By Dr. McKenzie Nisbet, ND
THE 4 DRIVERS OF PCOS
Polycystic Ovarian Syndrome (PCOS) affects 1 in 10 women of reproductive age. Before reading this article make sure you check out “What is PCOS? (and Why It Needs a New Name)” to learn about what qualifies as PCOS and how to get an appropriate diagnosis.
When it comes to treating PCOS you need to look deeper than the irregular periods, acne and androgen excess. You need to look for the underlying cause. Why is your cycle irregular? Where did the acne come from? Why are your hormones unbalanced in the first place? The answer can typically be boiled down to one (or more) of these four main drivers of PCOS. Once you know your driver(s) you can address the cause of your PCOS– not just the symptoms.
INSULIN RESISTANT PCOS
This is the most common driver, affecting up to 70% of women with PCOS. Insulin resistance impairs ovulation (a key feature in PCOS) by affecting androgen levels, LH levels, and proteins that bind to hormones in your blood.
[INSULIN RESISTANCE – Insulin’s job is to help move glucose (fuel from food) from your blood into your cells. Insulin resistance occurs when your cells, for various reasons, become resistant to the signalling power of insulin.]
Insulin resistance occur due to smoking, stress, sleep deprivation, alcohol, trans-fat, unhealthy gut bacteria, magnesium deficiency, and environmental toxins. All of which are very prevalent in North America.
Simple blood tests can be run to determine if you have insulin resistance. We can then target the causes of insulin resistance in your life. Lifestyle and dietary changes coupled with strategic supplementation can help reduce your body’s resistance to insulin and therefore improve your PCOS.
POST-PILL PCOS
The second driver of PCOS is the hormonal birth control pill. Studies show a link between the pill and androgen levels, insulin resistance, and (by design) an inhibition of ovulation.
After coming off the hormonal birth control pill your body is adapting to the removal of this hormonal ‘control’. Not everyone will experience unwanted changes when stopping the pill. However, if you’ve had menstrual issues or hormonal imbalances before starting the pill, you will likely experience some when stopping. These may include acne, unwanted hair growth, irregular periods, dysmenorrhea (painful periods), PMS (premenstrual syndrome), and/or a rise in androgens (especially if on an anti-androgen pill – commonly chosen if acne was a concern). Due to these changes you may fit the diagnostic criteria for PCOS. For many, post-pill PCOS is temporary and may resolve on its own with time. Strategically addressing hormonal imbalances and other minor/co- drivers can help resolve your PCOS and regulate your cycle sooner, helping you get back on track.
Talk to your health care provider about what to expect when coming off the pill so you know what is normal and what requires further investigation. Be sure to track your cycle while coming off the pill so you know if your body is adapting appropriately. To help reduce unwanted changes talk to your Naturopathic Doctor about how to prepare your body for this hormonal shift before you stop the pill.
INFLAMMATORY PCOS
Inflammation and environmental toxins are the third driver of PCOS.
Studies show endocrine disrupting chemicals (EDCs) such as bisphenol A (BPA) and phthalates may cause reproductive health problems such as infertility, premature ovarian failure, abnormal hormone levels (ie. excess androgens), and reduced ovulation. Studies also show that women with PCOS have higher levels of BPA in their bodies.
How do you combat this driver? You reduce your exposure. Removing many EDCs can be quite easy.
First: identify your exposures to ECDs.
Second: remove or replace these exposures with less harmful alternatives.
There are 3 easy places to start:
- Simply switching from plastic to glass – water bottles, kitchen containers, and choosing foods sold in glass containers.
- What you put on your body (shampoo, conditioner, body wash, face wash, moisturizer, make-up, hand soap, laundry detergent, etc).
- What you use to clean your house (kitchen cleaner, sprays, deodorizers).
For #2 and #3 visit ewg.org/SkinDeep and download the app “Think Dirty” on your phone. Type in the name and brand of the products you use. Each database will rank the products as Low-Hazard/Neutral (0-2), Moderate-Hazard/Half-and-Half (3-6), or High-Hazard/Dirty (7-10). Aim to replace your moderate/high-hazard products with low-hazard products to help reduce your exposure to harmful chemicals. You can do this all right away or over time – even one small change helps!
ADRENAL PCOS
If you have PCOS the main driver is likely one of the three mentioned above. In rare cases your adrenal glands may be the sole driver of your PCOS.
Your adrenal glands sit on top of your kidneys. You probably know them as the producers of cortisol (the stress hormone). But cortisol isn’t all these glands produce. DHEA-S (an androgen) also comes from the adrenal glands. Excess DHEA-S is linked to the presentation of PCOS and may be the only elevated androgen in up to 10% of PCOS patients.
To reduce this driver of PCOS first take a look at where your stress comes from. Is it family? Friends? Your relationship? Job-related? Finances? It’s likely a combination of a few, and at least one daily. So, what are you doing daily to reduce this stress?
Pick one of these stress-reduction techniques to try this week!
Mindful meditation. Download the app “Headspace.” This app contains guided mediations to help you master the skill of meditation.
Journaling. Use a regular notebook or one designed for mindfulness, such as “The Five Minute Journal.” Get your emotions and thoughts down on paper to help keep your mind clear.
Talk it out. Perceived social support is a strong protective factor for both depression and anxiety and helps foster coping strategies.
Nature Walks. Studies show spending time in nature can help reduce stress levels. This is also a great option for anyone who has difficulty with stationary meditation.
Working to reduce your stressors and your perception of these stressors can help ease the pressure on your adrenal glands. This can be done on your own or with the help of a professional (such as a psychotherapist). Nutraceuticals and botanical medicine can also be used to support your adrenal glands and modulate your stress levels. By improving adrenal function we can improve adrenal-driven PCOS.
That sums up the four main drivers of PCOS, but it is important to note there are other factors that may also be contributing to your PCOS. These include thyroid dysfunction, nutrient deficiencies, dietary restrictions, and elevated prolactin. Be sure to consult healthcare professional to ensure you are getting the appropriate testing and that all of your drivers of PCOS are being addressed.
To learn more book an appointment or a free 15-minute consultation here, or send me a private message here and get to know your options.
Resources:
INSULIN RESIATNCE: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3872139/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018970/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4334071/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3680959/; Briden, Lara. Period Repair Manual. Lexington: 2015. OCP: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4135453/, https://www.ncbi.nlm.nih.gov/pubmed/22811306/, https://www.webmd.com/sex/birth-control/stopping-pill-10-ways-body-changes#1; ENVIRONMENTAL: https://www.ncbi.nlm.nih.gov/pubmed/27559705, https://www.ncbi.nlm.nih.gov/pubmed/21193545, https://www.ncbi.nlm.nih.gov/pubmed/26063868; INFLAMMATORY: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3245829/; ADRENALS: https://www.ncbi.nlm.nih.gov/pubmed/17932770, https://www.ncbi.nlm.nih.gov/pubmed/18950759. https://www.ncbi.nlm.nih.gov/pubmed/27336356, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772979/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709294/, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2921311/, image: http://www.thevitpro.com/uploads/8/4/1/7/8417615/303034.jpg
