One of the most common reproductive conditions affecting women's health is Polycystic Ovary Syndrome (PCOS). It affects 15% to 20% of women of childbearing age. PCOS affects many areas of a woman's health. For example, hormonal imbalances, metabolism problems, skin and hair issues affecting appearance and self-esteem, and even infertility are all potential consequences of this syndrome.

This condition can be diagnosed at any age post-puberty. However, most of the time, it is diagnosed in women in their 20s and 30s who are seeking answers to their infertility. Because PCOS is a common cause of infertility, it is often found and diagnosed at this time.

The exact cause of PCOS is unknown. However, a functional medicine approach to understanding this condition helps to uncover some underlying (root) causes. These root causes include metabolic concerns such as insulin resistance and hormonal problems, specifically an inappropriately high amount of androgens (testosterone).

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What is PCOS?

Polycystic Ovary Syndrome (PCOS) affects hormones and occurs during the reproductive years. As the name suggests, many tiny sacs of fluid-filled cysts typically develop in one or both ovaries. These cysts are known as follicles, and in a healthy reproductive system, these follicles would contain mature eggs that would release during ovulation. However, in PCOS, the eggs in these cysts are immature and will not release, which affects fertility.

Interestingly, having multiple cysts is not necessary to meet diagnostic criteria because according to the 2003 Rotterdam criteria, the criteria that physicians use to diagnose PCOS, a woman must present with two of the three findings: hyperandrogenism (the overproduction of androgens, such as testosterone), ovulatory dysfunction (irregular cycles lasting more than 35 days but less than six months apart), or multiple cysts (polycystic ovaries).  

PCOS Symptoms

Since PCOS has two primary concerns, metabolic and hormonal, it is best to explain the symptoms with those two lenses.

Insulin resistance is strongly associated with PCOS and is the main reason for metabolic symptoms. The top metabolic symptoms experienced with PCOS are:

• High blood sugar
• High cholesterol and triglycerides
• High blood pressure
• Weight increases leading to obesity
• Acanthosis nigricans (a skin symptom where the skin darkens in the folds of the body, such as under the breasts, neck, armpits, and thighs)
  

Hormonal imbalances occur in PCOS mainly because the ovaries produce more androgens in this condition, which throws off the balance of all the reproductive hormones. The hormone-specific symptoms that may be experienced are:

• Irregular or missed periods
• Lack of ovulation
• Infertility
• Male-pattern hair loss
• Excess facial and body hair
• Acne
• Abnormal uterine bleeding
• Endometrial hyperplasia (pre-cancer growth)

What Causes PCOS?

The exact cause of PCOS is unknown. However, we can assess some strong associations to understand better why this condition is happening.

PCOS may be inherited. While exact genes have not been identified, this condition is commonly shared between sisters or a mother and daughter.

Insulin is a pancreatic hormone produced after eating to help our cells use glucose (sugar), our body's primary fuel source. Increased blood sugar is the result when cells become resistant to insulin. When this resistance occurs, our bodies produce excess insulin to try and lower blood sugar. But, excess insulin can also pose several issues in the body. For example, an increase in insulin leads to an increase in testosterone production, which is strongly associated with developing PCOS. Excess testosterone can interfere with ovulation, leading to infertility.

Low-grade inflammation also plays a role in the development of PCOS. Research suggests that those with PCOS have a type of long-term, low-grade inflammation that causes the ovaries to produce androgens. Also, this inflammation links the excess androgen hormones and insulin resistance to long-term metabolic and cardiovascular complications.

Top Functional Medicine Labs to Test for Root Cause of PCOS

While there is not currently a genetic test to determine whether someone is prone to PCOS, a thorough medical and family history should be assessed by your physician to help make connections and draw conclusions to see if PCOS is likely for you.

Since the primary suspected cause of PCOS is insulin resistance, testing for this is essential. One of the top functional labs for determining your insulin resistance status is the HOMA-IR test by BostonHeart Diagnostics. It measures fasting glucose, fasting insulin, and HOMA-IR, a marker that helps approximate insulin resistance. An HbA1c test is also essential. This marker can calculate your average blood sugar levels from the past 2-3 months to see if blood sugar imbalance is an ongoing issue.

To assess hormones, a thorough hormone test should be run. The DUTCH Complete test is an excellent option because it can detect reproductive hormones that may be out of balance. This test also includes markers for adrenal health. The adrenal glands, in addition to the ovaries, are responsible for producing androgens. So, assessing adrenal health is also warranted for PCOS since excess androgens are commonly produced in this condition.

Assessing for gut health is indicated since there is a strong association between gut health and metabolic syndrome. A Comprehensive Stool analysis can help assess general gut health.

Evidence has noted that those with PCOS tend to have certain micronutrient deficiencies, specifically B vitamins, vitamins D, K, E, and minerals such as selenium, chromium, zinc, and omega-3 fatty acids. Using a Micronutrient test is beneficial to detect if any of these deficiencies are progressing the PCOS picture.  

Functional Medicine Treatment for PCOS

Nutrition

Diet changes should be at the heart of treatment for PCOS because a healthy diet is associated with lower inflammation, a healthier gut microbiome, and, therefore, healthy hormones and blood sugar regulation. The Mediterranean diet is an excellent example of a diet that can help with those nutrition goals.

More specifically, the diet recommendations should include foods rich in micronutrients commonly deficient in PCOS, such as fruits, vegetables, nuts, seeds, legumes, poultry, and fatty fish, to combat deficiencies.

Complementary and Alternative Medicine

Certain supplements can also help correct the causes of PCOS. Inositol is a B vitamin and a secondary messenger of insulin. Research shows that inositol metabolism is often altered in those with PCOS, indicating that this nutrient supplement could be beneficial. Studies also show that inositol, in combination with α-lactalbumin (α-LA), found in whey protein, increases absorption and utilization of the inositol. Another study analyzed the combination of myo-inositol + gymnemic acid + l-methyl-folate and showed more favorable results due to the synergistic (combination) effects.

Berberine is another promising supplement. It shows similar blood sugar-lowering effects in PCOS patients as Metformin, a commonly prescribed pharmaceutical for PCOS and metabolic syndrome. Berberine is safe and effective for PCOS patients trying to conceive.

Cinnamon may be a helpful herb for those with PCOS to supplement with as it positively affects metabolic parameters.

Acupuncture may also be a great therapeutic option for those with PCOS. Evidence suggests that acupuncture can increase blood flow to the ovaries, reducing the number of ovarian cysts, and it can also help balance insulin sensitivity.

Another promising addition to a PCOS treatment protocol is yoga, which has been shown to help reduce symptoms of PCOS.

Summary

PCOS is a syndrome defined by metabolic and hormone imbalances. It is quite common and affects approximately 1 out of 10 women of reproductive age. PCOS has a strong association with insulin resistance. In fact, it is believed that insulin resistance is the cause of the overproduction of androgens (testosterone) from the ovaries.

Functional medicine can help detect underlying root causes and health associations by looking at a select few functional labs. Then, a holistic approach to care can help address those root causes, helping prevent PCOS complications and promote overall health.