I invite you to think differently about polycystic ovarian syndrome.
PCOS is not one thing. It is not one disease.
PCOS is a set of symptoms. The key primary symptom is failure to ovulate regularly. Failure to ovulate is why you are deficient in estradiol and progesterone. It’s why you have high testosterone, and why you develop secondary PCOS symptoms like hair loss, acne and infertility.
You cannot treat PCOS until you first ask: “WHY – in your particular case- do you not ovulate?”
I say ‘in your particular case’ because your reason may be different than someone else’s reason. That’s why there are so many different natural treatments, and that’s why only some of them will work for you.
?Tip: Don’t be too quick to accept a PCOS diagnosis. Proper diagnosis requires a blood test that shows high testosterone or other male hormones like androstenedione or DHEA. Never accept a diagnosis that was made by ultrasound alone.
4 Types of PCOS.
1) Insulin-Resistant PCOS.
This is the classic type of PCOS, and the most common. High insulin and leptin impede ovulation and stimulate the ovaries to make testosterone. Insulin resistance is caused by sugar, obesity, smoking, trans fat and environmental toxins.
Is this you? You have high fasting insulin or an abnormal glucose tolerance test. You may also have elevated LH (luteinizing hormone) on blood test. You are probably overweight, although you may be normal weight. Normal-weight insulin-resistance usually occurs in the years following dieting or eating disorder.
Treatment ideas: You may need to quit sugar and/or lose weight. Please also consider intermittent fasting, which works well to improve insulin sensitivity. Best supplements for insulin resistance are magnesium and berberine. The Pill is not a treatment for this type (or any type) of PCOS because it impairs insulin sensitivity. Improvement for Type 1 PCOS is slow and gradual over 6-9 months.
2) Post-Pill PCOS.
The Pill suppresses ovulation, an effect that can persist for months or even years after stopping it. Long term ovulation suppression does not happen for everyone that takes the Pill. Many women are fine, and return to a normal ovulation shortly after stopping the Pill. Some do not. Post-Pill PCOS is very real, and is the second most common type of PCOS that I see in clinic. We desperately need more research into it.
Is this you? You had regular periods before starting the Pill (although you may have had acne.) You probably now have elevated LH on blood test, although you may have normal LH, and high-normal prolactin.
Treatment ideas: If your LH is elevated, the best herbal treatment is Peony & Licorice combination. If your prolactin is high-normal, then the best herbal treatment is Vitex (also called chastetree or chasteberry). Both Peony and Vitex work on the pituitary-ovarian axis, and they are powerful herbs. I recommend you do not use them too soon or for too long. Do not take them if you are a teenager, or if you have just come of the Pill. (Give yourself 3-4 months off the Pill.) Peony and vitex should not be used for more than 10 months in a row. They should not need to be used that way. If they are the right herbs, they will work fairly quickly (3-4 months). And then, your periods should stay regular after you stop the herbs. You should not take licorice if you have high blood pressure. Please seek professional advice.
3) Inflammatory PCOS.
Inflammation – or chronic immune activation – results from by stress, environmental toxins, intestinal permeability and inflammatory foods like gluten or A1 casein. Inflammation is a problem for PCOS because it impedes ovulation, disrupts hormone receptors, and stimulates adrenal androgens like DHEA and androstenedione.
Is this you? You have other symptoms of immune-dysfunction such as recurring infections, headaches, joint pain or skin conditions. Your blood test shows inflammatory bio-markers such as vitamin D deficiency, abnormal blood count, elevated C-RP, thyroid antibodies or gluten antibodies. You may have elevated DHEA, and a positive urine test for intestinal permeability.
Treatment ideas. Reduce stress and exposure to environmental toxins like pesticides and plastics. Eliminate inflammatory foods like wheat, dairy and sugar. Treat intestinal permeability with zinc, berberine and probiotics. Supplement magnesium because it is anti-inflammatory and normalises adrenal hormones (HPA axis). Improvement is slow and gradual over 6-9 months.
4) Hidden-cause PCOS.
This is the ‘simpler-than-you-think’ type of PCOS. Fairly often- at least once every week – I encounter a PCOS patient who does not meet any of the criteria for the first 3 types of PCOS. These are my favourite cases, because -very often – there is one simple thing that is blocking ovulation. Once that single thing is addressed, this type of PCOS resolves very quickly, usually within 3-4 months. Common hidden-causes of PCOS include:
– Soy is an anti-estrogen and can block ovulation in some women
– Thyroid disease impairs ovulation because your ovaries need T3 thyroid hormone.
– Vegetarian diet because it causes zinc deficiency and your ovaries need zinc.
– Iodine deficiency because your ovaries needs iodine. Please be careful with iodine supplementation.
– Artificial sweeteners because they impair insulin and leptin signalling.
– Too little starch in the diet because your hormonal system needs gentle carbs.
Is this you? You do not exactly fit the criteria for the first 3 types of PCOS. You have tried a number of natural PCOS treatments and nothing seems to work. Look deeper.
Know when it’s time to let go of your PCOS Diagnosis. In most cases, PCOS is not a permanent condition. With the right diagnosis and the right treatment, PCOS can become a thing of the past.
I am the first to acknowledge that there is some overlap between these 4 types. For example, inflammation is a major cause of both insulin-resistance and thyroid disease (Types 1, 3 and 4). My intention was not to over-simplify, but rather to alert you to some treatment ideas that you have not yet considered.
Yours in Health, Lara Briden
