In the United States, it is estimated that 5 to 6 million women have Polycystic Ovary syndrome, otherwise known as PCOS. PCOS is the most common hormonal disorder among women of reproductive age, but many women don’t know they have it. A fair amount of controversy surrounds the exact collection of symptoms needed to make a PCOS diagnosis. This is why estimates will vary depending on the source.
It is important to note that PCOS is a syndrome, not a disease. This is because it’s diagnosed by identifying a specific collection of symptoms and ruling out other potential causes. Unfortunately, there is no PCOS blood test or a specific functional medicine lab that can be used to determine whether or not someone has PCOS, just a long list of symptoms and test results that create a specific profile labeled PCOS. However, it is a systemic, whole-body disorder that affects metabolism, the immune system, the cardiovascular system, the gut, the skin, and the mind.
According to the AE-PCOS Society and the CRE PCOS, a woman has PCOS if she has (those marked by an * are a required imbalance):
*Hyperandrogenism. This consists of an above average level of androgens, which are male sex hormones such as testosterone. (Note: DHEA-S is another androgen that is elevated in a small subset of PCOS women.)
Irregular or absent menstrual cycle in women of reproductive age. An irregular cycle is anything less than once every 35 days, or anything more frequent than every 21 days, and/or lasting more than 7 days.
Polycystic ovaries due to hormonal imbalances, the ovaries contain many small follicles. (Note: All women’s ovaries are full of follicles. When ovulation occurs properly, one follicle grows and develops each month until the egg bursts from the
follicle (ovulation) and travels down the fallopian tube into the uterus. If it is not fertilized by sperm, then it disintegrates or leaves the body along with the lining of the uterus (menstruation). In women with PCOS, no specific follicle gets recruited to be the one to ovulate, and so a large number of developing follicles continue to exist). Polycystic ovaries are diagnosed through a transvaginal ultrasound and are a symptom of PCOS, not a cause.
That’s it! That’s the list. This can cause confusion for some and misconception for others. Every woman has her own version of PCOS, so let’s take a further look into what many women experience.
Acne: High testosterone levels coupled with inflamed skin can lead to excess oil and an altered skin microbiome. The result is oily, inflamed skin covered in
unfriendly bacteria that result in breakouts.
Infertility: Women with PCOS have a variety of hormonal and inflammation
dysfunctions. Unfortunately, many women with PCOS do not have much success with fertility treatments due to the hormonal and inflammation imbalances. (Note: If using progesterone and you are getting yeast infections, run an OAT (Organic Acids Test). You can learn more about how to order your OAT here: At Home Lab Tests | BalancedVitality .
Miscarriage: An estimated 30% to 50% of PCOS pregnancies end in miscarriage. Because PCOS causes imbalances in many hormones, including testosterone, estrogen, insulin, progesterone, and luteinizing hormone, the risk of miscarriage is increased. Additionally, there are challenges involving the health of the placenta, the vascular system, the liver, and more — all of which increase the risk of pregnancy loss. All the more reason to begin finding the root cause(s) of your PCOS and begin to work with a practitioner who can help you rebalance your body so that you can have a happy and healthy pregnancy.
Hirsutism: Elevated testosterone levels trigger the hair follicles on your face,
abdomen, legs, chest, and back to sprout dark hair.
Alopecia: Often the result of the high testosterone levels, alopecia is the thinning of one’s scalp hair or scalp hair loss, somewhat similar to male-pattern baldness.
Obesity: An estimated 70% of women with PCOS are by definition “obese”. Obesity is defined as a body mass index (BMI) of 30 or higher. Study after study shows that for women with PCOS, losing 5% to 10% of body weight improves fertility, improves metabolic health, and substantially reduces the risks of heart disease, diabetes, and cancer (1,2). Metabolism relies on hormonal
messengers. It includes every organ in the body, especially the liver, pancreas, and hypothalamus. It occurs primarily on a cellular level, with individual cells absorbing or repelling sugars and fats circulating in the blood to use for fuel. And it incorporates the health and lifespan of those cells. If you have metabolic health, all of these organs and processes work smoothly together. Learn more about metabolic health here:
Other symptoms that may be associated with PCOS:
Gut Dysbiosis (IBS, GERD, SIBO): PCOS dysregulates your entire gastrointestinal tract, from the mouth all the way down through the large intestine, which makes it hard to keep things moving smoothly, regularly, and in the right direction.
Trouble Sleeping: PCOS women metabolize melatonin and cortisol, two hormones critical to the sleep-wake cycle, at abnormal levels and off-rhythm with the 24-hour day. Insomnia is exacerbated by depression and anxiety, which are also linked to PCOS. Balancing hormones including cortisol can often help improve sleep quality. If one’s cortisol levels are higher at night than it should be, then melatonin can’t do its job. Additionally, tracking your blood sugar level and improving your inflammation level, especially in the gut (leaky gut, bloating, yeast overgrowth) can improve not only sleep quality but hormone function, thyroid function, and stress levels.
Thyroid Dysfunction: Women with PCOS often have thyroid issues according to Dr. Eric Balcavage. By burning through minerals due to stress- which cause imbalances and taxes the adrenals, there is an effect on the thyroid (specifically the HPA axis). When our sympathetic nervous system is upregulated, downregulation happens with TSH, T3, and T4, which creates altered hormone signaling- especially in regard to FSH (Follicle Stimulating Hormone) and glucose resistance. If the conversion from T4 to T3 is less than optimal, one needs to find what inflammation is causing the conversion to operate at less-than-optimal levels. Interestingly, high cholesterol could tell us that it isn’t being converted accurately. In order to make DHEA, progesterone, and cortisol at the adrenal gland, you need cholesterol and correct levels of T3. LDL is t3 dependent also (So cool how all things are connected in some way in the body, isn’t it?!).
He makes note that low carb diets don’t prevent glucose resistance (as I mentioned in my article about diabetes and metabolic health). Also important to note is that there are different lab reference ranges when running labs, including those that look at the thyroid, depending on who you got to (conventional v. functional practitioners). This is why often medical doctors will say, “You’re fine! Your labs are within range.” When in fact they are above or below optimal or functional range levels. Something I think everyone should be aware of that he mentions is that being on thyroid medication for 5-10 years or more greatly increases your risk of different types of cancer (3).
Most women with PCOS have underlying, chronic inflammation, insulin resistance, gut dysbiosis, and hormonal imbalances that most treatment protocols don’t address. Over time, these conditions progress to long- term health conditions like auto-immune disease, cancer, type 2 diabetes, fatty liver disease, and cardiovascular disease.
All of these PCOS symptoms, every single one, can be tied to just a few underlying conditions:
Insulin Resistance
Hormone Dysregulation
Inflammation
Your circadian rhythm, gut microbiome, and the health of your environment all powerfully regulate all of these conditions.
So, where does one start on addressing their PCOS symptoms? Finding a practitioner who understands that PCOS is a multi-faceted issue and can offer lab testing!
In modern medicine, we treat the body like a series of parts. That’s not what I, and other practitioners like me, do. If you need help with lab testing or finding a practitioner, please reach out.
