Polycystic ovary syndrome (PCOS) is a commonly diagnosed condition — 1 in 10 women of childbearing age have the condition. Some experts estimate that the number is even higher, suggesting that as many as 20 percent of women experience PCOS symptoms.
PCOS is a leading cause of fertility struggles for women and can severely affect quality of life by causing hair loss on the scalp, unwanted hair growth along the chin and the chest, obesity, and acne. Unfortunately, its causes are widely misunderstood.
That’s because PCOS is not just one thing, says naturopath Lara Briden, ND.
The “view at the moment is PCOS isn’t one condition,” says Briden, author of Period Repair Manual: Natural Treatment for Better Hormones and Better Periods. “It’s an umbrella diagnosis, a description of the signs and symptoms some women experience. It is not one disease, like celiac disease.”
There are actually four different types of PCOS, continues Briden, each one with its own unique causes.
Adding to the confusion is the name of the syndrome itself: polycystic ovary syndrome implies that the ovaries develop cysts and that the cysts cause the symptoms. Indeed, in conventional settings, the condition is almost always diagnosed by doing an ovarian ultrasound.
But ovaries are cystic by nature, notes Briden, and the appearance of small cysts on the ovaries isn’t a sign of disease (larger cysts are different and can indicate other issues). The eggs produced by the ovaries each month naturally appear as cysts on the surface, and if ovulation (release of the egg into the fallopian tube) doesn’t occur, those cysts remain.
While irregular ovulation is a hallmark of PCOS, the presence of small cysts on an ultrasound simply indicates that ovulation hasn’t occurred that month (which can be a normal, occasional occurrence for many women). What the ultrasound doesn’t indicate is if a woman has ovulated the month before or if she will ovulate the following month.
So an “ultrasound is not enough” to diagnose the condition, says Briden.
Instead, the cysts are symptoms, just like excess facial hair and acne. And all these symptoms are caused by other underlying factors. Some experts have proposed changing the name of the condition to clear up this confusion.
In addition to irregular ovulation, the other widely accepted hallmark of PCOS is androgen excess. Androgens are specific sex hormones that are produced naturally in the body, but they can cause problems when produced in excess.
The hopeful news? When a woman knows what is causing her specific type of PCOS, she can use targeted natural treatments to reverse her symptoms.
Here are the four types of PCOS and strategies for addressing them naturally:
This is the most common type of PCOS, with 70 percent of women who meet the criteria for the condition showing signs of insulin resistance, says Briden.
Insulin is a hormone produced by the pancreas. Whenever we eat, the pancreas releases insulin because it helps our cells absorb the sugar in food. This an essential physiological process because our cells need sugar for energy. But the more sugary foods we eat, the more insulin is released — and over time this can become a problem because our cells stop “hearing” the insulin and its message to absorb the sugar (this is called insulin resistance). Rejected by the cells, the insulin accumulates in the bloodstream and wreaks havoc on other physiological processes – one of which is healthy ovarian function. One problem? Too much insulin tells the ovaries to overproduce androgens, which is one of the hallmarks of PCOS.
A woman meets the criteria for insulin-resistant PCOS if she has excess androgens, irregular ovulation and insulin resistance, which can be measured by a blood test. Women with this type of PCOS also often carry extra weight around their midsection, though not always. A blood test should always be used to make the final diagnosis.
The best natural strategy for insulin-resistant PCOS is to eat a low-glycemic diet, or foods low in sugar. These include grass-fed animal proteins, non-starchy vegetables, nuts and seeds, and low-glycemic fruits like berries. Avoiding sugary foods and beverages is also key.
Supplementing with magnesium has also been show to help women with this type of PCOS, says Briden.
Taking oral contraceptives can trigger PCOS in two ways: The pill can contribute to insulin resistance, explains Briden, and it also suppresses ovulation. For many women who go on the pill and then stop, ovulation begins again naturally. For others, anovulation persists for months, sometimes longer.
A woman has pill-induced PCOS if she has high androgens, irregular periods, is not (yet) insulin resistant, and had normal periods before starting the pill.
For this type of PCOS, Briden recommends the herbal combination of peony and licorice, which has been shown in clinical trials to reduce androgen levels in the body. She recommends taking a single dose in the morning before eating and to follow the dosing instructions on the bottle (since the concentrations in different formulas vary). She recommends against taking Vitex (or chasteberry), which is often suggested for women with PCOS. It is known to help restore periods when other conditions are present (like hypothalamic amenorrhea), but it increases certain hormones that can exacerbate PCOS.
This type of PCOS is triggered by exposure to environmental toxins, which in turn cause systemic inflammation in the body. Inflammation is a factor in all types of PCOS, but it is the main factor in this type of PCOS. Women have this type of PCOS if they have high androgens, irregular periods, are not insulin resistant, and have never been on the pill.
In these cases, inflammation shuts down ovulation, and it sends messages to the adrenal glands to produce more androgens.
Women who suffer from this type of PCOS also often experience headaches, fatigue, joint pain, and skin conditions like psoriasis or eczema.
To manage inflammatory PCOS, a first, best step is to reduce or eliminate inflammatory foods, like dairy, gluten and conventionally raised meats, and to reduce exposure to environmental toxins, like pesticides, herbicides and heavy metals like mercury and lead. Eating organic, non-GMO food is one way to dramatically reduce exposure to pesticides and herbicides, and reducing the use of plastics in the kitchen helps limits exposure to other damaging chemicals.
Supplementing with zinc can also be helpful, as can taking N-acetyl cysteine (NAC). NAC is a powerful antioxidant that is hugely important for detoxifying the body.
This type of PCOS is diagnosed when a woman has high androgens, irregular periods, is not insulin resistant, and has no obvious signs of high levels of inflammation. This type highlights also how many factors can ultimately be at play in a PCOS diagnosis.
Some of the main “hidden cause” factors Briden sees in her practice include: a sensitivity to soy foods, thyroid dysfunction, iodine deficiency, selenium deficiency, vitamin D deficiency, over-reliance on artificial sweeteners, extremely low-carb diets, and vegetarian diets.
The key to addressing this type of PCOS is identifying the cause, a process that can be helped by working with a qualified functional medicine practitioner. The good news is that once the problem is identified, the PCOS-related symptoms tend to resolve quickly.
Laine Bergeson is a longtime health journalist and functional nutrition educator and coach with Healthful Elements. She believes lifestyle medicine is a blockbuster drug.