Polycystic ovarian syndrome (PCOS) is one of the most common reasons for fertility issues in the West. The name reflects that fact that in some of the cases, one or both of the ovaries accumulate multiple cysts…in some cases so much so that the ovary looks like swiss cheese on an ultrasound. Not only does PCOS impact both fertility and the health of a pregnancy, it is associated with increased risk of liver disease, metabolic syndrome, type 2 diabetes, and uterine cancer.
PCOS may present at puberty, and a number of young women are put on birth control pills to force their body to have a period, though this doesn’t actually fix the underlying issues and one wonders what the impact hormonal usage starting at a young age has on hormonal regulation and fertility later on. Generally, when a woman stops the pill, the symptoms resume. Other cases present later on during a woman’s reproductive years. Thankfully, many cases of PCOS are responsive to natural support.
Signs & Symptoms Of PCOS
Generally, PCOS is diagnosed based on having at least 2 out of the 3 following signs:
- Polycystic ovaries: One or both ovaries may have an accumulation of cysts, which are simply egg follicles that have grown in preparation for ovulation but were never actually ovulated (released from the ovary).
- An irregular menstrual cycle: You may not have a period at all, or you may go a few months without one. If a period happens, bleeding may be very light or may, instead, be prolonged.
- Androgen excess: Androgens are male sex hormones that women also normally have. But in PCOS, levels of one or more androgens, such as testosterone, are elevated. This suppresses ovulation, in turn leading to irregular cycles or a lack of a discernible cycle. Androgen excess may also cause excess facial or body hair (this is called “hirsutism”) or acne, particularly along the chin and jawline. While these signs themselves don’t impact fertility, they can be very distressing. Sometimes male-pattern baldness may even manifest.
It’s a misconception that PCOS only happens in women with a higher body mass index (BMI). Though PCOS is more common at high BMI, about 40% of the cases happen in women with a normal BMI.
Causes Of PCOS
While the ultimate cause of PCOS isn’t known, there are some known contributing factors:
- Blood sugar and insulin imbalances: Insulin is a hormone that tells various cells in the body to take in blood sugar, which is needed for the cells to generate energy. Factors such as diet, genetics, a lack of sleep, high BMI, and smoking may result in insulin resistance…when the cells of the body stop taking up blood sugar in response to insulin. This can lead ultimately to type 2 diabetes. When cells are insulin resistant, the body makes even more insulin to try to get the cells to respond. These elevated insulin levels can trigger androgen production, hence the elevated levels of androgens often associated with PCOS. Excess androgen levels can suppress ovulation.
- Chronic inflammation: Low-grade inflammation, which can come from diet, lack of sleep, and other factors, may also stimulate androgen production and cause other problems throughout the body.
- Genetics: There is some evidence that a predisposition to PCOS may be inherited.
Diet & Lifestyle Changes For PCOS
Here are some changes you can make to your diet and lifestyle to help improve your PCOS symptoms.
- Eat a balanced, healthy diet. Vegetables should make up the majority of the diet. If visualizing a plate in front of you, at least half of the plate should be covered in veggies. It’s also important to have a healthy fat and protein at each meal, not only for the nutrients they provide but also for helping to attenuate large blood sugar and insulin swings. It’s a misconception that grains should be avoided with PCOS. A small serving or two of whole grains during the day should be fine (e.g., brown rice, rolled oats, hulled (but not pearled) barley, quinoa, etc.), making up no more than a quarter of your plate.
- Avoid refined carbohydrates. This is critical and includes foods made from white flour, white rice, anything with sugar added, fruit juice, dried fruit, or excess fruit intake in general (more than a few servings daily). Remember that sugar shows up in different forms: white, raw, honey, agave syrup, corn syrup…none of them are a good idea with PCOS. For grains, eating them in whole form is best, but if consuming pastas and breads, get those made from whole grain flour (the fresher, the better). It can be hard to wean yourself off of refined carbs, but having a good fat and protein with your meals may help to reduce cravings.
- Move your body. This is important for healthy metabolism and for training our muscle cells to more effectively use blood sugar. Not a gym rat? No worries. Dig in your garden. Go for an after-lunch or dinner walk for 15 minutes. Put on your favorite music and dance in the living room. Download a yoga video to do a few times a week. Or, if having other folks around motivates you, join a kickboxing class, or zoomba, or…?
Herbal & Botanical Support For PCOS
Botanical support may be helpful, but not without the three steps listed above. Here are some tried and true botanical allies…
- Maitake Mushroom (Grifola frondosa): A study in Japan found that maitake extract induced ovulation in women with PCOS who did not respond to treatment with clomiphene (Clomid), a common medication used to try to induce ovulation. The authors posit that this is due to the ability of maitake to improve insulin resistance. While not the best controlled study, the results are hopeful.
- Vitex, aka Chasteberry (Vitex agnus-castus): This herb, usually in combination with others such as saw palmetto, may help restore a more regular cycle. It’s traditionally used for cycle irregularities and studies have supported its use for suppressed cycles.
- Saw Palmetto (Serenoa repens): This nourishing herb provides support for healthy androgen regulation. It has less research on it with respect to PCOS, but the experience of herbal practitioners supports its use, especially when acne, hirsutism, or male pattern baldness present.
- Black Cohosh (Cimicifuga racemosa): Black cohosh was found in a few studies to provide further improvement in fertility rates beyond Clomid alone. One of these studies found that black cohosh was equivalent to Clomid in restoring fertility. Its effects appear to be at the level of the hypothalamus and pituitary gland in the brain.
- Spearmint (Mentha spicata): Yup…good old spearmint tea. Two cups daily two times a day was enough to reduce levels of free testosterone in women with PCOS and hirsutism.
- Cinnamon (Cinnamomum species): Cinnamon has been found to support healthy blood sugar and insulin regulation in a variety of ways. Plus, it tastes great. Cinnamon as an extract or as granules rather than the commercial powdered form may be the best to try. It’s commonly used by herbalists and has been tested in a small pilot study with promising results.
Many other herbs have been employed by herbal practitioners for support with PCOS and also have clinical research (of varying quality) that back up this usage. These include tribulus (Tribulus terrestris), peony root (Paeonia lactiflora) and licorice (Glycerrhiza glabra). Rather than going it alone, herbally-speaking, it’s a good idea to work with a trained herbalist—preferably one experienced in working on reproductive health.
This is not a fast process, but with diligence, many women see improvement. It may take a few months to notice any changes. It may take 6 or more months…depends on the person. Be patient with yourself.