Protein - Including a protein source at each meal can help with blood sugar regulation. Think: Eggs, nuts, seeds, hummus, pesto, cheese, yoghurt as well as meat products.
5. SPECIFIC NUTRIENTS:
Zinc picolinate can help nourish both ovarian and skin health. Helpful in PCOS with acne and may be helpful with hirsutism.
Chromium picolinate - can support insulin uptake of cells, helpful in PCOS driven by insulin-resistance.
Magnesium citrate - can support both ovarian health and support hormones.
6. SUPPORT GUT HEALTH:
Healthy liver and bowel function helps metabolize and excrete excess hormones.
Ensure you poop daily and support your micro-biome with probiotic and fermented foods daily.
Probiotic and fermented foods: Saurkraut, miso, kimchi, yoghurt, kefir.
7. FIND YOUR RHYTHM
Sleep, eat and exercise regularly.
Go to bed and wake up at the same time each day.
This helps balance your circadian rhythm and regulate your blood sugar.
Cardiac exercise can have a beneficial action on blood-sugar and insulin resistance.
Opt for 30-45minutes of cardiac exercise three times a week.
9. CREATIVE EXPRESSION
Your ovaries are the powerhouse of your fertility - and govern your creative energy.
Whenever there’s an issue with ovulation - consider the ways in which you engage, direct or express your creativity.
10. TRAUMA, GRIEF AND SAFETY
Your emotional body affects your physical body.
Unprocessed emotions and unexpressed grief can affect your relationship with and the healthy functioning of your body.
Making time for the self-care, therapy and/or craft that helps you process isn't always easy, but it is essential.
Feeling safe and well in our bodies is an essential need, and it's not available to all of us.
If you need support:
Maine Crisis Line is a free-call 1-888-568-1112 and available 24/7.
They are committed to serving non-English speakers as well as the deaf community.
New Hope For Women - provides support to people suffering from domestic or dating violence and stalking.
Free Call Domestic Violence support - Mid coast Maine. 1-800-522-3304
Free Call National Domestic Violence Line 1-800-799-7233
(If you're not in Maine, there are free-call services and online-therapy options available across the USA and internationally as well.)
Getting to the bottom of PCOS can be tricky - but it's not impossible.
Working with your doctor for the right diagnosis can help you uncover the underlying causes of your PCOS and point you in the right direction for healing.
A holistic practitioner can help guide you toward the herbal medicines, foods and practices that nourish your fertility and help you find your own rhythm.
Never doubt this - your body has an immense capacity to heal.
My best wishes for your PCOS journey,
For more insights into PCOS:
Dr. Lara Briden (2017) Period Repair Manual. Chapter on PCOS.
Her blog is a wonderful resource!
Ruth Trickey (2011) Women Hormones & The Menstrual Cycle. Chapter on PCOS.
Jerome Sarris & Jon Wardle (2010) Clinical Naturopathy. Chapter on PCOS.
Dr. Kerry Hampton (2015) Course notes on ovulation.
Leah Hechtman N.D. (2017) Is PCOS being over-diagnosed? Clinical biomarkers for PCOS.
Podcast archive: Fertility Friday: PCOS - wonderful conversations about healing PCOS.
Matthew Wood (2008) Earthwise Herbal.
Michael Tierra - East West School of Herbalism.
Gabrielle is a herbalist and fertility educator passionate about reproductive healing and empowerment.
She offers 1:1 session work and classes.
To book a session or say hello - firstname.lastname@example.org