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A Functional Medicine Approach to PCOS

A Functional Medicine Approach to PCOS

Polycystic Ovary Syndrome (PCOS) is a condition affecting the ovaries where the ovaries produce more androgens (male hormones) than they should. While there are different statistics out there, it appears that anywhere from 15% to 20% of female patients have PCOS. This makes it the most common hormonal disorder among women of reproductive age.

Even though this condition is so common, it is unfortunately underdiagnosed. This means that many women are suffering without any help or even the knowledge that most, if not all, of their symptoms, could be reversed with a functional medicine approach.

When PCOS is addressed with a functional medicine approach, it reduces the chance of developing some of the other health issues associated with it. These include infertility, IBS, type 2 diabetes, depression and anxiety, hypertension, and heart disease.

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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 diagnosed without evidence of cysts on the ovaries. Having the combination of high androgens (testosterone) and dysfunctional ovulation would be enough to qualify for 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 screened. They include metabolic symptoms and hormonal symptoms.

Metabolic symptoms occur because of the insulin resistance associated with this condition. Some of these symptoms include high blood sugar, high cholesterol and triglycerides, high blood pressure, acanthosis nigricans (skin darkening in the folds of the body such as under the breasts, neck, armpits, and thighs), and excess body weight (having a BMI greater than 25).

Hormonal symptoms occur because of the excess androgens produced by the ovaries during PCOS. These symptoms include irregular or missed periods, lack of ovulation during a cycle, infertility, male-pattern hair loss, excess facial and body hair, acne, endometrial hyperplasia (pre-cancer), and abnormal uterine bleeding.

PCOS Possible Causes

PCOS might have a genetic component since we frequently see it running 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 faces insulin resistance, it triggers the ovaries to pump out excess testosterone. This throws off the hormonal balance and is the reason women with PCOS face common symptoms, such as facial hair, acne, and hair loss.

But what about the causes of insulin resistance? The two largest culprits are processed diets leading to high blood sugar and high-stress levels. This is why diet and lifestyle are so important and impactful in addressing this condition.

Cleaning up the diet by eliminating processed/junk foods and sugar is an excellent start to combating these symptoms. And even though a truly stress-free lifestyle is nearly impossible these days, a stress-reducing daily practice such as yoga, reading, meditating, taking a bath, or a long walk can significantly help reduce insulin resistance and, therefore, PCOS symptoms.

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 function medicine labs is also a vital step for testing PCOS and diagnosing the root cause.

Comprehensive Lipid Panel

A comprehensive lipid panel analyzes the risk of cardiovascular disease, which is often seen in those with long-term PCOS. A baseline of these results is always a good idea to track progress over time.

Insulin Resistance Testing

Since there is a strong connection between PCOS, insulin resistance, and type 2 diabetes, it is important to measure glucose, insulin, and HbA1C to rule out metabolic disorders.  

Homocysteine Test

Vitamin deficiencies are commonly associated with PCOS. Homocysteine is a marker that can directly test for the deficiency of B12, B6, and Folic Acid and can indirectly assess the levels of inflammation in the body.

Vitamin D Test

Vitamin D deficiency is associated with both insulin resistance and inflammation, which is why this is often tested as well.

Comprehensive Female Hormones Panel

Assessing the reproductive hormones is critical in testing for and understanding how PCOS affects the body. For example, testing hormones can help rule out other hormonal conditions that may be hiding underneath the PCOS symptoms. And, it can tell us the amount of hormonal imbalance that is going on so that treatment can be adjusted accordingly.

Serum values are the most common way to test for hormones. However, the downside of a serum test is that it is merely 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 very 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 strange to look at the gut when discussing a hormonal condition, but gut health can greatly impact inflammation, hormonal balance, and insulin resistance.

One study found that a disrupted gut microbiome affected insulin levels and ovarian function.  

Functional Medicine Treatment for PCOS

The goals for the treatment of PCOS should be to decrease inflammation, correct insulin resistance, and balance the hormones to restore normal ovulation.

Nutrition for PCOS

Dietary guidelines and supplementation should be centered on the evidence that PCOS sufferers are typically deficient in key vitamins and nutrients such as B vitamins, vitamins D, K, E, and minerals like zinc, selenium, and chromium. Foods containing these nutrients are important to incorporate into the diet to counteract these deficiencies.

Patients should focus on organic food as much as possible and avoid other chemicals in the home. Non-organic foods, cleaning supplies, and personal care products contain endocrine-disrupting toxins. This means that these chemicals can behave like hormones in your body and throw off your hormone balance.

Supplements for PCOS

Additional supplements specifically helpful for PCOS include Inositol, N-Acetyl-Cysteine (NAC), Vitamin D3, and Berberine. Inositol is used to correct underlying metabolic issues and can restore regular ovulation. NAC is used to help reverse insulin resistance by improving the insulin response to glucose. Proper vitamin D levels are essential for inflammation regulation. Berberine has been shown to reduce testosterone, fasting glucose, and fasting insulin levels.

Exercise for PCOS

It is clear from the research that exercise is an integral part of PCOS recovery. Specifically, high-intensity interval training (HIIT) has been shown to improve metabolic health and improve some PCOS symptoms.

Follow up Treatments

Labs can be repeated as early as three months after treatment begins. This will give the body enough time to incorporate the treatments and rebalance and recover metabolic and hormonal health. Although, waiting a full six months will provide an even better picture of how well the treatment is going.

With functional medicine treatments, it is quite common for women to get off many medications associated with PCOS, such as high blood sugar, high cholesterol, high triglycerides, and high blood pressure. This type of treatment heals the body rather than covering up the symptoms. However, it is important to know these treatments take time. 6-9 months is a typical healing window when a patient is fully compliant with diet, lifestyle, and supplements.

Summary

PCOS is a common and complex condition affecting many women of reproductive age. It is commonly underdiagnosed and is typically poorly managed, leading to many women who are left suffering with no plan of action.

Functional medicine gives us the tools to understand and treat the root cause, utilizing nutrition, supplementation, and lifestyle adjustments.

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References

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